Appendix A
Frequently Asked Questions on Mental Illness in the Workplace

*Questions and answers marked with an asterisk are reproduced, with permission,
 from the Canadian Mental Health Association, Ontario website: www.mentalhealthworks.ca

PRIMARILY FOR EMPLOYEES

Do I have to tell my employer that I’m ill?*

If you are able to come to work, in most cases you do not have to tell your employer that you are ill.  However, if you have a mental health problem that could affect your ability to do your job, you will need to consider whether disclosure might be necessary and beneficial.

In some cases you may be required to disclose the fact that you have an illness; if, for example:

• there is an absenteeism policy that requires you to provide a medical certificate if you miss more than a specified number of days of work; or
• you are requesting accommodation—you do not necessarily have to disclose the nature of your illness, but you will have to provide enough information to the employer about your disability so that appropriate accommodation can be provided.

Are there other benefits to disclosing information about my illness to my employer?*

• It is very stressful to be in a situation where you feel that you must hide an illness.
• Your manager or supervisor may be able to provide you with support if they are aware of your problem.  Otherwise, they may misinterpret a change in your behaviour as a performance issue.
• It enables your manager to help you more quickly and effectively if you become ill while at work, whether from your illness or from the side effects of medication.

PRIMARILY FOR MANAGERS AND SUPERVISORS

How can I tell if someone is mentally ill?*

As an employer, manager or supervisor, it is not your job or your responsibility to diagnose a mental health problem. However, being aware of the signs that suggest someone might be experiencing a mental illness is important.  Mental illness includes a broad range of symptoms and behaviours, and it is not easy to determine whether someone is mentally ill. One key indicator is that someone may begin to act uncharacteristically; an energetic person may seem lethargic for a considerable time, or a person who is usually mild may make grandiose claims about their abilities.

Behaviour changes such as these may reflect personal difficulties that will be resolved quickly.  They may be signs that the person is no longer happy in their job. The individual might be going through a particularly stressful time in their life for any number of reasons.  These behaviour changes might, however, indicate that the person is experiencing a mental health problem that goes beyond being “stressed out” and that requires professional help.

There are a number of warning signs that can indicate that a person has a mental health problem, such as:

• consistent late arrivals or frequent absences;
• lack of cooperation or a general inability to work with colleagues;
• decreased productivity;
• increased accidents or safety problems;
• frequent complaints of fatigue or unexplained pains;
• difficulty concentrating, making decisions or remembering things;
• making excuses for missed deadlines or poor work;
• decreased interest or involvement in one’s work;
• working excessive overtime over a prolonged period of time;
• expressions of strange or grandiose ideas; or
• displays of anger or blaming of others.

It is important to emphasize that people behaving in these ways may be simply having a bad day or week, or may be working through a particularly difficult time in their lives that is temporary.  A pattern that continues for a longer period, however, may indicate an underlying mental health problem.

If an employee’s behaviour is a workplace problem, talking to them privately in the context of their workplace performance may help you determine whether mental health is a factor.  You may be able to encourage the individual to get help and/or request appropriate accommodation while they deal with their mental health issue.

How can I approach an employee about their mental illness?*

You may see behaviour or performance signs that suggest an employee has a mental health problem.  As an employer (or a manager or supervisor) you have a responsibility to both the individual and the organization to take action if you suspect that this is the case.  You may be able to provide the employee with an opportunity to get the support, professional help and workplace accommodation they need so that they can continue working productively.  In most cases the best approach is to meet with the person privately to talk about your concerns about their work-related performance.

Preparing for the meeting
Broaching the question of an employee’s health as it relates to work performance can be a delicate task, especially when mental health problems might be involved. It’s important to prepare for your meeting:

• Find out what resources your organization can offer an employee who is in distress.  Have this information at hand when you meet with the person.
• Become familiar with your organization’s accommodation policies and processes.
• Spend some time looking into the basics of mental health and illness before you talk with the employee.  Misunderstanding and fear are the greatest barriers people face in dealing with a mental health problem; be aware of the possibility that your own misconceptions and fears might interfere with your ability to respond appropriately.  Your employee might also benefit from good information. They may not understand what is happening or may think that mental illness is something they should be able to fix on their own.
• Think about how you can use your skills as a manager to help make the person feel safe and comfortable in the meeting.  If the employee is dealing with a mental health problem you will want to minimize their stress—not contribute to it. In addressing the performance issues, you can be honest, up front, professional and caring in your approach.
• Think about the person’s strong points and contributions that they have made. It will be important to talk about the ways in which the employee is valued before raising areas of concern.
• Consider open questions that will encourage an employee to request support or accommodation.  At the same time, remember that your job is not to probe into an employee’s personal life, to diagnose a problem or to act as their counsellor. Be prepared for the possibility that, while you may be opening a door to offer help, the employee may choose not to walk through the doorway.

Talking with the employee
Consider how well you know the employee.  Some people will feel more comfortable if you treat the meeting as a performance review, focussing first on their strong points as a worker before addressing areas of concern.  This format may make some people defensive, though, so you might begin by stating that you are concerned about the employee, then state reasons for your concern.  In either case, assure the employee that you intend to work with them to help them get back on track or get the supports they may need.  If you can create an atmosphere in which the person feels safe and comfortable, and let them know that what you discuss with respect to health matters is confidential, they may feel more open to talking to you.

If the situation is serious enough that the loss of a job is imminent, it is important to be clear and document the meeting as a performance issue so there is no confusion.

It is important that you:

• approach your concern as a workplace performance issue;
• raise the possibility of providing accommodations if needed;
• provide access to an employee assistance program (EAP) or referral to community services;
• assure the employee that meetings with an EAP provider are confidential;
• set a time to meet again to review the employee’s performance; and
• document this meeting fully.

But there are some things you should not say or do:

• Don’t offer a pep talk.
• Don’t be accusatory.
• Don’t say “I’ve been there” unless you have been there.  You may not understand or relate to a mental illness, but that shouldn’t stop you from offering help.
• Don’t try to give a name to the underlying issue.  Even if you suspect a particular illness or problem, focus on how the employee’s behaviour is concerning you and how you want to help them improve.
• If you learn that a specific illness is causing the behaviour, don’t ask what “caused” the illness. Focus on solutions.

Your employee may not know, or may refuse to acknowledge, that they have a mental health problem.  In that case, there may be little you can do to help them.  At this point, focussing on work performance is the best approach.

Follow up
Your organization’s involvement doesn’t end with this meeting.  You’ll want to follow up with the employee or designate someone who can follow up on your behalf.  Keep your notes on the meeting in a secure location.  A locked filing cabinet and password-protected computers are key to maintaining an employee’s confidentiality.

To provide appropriate accommodation, you will need to know:

• if there are any functional limitations that could affect the person’s ability to carry out the essential duties of their job; and
• what accommodations would enable them to continue to do their job effectively.

The employee may not disclose a problem to you but may seek help from the EAP provider or from a community service provider (such as a doctor, psychologist or counsellor).  After receiving professional help, the employee might decide to put in a request for workplace accommodation.

Be sure you and the employee understand the employer’s obligations to provide accommodation.  If there is a collective agreement in place, be familiar with the terms of the collective agreement.  If it would interfere with accommodation, make sure it is clear what steps can be taken to accommodate the employee.

How can I support an employee’s return to work after disability leave for a mental health problem?*

The fundamentals
Three fundamentals must be in place for an employee’s return to work to be successful:

• The work itself, and the employee’s presence in the workplace, should not pose a risk to the employee or co-workers.
• The employee must be able to perform the tasks of his or her job at a level where meaningful work is possible with appropriate accommodations.
• The workplace must be welcoming and free from harassment and other pressures that might delay recovery.

Evaluating these fundamentals requires a look at the demands of the job and at the employee’s progress, including:

• the employee’s symptoms, and the severity of those symptoms;
• the effectiveness of treatment;
• the employee’s resilience;
• the employee’s ability to prevent a relapse (by identifying and avoiding issues that lead to relapses); and
• the level of mental acuity and stamina the job requires.

Ask your employee what they need
More than anyone else, the employee will know what they are capable of and what they need to succeed in the workplace.  If you want to know how you can make their return to work successful, start by asking them—you’ll get valuable information that can smooth the reintegration process for everyone, and they’ll be motivated by the reassurance that they work in a supportive environment.

You should weigh their self-assessment, though, against those made by the treating physician.  Generally, work is an important support for people with mental health problems, and most are keen to return to work.  Occasionally an employee who is ready to return to work may try to put off their reintegration.  On the other hand, someone who’s not yet ready to make a meaningful contribution to the workplace may be overeager to get back to work or attempt to return to a fuller schedule than is advised by the treating practitioner.

When you talk to an employee about their return to work, you don’t need to know about their diagnosis or details of their treatment (although they may volunteer that information).  What you do need to know is what reasonable accommodations the employee will need to get back on the job, the pace at which they’ll be able to reintegrate into the workplace and if their work will be affected. Keep the conversation focussed on job performance.

You must work with the employee to identify appropriate work.  If it is a new or modified job, you must ensure that the employee has agreed to the change.  Modifying a job is a form of accommodation.  You are not necessarily required to offer a different job to the employee or to create a new job for them.

Matching tasks with your returning employee’s abilities is key to successful reintegration.  You can ask the treating physician or psychologist for advice on the patient’s abilities.  Be prepared to give them a job description to help them assess suitable work during the reintegration process.

Set benchmarks
Set realistic goals and standards based on the needs of the organization and the employee’s current abilities. The process of setting clear, defined goals is a useful way to reintegrate employees into the workplace.

You might be able to begin their reintegration by sending them work at home or having them return part time to work. The model should be based on agreements reached with the employee, the employee’s health care provider, the manager and, if appropriate, the long-term disability insurer.

Lead by example
Stigma, like gossip or infighting, is poisonous to a productive work environment. You can support an employee’s return to work, and encourage higher morale and better output from your team, by demonstrating that you still trust, respect and value a co-worker who has been on disability leave for a mental illness.

If you know the cause of your employee’s disability, you might want to learn more about it. Dispelling myths about mental illness is the most important step in eliminating the stigma that leads to discrimination. When co-workers see you treating a returning worker with trust and respect, they’ll likely follow your lead.

Don’t be surprised if fellow employees approach you with questions about the returning worker, or complaints about the accommodations they may see as special treatment. For advice on talking to other employees, see “One of my employees has a mental health problem. How can I explain the situation to other employees?”

Employees are often afraid to return to work because they fear harassment.  They may have been present when jokes or negative comments were made by colleagues about people with a mental illness. You have an obligation to ensure that the employee is returning to a safe environment that is free from harassment. Ideally, the organization has a policy on harassment and employees are aware of their obligations. If the message is communicated as part of regular training rather then when a particular situation occurs, the returning employee is less likely to feel as though they are to blame for any discipline that may take place.
(The Treasury Board policy on harassment can be found here)

What kinds of accommodations are people with a mental health problem likely to need?*

There is no comprehensive list of accommodations for people who are dealing with mental health issues.  Accommodations tend to be based on the individual needs of employees as well as on the resources available to the employer.  In some instances, a small employer will be unable to provide the same type of accommodation as a larger employer.  In most cases, accommodations are inexpensive and involve workplace flexibility rather than capital expenditures.

It is important to note that the following are suggested examples only.  Given the scope and diversity of psychiatric disorders, limitations may affect cognitive, emotional and social functioning.  These limitations may be temporary or intermittent, and, in some cases, may require long-term accommodation.  Consequently, each employee’s situation must be reviewed on a case-by-case basis.

The most commonly used accommodations for people with mental health problems include the following.

Flexible scheduling

• Flexibility in the start or end of working hours to accommodate effects of medication or for medical appointments.
• Part-time work (which may be used to return a worker to full-time employment).
• More frequent breaks.

Changes in supervision

• Modifying the way instructions and feedback are given.  For example, written instructions may help an employee focus on tasks.
• Having weekly meetings between the supervisor and employee may help to deal with problems before they become serious.

Modifying job duties

• Exchanging minor tasks with other employees.

Changes in training

• Allowing the person to attend training courses that are individualized.
• Allowing extra time to learn tasks.

Using technology

• Providing the employee with a tape recorder to tape instructions from a supervisor, training programs and meetings, if they have difficulty with memory.
• Allowing an employee to use headphones to protect them from loud noises.

Modifying work space or changing location

• Allowing an employee to relocate to a quieter area where they will be free from distractions.
• Allowing an employee to work at home.

More than anyone else, an employee will know what accommodation they need to allow them to work productively.  By talking directly with the employee, you will be able to come up with solutions that meet the needs of the individual as well as the organization.

One of my employees has a mental health problem.  How can I explain the situation to other employees?*

The co-workers of an employee with a mental illness may come to you with their concerns—maybe they’re nervous about working with someone they suspect or know has a mental illness.  Or they may approach you during the return to work of an employee who has been on disability leave for a mental illness, complaining that accommodations for that employee are special treatment.  This is often the case if the employee returning to work is given preferential hours, or is offered a private or preferential workspace.

Privacy comes first
First, remember your obligation to respect the privacy of your employees—a mental health problem is a medical problem, so you aren’t free to discuss it with other employees, just as you wouldn’t discuss confidential medical information.  In any case, there are constructive ways to answer other employees’ concerns.

If you hear other employees discussing the details of the individual’s illness, you need to talk to the other employees and let them know it is inappropriate.  If these conversations reveal discriminatory attitudes or could be seen to constitute harassment, appropriate disciplinary measures should be taken.

Ask your employee how they want to handle questions
Society still harbours stereotypes about people with mental illnesses, and those misconceptions and fears make their way into workplaces.  Although the stigma around mental illness can take the form of well-meaning misunderstandings, it often results in discrimination and harassment.  In a social environment like a workplace, it’s especially important to defuse and discourage stigma.  Remember, the employee with the problem will face the same questions you’re facing, and they’ll have to suffer the misunderstandings and resentments of other workers.

So ask the employee with the mental health problem how they’re handling questions about their problem and accommodations.  Some will be very open about recovering from an illness, or taking time each week to see a psychiatrist, or trying to manage stress.  Some will want to keep that information confidential, and it’s their right to do so. It’s crucial that you encourage the employee to communicate with you about their needs and preferences.  It will smooth the accommodation process for everyone.

Accommodations aren’t “special treatment”
Accommodations are used only when someone has a functional limitation—the limitation of skills and abilities due to a disability—preventing them from performing essential duties of their job.  Be open about the policy of accommodation at your workplace; accommodations—especially those for mental health problems—usually are easy and inexpensive to implement,  may be temporary, and increase the productivity of your workers.  Small adjustments can make a big difference in the mental health of your employees.

As a manager, what can I do about the unprofessional conduct of an employee, who I suspect has a mental illness, when he or she refuses to acknowledge there is a problem?  Can the employee be disciplined for his or her conduct?

The Commission as an employer has an obligation to provide a civil and respectful workplace for all employees. Harassment such as yelling and screaming, verbal abuse, hostile displays of anger and loss of temper, or rude, demeaning, vulgar or belittling comments from any employee should not be tolerated. The Commission has a harassment policy.

Where there is an indication that inappropriate conduct or a deficiency in an employee’s workplace performance may be health related, a supervisor should take proactive steps to discover the facts of the situation before deciding on a course of action. Managers and supervisors should thoroughly evaluate whether accommodation is necessary and whether the employee’s condition poses a serious threat to the operation of the branch or unit.  They should seek help from senior management within the branch, Human Resources and Corporate Services. Appropriate disciplinary measures may be imposed; however, if the misconduct was a consequence of a medical condition, that fact may be a mitigating factor in the imposition of discipline.
   
Note that while some forms of mental illness can impair a person’s ability to clearly assess his or her situation, without a statutory or collective agreement provision, an employer cannot force an employee to submit to a medical examination.
 
In cases of serious misconduct, if an employer has reasonable cause to believe that an employee is unfit to work or poses a serious risk, it may refuse to permit the employee to work until the employee produces adequate medical evidence supporting the ability to return to work.