As part of her graduate school studies to become a clinical social worker, Jillian had to complete a year-long intern placement. Halfway through the year, and mid-pandemic, her medication to regulate her lifelong premenstrual dysphoric disorder (PMDD), anxiety and depression stopped working.
“I was extremely stressed, working full time outside the placement to pay for grad school and caring for my two children,” explains Jillian, who lives in the US. “Suddenly, I was sad, depressed and hopeless – it was hard to function.”
During a performance review, her supervisor repeatedly asked if Jillian was OK. “She kept pushing, so I explained the reasons I wasn’t at my best and that I needed a few weeks of her patience,” explains Jillian. “I broke down and was told I wasn’t stable and didn’t belong in the organisation or the profession.” Despite an appointment on the calendar to adjust her medication, Jillian was released from the placement soon after the conversation.
Coping with a mental health issue while working is hard – but choosing whether to disclose that information to a manager or HR representative can be just as difficult. On one hand, informing higher powers can help workers get the accommodations they need, increase their support from peers and even improve workplace culture. Yet they also risk judgment, stereotyping, discrimination and even dismissal.
For many workers, although they may desperately need support, coming forward isn’t simple. Even as workplaces put in more resources than ever, some people have found out the hard way that disclosing their mental health struggles isn’t a black and white choice.
‘Disclosure is a double-edged sword’
According to late 2022 data from the World Health Organization, 15% of working-age adults have a mental health disorder, which is the number one cause of disability worldwide.
Many countries have legal mechanisms in place to aid and protect workers who struggle with both visible and invisible disabilities, including mental health issues. In the US, the Americans with Disabilities Act (ADA) requires employers to provide qualified employees “reasonable accommodation”; the UK’s Disability Discrimination Act (DDA) also requires employers to provide “reasonable adjustments”, and bars employers from dismissing workers for disabilities.
Home stresses can play a large part in mental health challenges, and some workers say personal struggles may be difficult to discuss (Credit: Alamy)
Despite this, conversations in the workplace about mental wellness still feel taboo to many. The Harris Poll found that more than half of global employees (58%) say they aren’t comfortable discussing their mental health at work. A 2023 study from the University of Melbourne found that people who experience mental health problems face stigma, making it deeply complex to decide if – and with whom – they should discuss their struggles.
“Disclosing a mental health issue is such a double-edged sword, and based on research, it’s more common that workers keep it a secret, than disclose it,” explains Nicola Reavley, deputy director of the Centre for Mental Health at the University of Melbourne in Australia, who specialises in mental health literacy and discrimination, who co-authored the review.
Workers grapple with a range of fluctuating individual factors when deciding whether to disclose: their diagnosis, how it impacts their day-to-day work, the benefits sought by disclosing and the potential relief it offers. But Reavley points out there are also serious structural questions to consider. “They need to weigh up the safety of that workplace, the systems and process of disclosure and whether, ultimately, the positives will outweigh the negatives.”
Some workers decide to disclose only after a crisis makes it clear they need long-term adjustments in their workplaces. This chimes with the experience of Pete, a consultant from the UK, who felt extreme pressure to perform at a small tech company in 2013. He was travelling constantly while grappling with suicidal thoughts. At home, his young daughter was ill.
To cope, Pete took a month of medical leave to rest, spend time with his family and get medical help. “I didn’t feel any kind of trepidation, because it was all about needing to escape, and I wasn’t really thinking into the future,” he explains. “It was like living in a fog.” Yet upon returning, he says management blamed him for the business’s failings, and made him feel as if he wasn’t fit to do the job.
“I explained my story to my director [upon returning], and he went on to share those private conversations with the family [who ran the business],” explains Pete. “Soon after, I was excluded from most business activities and left with no option but to quit.” Looking back, Pete – who has bipolar II, constant low-level suicidality and a hair-pulling disorder called trichotillomania – wanted support and guidance from his employers. “I was hoping they would offer routes to professional help, or to speak with health professional, but I also wanted them to realise that they couldn’t spread people so thinly without consequences,” he says.
For Jillian, after she was let go from her placement, she hired an attorney to help navigate getting back into the workplace. She was able to stay on in the graduate program, find another placement and finish her degree. Although she’s now employed in an environment where she feels supported, she’d still be hesitant to come forward to an employer.
“Having seen how bad it can go, I’d only disclose a mental health issue if I felt properly supported – otherwise, I’d just say it was issues related to family or illness,” says Jillian. Although she feels she’d be supported in her current work environment, she adds, “this whole experience has given me a better understanding of how mental health is stigmatised, even in the provider space. I have a much clearer picture of the kind of places I want to work, and if I ever decide to work any place else, mental health [support] will be the number one priority I look for”.
Disclosure can be difficult, but experts say there are more support systems in place for workers, and acceptance is rising (Credit: Alamy)
Freer to be themselves
Negative experiences like these can give pause to even the most confident individuals. Yet a growing body of data suggests that the workplace attitudes towards mental health are evolving in a positive direction.
According to a 2023 study from Arizona State University published in the Journal of Mental Health Policy and Economics, workers with schizophrenia, bipolar disorder or major depressive disorder who had disclosed their diagnoses reported more support and tolerance at work. Similarly, a recent study of Dutch adults showed 64.2% of survey respondents who disclosed their condition had a positive experience, compared to 9% who had a negative experience.
Pete, too, has seen a change. In the past decade, he’s had to make many more workplace disclosures, and has had a range of good responses. The most impactful was when he worked at a hospitality chain, under a supportive boss who empowered his direct reports.
“I knew as soon as I walked in that the business understood psychology, people and mental health,” says Pete. “I could share personal stuff with my boss over coffee or lunch, and he’d share things back – it was a two-way thing and made me realise I wasn’t the only person struggling.” Looking back, Pete feels the tough experience at the tech firm in 2013 was a product of its time.
Reavley adds there’s also an often-overlooked benefit to disclosing a mental health issue. “Able to be honest, people often feel better about themselves because there’s an emotional cost to hiding and keeping it to themselves – it’s a relief,” she says.
Along with procedural pluses like access to reasonable adjustments or counselling, it may be the start of a journey in self-help and acceptance. Pete’s boss at the hospitality chain suggested cognitive behavioural therapy (CBT) and a range of other coping mechanisms, which he still uses a decade later. “He kickstarted my recovery, helping me to understand my issues, triggers and responses,” says Pete, now in his 40s and working as an independent contractor, a style of work that fits around his wellbeing needs.
Reavley believes there’s a lot to celebrate, as more organisations are creating an environment where employees can raise mental health concerns and ask for what they need to thrive. “Plus, more senior people are publicly taking time off for their own mental health, in a way they wouldn’t a few decades ago,” she says. “They’re modelling that it’s acceptable to be human, have these experiences and seek help.”