Barriers and facilitators to requesting accommodation among individuals with psychiatric disabilities: A qualitative approach

Abstract

BACKGROUND:

Employees with psychiatric disabilities experience a great amount of workplace challenges such as lacking workplace supports and job accommodations. There is a lack of research surrounding job accommodations for persons with psychiatric disabilities within the United States. Thus, research is warranted to understand how to meet the needs of this population via accommodations.

OBJECTIVE:

This study examined barriers and facilitators to requesting accommodations among employees with psychiatric disabilities through a qualitative approach.

METHODS:

This study recruited 120 participants from multiple agencies serving individuals with psychiatric disabilities in the United States. Themes regarding barriers and facilitators were identified using the conventional content analysis approach.

RESULTS:

The most commonly identified themes were employees’ fear and anxiety negatively impacting accommodation seeking behaviors, employer discrimination and non-inclusive workplace culture, and employers lack knowledge of disabilities and ADA. Participants also identified positive experiences in requesting accommodations.

CONCLUSION:

Rehabilitation professionals and employers may utilize current findings, facilitate a positive and inclusive workplace environment and assist employees with disabilities to take full advantage of workplace resources and job accommodation to exert their potentials.

Keywords

Psychiatric disabilities accommodation disclosure challenges workplace

1 Introduction

An estimated 18%of the U.S. workforce reported having a mental health condition in any given month of 2018, indicating psychiatric disabilities as one of the more common disabilities covered under the Americans with Disabilities Act (ADA) (Centers for Disease Control and Prevention, 2019). The ADA defines psychiatric disabilities as mental impairment that substantially limits one or more of the major life activities of an individual; a record of impairment; or being regarded as having such an impairment (ADA National Network, 2018). Psychiatric impairments can vary widely in the nature and severity of presentations. According to the Centers for Disease Control and Prevention (2019), psychiatric disabilities may negatively affect job performance and productivity, engagement with one’s work, communication with coworkers, physical capability, and daily functioning.

Employment plays a defining role in most people’s lives, including individuals with psychiatric disabilities. Research underlines the personal, economic, and social benefits of employment for people with psychiatric disabilities. These benefits include autonomy, daily structure, a sense of purpose, financial gains, and societal contribution (Brohan et al., 2014; Hickox & Hall, 2018). On the other hand, a lack of access to meaningful employment can contribute to poor self-confidence, fewer vocational opportunities, greater health inequalities, and poverty (Drake & Whitley, 2014).

Employment disenfranchisement is common amongst persons with psychiatric disorders. For example, Corbière et al. (2014) found that between 40 to 60 percent of people with severe mental disorders do not maintain their employment for more than six months. Additionally, estimates show that the unemployment rate of those with psychiatric disabilities is three to five times higher than their counterparts without psychiatric disabilities (Chow & Cichocki, 2015). Workplace protection is warranted for people with psychiatric disabilities considering these challenges.

Since the passage of the ADA in 1990, support for disability inclusion in all aspects of public life has become more apparent (ADA National Network, 2018). The Americans with Disabilities Act Amendments Act of 2008 further expands the ADA’s protection for people with disabilities through being more inclusive and broadening the scope of who might qualify as having a disability (Isetti & Eadie, 2016). A surge of interest in the topic of psychiatric disabilities has emerged as the public and employers recognize the role those with psychiatric disabilities can have in the workplace with the implementation of accommodations (Anand & Sevak, 2017). Supported employment is an effective and cost-efficient way of enhancing vocational outcomes for individuals with severe disabilities (Bond, 1987; Bond et al., 2012, 2016). Supported employment refers to service provisions wherein people with disabilities, including intellectual disabilities, mental health, and traumatic brain injury, among others, are assisted with obtaining and maintaining employment (“Supported employment,” 2020). In addition to personal assistance services and nature supports, workplace accommodations serve as an important component of supplemented employment (“Supported employment,” 2020).

An accommodation is defined as “an adjustment to a job description or workplace environment to allow equal participation for people with disabilities in all aspects of employment when compared to their counterparts without disabilities” (U.S. Equal Employment Opportunity Commission, 2016). Workplace accommodations for persons with psychiatric disabilities can manifest in many different ways. Some common accommodation examples include flexible scheduling, reduced hours, enhanced training and supervision, modified job description/duties, and support from a job coach/employment specialist (Buhariwala et al., 2015; McDowell & Fossey, 2015).

Workplace accommodations permit employees with disabilities to perform essential functions of their jobs and ensure access to the equal benefits, assistance, and privileges of employment. Several studies identified the benefits of workplace accommodations for employees with psychiatric disabilities, including an increase in both job attendance and productivity, an enhanced sense of self-confidence as a qualified employee (Kirsh & Gewurtz, 2011; Schultz et al., 2011; Solovieva & Walls, 2013) as well as a longer job duration (Chow et al., 2014; Corbière et al., 2014; Sevak & Khan, 2017). Employers also experience benefits in providing reasonable accommodations such as increased company morale, enhanced company productivity, and the elimination of the cost of training new employees (Solovieva & Walls, 2013).

Despite the aforementioned benefits, there is a lack of request and use of accommodations among people with psychiatric disabilities. Under the ADA, employees with psychiatric disabilities have to make the decision of whether to disclose their disability to their employer and make a request for workplace accommodations. The rates of disclosure of disabilities and requesting accommodation are generally low among individuals with mental disabilities (Corbière et al., 2014; DeTore et al., 2019; Heinz et al., 2018). For example, Corbière et al. (2014) reported an accommodation request rate of 45.1%in their studies for people with psychiatric disabilities. Thus, understanding factors related to request and use of accommodation is important.

1.1 Literature review

1.1.1 Employers’ perspectives

Employers’ understanding and knowledge related to disability and accommodation are crucial factors. Shankar et al. (2014) found that a lack of knowledge and understanding among Canadian employers regarding psychiatric disabilities subsequently led to a lack of accommodation requests being granted. Similarly, employees with psychiatric disabilities have expressed desire for their employers to learn more about mental health issues and subsequent employee accommodation needs (Brohan et al., 2014).

Employers’ previous experiences with people with mental disabilities may impact the provision and request of accommodations. For example, employers with previous positive experience regarding persons with disabilities were more apt to both hire and accommodate those with psychiatric disabilities and were less likely to have prejudicial attitudes (Shankar et al., 2014). However, effects of negative experiences with persons with psychiatric illnesses made employers reluctant to grant requests (Shankar et al., 2014). In discussing the work environment and its contribution to requesting accommodations in Canada, Toth and Dewa (2014) found how departments or units handled past sensitive workplace situations affected employees disclosing and requesting decisions.

Employers’ and coworkers’ attitudes and perceptions related to psychiatric disabilities and legitimacy of accommodation are also important factors to consider. Stergiou-Kita et al. (2014) and Telwatte et al. (2017) both found that accommodations for psychiatric impairments were overall more difficult to obtain when compared to accommodations for other types of impairments. A majority of employers in a qualitative Canadian study believed their employees’ psychiatric disability was caused entirely by personal factors, negating the reality of how one’s workplace environment can create and perpetuate mental illness (Shankar et al., 2014). Thus, employers were more likely to perceive the accommodations requested by those with psychiatric disabilities as “unreasonable” compared to the requests of those with physical disabilities (Telwatte et al., 2017). Furthermore, the perception of fairness as well as the perceived characteristics of accommodation requests, such as perceived high expense, were identified as key factors affecting the likelihood of an accommodation request being granted by employers (Carpenter & Paetzold, 2013; Telwatte et al., 2017). Some co-workers tend to have negative reactions to accommodation requests, as they see these changes as unfair as well as having the potential for the coworkers to have to carry the perceived extra burden (Von Schrader et al., 2014).

Employers often interpret the ADA’s rules and regulations in different lights, which can result in accommodations not always being readily available for persons with psychiatric disabilities. This can be attributed to the perceived ambiguity, and therefore lack of clarity, when interpreting the ADA and other related laws (Wylonis et al., 2017). Although these laws are designed to protect people with disabilities, their applications can involve subjective interpretation from the workplace. Telwatte et al. (2017) found factors affecting subjective interpretation include whether the conditions were viewed as legitimate disabilities, whether the requested modification would be effective, and if the cost of implementing such accommodations were reasonable. Similarly, both individuals with disabilities and their employers did not necessarily believe that discrimination would be ameliorated by the ADA due to the perceived ambiguous language (Moloney et al., 2019).

Reframing accommodations in terms of job productivity rather than personal comfort can increase an employer’s likelihood of providing an accommodation (Chow & Cichocki, 2015). The positive workplace culture cultivated through this reframing may create an environment in which it is easier for employees to both ask for and receive accommodations (Chow & Cichocki, 2015).

1.1.2 Employees’ perspectives

Employees with disabilities, much like their employers, have been found to lack education on the subject of when or how to request accommodations in the workplace (Lindsay et al., 2018). Price and colleagues (2017) found that out of the faculty members at a university with psychiatric disabilities, 70%had either limited or no knowledge of the workplace accommodations available to them, and even fewer used them. In addition, these employees were found to have issues regarding the ability to fully understand the definition of their particular diagnosis, as well as how this diagnosis affects them (Price et al., 2017). This lack of knowledge has been found to particularly affect young people with psychiatric disabilities as they are often unaware of their strengths and weaknesses, and thus do not even know what accommodations would help them perform their job (Lindsay et al., 2018).

Poor self-concept due to the internalization of the term “disability”, underdeveloped advocacy skills, and severity of one’s mental illness have been identified as barriers to requesting accommodations (Lindsay et al., 2018). In a qualitative study surrounding the request and receipt of accommodations in women with various disabilities including psychiatric disabilities, Moloney et al. (2019) found that the participants experienced structural discrimination and nagivated devaluation threats in seeking workplace accommodations. In addition, the participants reported overcompensating at work due to their disability in order to decrease the stress of stigmatization (Moloney et al., 2019). Participants with mental health issues have also reported experiencing the personal impact of being labelled, as was evident by feeling uncomfortable in disclosing due to the desire to preserve a healthy self-image and avoid stigmatizing views (Brohan et al., 2014). Employees often struggle with the decision on whether to disclose their disability to their employer due to fear and the potential for negative repercussions. For example, employees with psychiatric disabilities have exhibited a fear of disclosure due to possible consequences, such as the loss of their job, decreased health benefits, social repercussions and limited promotion opportunities (Brouwers et al., 2020; Von Schrader et al., 2014). Individuals with psychiatric disabilities also expressed their fears of experiencing stigma and negative repercussions, which prevented them from exploring and/or pursuing potential accommodations (Price et al., 2017).

Perceived emotional support in the workplace was found to be a major facilitator in disclosure and the subsequent successful access of accommodations (Chow & Chichocki, 2015). A cross-institutional study of university faculty members with psychiatric disabilities showed that support within and outside of the workplace are important factors in creating an environment in which the employee with the psychiatric disability feels comfortable with disclosure (Price et al., 2017). Conversely, the absence of a dedicated contact person in relation to the accommodation process and a lack of feedback on the progress of their individual case led to employees feeling as if their employers neither listened nor were concerned with listening (Kensbock et al., 2017).

1.2 Literature gaps

Research on barriers and accommodations for persons with psychiatric disabilities in the United States is rather sparse (Syma, 2019), done with relatively small sample sizes (Sundar, 2017), and only focuses on either barriers or facilitators without examining both aspects simultaneously (McPherson et al., 2018). Individuals with psychiatric disabilities must consider and weigh the various repercussions as a result of disclosing their disability to an employer and requesting accommodations. Thus, in-depth qualitative works are needed in order to understand the beliefs, experiences, and behaviors surrounding both the disclosure of psychiatric impairments and the request for accommodations in the workplace (Brohan et al., 2014). To the best of our knowledge, only one qualitative study in the US was identified: Moloney et al. (2019). This study interviewed 42 women with various disabilities, including psychiatric disabilities and discovered these women were experiencing both intentional and unintentional structural discrimination, as well as repercussions when disclosing their need for workplace accommodations. When considering the research gap as well as the marginalization of this population, it is important to expand this area of research by examining the barriers and facilitators to requesting and receiving accommodations for persons with psychiatric disabilities, specifically in a qualitative study.

1.3 Purpose of current study

Thus, this qualitative study will examine barriers and facilitators of requesting accommodations using a large sample recruited from multiple agencies that serve individuals with psychiatric disabilities within the United States. The research question of this study is: What are barriers and facilitators in the course of workplace accommodation process from the perspectives of employees with psychiatric disabilities?

2 Method

2.1 Participants and setting

We recruited 120 participants from multiple agencies serving individuals with psychiatric disabilities in the US, including supported employment programs for individuals with psychiatric disabilities and the National Alliance on Mental Illness. All the participants met the following eligibility criteria: they were 18 years of age or older with self-reported psychiatric disabilities and needed workplace accommodation(s) in the three months prior to taking the survey. Among the participants, 91 (75.8%) self-reported as Caucasian, 9 (7.5%) as African American, 7 (5.8%) as Latinx, 5 (4.1%) as Native American and Asian American, respectively, and 3 (2.5%) did not report the information. Eighty-two (68.3%) self-identified as female. About 73 (69.8%) worked full time. In addition, 85 (70.8%) reported working at non-management positions with the remaining working at various management levels (low, middle and upper management).

2.2 Procedures

The first author contacted agencies serving individuals with mental health disabilities and provided a brief introduction to the study and the web link of an online survey to program directors. The program directors were asked to invite their constituencies to participate in this study. Participants who chose to complete the online survey were asked to read the online consent form prior to taking the survey. Informed consent was implied if participants filled out and submitted the survey. The online survey includes demographic items (e.g., age, gender, ethnicity, education levels, and work status). Participants were asked to recall workplace situations in which they needed accommodations three months prior to taking the survey, and answered survey questions on whether they requested/withheld the accommodation(s) and whether received accommodations if they did request. Among the 120 participants, 33 (27.5%) withheld their request and 87 (72.5%) requested accommodations. Among the 87 participants who requested accommodations, 63 (72.4%) requests were approved, 23 (26.4%) requests were denied and 1 (1.1%) requests were in process. In addition, participants reported on types and perceived cost of accommodations requested or withheld. See Table 1 for the types and frequency of accommodations requested or withheld. Among those who reported the perceived cost of accommodations (97 out 120), 67 %of the requests did not cost anything, around 29.9%of accommodation cost below $500 and only 3.1%cost more than $500. Participants also answered one open-ended question on their perception of workplace barriers or facilitative strategies related to requesting job accommodations. Because recruitments were conducted via online survey through snowball sampling over multiple branches of the mental health organizations, no response rate was estimated. All data were maintained in a secure, password protected computer file, and only accessible to researchers in this study. All data was analyzed and reported in a collective manner with no personal information identifiable for the participants.

Table 1
Workplace accommodations requested or withheld

Accommodation type Requested Withheld

N % N %

Job restructure 28 23.73% 10 35.71%

Assisted technology 26 22.03% 8 30.77%

Flexible schedule 56 47.46% 17 30.36 %

Telework 19 16.10% 7 36.84%

Reassignment 13 11.02% 8 61.54%

Office alterations 18 15.25% 7 38.89%

Assistance by others 27 22.88% 11 40.74%

Others 20 16.95% 6 30.00%

Accommodation type	Requested	Withheld
Job restructure	28	23.73%	10	35.71%
Assisted technology	26	22.03%	8	30.77%
Flexible schedule	56	47.46%	17	30.36 %
Telework	19	16.10%	7	36.84%
Reassignment	13	11.02%	8	61.54%
Office alterations	18	15.25%	7	38.89%
Assistance by others	27	22.88%	11	40.74%
Others	20	16.95%	6	30.00%

^*Percentages add up over 100%, as multiple accommodations can be chosen.

2.3 Data analysis

Through conventional content analysis (Berg, Lune, & Lune, 2012; Hsieh & Shannon, 2005), we analyzed the responses to the open-ended question on barriers and facilitative strategies to accommodation requests among individuals with psychiatric disabilities. Conventional content analysis serves as a qualitative approach to examine an under-studied phenomenon through a systematic classification process of coding and identifying themes or patterns (Hsieh & Shannon, 2005). A total of 166 participants participated in the survey study, 131 of them provided responses to the open-ended questions. We removed 11 unclear and/or incomplete responses. Thus, 120 responses were included in the qualitative analysis. Of these 120 respondents, 55 of them reported having more than one disability. Specifically, 19 reported having a sensory disability, 35 reported having a physical disability of some kind, and 8 reported having multiple sclerosis.

Prior to the start of the qualitative analysis, we reflected our assumptions and biases for individuals with psychiatric disabilities and tried to be impartial in the data analysis process. During the first phase of data analysis, we immersed ourselves in the data by each reading the open-ended responses multiple times. Data analysis was conducted initially by second and third authors engaging in a round of individual coding of the open-ended responses. A thematic approach was used by thoroughly reading responses, making inferences based on context, and identifying key concepts. The open responses were initially examined by noting first impressions and reflections as well as highlighting words and phrases from the open-ended responses that seemed to best capture significant concepts and schemes. This stage was followed by categorizing the statements and phrases associated with facilitators and barriers of workplace accommodations that were requested or withheld.

Following this, the second and third authors analyzed and interpreted each other’s findings through cross-examination. The cross-examination of independently gathered data serves to reduce errors in coding and allow for a more realistic interpretation of the qualitative data as different viewpoints were all examined. If there were discrepancies, the second and third authors would discuss and eventually reach consensus with consultation from the first author.

After initially coding all the open responses, we reexamined data within a particular code by either merging certain codes or splitting certain codes through consensus building among the researchers. Discussion on coding discrepancies also provided researchers opportunities to examine personal assumptions and biases in the coding process. The reexamination process continued until it became evident that data saturation was reached, as no further coding was needed or feasible (Berg & Lune, 2012).

The use of multiple-researcher format with different levels of familiarity with the research subject offers a great analyst triangulation. Analyst triangulation serves as a validity check on selective perception and illuminates blind spots in an interpretive analysis (Patton, 1999, 2001). The first author has multiple years of experiences in conducting research related to workplace accommodations for people with mental health issues through qualitative and quantitative approaches. The second and third authors are master-level students who are interested in the topic areas and bring in new perspectives in understanding the participants’ responses. To enhance the reliability and validity of the study, the second and third authors also conducted basic training for qualitative data coding and pilot analysis under the supervision of the first author prior to formal data analysis. Furthermore, we used group discussions and memos to keep an audit trail of emergent/superordinate themes, connections among themes, assumptions and biases, alternative interpretation, and analysis process to enhance transparency and trustworthiness of the findings (Smith et al., 2009; Whittemore et al., 2001).

3 Results

Seven themes were identified from the 120 analyzable responses, which include: employer discrimination and non-inclusive workplace culture, employers lack knowledge of disabilities and ADA, bureaucracy and lengthy process and procedure in accommodation request, employees’ fear and anxiety negatively impact accommodation seeking, employees lack knowledge of disability and associated ADA rights, employees lack competence and confidence to request accommodations, and good accommodation experience. See Table 2 for details.

Table 2
Themes on accommodation request in the workplace

Themes N/%

Employer discrimination and non-inclusive workplace culture 29/24.17

Employers lack knowledge of disabilities and ADA 23/19.17

Bureaucracy and lengthy process and procedure in accommodation request 13/10.83

Employees’ fear and anxiety negatively impact accommodation seeking 30/25

Employees lack knowledge of disability and associated ADA rights 9/7.5

Employees lack competence and confidence to request accommodations 12/10

Good accommodation experience 17/14.17

Themes	N/%
Employer discrimination and non-inclusive workplace culture	29/24.17
Employers lack knowledge of disabilities and ADA	23/19.17
Bureaucracy and lengthy process and procedure in accommodation request	13/10.83
Employees’ fear and anxiety negatively impact accommodation seeking	30/25
Employees lack knowledge of disability and associated ADA rights	9/7.5
Employees lack competence and confidence to request accommodations	12/10
Good accommodation experience	17/14.17

^*Percentages add up over 100%, as multiple themes can be embedded in one response.

3.1 Employer discrimination and non-inclusive workplace culture

Due to the stigma and discrimination surrounding psychiatric disabilities, participants face challenges in disclosing their disabilities and requesting accommodations in the workplace. This is further exacerbated when an employee has experienced discrimination from his or her employer, or a negative workplace culture in general. For example, one participant stated, “Discrimination, plain and simple. Employers don’t want to deal with someone whom they view as a burden.” Beyond subvert types of discrimination, participants also experienced overt rejection for reasonable requests as seen with the following response “I was crystal clear about my needs, options available, and ability of the organization and myself to meet my needs and increase my productivity. It was all dismissed forcefully.” Participants also expressed experiencing discrimination and judgement from employers and co-workers, which might inhibit those in seeking future accommodations. This is shown from the discriminatory workplace reaction from one participant after requesting accommodations: “I was ostrasized [sic] by supervisors and staff as soon as I needed and asked for accommodations . . . ” Finally, participants felt as though the company did not promote the inclusivity of diverse populations in the workplace. This is captured by the following statement, “. . . many companies do not want to consider the needs of their employees, they are only concerned with productivity . . . ”

3.2 Employers lack knowledge of disabilities and ADA

Employers may not have the proper education regarding the nature of psychiatric disabilities as well as their associated ADA obligations. For example, a female participant stated, “I do use a wheelchair, but some effects of my disability are not visible, as for they are internal, & people don’t understand how serious my health problems really are...” Some participants reported their employers having difficulty understanding the needs of employees with psychiatric disabilities. For example, one participant stated, “. . . my natural independent nature & leadership skills were seen as a bonus, until I asked to continue to have the flexibility to do my job . . . ” Participants also described their employers appeared to not understand that accommodation needs may evolve as time progresses. One participant reported “My job is fairly self-limiting and narrowt [sic] in focus. It has changed over the years such that the accommodations I have needed have changed with the responsibilities...”

3.3 Bureaucracy and lengthy process and procedure in accommodation request

The process of requesting accommodations can appear to be confusing or overtly arduous, which caused some participants to avoid seeking accommodations. The participants were often deterred from seeking out accommodations, as was indicated by one participant saying “the AMOUNT of work it takes to get those accomodations[sic].” This was further evidenced by another participant describing the difficulty of the process, saying “[the company] require you to jump through hoop to grt [sic] the accommodation and have your doctor sign off the HR department cannot consider a verbal requst [sic] . . . ” Moreover, participants found the accommodation request forms to be “confusing to fill out . . . ” Another reported problem involved issues with the union, as one participant stated “the union did not include assistance for the disabled in the contract . . . ”

3.4 Employees’ fear and anxiety negatively impact accommodation seeking

Participants reported fears and anxieties in relation to job security, job advancement and financial burden when seeking accommodations. For example, one participant reported, “the fear of loosing [sic] your job. When I told me [sic] employer of my disability...I was layed [sic] off...” Another participant acknowledged their fear that once one discloses his or her disability it could follow them and subsequently negatively impact future career advancement. This theme can be clearly identified with the following response: “. . . fear of being labeled or not considered for advancement later in my career due to stigma . . . ” Another participant expressed the concern that she could be seen as a financial burden by saying, “. . . feeling like my employer would be irritated at having to supply accommodations that cost money.” Participants also expressed fear of favoritism, as one participant noted “. . . hidden disabilities often breed an assumption of entitlement by others . . . ”

3.5 Employees lack knowledge of disability and associated ADA rights

Participants exhibited a lack of personal knowledge of their own disability as well as the associated ADA rights they have as persons with disabilities. Some participants expressed wanting aid but were not sure they had the right to do so. One participant responded, “Had no idea that I had the freedom or ability to ask for things may have needed to keep employment.” A few respondents expressed that they expected their employers to be inherently aware of their disability and provide the associated accommodations without requesting. One participant expected exactly this scenario, saying “Even though it was known what my disability is, I was not offered accommodations . . . ”

3.6 Employees lack competence and confidence to request accommodations

Participants expressed a perceived lack of skill in identifying one’s accommodation needs and navigating through the accommodation request process. One participant experienced such sentiment, stating “Not knowing what specific accommodations would help without an evaluation.” Another participant experienced difficulty in navigating accommodation requests in the workplace and stated the barrier as “my lack of skill to ask or negotiate.” The lack of procedural knowledge and competency was also evident, with one participant expressing that the accommodation needs would have been met if the participant had “. . . confidence, I would have liked a person in the office with me to help me explain my concerns . . . ”

3.7 Good accommodation experience

Despite the above-mentioned challenges, a number of participants reported positive experiences when requesting accommodations in their workplace. These participants experienced no barriers, and some employers went above and beyond to accommodate their employees’ needs. For example, one participant who received the requested accommodation of a parking spot near the office entrance noted, “I do not need other accomodations [sic] right now but my branch managrer [sic] has offered to widen the entrance door if I ever need a wheelchair.” Another participant noted the employer made the participant feel both cared for and comfortable expressing the accommodation needs, saying “I think it is hard for someone who is even depressed to ask for accommodations even if it is just some down time to get your thoughts and feelings back on track. I am lucky to have an employer who cares for her employees . . . ”

4 Discussion

This study identified themes surrounding barriers and facilitators to requesting and receiving accommodations for employees with psychiatric disabilities. Employers’ negative attitudes toward accommodation request and workplace discrimination on the basis of psychiatric disabilities are substantial barriers to employees’ requesting and receiving accommodations in the current study. These results seemed to resonate with previous studies in that employers who had discriminatory attitudes due to negative exposure with persons with psychiatric disabilities were known to be less likely to grant accommodations (Shankar et al., 2014). Subsequently, individuals with psychiatric disabilities may receive backlash and experience discrimination in the course of requesting accommodations. Monetary incentives for hiring those with disabilities, diversity training, and education for employers on psychiatric disabilities were all proposed as potential workplace adaptations that could be utilized to lessen the consequences of poor attitudes towards employees with psychiatric disabilities (Shankar et al., 2014).

Discrimination and judgement employees have experienced in the past from employers and co-workers create learned negative experiences surrounding the process of requesting accommodations, which could discourage this population from future disclosure and requests. In this study, many participants found themselves weighing the pros and cons of choosing to disclose their disability. Disclosure puts an employee at risk for discrimination, the potential labelling as “disabled”, or in extreme situations the loss of one’s job. However, disclosure serves as an important way to have accommodation needs met. Withholding disclosure may avoid stigma and repercussions, but the employee’s needs go unmet and they subsequently may face difficulty in completing their required tasks. To address the conundrum, rehabilitation professionals need to provide self-advocacy training for individuals with psychiatric disabilities, as well as educating employers of their responsibilities under the ADA and its amendments act in relation to provision of workplace accommodations.

Another barrier to requesting accommodations refers to a lack of knowledge from employers about both psychiatric disabilities and the laws concerning the associated rights of this population. The lack of knowledge might be attributed to genuine confusion amongst employers, as the ADA leaves much to interpretation regarding the implementation of accommodations (Telwatte et al., 2017). Additionally, there is a general lack of legal precedent regarding the responsibility of employers in providing workplace accommodations (Telwatte et al., 2017). The lack of clarity in the employers’ interpretation of the ADA in the current study also resonates with previous studies in that employers did not realize their legal obligations to fulfil accommodation requests from employees with disabilities (Wylonis et al., 2017; Telwatte et al., 2017). If employers understood the benefits of following such laws, this could incite them to strive towards a more inclusive workplace. Simplifying the presentation of ADA laws could also be a consideration for lawmakers, as most employers either do not have the time to or are not willing to read about legal precedents. Rehabilitation professionals may consider providing workshops and webinars to make legal precedents and policies clear to employers.

While employers need to be compliant with the ADA, employees with disabilities still have the responsibility to request needed accommodations in the first place. The current study found that almost three-quarters of respondents in this study requested accommodations, which is much higher than the accommodation request rate of 45.1%found in a previous study (Corbière et al., 2014). The relatively high rate of accommodation requests seen in the current study should be taken with caution as individuals with positive experiences surrounding this topic might be more likely to participate in an online survey. In addition, the relatively high request rate could also be attributed to the high education level of participants in the current study, which might not be representative of this population.

The current study also found a lack of education amongst employees in regard to their rights as a person with a disability. The current findings validate a previous study which found that employees often have either limited or no knowledge on workplace accommodations, as well as issues in understanding the definition of their particular diagnosis (Price et al., 2017). Those with psychiatric disabilities may fear social repercussions due to the potential for resentment from coworkers over either getting “special” excuses from certain activities or having to do extra work that the person with the psychiatric disability cannot perform. The workplace fairness perceptions to receiving a reasonable accommodation impacts an employee’s decision to seek help (Carpenter & Paetzold, 2013).

This study found that participants reported lack of skills in ability to properly request accommodations. Some respondents reported that they would have liked to request, but did not have the confidence to do so themselves. Internalized shame and societal discrimination could lead to the person with the psychiatric disability experiencing this lack of confidence (Drake & Whitley, 2014). This reflects a need for employees to receive education surrounding psychiatric disabilities as well as the rights and responsibilities laid out by the ADA and its amendments act. With well-rounded knowledge on related policies and competency in accommodation requests, employees can identify accommodation needs and correctly articulate a request for accommodations to facilitate work performance.

Lengthy processes and procedures related to accommodation requests were identified as another problem influencing an employee’s decision to request accommodations. This study found participants actively avoided seeking out and requesting accommodations due to the confusing or overly arduous process. This aligns with the findings of Kensbock et al. (2017) in that employees claimed the process duration until implementation of an accommodation was too long, or that they had experienced too many transfers during the process. Furthermore, employees found such delays as burdensome and thus might hinder employees’ perceptions of the process as being judged successful (Kensbock et al., 2017). Going forward, these issues should be examined by employers so that there are more efficient procedures in place to address the needs of employees with psychiatric disabilities in a timely manner.

Despite the above-mentioned barriers, participants also identified good experiences in relation to accommodation requests. Although the category of “good experience” does not fall into the study’s top three themes in regard to prevalence, it is still noteworthy as 14%of respondents reported this type of positive feedback. This study found a handful of participants were comfortable communicating accommodation needs with their employer or had positive experiences from their employers when filing requests. This study’s analysis of participants’ positive experiences in requesting and receiving accommodations acknowledges that job accommodations can improve the well-being and productiveness of people with psychiatric disabilities in the workplace. This idea aligns with research suggesting a wide range of benefits in receiving workplace accommodations, specifically increased job effectiveness (Nevala et al., 2014). Future research should further specify characteristics of workplace environments in which employees with psychiatric disabilities can find success in requesting and receiving accommodations.

4.1 Limitations

There are several limitations to this study that should be noted. First, this study examined responses only from the employees’ perspective. Therefore, this might not provide a full picture of the barriers and facilitators to accommodations for this interactive accommodation process. The employer’s perspective was not gathered, which is arguably an important aspect that could assist researchers in pinpointing key factors for granting or denying accommodations to persons with psychiatric disabilities in the workplace. Second, the results of this study may be limited as the sample may not be representative of all employees with psychiatric disabilities in the workforce. A majority of participants in this study were Caucasian females with a relatively high education level. Third, using an online survey as a medium of data collection resulted in a lack of clarity in some answers because there was no further context to reference. This led to the disqualification in using the qualitative portion in some participant’s responses, meaning potentially important experiences could not be examined. Additionally, this study relies on employees reporting and reflecting past experiences. Thus, the results of this study are dependent upon the objectivity and accuracy of the participants’ responses. Lastly, due to the nature of survey study, participants might have had a tendency to provide answers which would seem favorable to others under the potential influence of social desirability bias. Thus, results of this study should be interpreted with caution.

4.2 Implications for practice

This study offers a variety of implications for practice. In terms of direct knowledge application, there are different implications for different populations, specifically, employees with psychiatric disabilities, employers of this population, and rehabilitation specialists. First, employees with psychiatric disabilities must have sufficient and updated knowledge in relevant laws protecting rights of people with disabilities. It is necessary to provide brief and clear information in which employees can familiarize themselves in the laws, regulations, and expectations of the workplace. Second, employees with psychiatric disabilities need to be made aware of the available resources in the workplace and local community which aid in mental health assistance. Such resources may include, but not limited to, the Job Accommodation Network (JAN), ADA National Network, and the National Mental Health Consumers’ Self-Help Clearinghouse. By reaching out to these resources and attending relevant workshops on accommodations, employees can be encouraged to make use of various workplace resources. Third, training for employees with psychiatric disabilities to navigate stigma and prejudice experienced in help-seeking behaviors will help establish skills to combat discrimination. Peer support groups might promote camaraderie in overall challenges to requesting and receiving accommodations, as well as the experienced strengths and facilitators in the accommodation request process. Finally, specialized workshops could be hosted by rehabilitation professionals with the primary focus to adapt skills in self-advocacy to promote confidence and ability to communicate accommodation needs to the workplace.

Additionally, this study could assist employers who hire employees with psychiatric disabilities to better understand the possible struggles experienced by their employees as well as solutions to help reduce such struggles. In particular, diversity training for employers and coworkers might aid in realizing daily battles for persons with psychiatric disabilities as well as benefits to encompassing an inclusive workplace for all employees with and without disabilities. In this study, a common theme identified was employer lack of knowledge regarding psychiatric disabilities and ADA policies. Training and orientation on the ADA regulations will provide an understanding in the requirements employers need to uphold in providing accommodations. Rehabilitation professionals may assist employers to connect with ADA Disability and Business Technical Assistance Center and its regional centers, and encourage employers to consult with these centers to address specific issues related to provision of accommodations. In addition, job coaches and job developers might benefit from added training on how best to facilitate communication between the employer and the employee with a psychiatric disability (Granger, 2000).

4.3 Implications for research

Due to the preliminary nature and dearth of research in this particular field within the United States, more research is recommended by collecting data from multiple stakeholders (employees with psychiatric disabilities, employers, coworkers and rehabilitation professionals) and using difference methods (quantitative or mixed methods). Longitudinal studies are also recommended, as these would allow researchers to fully understand the challenges and facilitators of accommodation requests experienced by this population during various stages of professional development. Additionally, future qualitative studies could gather data from actual, in-depth interviews with subjects using open-ended questions to allow more space for participants to fully share their experiences. Finally, quantitative studies could be used to test the validity of these findings as well as to examine potential relationships among the variables identified in the study.

5 Conclusion

This study examined factors associated with the request of accommodations among a sample of working individuals with psychiatric disabilities. The most significant explanatory factors include employees’ fear and anxiety negatively impact accommodation seeking behaviors, employer discrimination and non-inclusive workplace culture, and employers lacking knowledge of disability and associated ADA obligations. Future work to clarify employee, employer, and workplace factors in requesting and receiving accommodations can assist rehabilitation counselors and employment specialists to develop interventions and strategies for overcoming those barriers for individuals with psychiatric disabilities.

Conflict of interest

None to report.

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