Article Abstract

Online ISSN: 1099-176X    Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 26, Issue 4, 2023. Pages: 137-147
Published Online: 1 December 2023

Copyright © 2023 ICMPE.

Employer-Provided and Self-Initiated Job Accommodations for Workers with Serious Mental Illness

Marjorie L. Baldwin,¹ Rebecca M. B. White,² Steven C. Marcus³

¹Emeritus Professor, W. P. Carey School of Business, Arizona State University, Tempe, AZ, USA.
²Professor, T. Denny Sanford School of Family and Social Dynamics, Arizona State University, Tempe, AZ, USA.
³Research Associate Professor, School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, USA.

We study job accommodations among a cohort of persons with serious mental illness (SMI) independently employed in regular jobs. By regular jobs, we mean: jobs paying at least minimum wage, not set aside for persons with disabilities, and not obtained with assistance from mental health services. The analysis sample includes 731 workers with diagnoses of schizophrenia, bipolar disorder, or major depressive disorder, who were employed in regular jobs post-onset of SMI. We identify a type of accommodation, self-initiated by the worker, that has not been studied before. These self-initiated accommodations are three times more prevalent than employer-provided accommodations in our sample. The most frequent accommodations of either type involve flexibility in scheduling or modifications to the workspace. Factors associated with the probabilities of requesting or self-initiating accommodations reflect needs for accommodation (e.g. compromised health) and feasibility of implementing accommodations in a particular job.

Background: Many individuals with serious mental illness (SMI) are capable of employment in regular jobs (i.e. jobs paying at least minimum wage, not set aside for persons with disabilities, and not obtained with assistance from mental health services), but they may need job accommodations to be successful. The extant literature focuses almost exclusively on accommodations for workers with SMI who are receiving employment support, so we know almost nothing about the nature or frequency of accommodations needed by workers who are independently employed.

Aims: Drawing on survey data from a sample of workers with diagnoses of SMI who are capable of regular, mainstream employment, we aim to: (i) describe the nature and frequency of job accommodations workers requested from their employer or initiated on their own; and (ii) identify individual- and work-related factors associated with the probabilities of requesting or initiating accommodations.

Methods: The analysis sample includes 731 workers with diagnoses of schizophrenia, bipolar disorder, or major depressive disorder, who were employed in regular jobs post-onset of SMI. Workers identified any job accommodations requested from their employer, or initiated on their own. Summary statistics describe the nature and frequency of accommodations in four categories: scheduling, workspace, supervision, job modification. Logistic regression models estimate the relationship between workers’ health- and job-related characteristics and the probabilities of requesting or self-initiating accommodations. 

Results: Whereas 84% of workers in our sample self-initiated accommodations, only 25% requested accommodations from their employer. The most frequent accommodations of either type involved flexibility in scheduling (63% self-initiated, 24% requested), or modifications to the workspace (58%, 19%). Factors significantly correlated with the probability of requesting accommodations include: supportive workplace culture, longer job tenure, more severe cognitive/social limitations. Factors significantly correlated with the probability of self-initiating accommodations include: younger age, more severe social limitations, greater job autonomy.  

Discussion: This is the first study of job accommodations among a cohort of persons with SMI independently employed in regular jobs. We identify a type of accommodation, self-initiated by the worker, that has not been studied before. These self-initiated accommodations are far more prevalent than employer-provided accommodations in our sample. Key factors associated with the probabilities of requesting/initiating accommodations reflect need (e.g. compromised health) and feasibility of implementation in a particular job. Limitations of the study include the cross-sectional design which limits our ability to identify causal relationships. 

Implications for Health Care Provision and Use: Providers who deliver vocational services for workers with SMI should be aware of the many ways these employees can accommodate their illness on their own, without the necessity of disclosing SMI to an employer.

Implications for Health Policies: Our results recommend workplace policies that support disclosure and employer-provided accommodations, as well as policies that create flexibility for employees to initiate their own accommodations.

Implications for Further Research: Given the prevalence of workers’ self-initiated accommodations, it is imperative that research on job accommodations for workers with serious mental illness includes consideration of these types of accommodation.