Some people living with psychosis were perceived to avoid job-seeking due to the possible need to disclose their condition to an employer and potential impacts of stigma and discrimination. Participants suggested that, due to self-stigmatisation and/or past negative experiences, some people living with psychosis believe others will not understand them and expect to be judged if they enter the workforce or return to work following a relapse. There was evidence that some people avoid work altogether due to fear of workplace rejection, preferring to associate with others in a similar situation. For example, a peer support worker commented:
A lot of people are afraid of people with schizophrenia too so they’re afraid of that rejection, you know. When they go places, if someone knows that person’s got schizophrenia then the other people in the workplace are gonna [sic] be scared of them, don’t want them there...and that is a real thing that still a lot of people don’t want those type of people around....so people just think, well, it’s easier to stick with staying home or hanging out with friends who also have schizophrenia....
Participants pointed out that some people choose not to use employment services due to concerns about disclosure, labelling and stigma. Others seemed to try to avoid stigma by seeking work independently without accessing government funded employment support programs. A mental health case manager remarked:
...a lot of people want to return back to the workplace but they want to do it on their own because they don’t want to be labelled with a mental illness going into the workplace. They’ve still got that stigma. They believe there’s that stigma still there, so they’ll attempt [to find work] themselves and probably do quite a poor job of trying to get back in the workplace.
You’re acting as being a business, you’re running a business and you’re gonna have ten people come up to ya [you], right, nine of them perfect and one of them got this problem [psychosis]. You gonna hire that one person? Yeah but I’m not saying that why, we’re saying what people don’t hire ’em for. You know I’m not saying it’s right or wrong it’s what they do.
A number of participants alluded to attempts on the part of employers to screen out applicants with mental health conditions during the interview process. One participant who had been offered a job placement found that after she disclosed having bipolar disorder a job offer was not followed up. She recalled, “I could see body language change when I told them I was a bit bipolar ...”
Treated differently
Participants reported being viewed and treated differently from other employees in the workplace. An interviewee living with bipolar disorder described being a victim of heightened scrutiny and baiting:
… after I’ve got the job they watch me like a hawk. And I’ve found a few jobs they actually bait me to see how I’ll go, whether I’ll go one way or the other. They’ll bait me to see what I’ll do… then she’d smile at me but she’d know it’d piss me off so she’d watch me react and unfortunately she got a reaction out of me and that’s how I lost one of my jobs.
.... people just sort of look at you and think you’re a little bit different, start treating you a little bit differently, watch you a little bit more closely.
This respondent also described a phenomenon relating to misattribution of her moods.
You can’t have happy days...like everyone has emotions; everybody has a happy day; everyone has a sad day but when you have bipolar it’s like ah no have you checked your medication lately? you’re really not quite well ...it’s like shit… no, I’m just having an off day like everybody else. Usually [it’s]when you’re having a disagreement with them that’s when something [like this] …comes up.
Less tolerance in the workplace
An experienced employment consultant expressed the view that some employers may be less tolerant of work absences if the employee is known to have a mental health condition:
The other aspect too with employers is that ‘I’ve tried one of those before’. You know if somebody has a mental illness and it doesn’t work out, some employers say ah been down that track and it doesn’t work, they’re unreliable; yet if a non-disabled person comes to Friday night and has a night on the tiles and doesn’t come to work on Saturday morning that’s normal behaviour for young people here on [XXX]
A community member expressed a similar view:
Do you think there’d be less tolerance? Like the employer gives someone a go and says alright I’m not going to put them in the box of ‘nutter.’ I’m going to give this person a go. He gives them a go and then he has an episode…he doesn’t turn up for work one day or he comes in and … his condition is affecting his performance and he misses a day’s work. Do you think that employer… may be less tolerant of the fact that he has had this episode rather than the person who wakes up in the morning and says, ‘Ah I’ve got a cold and I can’t come in’? You know would you let them get away with that but the other guy I can’t come in because I’m having an episode? And do you think the employer would say ‘I knew this would happen’?... Not cut him as much slack as the bludger who just can’t be bothered to get up that day?
Victimisation
Victimisation in the workplace was perceived to take a variety of forms including rejection, bullying and harassment, humiliation, exploitation and unfair dismissal. Participants described being victims of ostracism, teasing and bullying. For example, a respondent living with schizophrenia said, “Work mates... they know you got a disability, they take it out on ya [you] and they pay out on ya [you] and so you just don’t want to be there”.
A community member pointed out that co-workers may feel uncomfortable, be resistant or reject such a person:
She’s been there [in the workplace] about four months and still the people [co-workers] tease her and they’re all young. Everyone’s only twenty and they don’t talk to her and include her and it's sort of mean in the workplace but the employees just don’t mesh well with her. They just don’t want to have anything to do with them because they’re so different. Like this lady once tried to interact but some people just laughed at her and walked away from her and that puts the boss in a position because he has to say, “Okay, well you can’t treat her like that”. And that makes the boss look bad, and the employees get grumpy because they like teasing each other...
A client respondent referred to having been the victim of name-calling in the workplace and suggested this was more likely to occur following a disagreement with a co-worker:
For years I self-mutilated so my arms are full of scars... so you get called ‘slashy’ or ‘slasher’ or something like that…just names and that’s well that’s just part of it. You just let it go
Inequitable remuneration and reduced opportunities for advancement
Participants cited inequitable employment practices including exploitative remuneration rates in sheltered workshops and lower remuneration rates in competitive employment situations. For example, a person who had been diagnosed with schizophrenia said:
I was getting one dollar per hour. And then after two weeks they said to me “What do you think of the job?” I said, “It’s horrible”. I said, “I’ve been to university and you’ve given me one dollar an hour for doing this”. I said, “I don’t want anything to do with it.”
There was a perception that if people living with psychosis do get jobs, they tend to be lower level jobs that are mismatched to their abilities and interests, and therefore not conducive to motivation or longevity of employment. For example, a peer support worker living with bipolar disorder commented:
Though I didn’t finish my degree and people say, ‘Ah, it’s good honest work’... I don’t want...I’m not going to go from studying science at university to being a check-out chick so there’s a lot of people like that, that’s very intelligent people but... their education was disrupted early...
Well from my point of view, from my experience, say if I [needed time off because I] was changing medications or stuff like that, communicating that with the boss.... it’s like a hard taboo subject…to talk about it...and if you do talk about it, you say “Ah look I’m changing medications” and then they go “Why” and you go “Ah well it’s because of this” and they don’t understand.... it’s hard to explain to someone, you know, I can’t function [while I’m changing my medication].
Disclosure difficulties
Participants reported some workers tend to be secretive about their condition and either do not disclose or partially disclose a condition in the workplace. Several participants were of the view that external social stigma and internalised self-stigma contribute to disclosure difficulties in the workplace. Disclosure difficulties can in turn impact on job retention and sustainability of employment. For example, a respondent living with bipolar disorder reported difficulty communicating with her employer due to a sense of shame associated with having a mental illness:
I did have a really good job years ago and because of some of my behaviour at the time [related to mental health condition] I lost the job and my father wanted me to take it further and I wouldn’t just ’cause of my shame around my illness but I probably should have pursued that but there was no support then to return to work. And…once again, you’re dealing with someone that’s been really unwell that doesn’t have that confidence to pursue that with the employer, to have that conversation, and probably they’re ashamed of their illness and they will leave rather than return to work.
Another participant pointed out that people may conceal their condition from work colleagues due to concerns about the consequences of disclosure:
I know a young woman who has serious bipolar disorder...but she understands it, she takes her medication and you and I could meet her in the workplace and you would have no idea... whilst working with her, I never dreamed that she had bipolar. We had never discussed it. There was never any opportunity. She certainly didn’t talk widely about it. It was only after my son’s incident that she came to me and said, you know, “I’d like to have a talk to you” and she said "I don’t tell anyone because”, she said, “straight away, it’s like there’s a barrier that people don’t understand or are frightened of it” ...she said, “I try not to tell anyone”. I think at that stage her employer did not know....that she was quite heavily medicated but well in control, just absolutely, so she had never felt comfortable enough to tell anyone... and it’s only that she shared it and I felt really sorry for her then...I thought that’s sad that you have to hide that sort of thing…
… it’s hard when, you know, like you’re taking medication and someone sees you and they ask you what it’s for or you have to go “Ah I’m going to the doctor”... all the time (laughs) or I’m going for a..... yeah, they start asking questions so that’s kind of hard…
A lot of it also comes down to whether they disclose [having a mental illness]. A lot of times we have that argument on our hands with new clients. Do I disclose [or] do I not? You’re sort of damned if you do and you’re damned if you don’t. Do I let those barriers down and tell the person [employer] and be honest because I may need to have periods off? Will that employer be willing to give me that time, or am I cutting my nose off to spite my face by telling them because I may not need any of that time off? So I tell them and I might not get the job but if I don’t tell them and I do need that time off they’re not gonna be aware of it and at least if they do know there may be a little bit of leniency there but that could also backfire on me and not get me the job
Non-disclosure may also affect employment consultants’ willingness to assist jobseekers, with some employment service providers regarding disclosure as crucial to a successful employment outcome. For example, one specialist disability employment consultant commented:
... in terms of helping and facilitating a good job match and supporting someone through an employment placement, disclosure is imperative. If you don’t have disclosure.....we can [only] point them in the direction of the job. We can assist with interview techniques and all those things that build around placement however we can’t help ’em any further than that.
Non-disclosure to an employer and/or to co-workers, due to fear of stigma and discrimination, may also result in a lack of employment support in the event of a relapse. Conversely having a supportive employer facilitates disclosure. A participant living with bipolar disorder commented:
Some [employers] are supportive, some aren’t. The one I’ve got at the moment is very, very supportive. It depends if they’re a supportive boss. If they’re supportive and you know they’re gonna be supportive give them a hundred percent [disclosure], don’t worry about it but if they’re not supportive no don’t tell them a damn thing ’cause they’ll hold it against you.
Impacts on emotional wellbeing
Responses indicated that stigma and discrimination contribute to work-related stress through several mechanisms. The need to conceal a condition from employers and co-workers can itself generate increased work-related stress. A major theme raised by participants was the stress generated by the decisions around disclosure of a mental health condition to an employer due to the significant risks of disclosure or benefits of non-disclosure. Table 1 lists benefits and costs of disclosure and non-disclosure, as perceived by participants.
Disclosure was commonly associated with fear, ambivalence, discomfort and embarrassment. Disclosure was also seen to carry the risk of discrimination, including various forms of victimization and heightened scrutiny in the workplace. A client participant said, “I’d rather tell them that right up front because I’ve always been upfront...that I am bipolar but I feel you get discriminated against...it happened to me”. Conversely non-disclosure to an employer was perceived to have stressful consequences for the employee. Importantly, it was pointed out that non-disclosure would preclude access to appropriate employment support if required.
The need to be secretive and conceal a condition from employers and co-workers was reported to create moral dilemmas. A participant with lived experience of bipolar disorder said, “I’ve found I need to be a little bit more cautious about who I tell-although I’m a woman of integrity- because some people judge you”. Others, who chose not to disclose, felt they had to resort to fabrication to explain absences:
Interviewer: how did you feel after disclosing it [mental health condition] to her [employer]?
Respondent: Um a bit of relief because I didn’t have to (loud sigh), not make up stories, but just sort of fabricate things and where I’m, you know...can I take this day off I’ve got an appointment and she’s like great what’s this appointment? She’d never ask me what the appointments were but in a way I kind of felt it was my duty to tell her
One participant acknowledged he had resorted to deception to fill gaps in his resume saying, “I’m a good con artist when it comes to writing job applications. I’m a con artist, yeah… when it comes to that…I know how to present at interviews”
A participant with lived experience pointed out that non-disclosure heightens the ongoing fear of relapse due to anticipated adverse reactions to relapse from their employer and colleagues who may be unaware of or lack understanding of these conditions.
The pressure to prove oneself to be as good as others in the workplace was also identified. A community participant, having discovered a work colleague was living with bipolar disorder, reflected:
... I thought you’ve lived with this [bipolar disorder] for years, trying to do all the right things, trying to prove that you’re as good as anybody else and you are, but for some reason she’d felt she had to do a better job. She had to make sure that everyone knew she was as good as everybody else. I thought that’s sad that you have to bend over backwards to prove that you’re as good as everybody else when there’s nothing to prove. She was excellent. She was a wonderful employee and is.
These stressors were seen to contribute to exacerbation of symptoms, decreased ability to cope and reduced capacity to sustain employment. The data indicates some non-disclosing clients, when unable to sustain work, would prefer to simply leave their employment rather than disclose their condition to an employer.
It should be pointed out several participants living with psychosis reported having had supportive employers and positive workplace experiences. Other participants pointed to the potential of people living with psychosis to become excellent employees. Importantly, many participants expressed the need for culture change in the workplace to overcome stigma towards people living with psychosis and to give them a “fair go”.