Disabling accommodation barriers: A study exploring how to better accommodate government employees with anxiety disorders

Abstract

BACKGROUND: Accommodating mental health in the workplace is challenging. Despite policy efforts to encourage the availability of mental health accommodations in the workplace, employees experiencing mental illness are missing out on accommodations that they need.

OBJECTIVE: To inform vocational rehabilitation professionals and managers in the public service of best practice accommodations for government employees with anxiety disorders.

METHODS: Thematic analysis was applied to data collected from the online Accommodating Government Employees with Anxiety Disorders Survey undertaken by 71 Australian public service employees diagnosed with at least one anxiety disorder.

RESULTS: Our research results include theme and sub-theme representations of accommodations received, accommodations reported as missing, accommodations that study participants felt they couldn’t request, along with rejected accommodations.

CONCLUSION: From the study participants’ accounts, three key findings supporting desirable vocational outcomes become apparent. First, that the availability of ‘standard’ flexible work arrangements, along with personalised accommodations, can assist persons with anxiety disorders (where needed) to reach and retain government positions. Second, the chief barriers reported to making accommodation requests revolve around fears of being stigmatised and penalised. Finally, there is a need for managerial decision-makers to remain open-minded, particularly when assessing requests for accommodations that may break from government norms.

Keywords

Mental disorders workplace accommodations vocational rehabilitation

1 Introduction

Current policy and practice from Australia and overseas support the accommodation of employees with anxiety disorders. Examples from Australia include: Australia’s National Disability Strategy which “recognises that attitudes, practices and structures are disabling and can prevent people from enjoying economic participation” [1, p.16], the Australian Government’s JobAccess resource that advises employers of how they can promote flexible workplaces [2], and Disability Employment Australia [3] who promote disability confident workplaces as positive work environments for all employees. International examples are a United Kingdom (UK) Department for Works and Pensions [4] program that encourages employers to offer flexible work arrangements for employees experiencing mental health conditions, the Canadian Human Rights Commission’s [CHRC] policy and procedures on accommodating mental illness that informs employees about the steps to making accommodation requests [5] and the 1990 Americans with Disabilities Act (ADA) which promotes an anti-discrimination policy stance in relation to disability [6]. Moreover, the ADA Amendments Act since being introduced in January 2009 and broadening the definition of disability, has inspired a greater volume and variety of employee workplace accommodation requests [7]. The Job Accommodations Network also encourages the employment of Americans with disabilities by providing “expert guidance to employers, service providers, persons with disabilities, and others who facilitate employment and retention of workers with disabilities” [8, p.197].

Investing in disability accommodations makes economic sense. Anxiety disorders are the most frequently experienced mental health problem in Australia, with the 2007 National Survey of Mental Health and Wellbeing reporting a 12 month prevalence rate of 14 percent. With one in six persons of working age experiencing mental ill-health at any one point in time, associated economic costs are high [9, p.4]. According to an Australian Network on Disability Commissioned report, “if the gap between the participation rate and unemployment rate for people with and without disability could be reduced by just one third, phased in over the next decade, the cumulative impact on GDP over the next decade would be $43 billion” [10, p.25]. Further while anxiety disorders contribute less to long-term work absenteeism than depressive disorders, co-existing anxiety-depressive disorder is reportedly associated with the greatest risk of long-term absence from the workplace [11]. The World Health Organisation’s Workers’ Health: Global Plan of Action also emphasises that the health (including mental health) of workers is a fundamental requirement for economic development [12].

Despite policy efforts to encourage the availability of mental health accommodations in the workplace, along with the economic benefits that come from making these accommodations, Wang, Patten, Currie, Sareen and Shmitz [13] noted that only around one-third of the 784 employees with mental ill health that they surveyed received the accommodations they require. Reasons for missing accommodations include: employees being unaware of their right to make accommodation requests; employees lacking in confidence or assertiveness to make such requests; employees experiencing stigma (especially within male-dominated professions); and employees fearing job loss in a period of global economic crisis [13].

Other research helps to explain the accommodation investment gap experienced by many employees who are living with mental ill-health. Sonnenberg and Nadeau [14] recognise that accommodating an employee with an obvious physical problem is relatively easy compared with accommodating a staff member who has an anxiety disorder or depression. On such occasions, there can be confusion about what qualifies as reasonable adjustment that will allow an employee with mental health needs to carry out the core duties of their position [15]. Bolo et al. [16] noted barriers to making accommodation requests that include poor employer-employee relationships, fears of burdening employers or colleagues, and fears of jeopardizing their employment futures. They went on to call for research to further examine the reasons as to why employees with anxiety disorders are not receiving all of the accommodations that they need.

The public service is a challenging setting in which to accommodate the needs of employees experiencing mental ill-health. Robertson, Lewis and Hiila [17] note that downsizing trends in departments, job entry criteria, and the time-consuming process of securing public service jobs can be obstacles for people with disabilities who seek to gain government employment. Consequently, more research is required to better understand the challenges involved in accommodating government employees with anxiety disorders.

This study of individuals with a diagnosed anxiety disorder working within the public service in Queensland, Australia aims to inform vocational rehabilitation professionals and managers about the kinds of ‘client-focused’ accommodations received by these individuals that have assisted them to reach and retain their current government positions. The study also endeavours to promote a better understanding of the challenges involved in accommodating government employees with anxiety disorders. Importantly, the study will canvass practical policy and practice implications of research findings.

2 Method

The aim of this study was to develop our understanding of how best to accommodate government employees with anxiety disorders by exploring the following questions:

What accommodations can assist persons with anxiety disorders to reach and retain positions in government?

What challenges from the employee’s perspective can be encountered in accommodating government employees with anxiety disorders?

Based on results for questions 1 and 2, what policy and practice actions may assist to reduce the challenges experienced by government employees with anxiety disorders?

2.1 Data collection

Following University of Sydney Human Research Ethics Committee approval to proceed with the study, the Queensland government Department of Communities, Child Safety and Disability Services and the Department of Environment and Heritage Protection agreed to participate. A Study Participant Invitation Flyer was uploaded to the participating departments’ intranets. This Flyer provided access to the online Accommodating Government Employees with Anxiety Disorders Survey. The survey questions related to accommodations received and accommodation challenges faced by employees. Before undertaking the survey, potential study participants confirmed that: they had been diagnosed with at least one anxiety disorder; they were presently employed in the Queensland public service; and that they had been performing their present role for a minimum period of one year.

2.2 Data analysis

This study applied the Braun and Clarke [18] approach to thematic analysis. This approach involved: the lead author reading surveys and noting any preliminary ideas; updating a Reflexivity Analysis Table with research questions, initial codes, data items and the coding rules; arranging codes into themes and sub-themes and defining the sorting rules; checking that themes were unique; and presenting themes, sub-themes and corresponding data in study results.

Theme/sub-theme prevalence was determined by the number of study participants who raised them in response to a survey question. With responses to some survey questions being small in number yet diverse in content, results included sub-themes that were raised by one or two study participants. However the ‘keyness’ of a theme is determined by what it contributes to answering a research question rather than any quantitative measure [18]. This means that a sub-theme raised by few study participants is not necessarily any less important in its contribution to a research question than a sub-theme raised by many study participants. To promote reliability, a second member of the research team validated the coding of several completed surveys. The validation process involved this team member critically reviewing the coding of these surveys as recorded in a Reflexivity Table to ensure that the rules for assigning themes/sub-themes aligned with the data items (i.e. survey quotes). Any questions on this alignment were discussed and themes and sub-themes retained only where agreement between the two researchers wasreached.

3 Results

3.1 Demographic details

A total of 71 participants consented to complete the survey. Of these, eight participants discontinued the survey before completing demographic information. Of the 63 participants who provided demographic information, 46 (73.0%) went on to complete the whole survey. Demographic details for participants are summarised in Table 1. Chi-square analyses were completed to examine if there were differences between those participants who completed the entire survey and those who did not (see Table 1). Females were more likely to complete the survey as compared with males and participants in the age ranges 35 to 44 and 45 to 54 were more likely to complete than participants in the age ranges 25 to 34 and 55 to 64. No other differences were found according to qualifications, classification, occupational group or self-reported diagnosis.

3.2 Accommodations not received or needed

Eight study participants answered “No” to receiving or needing any accommodations. Three of these study participants elaborated as to why accommodations were not required. Table 2 identifies the theme, theme prevalence, sub-themes, sub-theme prevalence and exemplifying quotes derived from study participants’ comments about not receiving or needing accommodations.

3.3 Accommodations received that have assisted people to reach current positions

Of the 61 study participants who answered the question: “Has your employer made any accommodations/adjustments related to your anxiety disorder(s) that have assisted you to reach your current position?”, 13 participants (21.3 percent) answered “Yes”. Table 3 identifies the themes and their prevalence; sub-themes and their prevalence; and exemplifying quotes derived from the study participants’ reporting of these received accommodations.

3.4 Accommodations received assisting to retain current positions

Of the 55 study participants who answered the question: “Has your employer made any accommodations/adjustments related to your anxiety disorder(s) that assist you to retain your current position?”, 18 participants (32.7 percent) answered “Yes”. Table 4 identifies themes, theme prevalence, sub-themes, sub-theme prevalence and exemplifying quotes derived from the study participants’ reporting of these received accommodations.

3.5 Missing accommodations – reach position

Of the 60 study participants who answered the question: “Were any employer accommodations/adjustments related to your anxiety disorder missing that if available, would have made it easier to reach your current position?”, 20 participants (33.3 percent) answered “Yes”. Table 5 identifies the themes, theme prevalence, sub-themes, sub-theme prevalence and exemplifying quotes derived from the study participants’ reporting of these missing accommodations.

3.6 Missing accommodations – retain position

Fifty-three study participants answered the question: “Are any employer accommodations/adjustments related to your anxiety disorder (s) missing that if available, would assist you to retain your current position?” Of these, 16 respondents (30.2 percent) answered “Yes”. Table 6 identifies themes and their prevalence, sub-themes and their prevalence and exemplifying quotes derived from the study participants’ reporting of these missing accommodations.

3.7 Missing accommodations – advance position

Of the 49 study participants who answered the question: “Are any employer accommodations/adjustments related to your anxiety disorder (s) missing that if available, would assist your appointment to a higher position?”, 20 respondents (40.8 percent) answered “Yes”. Table 7 identifies themes and their prevalence, sub-themes and their prevalence and exemplifying quotes derived from the study participants’ reporting of these missingaccommodations.

3.8 Accommodations participants felt they could not request

Forty-eight study participants answered the question: “Are there any employer accommodations/adjustments related to your anxiety disorder(s) you need but you feel you can’t ask your employer for?” Of these, 26 participants (54.1 percent) answered “Yes”. Six of these study participants did not specify any particular accommodation. Table 8 identifies themes and their prevalence, sub-themes and their prevalence and exemplifying quotes derived from the study participants’ reporting of the accommodations that they could not request.

Study participants were asked, “Why do you feel that you can’t ask your employer for these anxiety disorder related accommodations/adjustments?” Table 9 identifies the themes, theme prevalence, sub-themes, sub-theme prevalence and exemplifying quotes derived from the study participants’ reporting of reasons for not requesting accommodations.

3.9 Rejected accommodations

Of the 47 study participants who answered the question, “Are there any accommodations/adjustments related to your anxiety disorder(s) you have asked for that your employer has rejected?”, seven respondents (14.8 percent) answered “Yes”. Table 10 identifies the theme and its prevalence, sub-themes and their prevalence and exemplifying quotes derived from the study participants’ reporting of rejected accommodations.

Of those study participants who answered the question, “Did your employer provide any explanations as to why the requested accommodations/adjustments related to your anxiety disorder(s) were rejected?”, 71.4 percent answered “Yes”. These study participants were then asked to ‘Please describe any employer explanations as to why your requested anxiety disorder(s) related accommodations/adjustments were rejected.’ Table 11 identifies the theme and its prevalence, sub-themes and their prevalence and exemplifying quotes associated with theirresponses.

3.10 Disclosure barriers

Forty-seven study participants answered the question, “Have you told your employer, supervisor and/or colleagues about your anxiety disorder(s)?” Of these, 24 participants (51.1 percent) answered “No”. These study participants were then asked to “Please describe why you haven’t told your employer, supervisor and/or colleagues about your anxiety disorder(s).” Table 12 identifies the themes, theme prevalence, sub-themes, sub-theme prevalence and exemplifying quotes derived from the study participants’ reporting of reasons for not disclosing their anxietydisorders.

4 Discussion

Based on the study research questions, the discussion here will focus on: 1) the accommodations assisting employees with anxiety disorders to reach and retain their current government positions; 2) challenges encountered in accommodating these employees; and 3) policy and practice measures that can be put in place with the aim of reducing these challenges.

4.1 Accommodations received assisting individuals to reach and retain current positions

The survey results suggest that not all government employees with anxiety disorders need or want to receive accommodations. Cognitive behavioural therapy (CBT), ability, and medication were provided as reasons as to why accommodations were not required. Based on this it would be wrong to assume that all government employees with anxiety disorders need to be accommodated in some way. Nevertheless, for many other study participants, some form of accommodation was reported as being needed andreceived.

Study participants highlighted a theme of ‘flexibility’ when reporting on the accommodations that have assisted them to reach and retain their current positions. The telecommuting flexible work arrangement assisted five study participants to reach and/or retain their current positions. The Linden and Milchus [19, p.473] United States (US) study involving 373 persons with disabilities revealed that “Only 47% of teleworkers reported telework as a job accommodation.” “Of those, 57% were satisfied with telework and 76% reported it as important to job task completion” [19, p.473]. This study did not explore reasons for reported dissatisfaction with teleworking [19]. Linden calls for more data about telecommuting that is specifically related to persons with disabilities. Our research suggests that this flexible accommodation can offer practical assistance for government employees experiencing anxiety disorders. Further Anderson, Bricout and West [21] recognised that workers with agoraphobia may benefit from the greater level of privacy offered by telecommuting. Noting that no study participants in this exploratory study reported agoraphobia as a feature of their disorder, future research could explore how this accommodation might support persons with this disability who are qualified to work in government, who wish to work in government, but who cannot currently do so as they are unable to leave their homes.

Blok et al. [22] expect that the ‘habituating’ of staff to flexible workplaces will positively influence the “experienced suitability of the work environment” (p.5080). For some study participants, such suitable settings extended to when they were allowed to work. This flexibility came in the form of flexible working hours, accrued time (i.e. flexi-time) and part-time work arrangements. Desired work times varied markedly. For example, one study participant preferred an ‘early bird’ start that allowed the planning of daily activities, thereby reducing anxiety. But for another study participant, starting late and finishing late allowed them to avoid office noise that was a major trigger for their anxiety. Flexible work hours can therefore provide opportunities for employees with anxiety disorders to work at times that have the least impact upon their disorders.

Government employees with disabilities are entitled to apply for flexible work arrangements that include telecommuting, flexible work hours and part-time work [23]. Study results support the role of these arrangements in assisting persons with anxiety disorders to reach and retain their positions in government. This research also suggests that there is no ‘one size fits all’ approach to accommodating people with anxiety disorders. Other accommodations raised less frequently by study participants do not fit neatly against any ‘standard’ flexible work arrangements (e.g. support services, balanced workloads and presentation delivery options). Being nonstandard, these ‘personalised’ accommodations were nevertheless reported as assisting the study participants who received them. This finding supports the Nygren et al. [24] position that is important to create ‘individualised’ strategies for persons experiencing psychiatric illness. Accommodations should thus be person centred and individualised in alignment with principles of recovery, where what it means to be and stay mentally healthy depends on the individual [25].

Seven study participants reported receiving support services that assisted them to reach and/or retain their current positions. As highlighted by one of these study participants, supervisors can support staff with anxiety disorders (who desire professional assistance) to take action and sign up to an Employee Assistance Service (EAS). This service offers professional counselling on work and personal issues for government staff and their immediate families [26]. But results also warn that ‘issues’ with supervisors may trigger anxiety disorders among subordinates. For example, one study participant states that the onset of their panic disorder (PD) was a consequence of these issues. This response aligns with research by Doherty [27] suggesting that people who are bullied in the workplace are more likely to experience panic attacks. On this occasion, management was reported as taking the necessary action to enable the study participant to safely transition back to work.

Workload balancing is another personalised accommodation that can assist employees withanxiety disorders to reach and retain their positions. Appreciating that “people with depression and anxiety disorders are at risk of over working” [28, p.260], supervisors need to be aware of the specific risks involved with breaching balanced workload accommodations. One study respondent reported such a breach as follows, “while I negotiated a set of projects suitable for the agreed hours that I was working, this workload was increased despite clear instructions from HR that this was not to occur.” Campos et al. [29] describe inequality in tasks’ allocation as a workplace psychosocial risk. It is therefore important that employees with anxiety disorders who have a balanced workload accommodation in place do not become purposely or inadvertently exploited by supervisors who may overload them with work.

One participant reported than an informal personalised accommodation had been put in place to support the participant to do presentations. In this example, the individual was allowed to make use of teleconferencing and webinar tools instead of giving traditional ‘stand up in front of the audience’ presentations. While this personalised accommodation assisted the study participant, it is not a panacea for presentation anxiety. In a review of recent studies about the fear of speaking in public, Bull [30] noted the potential of cognitive restructuring and gradual exposure programs for treating public speaking anxiety. However future research is needed to identify accommodations that may assist on occasions where these public speaking ‘treatments’ areineffective.

Another reported personalised accommodation was anxiety-friendly office design. A study participant reported benefiting from being relocated to a position in the office that minimised noise and traffic past their desk. This example illustrates that for some employees with anxiety disorders who are office-based, environmental psychology can be an important issue. Environmental psychology looks at how physical factors such as crowding, noise, temperature, wall colours and art displays can influence psychological wellbeing [31]. Supporting the Schell, Theorell and Saraste [32] position that “the inclusion of work place aesthetics in work environment improvements and health promotion is an issue to consider” (p.211), this example also makes the point that some anxiety-friendly office design solutions need not be expensive to implement.

Among the kinds of accommodations as defined by Queensland Government [33] the following relates to secondments, “access to training, transfer, acting, trial or higher duties positions, traineeships or other forms of opportunity to demonstrate or develop capacity in a position.” Cartwright and Holmes [34] suggest that secondments can offer opportunities for employees to participate in activities that are meaningful to them. Results of this study indicate that secondment opportunities can also benefit people with anxiety disorders. As highlighted by one study participant, a secondment opportunity was effective in helping them to reduce their work stress. This study participant commented, “currently in a different position for 4 weeks to reduce driving time and general work stress.” Future research is needed to examine the anxiety-reduction benefits that secondments may offer employees with anxiety disorders.

4.2 Missing accommodations

The study results presented above reveal flexible work arrangements and personalised accommodations assisting some study participants to reach and retain their current positions. However while these accommodations were available for some study participants, they were reported as missing by others. Other desired accommodations such as anxiety disorder awareness in the workplace and anxiety disorder friendly team building activities were reported as missing entirely. Appreciating the potential for co-workers to support jobseekers living with anxiety during their practical work experience [35] employee access to such support could be a feature of anxiety disorder aware workplaces.

Some of the missing accommodations were described in terms of their potential to support career advancement, for example alternatives to the ‘preferred’ interview job selection method, mentoring, and training. One study participant stated, “I would have needed to find other employment and seek additional assistance from WorkCover if this [accommodation] had not been achieved.” This comment suggests that the availability of accommodations may help to prevent government employees who are experiencing mental illness from leaving the public service.

Wang et al. [36] called for further research to examine why a large gap exists between perceived need for workplace accommodations and the availability of these accommodations for employees with mental disorders. This research suggests that while some government employees with anxiety disorders feel they need accommodations, they are unwilling to ask for these accommodations because of undesirable personal impacts seen to accompany their requests, along with perceived organisational barriers. Stigma and penalties were the most prominently reported personal barriers to making accommodation requests. Griffiths et al. [37] recognises that with the exceptions of schizophrenia and psychosis, educational interventions can assist in reducing personal stigma for various types of mental disorder. However research has yet to be conducted examining the effectiveness of such interventions in reducing stigma for mental health conditions of panic disorder, social anxiety and post-traumatic stress disorder [37]. Where supported by research, education about the reality of mental ill-health, including anxiety disorders, for managers and fellow staff would be a logical next step in changing attitudes.

When accommodations are missing, some employees with anxiety disorders may decide to ‘self-accommodate’. According to Plaisier et al. [38] anxious employees may assist their work functioning by avoiding the triggers that set off their anxieties. But findings from this research reveal that less productive possibilities can result from self-accommodations. For example, one study participant reported avoiding certain meetings because they feared entering into crowded lifts. However by missing out on opportunities to receive and share information at meetings, this anxiety avoidance tactic can hardly be described as ‘functional’. A more functional accommodation could be deliberatively explored for the above example. One such option might involve the study participant teleconferencing into meetings. While they would still be avoiding their anxiety trigger (i.e. crowded lifts), this accommodation would enable them to access meetings that they would otherwise miss by self-accommodating. As noted by Andrade and Ely [39] “despite the great advances that have occurred in relation to social awareness, people with disabilities and who suffer restrictions are still excluded from common activities such as access to public and cultural buildings” (p.3780). This example illustrates that such accessibilityrestrictions can extend to persons experiencing anxiety disorders.

4.3 Rejected accommodations

This study reveals a range of accommodation requests that management have rejected. Examples include requests for flexible work hours, part-time work, telecommuting, and secondment opportunities. According to the Anti-Discrimination Commission Queensland [ADCQ] [40], “adjustments should be made to accommodate the incapacity unless it would amount to an unjustifiable hardship on the employer.” However study results suggest that accommodation decisions are not always made in this spirit. In the words of study participants: “senior officers are of the old school mentality and often do not understand the impact mental illness does have”; “3-person panel interviews are the same old format used for getting a position in the first place”; and “people would be able to continue to contribute and be productive if they were able to have a more flexible work arrangement in place.” It is therefore important that accommodation requests are not summarily dismissed because they do not fit with a particular manager’s (or direct supervisor’s) view of how business in government should ‘traditionally’ be done.

Various organisational barriers were reported as standing in the way of accommodation approvals. For example, one study participant claims to have been denied a part-time flexible work arrangement because their supervisor feared losing partial funding of a full-time equivalent (FTE) position. But under the Queensland government’s job-sharing arrangement, a FTE position can be shared among two or more employees [41]. Under this accommodation, the position could be retained and shared among two or more employees without budget impact. Care therefore needs to be taken when assessing the financial costs associated with anxiety disorder accommodation requests so that expenses are not exaggerated.

According to Bjelland et al. [42], organisations with cultures of trust and inclusion promote open communication. Almost one third (i.e. 28.6 percent) of the study participants who reported having accommodations rejected claimed that these rejections happened without any reasons being given. By shutting down communication channels, opportunities are lost to deliberatively engage with employees who have made accommodations requests. Consequently, opportunities to identify accommodation solutions that do not impose unjustifiable hardship foremployers are also lost. As recognised by Shaw and Lindsay [43] “Collaboration and partnering requires a conscious effort and commitment to ensure that a more equitable approach is used that includes participation of all stakeholders” (p.217). Such effort is needed to help keep communication channels open between employees with anxiety disorders and accommodation decision makers.

4.4 Disclosure barriers

Study participants reported personal impacts of penalties and stigma as prominent barriers to disclosing their anxiety disorders in the workplace. Staff did not want to be “seen as weak”, experience the “stigma of not coping” or to “be discriminated against”. Employees can also resist disclosure of mental ill health due to unwanted accommodations. For example one study respondent commented, “I had a very bad experience last year when I was not coping with some travel I had to do and when I finally broke down at work I was stopped from travelling and have never had another opportunity since.” “I enjoy the travel when I am not suffering with anxiety and my depression is seasonal so am very capable of doing what is required at other times however this is no longer recognised and I am limited to the south-east corner of the state.” While we did not purposefully collect information about the duration of accommodations (i.e. whether they are received on a temporary or permanent basis), this example highlights that accommodations should be received on a person centred support basis. Specifically reasonable accommodations should be consistently available for as long as they are medically required (i.e. required for preventing, reducing or removing symptoms) and are desired by and acceptable to the individual in their current design and promptly modified or removed where they are not. For some employees with anxiety disorders this availability may be permanent in line with their medical requirements and desire to be accommodated in a particular way (or ways). However for others whose symptoms are of an episodic nature and who do not see any need for accommodation(s) to be constantly in place in order to prevent their symptoms (as in the example provided), accommodation availability will need to vary.

4.5 Policy and practice implications

Disability policies and programs tend to overlook the tremendous variance in disabilities [44].Consequently, there are people who may benefit from the availability of policy which specifically addresses the employment of individuals with a diagnosis of mental ill-health. At a base level this would revolve around the three key areas of recruiting, retaining and advancing persons with anxiety disorders in positions. This must be underpinned with a focus on the individual’s own life, abilities and needs and therefore incorporate person centred and recovery-focused values. To support policy action, targets should be set (and monitored) for each of theobjectives.

Implementation programs provide bureaucrats with practical guidance by translating policy objectives into practice [45]. Based on the findings of this research, key strategies for these implementation programs would focus on accommodations and supports related to: office working; performing standard hours; conducting verbal, face to face interactions; giving traditional ‘stand up in front of the audience’ presentations; competing in ‘standard’ job interviews; and participating in anxiety-insensitive team building activities. Programs that allow greater flexibility around how these (and other) activities are normally carried out may assist persons with anxiety disorders who are currently employed as public servants, or who desire to follow this career path. However, these strategies will not work for everyone with an anxiety disorder and it should be emphasised that any implementation strategy should take a person-centred approach that builds on what works for the individual. This focus on flexibility and individual needs aligns with the Schreuer et al. [46] position that the accommodation process isdynamic.

5 Conclusion

Aiming to inform vocational rehabilitation professionals and managers in the public service about how to better support individuals experiencing anxiety disorders (where such assistance is needed), this study investigated which accommodations can assist these employees to reach and retain government positions, and what challenges can be encountered in accommodating these persons. From the research data presented here, three key findings are apparent. First, the availability of ‘standard’ flexible arrangements generally offered by government, along with personalised anxiety disorder accommodations that are customised to meet specific anxiety disorder needs, can assist persons with anxiety disorders (where needed) to reach and retain government positions. Research results also suggest that for persons needing accommodations, such needs arediverse.

Second, study results reveal a range of standard and personalised accommodations claimed to be missing, along with reported barriers to making accommodation requests. Chief among these barriers are fears of being stigmatised and penalised in the workplace. This study supports the Griffiths et al. [47] call for future research to determine whether such personal impacts may be reduced through education interventions (i.e. awareness training) across the various types of anxiety disorders.

Finally, employees with anxiety disorders require accommodation decisions to be consistently made in a fair, open-minded and transparent manner. Fair decisions necessitate accommodations not being rejected because they do not fit with an accommodation gatekeeper’s view of how things are traditionally done in government. Decision-makers will therefore need to remain open-minded, particularly when assessing requests for accommodations that may break from government ‘norms’. And transparent decisions necessitate open communication so that decision makers clearly explain why an accommodation request is rejected, with opportunity given to deliberatively develop an acceptable alternative.

This has been an exploratory study, limited by several factors including a research site that was within only one government setting, a relatively small sample and the limitations of self-reporting of accommodations received and challenges experienced. However, the findings are offered here as a basis upon which future research will build. Exploration of the same questions within larger, more diverse settings will determine the extent to which the findings of this study can be generalised on more broadly.

Conflict of interest

The authors have no conflict of interest to report.

Footnotes

Acknowledgments

The study team would like to acknowledge the Queensland government Department of Communities, Child Safety and Disability Services, and the Department of Environment & Heritage Protection for agreeing to participate in this study. The team would also like to thank the study participants for taking the time in their busy schedules to enthusiastically undertake the surveys.

References

Commonwealth of Australia [COA] 2010-2020 National Disability Strategy. Canberra: COA; 2011.

Australian Government. Mental health: How to support an employee when they experience symptoms of mental illness. 2012 [cited 2014 Dec 17]. Available from: http://jobaccess.gov.au/content/mental-health%E2%80%94how-support-employee-when-they-experience-symptoms-mental-illness

Disability Employment Australia. Disability confident workplaces. 2014 [cited 2014 Dec 17]. Available from: http://disabilityemployment.org.au/for-employers/disability-confident-workplaces/

Department for Works and Pensions. Guidance: Employing disabled people and people with health conditions. 2014 [cited 2014 Dec 27]. Available from: https://www.gov.uk/government/publications/employing-disabled-people-and-people-with-health-conditions/employing-disabled-people-and-people-with-health-conditions

Canadian Human Rights Commission [CHRC] Policy and procedures on the accommodation of mental illness. 2008 [cited 2014 Dec 27]. Available from: http://www.chrc-ccdca/sites/default/files/policy_mental_illness_en_1.pdf

Vedeler

, Schreuer

. Policy in action: Stories on the workplace accommodation process. Journal of Disability Policy Studies 2011;22(2):95–105.

Dwoskin

, Squire

. Reasonable accommodation under the new ADA: How far must employers go? Employee Relations Law Journal 2013;38(4):3–27.

Solovieva

, Walls

, Hendricks

, Dowler

. Cost of workplace accommodations for individuals with disabilities: With or without personal assistance services. Disability and Health Journal 2009;2(4):196–205.

Harvey

, Joyce

, Tan

, Johnson

, Nguyen

, Modini

, Groth

. Developing a mentally healthy workplace: A review of the literature. Sydney: University of New South Wales; 2014.

10.

Deloitte Access Economics. The economic benefits of increasing employment for people with disability. Sydney: Deloitte; 2011.

11.

Hendriks

, Spijker

, Licht

, Hardeveld

, de Graaf

, Batelaan

, Penninx

, Beekman

. Long-term work disability and absenteeism in anxiety and depressive disorders. Journal of Affective Disorders 2015;178:121–30.

12.

World Health Organization. Workers’ health: Global plan of action. Agenda item 12.13 to the sixtieth World Health Assembly. Geneva: 2007 14-23 May.

13.

Wang

, Patten

, Currie

, Sareen

, Shmitz

. Perceived needs for and use of workplace accommodations by individuals with a depressive and/or anxiety disorder. Journal of Occupational and Environmental Medicine 2011;53(11):1268–72.

14.

Sonnenberg

, Nadeau

. Accommodating mental disabilities in the workplace. New York Law Journal 2007;237(91). [cited 2013 11 Mar] Available from: http://www.nylj.com

15.

Baldwin

, White

. Workplace accommodations that work for persons with mental illness. In: Williams-Whitt

, Taras

. Editors. Perspectives on disability and accommodation. Victoria: National Institute of Disability Management and Research; 2010. pp. 115–31.

16.

Bolo

, Sareen

, Patten

, Schmitz

, Currie

, Wang

. Receiving workplace mental health accommodations and the outcome of mental disorders in employees with a depressive and/or anxiety disorder. Journal of Occupational & Environmental Medicine 2013;55(11):1293–9.

17.

Robertson

, Lewis

, Hiila

. Supported employment in the public sector for people with significant disabilities. Journal of Vocational Rehabilitation 2004;21(1):9–17.

18.

Braun

, Clarke

. Using thematic analysis in psychology. Qualitative Research in Psychology 2006;3(2):77–101.

19.

Linden

, Milchus

. Teleworkers with disabilities: Characteristics and accommodation use. Work 2014;47(4):473–83.

20.

Linden

. Telework research and practice: Impacts on people with disabilities. Work 2014;48:65–7.

21.

Anderson

, Bricout

, West

. Telecommuting: Meeting the needs of businesses and employees with disabilities. Journal of Vocational Rehabilitation 2001;16(2):97–104.

22.

Blok

, Groenesteijn

, Schelvis

, Vink

. New ways of working: Does flexibility in time and location of work change work behavior and affect business outcomes? Work 2012;41:5075–80.

23.

Queensland Government. Types of flexible working arrangements. 2014 [cited 2014 24 Aug]. Available from: https://www.qld.gov.au/jobs/balance/arrangements/pages/types.html

24.

Nygren

, Markströmb

, Bernspånga

, Svenssonc

, Hanssonc

, Sandlundd

. Predictors of vocational outcomes using individual placement and support for people with mental illness. Work 2013;45:31–9.

25.

Slade

, Amering

, Farkas

, Hamilton

, O’Hagan

, Panther

, Perkins

, Shepherd

, Tse

, Whitley

. Uses and abuses of recovery: Implementing recovery-oriented practices in mental health systems. World Psychiatry 2014;13(1):12–20.

26.

Queensland Government (2015). Employee assistance service. 2015 [cited 2015 22 Jan]. Available from: http://www.premiers.qld.gov.au/publications/categories/policies-and-codes/handbooks/ministerial-handbook/human-resource/employee-assistance-service.aspx

27.

Doherty

. High cost of bullying to nurses and trusts revealed. Nursing Standard 2003;17(31):7–.

28.

Waghorn

, Chant

. Overworking among people with psychiatric disorders: Results from a large community survey. Journal of Occupational Rehabilitation 2012;22(2):252–61.

29.

Campos

, da Silva

, Trevisan

, Cruz

. Moral harassment at work model and inability Work 2012;41:2060–7.

30.

Bull

. Current status of knowledge on public-speaking anxiety. Current Opinion in Psychiatry 2012;25(1):32–8.

31.

Russell

, Ward

. Environmental psychology. Annual Review of Psychology 1982;33(1):651–89.

32.

Schell

, Theorell

, Saraste

. Workplace aesthetics: Impact of environments upon employee health? Work 2011;37:203–13.

33.

Queensland Government Department of Education, Training and Employment. Reasonable adjustment for employees with a disability. 2013 [cited 2016 30 Jan]. Available from: http://education.qld.gov.au/health/pdfs/reasonable-adjustment-factsheet.pdf

34.

Cartwright

, Holmes

. The meaning of work: The challenge of regaining employee engagement and reducing cynicism. Human Resource Management Review 2006;16(2):199–208.

35.

Matthews

, Harris

, Jaworski

, Alam

, Bozdag

. Function, health and psychosocial needs in job-seekers with anxiety, mood, and psychotic disorders who access disability employment services. Work 2014;49(2):271–9.

36.

Wang

, Patten

, Currie

, Sareen

, Shmitz

. Perceived needs for and use of workplace accommodations by individuals with a depressive and/or anxiety disorder. Journal of Occupational and Environmental Medicine 2011;53(11):1268–72.

37.

Griffiths

, Carron-Arthur

, Parsons

, Reid

. Effectiveness of programs for reducing the stigma associated with mental disorders: A meta-analysis of randomized controlled trials. World Psychiatry 2014;13(2):161–75.

38.

Plaisier

, Beekman

, de Graaf

, Smit

, van Dyck

, Penninx

. Work functioning in persons with depressive and anxiety disorders: The role of specific psychopathological characteristics. Journal of Affective Disorders 2010;125(1):198–206.

39.

Andrade

, Ely

. Assessment method of accessibility conditions: How to make public buildings accessible? Work 2012;41:3774–80.

40.

Anti-Discrimination Commission Queensland [ADCQ]. Incapacity and work. 2014 [cited 2014 Sep 6]. Available from: http://www.adcq.qld.gov.au/resources/brochures-and-guides/fact-sheets/incapacity-and-work#Link4

41.

Queensland Government. Types of flexible working arrangements. 2014 [cited 2014 24 Aug]. Available from: https://www.qld.gov.au/jobs/balance/arrangements/pages/types.html

42.

Bjelland

, Bruyère

, von Schrader

, Houtenville

, Ruiz-Quintanilla

, Webber

. Age and disability employment discrimination: Occupational rehabilitation implications. Journal of Occupational Rehabilitation 2010;20(4):456–71.

43.

Shaw

, Lindsay

. Renewing focus and building capacity for enacting authentic collaboration in work rehabilitation. Work 2008;30:215–8.

44.

Scotch

. Disability policy: An eclectic overview. Journal of Disability Studies 2000;11(1):6–11.

45.

Bigby

. The challenge of implementing state disability policy to achieve second generation rights for people with disabilities. Just Policy: A Journal of Australian Social Policy 2007;43:68–75.

46.

Schreuer

, Myhill

, Aratan-Bergman

, Samant

, Blanck

. Workplace accommodations: Occupational therapists as mediators in the interactive process. Work 2009;34(2):149–60.

47.

Griffiths

, Carron-Arthur

, Parsons

, Reid

. Effectiveness of programs for reducing the stigma associated with mental disorders: A meta-analysis of randomized controlled trials. World Psychiatry 2014;13(2):161–75.