Originally published here.
SAMHSA’s National Survey on Drug Use and Health [1] estimated that approximately 11.4 million adults in the United States had a serious mental health disorder in the past year. Mueser and McGurk [2] found that a majority of adults with a severe mental health disorder self-identified as being willing and able to work. Paid employment is associated with better self-perception of mental and physical wellbeing [3] and predicts a reduction in anxious and depressed symptomology [4]. Similarly, individuals with mental disorders may seek employment to improve financial resources and increase sense of belonginess to their community [5].
Despite well-documented benefits of employing adults with mental disabilities, employment challenges for this population remain prevalent [6]. Prior research consistently found that only a tenth to a fourth of adults with a severe mental health disorder obtain competitive employment [2, 7, 8]. A negative association was present between increasing severity of symptoms related to mental health disorders and employment rates in the United States [6]. Poor employment situations can negatively impact adults with mental disabilities by limiting their financial independence, which may, in turn, hinder their quality of life, social inclusion, and overall well-being [7, 9].
Thus, assisting individuals with mental disabilities to obtain and maintain stable employment is crucial to them, their families, and society. To combat poor occupational outcomes, federal and state legislatures aim to assist individuals with disabilities – including those with mental disabilities – with obtaining equal opportunities to gain stable employment. For example, the Americans with Disabilities Act (ADA) Amendments Act (2008) prohibits discrimination towards people with disabilities and mandates that reasonable accommodations should be provided to individuals with disabilities if it does not result in undue hardship for employers.
Accommodations refer to any change or adjustment to a job or work environment to help a person with a disability apply for a job, perform the duties of the job, or enjoy the benefits and privileges of employment [10]. To address the needs of individuals with mental disabilities, reasonable accommodations may include modifications to employees’ job structure, duties, or social accommodations [11] as well as provision of flexible scheduling, modified supervision, and training activities, etc. [12].
Ensuring that employees with mental disabilities receive needed accommodations in the workplace is especially pertinent. Workplace accommodations had positive implications on maintaining employment and monthly hours worked by participants with mental disabilities [13, 14]. Workers who received workplace accommodations had an average employment duration 31% longer than employees who did not receive accommodations [13]. In addition to increases in productivity and reductions in staff turnover [15], providing accommodations may result in affective commitment to the company or organization [16, 17].
However, to actualize the benefits of these accommodations, individuals with mental disabilities need to disclose at least some aspects of their mental health disorders in the accommodation request process (Americans with Disabilities Act Amendments Act, 2008). Despite these benefits, disclosure rates for accommodation requests among adults with mental disabilities are generally low [18, 19], though with variations. For instance, DeTore et al. [18] and Corbiere et al. [14] reported workplace disclosure ` rates of 55.8% and 45.1%, respectively, in their studies for people with various mental disabilities.
A longitudinal study conducted over 23 years observed that only 27% of their study’s participants with depression disclosed issues relating to their mental or personal health to their employers to gain assistance [19]. However, a prior study reported workplace disclosure rates of mental disabilities of approximately 87% [20]. Wide variations in disclosure rates suggest a vital need for further research to increase our understanding of challenges that people with mental disabilities may face, regarding the process of deciding whether to submit a workplace accommodation request.
Multifaceted workplace-, employer-, and employee-related factors result in barriers to requesting and obtaining accommodations in the workplace. For example, many supervisors were uninformed with regards to the implications of an employee’s mental disability on their work and possessed a lack of awareness on the types of appropriate accommodations to offer their employees [8]. Individuals with mental disabilities may also need to navigate through interpersonal difficulties. Fear of stigmatization and discrimination may act as a persistent barrier to disability disclosure and accommodation request initiation for individuals with severe mental health disorders [7, 21].
A systematic literature review found that hypothetical job applicants who disclosed a mental health issue received lower suitability ratings for employment than those who did not disclose a mental health issue [22]. Concerns relating to possible workplace discrimination may hinder individuals with mental disabilities from requesting or utilizing accommodations [23]. Chow et al. [24] found that lack of workplace supports, and greater severity of mental disability were associated with a lower likelihood of requesting workplace accommodations. On the other hand, employees’ increased familiarity with the ADA legislation and workplace supports from employers and coworkers were significantly associated with disclosure of mental health concerns in the workplace and request of accommodations [22, 25, 26].
McDowell and Fossey’s [12] findings supported the need for additional research on how to increase efficacy of requesting workplace accommodations for individuals with mental disabilities. Accommodation requests from this marginalized population were viewed as less legitimate and reasonable [27]. These findings highlighted the importance of research on psychological, cognitive, and social factors which may influence initialization of workplace accommodation requests [28]. Sociodemographic risk factors for refusing to request accommodations also requires further study.
Cognitive and psychological constructs, proposed by the Social Cognitive Career Theory [29], may predict initiation of workplace accommodation requests [30]. These constructs consist of self-efficacy, outcome expectancy, and affect. An individual’s selfefficacy (i.e., beliefs about one’s competency to successfully perform certain behaviors or courses of action) and outcome expectancy (i.e., beliefs about the outcomes of given actions) influence job performance and work behaviors [29]. In addition, affect (i.e., one’s feelings and emotions) serves as a filter through which outcome expectancy and self-efficacy information are processed [31].
A positive association between outcome expectancy, positive affect, and self-efficacy on workplace accommodations has been observed among people with various disabilities [30, 32]. Both these studies found that self-efficacy, outcome expectancy, and positive affect accounted for 50% to 55% of the variance in intention to request accommodations. Furthermore, self-efficacy mediated the relationship between positive affect and intention to request accommodations; outcome expectation mediated the relationship between selfefficacy and intention to request accommodations among people with different types of disabilities. Despite these past studies, no study – to our knowledge – has examined the impact of these cognitive constructs on requesting accommodations through the framework of social cognitive theory among individuals with mental disabilities.
Given the unique nature of mental disabilities, this literature gap is concerning. Beatty [33] suggested that examining people with disabilities as a homogeneous group may impede us from capturing the experiences of groups with specific types of disabilities. In addition, no study, with exception of Chow et al. [24], has explored workplace supports and demographic factors along with cognitive constructs, among individuals with mental disabilities.
Thus, this study aimed to examine the influences of psychosocial factors (i.e., self-efficacy, outcome expectancy, affect, and workplace supports) and demographic factors on requesting accommodations among individuals with mental disabilities. The research questions include: 1) What are the types of workplace accommodations requested or withheld by people with mental disabilities? and 2) What are the impacts of psychosocial (i.e., self-efficacy, outcome expectancy, affect and workplace support) and demographic factors on requesting accommodations among individuals with mental disabilities?
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