RTW Programs: Integrating Accommodation

Tasha Patterson@Work

Mental Health and the Disability Mindset: How Employers Can Help Prevent the Spiral

Mental Health and the Disability MindsetBy Daniel Jolivet, PhD

Behavioral Health Director
The Standard

If you looked online on Oct. 10, 2017, you would have seen a flood of tweets, blog posts, and news articles about World Mental Health Day. These candid posts, written by individuals who have experienced and often overcome a behavioral health condition, showcased how people with a mental illness see themselves.

A common theme among the posts was that people with behavioral health conditions — including depression, anxiety, post-traumatic stress disorder, or substance abuse issues — frequently struggle with feelings of inadequacy and worthlessness. What’s more, these individuals noted how they often suffer through their conditions in silence because they fear how others will label them.

While our culture has made great strides in recent years to become more accepting of people with behavioral health conditions, these individuals often face a huge challenge: rejoining or remaining in the workforce.

The Disability Mindset

One of the biggest issues for these individuals is how employers approach or support an employee experiencing a mental illness, especially someone using a disability leave for their condition.

Many employers unconsciously assume that an employee with a behavioral health diagnosis won’t improve, that a depressed or anxious employee will always be depressed or anxious, for example. The assumption may be “unconscious” but employees can identify it; according to a survey by The Standard, 60% of employees were concerned about losing their job when coming forward about the need for accommodations or disability support. That unconscious assumption is harmful to employees and their success in the workplace, and it puts employers at risk of litigation.

An employee’s feelings of shame and inadequacy can spiral into a mindset that’s hard to overcome. This “disability mindset” occurs when someone on a disability leave thinks about their abilities in a self-limiting way, which clouds how they envision their future. This mindset can make employees feel that they won’t be able to get better and resume their normal predisability life.

This perception has wide-ranging implications. If someone thinks that they’ll never be able to rejoin or stay in the workforce because of their condition and that their employer has written them off as permanently disabled, it’s easy for them to feel hopeless and stop trying.

Employees with behavioral health issues can and do get better. But it often takes the help of an alert, informed employer. The opportunity for employers lies in supporting an employee with a behavioral health condition and understanding that these employees can contribute to the workplace — just like employees who have a physical health condition.

Providing Accommodations Under the ADAAA

Accommodations are key in creating an environment that helps employees overcome a disability mindset and encouraging stay at work (SAW) or return to work (RTW).

It would be surprising for an employee with cancer to be denied the time to attend their chemotherapy and radiation appointments. But employees with behavioral health diagnoses are often denied the time to attend to their care during work hours (e.g., attend psychiatric appointments or substance abuse recovery meetings) or provided with accommodations (e.g., modified work schedules or a temporary job). Employers are often less sympathetic toward behavioral health diagnoses because of the cultural perception that an employee just needs to “pull it together” and work through the condition.

However, the Americans with Disabilities Act Amendments Act (ADAAA) requires employers to provide reasonable accommodations for employees with health issues, including behavioral health conditions. Employers need to be aware that failing to accommodate an employee may not just result in the loss of a qualified employee; it also could result in legal action.

Accommodations can be incredibly helpful in mitigating an employee’s behavioral health condition and aiding in SAW or RTW. However, it’s important that these accommodations be targeted to an employee’s exact situation. That is necessary medically and fits with the ADAAA requirement to engage employees in an interactive process that identifies and implements a reasonable accommodation.

Successful accommodations for an employee with a behavioral health condition are often straightforward in nature. Here are a few examples:

  • Flexibility with appointments allows employees to attend treatment through an employee assistance program (EAP), see their doctor, or participate in a substance abuse recovery program.
  • Many behavioral health conditions disrupt an employee’s natural sleep/wake cycles. A flexible schedule can allow for increased productivity and help reduce errors or accidents.
  • Employees with depression or anxiety often struggle with focus and attention to detail. Here, an employer can break down tasks into smaller actions, provide coaching or reviews of work, or move the employee’s workstation to a quiet place that allows them to better focus.

In addition, it’s important for employers to ensure their policies don’t limit or impede an employee’s ability to keep working or RTW. For instance, policies that require employees to be 100% recovered before RTW create the perception that an employer doesn’t support an employee’s recovery and that an employee with a mental health condition is damaged.

Creating a Culture of Acceptance and Support

There are additional ways to foster a supportive workplace that accepts employees with behavioral health issues:

  • Make the most of vendor services. A disability carrier or third-party administrator may be able to assist in SAW and RTW support, particularly in terms of setting up a formal RTW program with transitional duty positions. Some vendors have comprehensive disability programs to help identify employees before a disability claim is filed and to help an employer implement accommodations proactively.
  • Give employees early reminders of available benefits. For some employees, early assistance can successfully address their condition before it requires a disability leave. Even before a claim, perhaps while employees are experiencing productivity problems, remind them about benefits available, including an EAP, wellness program, or health concierge services.
  • Reach out to employees on a disability leave. We often hear employers say that they don’t want to intrude or don’t know what to say to an employee who is out on leave. However, regular communication can prevent an employee from becoming isolated and thinking that their employer has written them off entirely. This also maintains an open line of communication for an employer to understand where an employee may be in the recovery process.

Group Success Story

Helping support employees with behavioral health conditions can create measurable improvements. A state public administration group implemented a SAW/RTW program providing better benefits coordination and communication of available employee resources, accommodations for employees with behavioral health conditions, transitional work support, manager training, and efforts to shift the group culture to be more inclusive of people with mental health issues. After four years, the group’s average short-term disability (STD) duration for behavioral health claims was 30% lower than the average duration of similar groups in the Integrated Benefits Institute benchmarking database. We do not know how much improvement this represents because a baseline number for STD behavioral claims was not available for this employer at the start of the program.


Based on our experience, we believe that understanding mental health issues in the workplace and providing accommodation can pay off, especially in terms of an employee’s dedication to a company. When employees are helped through difficult times, they usually are more loyal and committed to their company. In addition, this approach demonstrates a company’s commitment to its workforce; other employees will notice, too. In the current tight market for key talent, this approach can help retain valued employees and reduce the time and cost associated with finding and training new employees.