Employment
Learn about disability rights related to work, accommodations to consider, and where to go for employment support.
How does someone with SMI find meaningful work?
Employment is possible for many people diagnosed with a severe mental illness (SMI). Some people are able to maintain full-time professional careers, while others choose part-time jobs or intermittent volunteering. Some people find that managing their illness is a full-time job.
The person who experiences SMI will need to decide how much and what type of work feels manageable. If disability accommodations are needed, an employee will need to navigate a support plan with their employer. Read on to learn about disability protections and what a reasonable accommodation might look like.
Advocacy is needed to grow supported employment opportunities for people with SMI. Federal guidance to build programs is included at the end of this resource.
If previous career goals are now unrealistic, everyone involved may need to grieve the loss of former aspirations. SMI can cause ambiguous loss, and a key to coping is to name what has been lost and recognize grief as a logical response, even when the loss lacks clarity.
How are accommodations federally protected, and what is reasonable to ask for?
How much support a person needs to access work and stay employed will depend on the level of illness. If a person’s condition is persistent and disabling, they have protections within Title I of the Americans with Disabilities Act (ADA) and Section 501 of the Rehabilitation Act of 1973. The ADA Amendments Act of 2008 (ADAAA) broadened the definition of disability to provide legal protections against employment discrimination for more individuals with disabilities, including people with psychiatric disabilities.
To exercise ADA protections and request accommodations, the person will need to disclose some information about their disability. Disclosure is a choice, and confidentiality rules apply. The ADA National Network provides additional information about federal protections and defines a “reasonable accommodation” as “any change in the work environment or in the way things are customarily done that enables an individual with a disability to enjoy equal employment opportunities.” An employer cannot be required to provide an accommodation that causes “undue hardship.”
Here are examples of accommodations related to mental health:
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- An employee whose condition causes concentration or distraction issues might request more frequent reminders of tasks and due dates, a quieter work environment, more frequent short breaks, or work from home.
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- To support treatment management, an employee might request a flexible schedule to allow for appointments, breaks that align with their medication schedule, use of a water bottle, or a part-time shift in work until a medication plan stabilizes.
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- If anxiety is part of their condition, an employee might request access to white noise earphones, remote access for meetings, work from home, a change in supervisor, or flexibility to exchange non-essential tasks with a coworker.
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The U.S. Equal Employment Opportunity Commission offers two resources with additional information about navigating a plan for accommodations related to mental health:
Can an employee with SMI use FMLA?
An employee may be eligible for up to 12 weeks of unpaid, job-protected leave per year if they are unable to work because of a serious health condition. These protections through the Family and Medical Leave Act (FMLA) include contingencies related to length of employment and the size of the company. Download The Employee Guide to the Family and Medical Leave Act for more information, including how to request FMLA leave.
What is vocational rehabilitation?
Each state is required under the Rehabilitation Act of 1973 to provide vocational rehabilitation (VR) services to individuals with disabilities to maximize their employment, independence, and integration into the community and competitive labor market.
The Regional Services Administration provides information about VR departments serving each state and territory.
The supported employment approach to VR is designed to help people with SMI find an integrated employment setting with competitive pay. VR can also include independent living services, such as peer support, skill development, systems advocacy, referrals, assistive technology, transition services, housing assistance, and personal assistance. Independent living services are offered at no cost to the participant.
Advocates and professionals invested in growing supported employment programs can use the resource shared at the end of this article.
Other programs:
Ticket to Work
Ticket to Work is a program run by the Social Security Administration to provide work experiences and training for people receiving benefits due to disability. This free program helps people aged 18-64 progress toward financial independence.
Clubhouse International
A work-ordered day is part of the model for Clubhouse International, which accredits agencies that provide specific help, meals, and community for people in recovery from SMI. Clubhouses support members seeking transitional, supported, and independent employment and the model emphasizes work as a gateway to recovery. Use the Clubhouse International directory to see if there is a Clubhouse in your community.
A note on income limits for people with SMI receiving benefits
People with disabilities who want to work need to consider Social Security income limits. If a person earns more than a certain amount they may risk losing a direct payment, a housing subsidy, or Medicaid eligibility. In some situations, Social Security will send a payment and later ask for that money back.
A new job might replace the income or benefits, but there may be a gap in income or insurance. Access to medication may be critically important, so even a short gap in insurance coverage needs to be seriously considered. No easy solutions exist for these conflicts, but it helps to know the income limits and make thoughtful plans for a new job, a change in work hours, a pay raise, or any insurance impacts.