The Three Cs of Disclosing Serious Mental Illness at Work: Control, Conditions, Costs

Abstract

This Open Forum describes a framework for analyzing factors that influence an individual's decision to disclose serious mental illness in the competitive workplace. The disclosure decision is multifaceted, organized in dimensions of control, conditions, and costs. Control refers to the extent to which a mental illness is concealable, so that a worker may choose whether to disclose. The conditions workers impose on disclosure determine when, to whom, and how much they choose to say. The costs, both monetary and emotional, are a manifestation of the pervasive stigma associated with mental illness. The framework described here can form the basis for rigorous empirical studies of the disclosure decision that will inform both workers' decisions to disclose and employers' responses to disclosure. The objective of this research is to improve labor market outcomes for the significant numbers of workers with serious mental illness who can engage in mainstream, competitive employment.

Workers’ Perspectives on Workplace Disclosure of Serious Mental Illness and Their Employers’ Responses

“…The Baldwin (2021) model, which characterizes disclosure in three dimensions (control, conditions, costs), is a better fit for some of the disclosure contexts in our data. Workers who disclosed in the context of symptom-based inquiries, or after being exposed, for example, had lost some measure of control over the disclosure decision because their mental illness had become visible.…”

“…The other two typologies describe workers disclosing in response to a triggering incident (exposure or symptom-based inquiries), as suggested by the Toth and Dewa (2014) framework. Workers who were exposed might have expected the most negative responses to disclosure, given that they had lost considerable control over the disclosure decision (Baldwin, 2021; Bril-Barniv et al, 2017). Indeed, workers in this typology were more likely than most other groups to mention threat (present or absent) when describing their employers’ response to disclosure.…”

“…A regular job (i.e., a job which pays at least minimum wage, is not set aside for persons with disabilities, and is not obtained with the help of mental health vocational services) is the pathway to financial security and independence for most adults. Recent research demonstrates that, contrary to the stereotypes, many persons with SMI are successfully employed in regular, well-paid jobs (Baldwin, 2021; Ellison et al, 2008; Joyce et al, 2009). Understanding challenges encountered by persons with SMI in regular employment is critical to reducing the burden of mental illness on individuals, families, and society.…”

“…Workers remain in the default position unless a triggering incident (e.g., recurrence of symptoms, negative performance evaluation) causes them to reassess the risks and benefits of disclosure. The third framework views disclosure through dimensions of control, conditions, and costs (Baldwin, 2021). A worker has control over disclosure if their mental illness is concealable and if those who have been informed respect the worker’s privacy.…”

“…Recent research demonstrates that, contrary to the stereotypes, many persons with SMI are successfully employed in regular, well-paid jobs (Baldwin, 2021;Ellison et al, 2008;Joyce et al, 2009). Understanding challenges encountered by persons with SMI in regular employment is critical to reducing the burden of mental illness on individuals, families, and society.…”