Attitudes of employers to the mentally ill
Cressida Manning and Peter D. White
Psychiatric Bulletin 1995, 19:541-543.
Access the most recent version at doi: 10.1192/pb.19.9.541
Reprints/ To obtain reprints or permission to reproduce material from this paper, please write
permissions to email@example.com
You can respond http://pb.rcpsych.org/cgi/eletter-submit/19/9/541
to this article at
Downloaded http://pb.rcpsych.org/ on November 23, 2011
from Published by The Royal College of Psychiatrists
To subscribe to The Psychiatrist go to:
Attitudes of employers to the
Cress/do Manning and Peter D. White
Patients often ask psychiatrists for advice on how to From clinical experience, we believed that
answer questions about their health, when seeking the stigma and ignorance of mental illness
employment. They fear not being employed if they often determined the employment prospects of
declare that they have suffered from a mental illness. those who had been mentally ill. We therefore
The attitudes of personnel directors of 200 randomly designed a study to examine the attitudes of
chosen public limited companies were measured. This employers to the employment of people who
confirmed significant reluctance, stigma and ignorance were or had been mentally ill.
about employing and believing the mentally ill.
Employers decided whether to employ someone by
considering the job description, the standard of
previous work, whether the applicant was receiving The study
treatment, previous time off sick, and the particular A 17-item questionnaire was designed to ask
illness suffered. Those with depression were more likely
about attitudes to employing people who
to be employed than those with schizophrenia or
alcoholism. The largest companies were significantly
had been or were mentally ill. It was piloted
more likely to employ patients and were less likely to
with three personnel officers and the edited
seek dismissal than the smallest. Employers would
questionnaire was sent to a sample of
welcome more information about mental ill health. 200 personnel directors of public limited
Potential employees should approach large firms and companies, randomly selected from those
seek treatment. registered with the Stock Exchange (Crawford,
1992). A reminder and second questionnaire
were sent out after six weeks. The data were
Unemployment is one of the main difficulties described and analysed using either the Mann-
faced by people trying to get back to a normal Whitney U test or the x2test.
life after a mental illness (Herman & Smith,
1989). Dightman & Marks (1968) found that
being in hospital a year previously and a lack
of relevant work skills more or less guaranteed Findings
unemployment. That unemployment itself One hundred and twenty questionnaires were
causes mental ill health produces a vicious received, which correspond to a 60% response
circle that is hard to break out of (Lahelma, rate. Of these, 11 questionnaires were
1992). incomplete or inadequate and were therefore
People with affective disorders are more excluded.
likely to be employed than those with Table 1 gives the main results. Half the
alcoholism. People suffering from schizo employers would never or only occasionally
phrenia are the least likely to be employed employ someone currently unwell. This
(Bacani-Oropilla et al, 1991). Social rejection proportion was reduced to 28% when con
of the mentally ill is determined by previous sidering those previously unwell. Over half of
personal experience of illness, perceived employers would never/occasionally employ
dangerousness, and age. Educational level someone who was currently depressed,
may be particularly important in determining increasing to 66% when considering someone
employment (Trute et oÃ-,1989). Fortunately currently suffering from schizophrenia and
employers who specifically hire people with 73% for those with alcoholism (/2=28.5. 2d.f.,
mental illness are motivated to re-integrate P<0.001). The proportion never/occasionally
them into work and want more information employed fell by 13% if the employee was
about mental illness (Hubschmid & Schaub, undertaking a "medically approved psychiatric
1988). drug treatment".
Psychiatric Bulletin (1995), 19, 541-543 541
Table 1. Percentage of employers who would recruit patients
Percentage responses (n=109)
Health oÂ«andidate Always/usually Sometimes Occasionally/never Unsure
Table 2. Factors considered in deciding offer of employment
Percentage responses (n=109)
Factor Always/usually Sometimes Occasionally/never Unsure
Standard of previous
yearParticular in previous
To measure stigma we asked employers The size of the firm, as measured by the
about whether they believed the medical number of employees, had little influence on
diagnoses given in sick-notes. Eighty-two per the employment of the mentally ill, when
cent of employers would usually believe analysed by a median split. However, there
someone being off sick for a physical illness, were differences when we compared the largest
compared to only 63% of employers believing 25% of companies with the smallest quartile.
someone was genuinely ill with a psychological We found that the largest employers were
illness (Â¿2=5.37,1 d.i., P=0.02). Twenty-three significantly more likely to employ current
per cent would sometimes dismiss an mentally ill people (Mann-Whitney test:
employee for a previously undeclared mental P<0.01). The largest firms were also more
illness, compared to 23% never doing so. likely to employ people with current alcohol
Forty-nine per cent of employers would never problems (P=0.02) and were less likely to
dismiss someone developing a depressive dismiss them (P=0.01).
illness during employment, compared to 15%
for alcoholism and 13% for schizophrenia
(X2=40.8.2 d.f, P<0.0001). Comment
Fifty-six per cent of employers considered We achieved a good response rate for an
that other employers were usually biased unsolicited random survey. We measured the
against employing those who were currently bias of non-participation by asking
mentally ill. Twenty-nine per cent of employers respondents to judge the attitudes of other
thought that other employers were usually employers. These results were remarkably
biased against those who had been similar to their own attitudes. Fifty per cent
previously mentally ill. of employers would never/occasionally employ
Table 2 shows the criteria that employers the currently mentally ill, compared with 56%
said they used to decide whether to employ of other employers who were judged to be
someone who was or had been mentally ill. The usually/always biased against employing the
most important factors were the job currently ill. This suggests that these results
description, the standard of previous work, are representative of all public limited
whether receiving treatment, and the time companies in this country. However, these
spent off sick in the previous year. results may not represent what employers do
542 Manning & White
in practice. Personnel directors may also good work record and minimal sick leave.
behave differently from other executives. Finally, it may be wise to seek employment
Most employers were cautious about from larger rather than smaller firms.
employing people who were currently mentally Many employers were 'unsure' in their
ill, particularly those with schizophrenia or replies. This may reflect ignorance about
alcoholism. This replicates the findings of mental illness and its effect on work ability.
Bacani-Oropilla et cd (1991), except that, in Mental and occupational health professionals
this study, alcoholism made a more negative should provide appropriate information for
impression. employers. Mental health professionals
The negative attitudes towards current or should pay more attention to rehabilitation
ex-patients may be related to previously back to work (Lohr-Wiegmann, 1988). We
unsuccessful employment. Against this, some should also fight prejudice by educational
employers prefer to employ a skilled patient programmes, such as the Defeat Depression
more than an unskilled well person (Dightman campaign (Sims, 1993), and working with the
& Marks, 1968; Hubschmid & Schaub, 1988). media (Scott, 1994) and employers.
However, the strength of stigma and ignorance
of mental illness was shown by the observation Acknowledgements
that employers were more likely to believe a
sick-note declaring a physical rather than The authors thank Fiona Ash, Janet Whelan,
mental illness. Anne Elliott, Marianne Woods and Dr Ruth
Only 13% of employers would usually Seifert for their help and advice, as well as the
dismiss an employee for having a mental companies who participated in the study.
illness which was previously undeclared.
The majority of firms would not dismiss an References
employee for developing a depressive illness, T.. S..
BACANI-OROPILLA. LJPPMANN, TULLY,E., et al (1991)
but the attitude to alcoholism or schizophrenia Patients with mental disorders who work. Southern
was less liberal. The Employment Protection Medical Journal. 84. 323-327.
CRAWFORD'S IRECTORY F Cnr CONNECTIONS (1992) London:
(Consolidation) Act (1978) does not discrim Benn Business Information Services.
inate between physical and mental ill health CRONER(1988) Croner's Employment Law. London: Croner
regarding dismissal on the grounds of Publications.
incapability. Dismissal usually occurs for two C.
DIGHTMAN. R. & MARKS.J. B. (1968) Employer attitudes
toward the employment of the ex-psychiatric patient.
reasons. First, the employee may be absent Mental Hygiene, 52. 562-569.
from work for considerable periods. Second, HERMAN,N. J. & SMITH. C. M. (1989) Mental hospital
the illness may affect the employee's ability to depopulation In Canada: patient perspectives.
perform his/her job satisfactorily or safely. Canadian Journal of Psychiatry. 34, 386-391.
HUBSCHMID. & SCHAUB,M. (1988) Long-term psychiatric
The employer usually asks for a medical patients In the workplace. A survey of employers.
report. Using this information, the employer Rehabilitation-Stuttgart. 27. 145-148.
will decide the best course of action, balancing E.
LAHELMA. (1992) Unemployment and mental well-being:
the needs of the employee and the firm elaboration of the relationship, international Journal of
Health Services. 22. 261-274.
(Croner, 1988). Options include deferral of a U.
LOHR-WlEGMANN. (1988) Occupational rehabilitation of
decision until the prognosis is more clear, psychiatrically handicapped patients-concomitant help
transfer to other work within the firm, place in employment. Rehabilitation-Stuttgart. 27. 69-76.
ment on a 'holding register' until recovered, SCOTT.J. (1994) What the papers say. Psychiatric Bulletin.
early or medical retirement or dismissal. SIMS, A. (1993) The scar that is more than skin deep: the
Encouragingly, the most important criteria stigma of depression. British Journal of General Practice,
for recruitment were the work record, the job 43. 30-31.
on offer, and previous sick leave, rather than TRUTE.B.. TEFFT. B. & SEGALL.A. (1989) Social rejection of
the mental illness itself. Employment chances the mentally ill: a replication study of public attitude.
Social Psychiatry and Psychiatric Epidemiology. 24.
may be enhanced by being on a medically 69-76.
approved treatment programme.
What should potential employees do to Cressida Manning. Medical student. The Royal
London Medical School, and *Peter D. White,
enhance their chances of employment?
Chances of employment are improved if the Senior Lecturer in Psychological Medicine, St.
Barthlomew's Hospital Medical College.
applicant is recovered, on a medically
approved treatment programme, declaring a London EC1A 7BE
depressive illness, and stressing a previously Â»Correspondence
Attitudes of employers to the mentally ill 543