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(Provided by the CCER - Western
Washington University)
Disclosure and the Mental Health Disability
If you are a provider of supported
employment services primarily to people with long term mental illness,
rarely can you avoid dealing with this issue. Developing a plan, or
strategy for how you will train, educate supervisors or your employer
with regard to mental illness, or accommodation including what or how to
disclose important information is extremely important, but at the same
time problematic.
While individuals with obvious physical
disabilities don't have the option of not disclosing their disability
status, people with disabilities like mental illness, traumatic brain
injury and learning disabilities may be able to get through the
interviewing and hiring process without anyone knowing that they have a
disability. It is usually very useful to discuss the issues of whether,
and when, and to whom to disclose information about the disability
before the individual is in the interview or application situation. A
full discussion of the following issues would insure that your client
has the benefit of informed choice.
Here are some reasons to disclose
one's hidden disability:
- Legal protection under the Americans
with Disability act occurs only when the employer knows about the
disability.
- Employers and other workers can be
very supportive and usually want to provide for a stable employee.
- Disclosure may help your employer deal
with other employees who do not understand or who may feel unfairly
treated
- A disability which may require some
sort of accommodation, whether in the form of breaks or unusual hours,
or which may exhibit symptoms can be very difficult to keep secret. In
a small community, people may already know (or guess).
- Disclosure allows a worker to involve
an employment service provider, a job coach or other third party in
the learning of skills and the development of accommodations.
- Disclosure can set clear expectations
for otherwise difficult situations. Everyone may do better when
contingencies are planned for. It will help avoid emergency planning.
- This is another opportunity to correct
myths about mental illness-how else will public perceptions be
changed.
- Protecting that "secret" can take a
lot of energy.
Here are some reasons not to disclose
one's disability
- Despite the ADA, employers may find
ways to avoid hiring or promoting individuals with known disabilities.
- There are risks that disclosure might
backfire, make the worker increasingly conspicuous. Coworkers may
tease, harass, or otherwise discriminate
- Why do I have to be the one to take on
public attitudes?
- Your participant may have difficulty
with self-advocacy. Disclosing information about your disability can
be extremely. sensitive and not easy to do.
- There are strict rules around
disclosure, particularly of medical information. Disclosure should not
happen without a full discussion of these issues. As a provider you
will need the agreement of the participant.
- The participant in many cases may have
a secondary condition. Should you disclose this as well?
- Your worker may not see himself or
herself as "disabled"-- to do so may conflict with his/her beliefs or
self-image.
Discussing the pros and cons of
whether to*disclose a disability is a good example of informed choice.
Suppose that you and your participant
have discussed the pros and cons of disclosing his or her disability and
that the participant has decided disclosing will be the best choice.
Next you should decide how you will discuss the disability with the
employer and supervisors and perhaps practice or role play the
situation.
Here are some examples of possible
disclosure statements:
"Ray likes to understand directions
thoroughly, he does not like to make mistakes. If new instructions-
are written down so Ray can memorize them and keep them for reference
he will feel more productive."
"If Susan learns the tasks that take place in one room or one work
site ... it seems to work best to create a different training for
another location. Susan seems to memorize the location and the tasks
together."
" Bob has a medical condition which may make him tire easily.
Unscheduled breaks seem to help him bounce back."
Some guidelines and principles for
disclosure:
- The consumer is in charge, privacy
first
As we have demonstrated, this is a situation for informed choice.
- Use the guidelines of the ADA
- The rules of the ADA apply to
employers with 15 or more employees. A covered employer can only
base hiring decisions on the applicant's ability to perform the
essential functions of the job, with or without accommodation.
- Pre-employment inquiries cannot be
made regarding the nature or extent of the person's disability; i.e.
the interviewer may not ask if the person has a disability or
disease or about past or present psychiatric treatment.
- The interviewer may ask about the
person's ability to perform job-related functions; or about
education, work experience, skills, or licenses that are job
related.
- If an individual has *a known
disability that appears to interfere with an essential function, he
or she may be asked to describe or demonstrate how he/she would do
this function.
- The traditional interview evaluation
may be lead to discrimination for persons with a
disability. The following issues, for example, may give a poor
impression but could be
quite unrelated to the client's ability to do the job: Body language
(handshakes, eye contact, etc.), Communication skills, Social skills
- Good Strategies to offset poor
interviewing impressions: Job coach support, Written documentation
of skills, Trial work periods, Interviews held on familiar
ground
- Prepare from the beginning of
relationship and job development
You have numerous occasions to collect information about your client
and their disability: at referral, intake, testing, situational
assessments, person centered planning, informal time like shopping,
and during placement. In many psychiatric settings the client is
excluded from the room while the staff talk about confidential
clinical things. What we ought to be doing is working with our
consumers from the beginning on how we will talk to each other and to
others about medical and disability issues. What terms are most
comfortable, or helpful to use. Do we use terms which we both can
share or do we use terms which makes one of us a medical professional
and one of us a patient. I worked for many years in a Fountain House
model Clubhouse where I learned that staff and consumers can talk
about symptoms and mental illness together in a very positive and
caring manner.
- Seek contractual or defined roles.
Agree with your client on what your role is. Sketch the
responsibilities on paper or on a contract
- Talk about functions, not diagnosis
Avoid using medical terms such as schizophrenia, manic-depression;
or uncomplimentary labels such as "mental patient" or "high school
dropout".
- Remember that employers want
employees who can do the job
- Describe your client in terms of
his/her qualifications for the job, not in terms of his/her
disability.
- Stress you client's being in
control, as many people think of people with psychiatric
disabilities as not capable of controlling their lives. This control
should be described as their seeking assistance, they're making a
vocational decision, and their being active in the job hunt.
- Check your attitude. Be positive
about the contribution of people with mental illness to the
workforce.
- Seek normalcy, common experiences
- If you have ever been up all night
drinking coffee and studying for a test and you find the next day
you cannot think very clearly .... you are experiencing what it may
be like to have a cognitive impairment.
- Has something ever happened at work
that upset you so much you could not stop thinking about it-you even
went to the movies but could not enjoy the movie. Then you know what
it may be like to have an idea intruding in your normal comfortable
routine. Even though these experiences differ perhaps radically by
the degrees they are felt they nonetheless are commonly understood
experiences.
Try to think of other ways to describe
the following experiences. For example use "hearing voices" in a
sentence and then substitute the word 'distracted". Or how about these:
"Obsessing about things" versus "
having trouble concentrating"
"In a manic phase" versus "Was unable to sleep last night".
" I think-I'm the invisible king" versus "I need to get my bearings"
Obviously the most commonly expressed
experiences will elicit the most positive responses and understanding.
Additional preparation:
- Role playing the job interview
- Anticipating and practicing for
difficult questions which may be asked by co-workers.
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