Mental illness disability in the workplace – the stigma is real.
Work is good for your mental health but many employees with mental health-related disability face an uphill battle against discrimination, stigma and ignorance as they strive for equality and full participation in work.
At the same time, employers who fail to offer reasonable accommodation or adapt working conditions or duties for an employee with psychosocial disability can find themselves on the wrong side of the law.[i]
One in three[ii] South African adults will experience mental illness at some point in their lives, with mental health conditions accounting for five of the 10 leading causes of disability worldwide[iii], making it just as important for employers to understand how to accommodate the “invisible disability” as it is for physical disabilities.
Psychosocial disability – when mental illness hampers a person’s ability to function and participate fully in daily life, including work – is one of the most misunderstood areas of disability, especially in that it is not necessarily permanent, says psychiatrist and past Eastern Cape chair of the South African Society of Psychiatrists (SASOP), Prof Christoffel Grobler.
Despite South Africa’s progressive legislation protecting the rights of people with disabilities and promoting workplace equality, a lack of understanding of how mental illness impacts on a person’s ability and competence to continue working, can lead to the employee facing disciplinary action or even dismissal for incapacity, he said.
Speaking ahead of the International Day of Persons with Disabilities on 3 December, Prof Grobler called on mental healthcare professionals to advocate for the rights of people with psychosocial disability against workplace discrimination and to assist them in staying in employment or returning to work as soon as possible.
Healthcare professionals also have a role to play, he said, in educating their clients and their employers on the types of measures that can assist a person with psychosocial disability to cope in the working environment.
“Work has been shown to aid recovery from mental illness, and potentially prevent temporary ineffectiveness from becoming a permanent disability. Work is linked to good rather than ill health and is proven very beneficial for psychological well-being.”
“However, loss of work on the other hand can lead to isolation, deterioration in physical and mental health and can increase mortality. Prolonged periods of being medically booked off work make returning to work less likely and that, often is the start of a slippery slope to long-term worklessness,” he said.
Employees suffering from a mental illness often hide their condition out of shame or fear, leading them to disclose their condition only once a crisis point is reached, usually when the employer is considering action to address what appears to be poor performance, misconduct or incapacity.
Prof Grobler emphasised that South African courts have consistently held that employers must offer reasonable accommodation measures to assist people with disabilities to remain in work and the impact of a psychosocial disability on work performance needs to be taken into account, before starting dismissal proceedings.
“An employee with a psychosocial impairment can often perform the essential functions of the job, but might require some reasonable accommodation to do so. However, the stigma associated with mental illness creates the expectation that a person with psychiatric disability will be incompetent or have a reduced capacity to work, leading to their exclusion from work, dismissal or victimisation.”
“Psychosocial impairment is often episodic or temporary, unlike physical disability, and since it is not well understood, many employers treat temporary incapacity as permanent, with devastating results for the patient.”
Prof Grobler said medical professionals needed to be more aware of the “potential dangers of prolonged sick leave” and have better understanding of the labour legislation that protects the rights of impaired and disabled employees.
“At the same time, legal professionals and employee relations practitioners also need better understanding of how reasonable accommodation measures can support full participation in the workplace, and that temporary or episodic impairment that may require some reasonable accommodations should not be misconstrued as permanent incapacity,” he said.
He said that “reasonable accommodations” or adaptation of the employee’s working arrangements or duties did not necessarily have to be costly to the employer or difficult to implement.
Depending on the nature of the impairment, employers can consider flexible scheduling or remote working, which could assist the employee in continuing to work as well as allowing time for the employee to attend therapy or rehabilitation.
Management and supervision should be supportive and offer positive reinforcement and constructive feedback, and take advice from the employee’s mental health practitioner on how their job functions or work environment can be adapted to aid their recovery.
In some cases, solutions might involve a move from an open-plan workspace to a more private space, or noise-cancelling headphones to aid concentration and remove intrusive background noise.
Prof Grobler recommended that professionals and service providers work more closely together in assessing whether a person was in fact permanently disabled and to what extent they are able to continue working.
“Until these gaps are addressed, people with psychosocial disability will continue to find themselves invisible, isolated and discriminated against,” he said.
[i] Van Niekerk L et al. Conceptualising disability: Health and legal perspectives related to psychosocial disability and work. SA Journal of Bioethics and Law (SAJBL). Vol 13 (No 1) 2020. http://www.sajbl.org.za/index.php/sajbl/article/view/633
[ii] Herman AA, Stein DJ, Seedat S, et al. The South African Stress and Health (SASH) Study: 12- month and lifetime prevalence of common mental disorders. South African Medical Journal. 2009; 99:339–344. [PubMed: 19588796] http://www.samj.org.za/index.php/samj/article/view/3374
[iii] World Health Organisation (WHO). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2560741/pdf/10885158.pdf