Hiring and employing individuals with psychiatric disabilities: Focus groups with human resource professionals

Abstract

BACKGROUND:

Individuals with psychiatric disabilities experience greater unemployment than the general population. Contributing to this high rate of unemployment is employer stigma, specifically as related to employers’ concerns regarding hiring individuals with psychiatric disabilities.

OBJECTIVE:

This study examined human resource (HR) professionals’ views on hiring and employing individuals with psychiatric disabilities.

METHODS:

Focus groups were conducted with members of a large HR association in a middle-Atlantic state.

RESULTS:

Two major findings in this study include the identification of specific attributes that HR professionals look for in job candidates and that the individuals who disclose a psychiatric disability before a job offer will likely be screened-out.

CONCLUSION:

The knowledge gained from HR professionals can be used to help prepare job seekers for the competitive employment market and assist job developers in their interactions with employers. The contrast between the model employee, as described by HR professionals, and their concerns about hiring individuals with psychiatric disabilities is further explored.

Keywords

Psychiatric disabilities employment human resource professionals focus group employer attitudes

1 Introduction

A key measure of citizenship is employment. From a very young age, we learn that our worth in society is measured by our participation in school, work, and the community at large. Unfortunately, individuals with psychiatric disabilities have interrupted developmental experiences and often never fully, if at all, realize the goal of embarking on careers (Rowe et al., 2012). Employment is a goal for many people with psychiatric disabilities (Frounfelker, Wilkniss, Bond, Devitt, & Drake, 2011; Ramsay et al., 2011). However, unemployment continues to be high for this population (Bertram & Howard, 2006; Bureau of Labor Statistics, 2017; Salkever et al., 2007). Research has found that the unemployment rate for people with psychiatric disabilities in the US is as high as 60–90% (SAMHSA, 2012). Unemployment for people with psychiatric disabilities is significantly higher than those without disabilities (BLS, 2017; WHO, 2018). This has been attributed to several factors, including disincentives within the Social Security benefits system (Cook, 2006; MacDonald-Wilson, Rogers, Ellison, & Lyass, 2003; Henry, 2016; Johannesen, McGrew, Griss, & Born, 2009; McQuilken et al., 2003), limited education, interrupted careers (Baron & Salzer, 2002), and employer stigma (Ju, Roberts, & Zhang, 2013; Kosyluk, Corrigan, & Landis, 2014; Nota, Santilli, Ginerva, & Soresi, 2014).

Employer attitudes about individuals with psychiatric disabilities impact hiring decisions. Negative attitudes result in concerns that may prevent a person from being hired (Shankar et al., 2014). The research on employer attitudes suggests that employers are more concerned about hiring individuals with psychiatric disabilities than people with other disabilities (Hipes, Lucas, Phelan, & White, 2016; Ju et al., 2013; Unger, 2002). Specifically, employers expressed concerns about how employees with psychiatric disabilities would get along with their co-workers, resolve workplace conflicts, as well as concerns that they would require more supervision and be less productive (Hand & Tryssenaar, 2006; Tsang et al., 2007). Additionally, employers express concerns about individuals with psychiatric disabilities lacking emotional control and their perceived potential for violent behavior (Tsang et al., 2007; Tse, 2004).

Contrasted with these employer concerns is research suggesting that employers actually benefit from hiring individuals with disabilities (Lindsay, Cagliostro, Albarico, Mortaji, & Karon, 2018). Among the 39 studies included in their systematic review, Lindsey et al. (2018) found that employers identified hiring individuals with disabilities as cost-effective and contributed to a positive company image. These hopeful results are encouraging when considering marketing efforts to prospective employers about hiring people with disabilities. It is important to note, however, that many of the articles reviewed were not specific to employees with psychiatric disabilities but rather included a variety of disabilities. Since we know that individuals with non-psychiatric disabilities are, oftentimes, viewed in a more positive light than individuals with psychiatric disabilities (Hipes et al., 2016; Ju et al., 2013; Unger, 2002), it is important that we learn more about the attitudes of HR managers specific to people with psychiatric disabilities.

Because of employer concerns, some job seekers are hesitant to disclose the presence of a psychiatric disability during the employment application process or once employed (Allen & Carlson, 2003; Ellison, Russinova, MacDonald-Wilson, & Lyass, 2003; Goldberg, Killeen, & O’Day, 2005; Henderson, Robinson, Evans-Lacko, & Thornicroft, 2017; McGahey, Waghorn, Lloyd, Morrissey, & Williams, 2014; Russinova, Griffin, Bloch, Wewiorski, & Rosoklija, 2011; Waynor, Dolce, & Aftab 2015; Wheat, Brohan, Henderson, & Thornicroft, 2010). The choice to not disclose a psychiatric condition may be a good choice for some individuals, but for others it limits their ability to access reasonable accommodations and may make explaining gaps in their work history challenging (Rüsch et al., 2018).

There is some research from employers’ perspectives on disclosing a psychiatric disability during the interview or prior to job offer. Dalgin and Bellini (2008) found in their study of 60 employers that individuals who disclosed a psychiatric disability during the interview were rated less favorably than individuals who disclosed a physical disability. Pearson, Yip, and Lo (2003) found that job candidates who disclosed the presence of any disability during the application process, particularly psychiatric conditions such as depression, were less likely to be called in for an interview. Candidates who did not identify having a disability during the application process were more likely to be called in for an interview (Pearson et al., 2003).

HR professionals and employers, in general, look for specific qualities in applicants. In a 2016 Society for Human Resource Management (SHRM) study, HR professionals identified dependability and reliability as key skills for entry-level positions (Gurchiek, 2016). A National Association of Colleges and Employers (NACE) 2017 survey identified the ability to work on a team and problem solving skills as important attributes they look for on an applicant’s resume (NACE, 2017). These results demonstrate the need for applicants to possess and project specific attributes that employers are looking for in job candidates.

Examining HR professionals’ views on hiring individuals provides an opportunity to gain better insight from a group of individuals who have the primary tasks in their organizations to understand the complexities of hiring and employee training (Hasson Villaume, von Thiele Schwartz, & Palm, 2014). There is a body of research pointing to the need for Human Resource development to focus on corporate social responsibility in both small and large employers (Ardichvilli, 2013; Jenkins, 2006). Hiring individuals with psychiatric disabilities is a step toward being a socially responsible organization (Ardichvilli, 2013).

This current study explores the views of HR professionals in a middle-Atlantic state on hiring and employing individuals with psychiatric disabilities. As part of this exploration is an in-depth look into what HR professionals look for in an ideal employee as contrasted with their expressed concerns with hiring and employing individuals with psychiatric disabilities. The comparison between the model employee and commonly held beliefs about individuals with psychiatric disabilities is further explored. The intent is to better understand HR professionals’ perspectives in order to (a) enhance job development activities, (b) better prepare job seekers for the competitive labor market, and (c) increase the hiring rates of employees with psychiatric disabilities. The overarching research question that propelled this study was what views, concerns, and advice can HR professionals offer regarding hiring and employing individuals with psychiatric disabilities?

2 Method

Following is a description of the study methods, participants, research questions, and data analysis. A qualitative focus group method of research was used for this study.

2.1 Focus group

The focus group format was seen as a valuable method to explore human resource professional’s views, concerns, and advice regarding hiring and employing individuals with psychiatric disabilities. Focus groups provide a broader and more in-depth exploration of a topic than a survey would allow (Morgan, 1998). Focus groups are a social method of obtaining research data through group discussions on a specific topic (O’hEocha, Wang, & Conboy, 2012). Focus groups are designed to enable participants to explore and expand on each other’s responses and comments. Compared to other methods such as individual interviews and surveys, the interactive and synchronous group discussion aspect of focus groups allows participants to discuss, agree, or dissent with each other’s ideas and to elaborate the opinions they have already mentioned. Therefore, the method helps one attain a deeper shared meaning of responses that enhances the trustworthiness of research results (Kitzinger, 1994). The dynamic process of the focus group provided a format to generate a rich understanding of the study participants’ experiences and beliefs regarding hiring and employing individuals with psychiatric disabilities.

Prior to recruitment, IRB approval was obtained. All study participants shared common membership in a national human resource professional organization. Although not a member, one of the researchers attended local networking meetings and gained insight into the unique position HR professionals play in their organizations. This research study grew out of this connection.

An on-line data source that provided contact information of current regional presidents was utilized to make initial contact. Study investigators attended several monthly networking meetings to discuss the study and begin recruitment. Researchers informed potential participants they were looking for open and candid thoughts and feelings from HR professionals in regards to hiring individuals with psychiatric disabilities. HR professionals self-identified an interest to participate in the study. Three focus groups were conducted in the southern, central, and northern part of the state.

2.2 Participants

A total of 14 individuals volunteered to participate in one of three focus groups held in either the northern, central or southern region of the state. Demographic information was collected for 12 of the 14 participants. Two individuals did not complete the demographics questionnaire. The average number of years participants worked in the HR field was 15.8 (SD = 7.52). Ninety-one percent of participants held bachelor degrees or above and 41.6% held additional HR specific credentials. 66.6% of the participants worked in companies with over 91 employees in a wide range of industries. Table 1 summarizes the characteristics of the focus group participants.

Table 1
Characteristics of focus group participants

Variable N %

Length of time in human resources

3–10 years 3 25

11–20 years 6 50

21–30 years 3 25

Type of industry/company

Manufacturing 1 8.3

Health Care 2 16.7

Information and Technology 2 16.7

Social Services 1 8.3

Financial 1 8.3

Other (e.g., staffing, pharmaceuticals, government, consulting, energy) 5 41.7

Size of Company (number of employees)

Less than 5 1 8.3

5–14 1 8.3

41–90 2 16.7

91–200 4 33.3

501 and over 4 33.3

Education Level

Some college 1 8.3

Bachelor’s degree 6 50

Master’s degree 4 33.3

Doctorate degree 1 8.3

HR specific credentials

SPHR (Senior Professional of Human Resources) 1 8.3

PHR (Professional of Human Resources) 4 33.3

Variable	N	%
Length of time in human resources
3–10 years	3	25
11–20 years	6	50
21–30 years	3	25
Type of industry/company
Manufacturing	1	8.3
Health Care	2	16.7
Information and Technology	2	16.7
Social Services	1	8.3
Financial	1	8.3
Other (e.g., staffing, pharmaceuticals, government, consulting, energy)	5	41.7
Size of Company (number of employees)
Less than 5	1	8.3
5–14	1	8.3
41–90	2	16.7
91–200	4	33.3
501 and over	4	33.3
Education Level
Some college	1	8.3
Bachelor’s degree	6	50
Master’s degree	4	33.3
Doctorate degree	1	8.3
HR specific credentials
SPHR (Senior Professional of Human Resources)	1	8.3
PHR (Professional of Human Resources)	4	33.3

2.3 Focus group questions

Focus group protocol questions were developed to use in a semi-structured interview format. The original interview protocol included ten open ended research questions, following Krueger’s (1998) transitional process—opening, introduction, transition, key, and ending. After piloting the original ten questions some of the questions were eliminated. This was done for two reasons: one to shorten length of the focus group to accommodate busy HR professionals, and two, to garner the most relevant information as identified by the pilot group. Krueger (1992) clarifies that these categories are suggested as general guidelines. When study investigators were challenged with difficulty recruiting study participants, advice from HR professionals, not related to this study, was sought. Shortening the time commitment of study participants and holding focus groups either just before, or just after, their monthly regional meetings was suggested. Each focus group lasted approximately 45 minutes. This advice accommodated HR professionals and allowed for focus groups to take place.

Protocol questions used included the following:

Describe a model employee?

What concerns do you have in hiring or employing an individual with psychiatric disabilities?

What advice do you have for us to better assist people with psychiatric disabilities get jobs?

Question one introduced the general topic of hiring employees (Krueger, 1998). It provided an opportunity for participants to reflect on individual experiences and make a connection with the overall topic of hiring individuals with psychiatric disabilities. This introductory question allowed for participants to begin feeling comfortable with each other, the moderators, and with the fact that they were being recorded. The introductory question provided insight into participants’ perspectives. Information gleaned from this question was interwoven throughout the focus group discussion. Additional questions were introduced, along with follow-up prompts to elaborate on what were identified as key points. The focus group format provided for an ongoing flow of ideas between study participants.

2.4 Moderating the focus groups

Prior to each focus group, participants were asked to complete a background questionnaire and confidentiality was reviewed. The investigators then provided a brief introduction to the group including a definition of psychiatric disability to include major depression, anxiety disorders, bipolar disorder, and schizophrenia.

The two study investigators moderated the focus groups. One moderator asked questions while the other moderator managed the audio equipment, took notes, and observed participants’ tone, emphasis, and body language. A flip chart was utilized to record discussion notes, which were then used to provide the group with a detailed summary of group foci—constituting the beginning of data analysis (Rabiee, 2004). At the conclusion of the group, this written summary provided the participants the opportunity to confirm the moderators’ initial understanding of the data, make changes and provide clarifications and additional information. The groups were audio-taped and transcribed. One investigator was a doctoral level student at the time of the study and completed qualitative research courses which included mentoring by a professor with expertise in qualitative research.

2.5 Data analysis

Consistent with other qualitative research methods, analysis of data began during the group discussion and the interviewers’ involvement in the process (Rabiee, 2004). Intense familiarization with the data moved analysis forward. Investigators listened to tapes several times in their entirety, along with several readings of group transcriptions and summary notes. In this way study investigators were able to immerse themselves in the details, and get a full sense of the interviews before breaking them into codes and eventual themes; distinct inferences began to emerge during this process. A computer word processing program was used to highlight, sort, and rearrange participant quotes into related categories (Krueger, 1998). Color coding and a spreadsheet assisted in the management of data. Reoccurring categories found across all focus groups were grouped into themes. Two additional coders, who were otherwise not associated with this project, independently reviewed and categorized data. Finally, resolution of analysis differences and theme fidelity was established by all four investigators/coders through group discussions.

3 Results

Responses to the focus group questions are described below. Each question had a set of themes that developed from the combined focus groups. The results are categorized to show the themes that emerged from each question.

3.1 Question One: Describe a model employee

Four themes were identified by all three focus groups in regards to a model employee: 1) reliability 2) ability to get the job done 3) flexibility and 4) interpersonal skills. According to this group of HR professionals, reliable workers were described as “being responsible, coming to work on time and when scheduled,” and “having an understanding of their role and responsibilities.” Closely related to reliability was the theme of ability to get the job done. A model employee “gest the job done without needing prompting” and “looks for what is needed to get done” and does not “wait to be told what to do.” Flexible workers “adapt to change” and “think outside of the box.” They are “open minded and accepting of change and challenge.” A model employee with good interpersonal skills was described as someone who “gets along well with others” and “lacks a bad attitude,” specifically, not complaining all the time about the job, co-workers, or the organization.” The themes and participant responses are detailed in Table 2.

Table 2
Question # 1: Describe a Model Employee

Themes Participant Responses

Reliability – Responsible, comes to work on time and when scheduled

Ability to get the job done – Gets the job done

– Does not need prompting

– Does not wait to be told what to do

– Looks for what needs to be done

Flexibility – Adapts to job change, willing to change

– Open-minded and accepting of change or challenge

– Thinks outside of the box

Interpersonal skills – Gets along well with others

– Does not cause interpersonal problems with others

– Does not have a bad attitude

– Does not complain about the job, co-workers or the organization

– Is a team player

– Communicates well with co-workers and supervisors

Themes	Participant Responses
Reliability	– Responsible, comes to work on time and when scheduled
Ability to get the job done	– Gets the job done
	– Does not need prompting
	– Does not wait to be told what to do
	– Looks for what needs to be done
Flexibility	– Adapts to job change, willing to change
	– Open-minded and accepting of change or challenge
	– Thinks outside of the box
Interpersonal skills	– Gets along well with others
	– Does not cause interpersonal problems with others
	– Does not have a bad attitude
	– Does not complain about the job, co-workers or the organization
	– Is a team player
	– Communicates well with co-workers and supervisors

3.2 Question Two: What concerns do you have in hiring or employing an individual with a psychiatric disability?

Although no consensus was found across all three focus groups, consensus across two of the groups identified several concerns: 1) attendance, 2) job performance 3) safety, 4) dealing with stress and timelines, and 5) HR professionals own lack of knowledge about mental illness. Attendance was a prime concern for these HR professionals, irrelevant of disability. As one group participant stated, “absenteeism is the strongest predictor that something is amiss.” Job performance and the ability to deal with stress and timelines were concerns for several participants. Specifically, participants expressed concern about the “impact the illness would have on the job.”

The themes and participant responses are detailed in Table 3.

Table 3
Question # 2: What concerns do you have in hiring or employing an individual with a psychiatric disability?

Themes Participant Responses

Lack of knowledge – Lack understanding how illness can impact co-workers

about mental illness – Not skilled in how illness may impact job placement

Attendance – Absenteeism is the strongest indicator that something is amiss

– Shows up for work on time and when scheduled

Job performance – Ability to perform the essential functions of the job

– Capability in job performance

Stress – Ability to deal with stress, anxiety and timetables

Safety – Safety for self and fellow employees

Themes	Participant Responses
Lack of knowledge	– Lack understanding how illness can impact co-workers
about mental illness	– Not skilled in how illness may impact job placement
Attendance	– Absenteeism is the strongest indicator that something is amiss
	– Shows up for work on time and when scheduled
Job performance	– Ability to perform the essential functions of the job
	– Capability in job performance
Stress	– Ability to deal with stress, anxiety and timetables
Safety	– Safety for self and fellow employees

3.3 Question Three: What advice do you have for us to better assist people with psychiatric disabilities to get and keep jobs?

Two themes emerged from this question: 1) disclosure, and 2) employment gaps. Group participants agreed that it is best not to disclose before being hired. It was unanimously expressed that employment gaps negatively impact a person’s potential to be called in for an interview. One participant responded with, “It’s a don’t ask, don’t tell situation. There are plenty of candidates. When you look at certain skills and background you want and one candidate is a person with a mental illness, they may end up in the B pile.” Several participants echoed and agreed with the above response. The themes and participant responses are detailed in Table 4.

Table 4
Question # 3: What advice do you have for us to better assist people with psychiatric disabilities to get and keep jobs?

Themes Participant Responses

Disclosure – It is not advisable to say you have a mental illness at an interview.

– If necessary, disclosure to a HR professional is preferable to a hiring manager.

Employment gaps – People are not called in for interviews because of employment gaps.

– Be prepared to say why you left jobs.

– Have a solid and viable explanation for gaps in employment.

– Stay away from negative words.

Themes	Participant Responses
Disclosure	– It is not advisable to say you have a mental illness at an interview.
	– If necessary, disclosure to a HR professional is preferable to a hiring manager.
Employment gaps	– People are not called in for interviews because of employment gaps.
	– Be prepared to say why you left jobs.
	– Have a solid and viable explanation for gaps in employment.
	– Stay away from negative words.

4 Discussion

Following previous studies examining the views and concerns of employers regarding individuals with psychiatric disabilities, our study sought to delve deeper into these perspectives through focus groups with HR professionals. There were key findings from this project. Principally, the finding that disclosure during the interview or prior to job offer was not advisable because it may be used to screen out a job candidate. This is consistent with prior studies that show employers are less likely to hire individuals who disclose the presence of any disability (Bricout & Bentley; 2000; Moss, Vemuri, Hedley, & Ujarevic, 2016; Pearson, Yip, & Lo, 2003). Although, disclosure of a psychiatric disability is met with greater concern among employers when compared to most other disability groups (Hipes et al., 2016; Ju et al., 2013; Unger, 2002). There is some developing research that suggests assisting job seekers with developing a plan to manage disclosure of personal information is critical in the job preparation stage, resulting in improved employment outcomes (McGahey, Waghorn, Lloyd, Morrissey, & Williams, 2014).

Consistent with previous surveys conducted with HR professionals and employers, HR professionals desire employees with certain attributes, including reliability, flexibility, and good interpersonal skills (Gurchiek, 2016; NACE, 2017). HR professionals have an ideal employee in mind when hiring. Additionally, they have concerns about the ability of people with psychiatric disabilities to do the job and to get along with co-workers. Knowledge of a job applicant’s psychiatric disability may influence a hiring decision if an employer believes that person does not possess the desired attributes or have the ability to do the job. This may exclude qualified candidates because of preconceived biases regarding individuals with psychiatric disabilities. For example, our sample of HR professionals expressed that individuals with psychiatric disabilities will have poor attendance and work performance, and for some people, that may be true (Greenberg et al., 2015; Levinson et al., 2010; Tsuchiva et al., 2012). Tsuchiva et al. (2012) found mood disorders, including major depression, were associated with poorer work performance. Although, according to these authors, there was no significant relationship between sick/absent days and mental health disorders.

The results of our study support the need to educate employers and HR professionals about psychiatric disabilities. Employers have concerns regarding a psychiatric disability and its impact on job performance. Providing accurate information and education to counter stigmatizing beliefs has been shown to produce more positive views of persons with psychiatric disabilities (Corrigan, et al., 2001: Corrigan, Morris, Michaels, Rafacz, & Rüsch, 2012; Griffiths, Carron-Arthur, Parsons, & Reid, 2014). Job developers and employment specialists do not always have the opportunity to educate employers about psychiatric disabilities because of disclosure and confidentiality concerns. Nevertheless, educating the business community can happen in many ways (Martin, Woods, & Dawkins, 2014). Formal training can occur through workshops and seminars offered to the local employment community. This training can dispel myths regarding mental illness and provide the supporting evidence from research regarding recovery from mental illness (Corrigan et al., 2001; Griffiths et al., 2014). Disability related topics can be taught in business education programs at colleges and universities that prepare HR professionals for the workforce (Parry & Rutherford, 1996).

Additionally, practitioners can better assist job seekers, who may have difficulties with attendance and job performance, by educating them on the expectations of the workplace. Thorough assessments and discussions around prior challenges with attendance and work performance are critical in developing plans to manage these issues. There is some research suggesting that depression management programs conducted by care managers have a positive effect on individuals’ work performance and absenteeism (Rost, Smith, & Dickinson, 2004). These types of programs that emphasize managing symptoms in order to improve on the job functioning are critical in supporting individuals in their employment pursuits and tenure.

5 Limitations

There are limitations to consider when interpreting these results. One possible limitation is the potential for selection bias. It is not known why those who participated volunteered to do so. Perhaps participants volunteered because of personal experiences with psychiatric disabilities. Additionally, all study participants were members of a large HR professional association that meets regularly for training and networking. These participants may not be representative of all HR professionals in that they may engage in more opportunities to increase their knowledge on issues facing their field. Furthermore, HR professionals may not always be the people in their organizations who initially interview and subsequently make a hiring decision. Finally, the focus groups were held in 2009, during a time of economic downturn in our region and nationally. The results may have been influenced by the economic situation of that time and may not be fully reflective of the views of HR professionals today.

6 Future research

This was an exploratory study and like many qualitative research designs the results reveal insight into important topics for future research. Studying a larger sample of HR professionals with varying backgrounds would better represent the potentially diverse attitudes and experiences of the profession. Additionally, examining the changes in HR professionals’ attitudes and hiring practices in response to educational interventions would be consequential. Further research from the employer’s perspective, specifically hiring managers, on the impact of disclosure on employment outcomes would provide insight into the disclosure dilemma that many individuals with psychiatric disabilities face.

Conflict of interest

None to report.

References

Allen,

, & Carlson,

(2003). To conceal or disclose the presence of a disabling condition? A dilemma of employment transition. Journal of Vocational Rehabilitation, 19, 19–30.

Ardichvili,

(2013). The role of HRD in CSR, sustainability, and ethics: A relational model. Human Resource Development Review, 12(4)), 10.1177/1534484313478421.

Baron,

R. C

, & Salzer,

M. S.

(2002). Accounting for unemployment among people with mental illness. Behavioral Sciences and the Law, 20, 585–599.

Bertram,

, & Howard,

L. E.

(2006). Employment status and occupational care planning for people using mental health services. Psychiatric Bulletin, 30, 48–51.

Bricout,

J. C

, & Bentley,

K. G.

(2000). Disability status and perceptions of employability by employers. Social Work Research, 24(2)), 87–95.

Bureau of Labor Statistics (BLS, 2017). Persons with a Disability: Labor force characteristics summary. Not in the labor force. Retrieved from, http://www.bls.gov/news.release/disabl.nr0.htm.

Bureau of Labor Statistics (BLS, 2018). Unites States department of Labor. Labor Force statistics from the current population survey. Data on the employment status of people with a disability. Retrieved from https://www.bls.gov/news.release/empsit.t.htm.

Cook,

J. A.

(2006). Employment barriers for persons with psychiatric disabilities: Update of a report for the president’s commission. Psychiatric Services, 57, 1391–1405.

Corrigan,

P. W

, Morris,

S. B

, Michaels,

P. J

, Rafacz,

J. D

, & Rüsch,

(2012). Challenging the public stigma of mental illness: A meta-analysis of outcome studies. Psychiatric Services, 63(10)), 963–973.

10.

Corrigan,

P. W

, River,

P. L

, Lundin,

R. K

, Penn,

D. L

, Uphoff-Wasowski, Campion

, Mathisen,

, … Kubiak

M. A.

(2001). Three strategies for changing attributions about severe mental illness. Schizophrenia Bulletin, 27(2)), 187–195.

11.

Dalgin,

R. S

, & Bellini,

(2008). Invisible disability disclosure in an employment interview: Impact on employers’ hiring decisions and views of employability. Rehabilitation Counseling Bulletin, 52(1)), 6–15.

12.

Ellison,

M. L

, Russinova,

, MacDonald-Wilson,

K. L

, & Lyass,

(2003). Patterns and correlates of workplace disclosure among professionals and managers with psychiatric conditions. Journal of Vocational Rehabilitation, 18(1)), 3–13.

13.

Frounfelker,

R. L

, Wilkniss,

, Bond,

G. R

, Devitt,

T. S

, & Drake,

R. E.

(2011). Enrollment in supported employment services for clients with a co-occurring disorder. Psychiatric Services, 62, 545–547.

14.

Goldberg,

S. G

, & Killen,

M. B.

(2005). The disclosure conundrum: How people with psychiatric disabilities navigate employment. Psychol Public Law, 11, 463–605 .

15.

Greenberg,

P. E

, Fournier,

A. A

, Sisitsky,

, Pike, Kessler

R. C.

(2015). The economic burden of adults with major depressive disorder in the United States (2005 and 2010). Journal of Clinical Psychiatry, 76(2)), 155–162. 10.4088/JCP.14m09298.

16.

Griffiths,

K. M

, Carron-Arthur,

, Parsons,

, & Reid,

(2014). Effectiveness of programs for reducing the stigma associated with mental disorders. A meta-analysis of randomized controlled trials. World Psychiatry, 13(2)), 161–175. 10.1002/wps.20129.

17.

Gurchiek,

(2016). HR ranks these must-have skills high on entry-level workers’ resumes. Society for Human Resource Management. Retrieved from https://www.shrm.org/about-shrm/news-about-shrm/pages/dependability-integrity-high-on-entry-level-workers-must-have-skills.aspx.

18.

Hand,

, & Tryssenaar,

(2006). Small business employers’ views on hiring individuals with mental illness. Psychiatric Rehabilitation, 29(3)), 166–173.

19.

Henderson,

, Robinson,

, Evans-Lacko,

, & Thornicroft,

(2017). Relabionships between anti-stigma programme awareness, disclosure comfort and intended help seeking regarding a mental health problem. British Journal of Psychiatry, 211, 316–322.

20.

Hasson,

, Villaume,

, von Thiele Schwartz

, & Palm,

(2014). Managing implementation: Roles of line managers, senior managers, and human resource professional in an occupational health intervention. Journal of Occupational and Environmental Medicine, 56(1)), 58–65. 10.1097/JOM.0000000000000020.

21.

Henry,

A. D

, Barkoff,

, Mathis,

, Lilly,

, & Fishman,

(2016). Policy opportunities for promoting employment for people with psychiatric disabilities. University of Massachusetts Medical School and the Bazelon Center for Mental Health Law. Retrieved from http://www.bazelon.org/wp-content/uploads///UMASS_Document_PolicyOppForPromEmployPPD_CHPR__v5.pdf

22.

Hipes,

C. L

, Lucas,

, Phelan,

J. C

, & White,

R. C.

(2016). The stigma of mental illness in the labor market. Social Science Research, 56, 16–25. 10.1016/j.ssresearch.2015.12.001.

23.

Johannesen,

J. K

, McGrew,

J. H

, Griss,

M. E

, & Born,

D. L.

(2009). Change in self-perceived barriers to employment as a predictor of vocational rehabilitation outcome. American Journal of Psychiatric Rehabilitation, 12, 295–316. doi: 10.1080/15487760903248358

24.

Ju,

, Roberts,

, & Zhang,

(2013). Employer attitudes toward workers with disabilities: A review of research in the past decade. Journal of Vocational Rehabilitation, 38, 113–123, 10.3233/JVR-130625.

25.

Karpur,

, & VanLooy,

(2014). Research brief: Employer practices and the employment of people with disabilities: Scoping the literature. Retrieved from https://digitalcommons.ilr.cornell.edu/edicollect/1348/.

26.

Kitzinger,

(1994). The methodology of focus groups: The importance of interactions between research participants. Sociology of Health and Illness, 16, 103–121. 10.1111/1467-9566.ep11347023.

27.

Kosyluk,

K. A

, Corrigan,

P. W

, & Landis,

R. S.

(2014). Employer stigma as a mediator between past and future hiring behavior. Rehabilitation Counseling Journal, 57(2)), 102–108, 10.1177/0034355213496284.

28.

Krueger,

R. A.

(1998), Focus groups: A practical guide for applied research. Thousand Oaks, CA, US: Sage Publications.

29.

Levinson,

, Lacoma,

M.D

, Petukhova,

, Schoenbaum,

, Zaslavsky,

A. M

, Agnermeyer,

, ⋯ Kessler

R. C.

(2010). Associations of serious mental illness with earnings: Results from the WHO World Mental Health surveys. British Journal of Psychiatry, 197(2)), 114–121. 10.1192/bjb109.073635.

30.

Lindsay,

, Cagliostro,

, Albarico,

, Mortaji,

, & Karon,

(2018). A systematic review of the benefits of hiring people with disabilities.. Journal of Occupational Rehabilitation. 10.1007/s10926-018-9756-z.

31.

Martin,

, Woods,

, & Dawkins,

(2014). Managing employees with mental health issues: Identification of conceptual and procedural knowledge for development within management education curricula. ACAD Management Learning and Education, 14(1)), 50–68.

32.

Morgan,

D. L

, Krueger,

R. A

, & King,

J. A.

(1998). The focus group kit. Thousand Oaks, CA, US: Sage Publications.

33.

McDonald-Wilson,

K. L

, Rogers,

E. S

, Ellison,

M. L

, & Lyass,

(2003). A study of the Social Security Work Incentives and their relation to perceived barriers to work among persons with serious mental illnesses. Rehabilitation Psychology, 48(4)), 301–309.

34.

McGahey,

, Wagnorn,

, Lloyd,

, Morrissey, Williams

P. L.

(2014). Formal plan for self-disclosure enhances supported employment outcomes among young people with severe mental illness. Early Intervention in Psychiatry, 10, 178–185. 10.1111/ei12196.

35.

McQuilken,

, Zahniser,

J. H

, Novak,

, Starks,

R. D

, Olmos,

, & Bond,

G. R.

(2003). The work project survey: Consumer perspectives on work. Journal of Vocational Rehabilitation, 18, 59–68.

36.

Moss,

, Vemuri,

S. R

, Hedley,

, & Ujarevic,

(2016). Initiatives that diminish the biases of recruiters against people who disclose or demonstrate a diagnosed mental disorder. Equality, Diversity and Inclusion: An International Journal, 36(1)), 2–16. 10.1108/EDI-05-2016-0037.

37.

National Association of Colleges and Employers. (2017) Job outlook. Retrieved from http://www.naceweb.org/about-us/press/2017/employers-seek-teamwork-problem-solving-skills-on-resumes/.

38.

Nota,

, Santilli,

, Ginerva,

M. C

, & Soresi,

(2014). Employer attitudes towards the work inclusion of people with disability. Journal of Applied Research in Intellectual Disabilities, 27, 511–520. 10.1111/jar.12081.

39.

O’hEocha,

, Wang,

Conboy

(2012). The use of focus groups in complex and pressurized IS studies and evaluations using Klein & Myers principles for interpretive research. Info Systems Journal, 22, 235–256. 10.1111/j.1365-2575.2011.00387.x.

40.

Parry,

L. E

, & Rutherford,

(1996). Too little, too late: Are business schools falling behind the times?Journal of Education for Business, 71(5)), 293–299.

41.

Pearson,

, Yip,

, & Lo,

(2003). To tell or not to tell; Disability disclosure and job application outcomes. Journal of Rehabilitation, 69(4)), 35–38.

42.

Ramsay,

C. E

, Broussard,

, Goulding,

S. M

, Cristofaro,

, Hall,

, Kaslow,

N. J

, … Compton

M. T.

(2011). Life and treatment goals of individuals hospitalized for first-episode non-affective psychosis. Psychiatry Research, 189, 344–348.

43.

Rabiee,

(2004). Focus-group interview and data analysis. Proceedings of the Nutrition Society63, 655–660. 10.1079/PNS2004399.

44.

Rost,

, Smith,

J. L

, & Dickinson,

(2004). The effect of improving primary care depression management on employee absenteeism and productivity: A randomized trial. Medical Care, 42(12)), 1202–1210.

45.

Rowe,

, Clayton,

, Benedict,

, Bellamy,

, Antunes,

, Miller,

, … O’Connell

M. J.

(2012). Going to the source: Creating a citizenship outcome measure by community-based participatory research methods. Psychiatric Services, 63(5)), 445–450.

46.

Rüsch,

, Corrigan,

P. W

, Waldman,

, Staiger,

, Bahemann,

, Oexle,

, … Becker

(2018). Attitudes toward disclosing a mental health problem and reemployment. The Journal of Nervous and Mental Disease, 206, 383–385.

47.

Russinova,

, Griffin,

, Bloch,

, Wewiorski,

N. J

, & Rosoklija,

(2011). Workplace prejudice and discrimination toward individuals with mental illnesses. Journal of Vocational Rehabilitation, 35, 227–241. 10.3233/JVR-2011-057.

48.

Salkever,

D. S

, Karakus,

M. C

, Slade,

E. P

, Harding,

C. M

, Hough,

R. L

, Rosenheck,

R. A

, … Yamada

A. M.

(2007). Measures and predictors of community-based employment and earnings of persons with schizophrenia in a multisite study. Psychiatric Services, 58, 315–324.

49.

SAMHSA Uniform Reporting, summary (2012). Mental illness: NAMI report deplores 80% unemployment rate; State rates and ranks listed-model legislation proposed. Retrieved from http://www.namidelaware.org/sites/default/files/StateMIUnemploymentRates.pdf.

50.

Shankar,

, Liu,

, Nicholas,

, Warren,

, Lai,

, Tan,

, ... Sears

(2014). Employers’ perspectives on hiring and accommodating workers with mental illness. Sage Open, 4(3)), 2158244014547880.

51.

Stewart,

D. W

, & Shamdasani,

P. N.

(2015) Focus Groups: Theory and Practice, (Applied Social Research Methods Series), (3rd ed) Thousand Oaks, CA: SAGE.

52.

Tsang,

W. H

, Angell,

, Corrian,

P. W

, Yueh-Ting,

, Kan,

, Chow,

S. L

, … Fung

K. M. T.

(2007). A cross-cultural study of employers’ concerns about hiring people with psychotic disorder: Implications for recovery. Social Psychiatry and Psychiatric Epedemiology, 42(9)), 723–733.

53.

Tse,

(2004). What do employers think about employing people with experience of mental illness in New Zealand workplaces?Work, 23(3)), 267–274.

54.

Tsuchiva,

, Kawakami,

, Ono,

, Nakane,

Nakamura

, Fukao,

, … Kikkawa

(2012). Impact of mental disorders on work performance in a community sample of workers in Japan: The World Mental Health Japan Survey 2002-2005. Psychiatry Res, 198(1)), 140–145. 10.1016/j.psychres.2011.10.014.

55.

Unger,

D. D.

(2002). Employers’ attitudes toward persons with disabilities in the workplace: Myths or realities?Focus on Autism and Other Developmental Disabilities, 17(1)), 2–10.

56.

Waynor,

W. R

, Dolce,

J. N

, & Aftab,

(2015). The role of self-efficacy in managing personal information with employers. Rehabilitation Counselors and Educators Journal, 8(1)), 33–40.

57.

Wheat,

, Brohan,

, Henderson,

, & Thornicroft,

(2010). Mental illness in the workplace: Conceal or reveal?. Journal of the Royal Society of Medicine, 103, 83–86. 10.1258/jrsm.2009.090317.

58.

WHO (2018). Mental Health, poverty and development. Geneva, World Health Organization. Retrieved from http://www.who.int/mental_health/policy/development/en/.