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Attitudes of employers to the mentally ill


									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

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                                                                                       ORIGINAL PAPERS

Attitudes of employers to the
mentally ill
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 o«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
              off sick
        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 (¿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
                                                                                           ORIGINAL PAPERS

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.
                                                               D          O
                                                   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.
                                                      18. 489-491.
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     »Correspondence

Attitudes of employers to the mentally ill                                                                     543

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