Monday, 26 October 2015

There is a relationship between Mental Illness, stigma and discrimination and productivity in the workplace; lessons for Uganda

Mental illness is a human condition caused by factors such as: trauma, accidents, racism, subjugation, lopsided laws, inequity, inequality, torture, criminalization and social structures (homelessness and treatment of women). Mental illness affects productivity due to: the different diagnosable mental disorder and how they are treated; work-defined disability; employer-defined disability; utilization and access of workplace rehabilitation facilities. Mental illness is a health condition that has been the trigger of stigma and discrimination.  

To locate how productivity and mental illness affect each other one has to first understand how productivity at the workplace is nested as well as how mental illness is perceived in society today.  Productivity at the workplace involves a multitude of baseline factors. The factors are: human resource; shelter; economic status of people;  the money invested to establish the job, the level of qualifications, skills, competency, assets; and job description. The jobs range: army, intelligence, banking, law, government, Non Government Organizations, Faith Based Organizations, education, hospitality, service industry, transport, post, telecommunication, administration, media, broadcasting, artisanship, architecture, engineering, construction and publishing. At a minimum, a job requires one to match the job requirements, appear on time at work, stay at work for the requisite duration, have the ability to interpret and transform all work processes into performance. To be good at a job, one has to have values such as: must be able a team-player, dependable and responsible. Human-resource related factors depend on health status of an individual. The way one is treated at work or in society has repercussions on performance. Cognitive levels directly affect  safety behavior, workplace accidents and level of conscientiousness (Wallace, 2003).

Privilege, class, racism, levels of sophistication and the striation due to patriarchy or matriarchy directly affect the way societies produce materials. In today’s world, one has to appreciate the presence of social, cultural and behavior values that are different. One has to also appreciate that some values in one culture may be ridiculed by another. Whole races have had to be subject to denigration by others. Many examples abound. This is seen in the service, education, banking, government, law and health-care. For the purpose of mental illness and productivity in the workplace, the way diagnosis of mental illness need to be tailored to the client who presents the illness. Follow up care should be tailored to that person’s cultural background.  Historically, western social and behavioral scientists have focused largely on the individual as a major source of psychological and social dysfunction or impaired mental health. This tends to ignore the role of social structures that certain cultures depend on.  There is power in social structures and practices and their impact on individual behavior. This needs to be in-built in the rehabilitation path of one with mental illness. Addressing minority issues in the US calls for this (Dorothy, 1990). 
Women have borne the brunt of mistreatment and many end up with mental illness. In the workplace, a woman may choose to keep secret the way she is treated by her husband or men in her life. This can affect her workplace productivity. Women’s struggle for equality is impeded by over 800 pieces of blatantly sex-discriminatory law currently on the US statute books. In most states women cannot co-sign for a loan even though property is jointly owned. In rape cases, a woman with prior sexual experience is less likely to be believed if she claims she was raped. To an extent, a woman is still seen as “property” to be controlled and owned by men( Chambliss, W.J., 2011).

Mental illness, unfortunately has been used as the reason to discriminate and stigmatize those suffering from it. There is potential in many who are labelled and stigmatized as mentally ill. Because of this many isolate themselves and never seek opportunities available to them to rehabilitate as well as be of service to their communities. In this, they are depriving society of taxable incomes. By the year 2020, depression arising from mental illness will emerge as one of the leading causes of disability globally (WHO). Mental illness in and by itself affects workplace productivity. Mental illness arises when social economic opportunities are absent; combined with substance abuse; low socioeconomic class; differential family structure; poor performance in school;  and antisocial behavior of parents (Williams, 1986). Under diagnosed mental illness in a culturally diverse setting from the stand point of stereotyping may perpetuate the very illness it is supposed to treat. Multicultural context approach e.g. transcultural, inter-cultural, cross-cultural, anti-racist and feminist are forms of counseling needed if one is to deal with minority groups. These have sound theoretical base, value and effectiveness if beneficiaries participate in them (Moodley, 1999).

In the US, 75%-85% of people with severe mental illness are un employed and in UK they are 61%-73%. Just because they have severe mental illness, it should not be a reason for them to be denied employment.  There are compelling ethical, social and clinical reasons  for helping people with mental illness to work. From an ethical stand point, the right to work is enshrined in the Universal Declaration of Human Rights 1948. From a social stand point, high un employment rates are an index of the social exclusion of people with mental illness, which the US and UK governments are committed to reducing. From a clinical stand point, employment may lead to improvements in outcome through increasing self esteem, alleviating psychiatric symptoms, and reducing dependency (Crowther, 2001).

  A given percentage of employed people with diagnosable mental disorders are employed. Employees with mental disorders need to be cared for and this costs money. Canada loses $ 4.5 billion attributed to work-related productivity losses due to depression (Dewa, 2004). Mental illness contributes to absenteeism and disability days. This in turn contributes to decreased productivity. Mental illness is also associated with short term and long term disability, which in turn is often related to insurance coverage. Mental illness accounts for 30% of disability clams, at a cost of $ 15- $ 33 billion annually (Dewa, 2004). 

Mental illness affects productivity due to the different manifestations such as: co-morbid disorder; mental disorder (major depressive disorder, mania disorder); anxiety disorder ( social phobia, agoraphobia, panic); affective disorder; substance dependence (alcohol dependence, illicit drug dependence). Work-defined disability is defined as any restriction or lack of capacity to perform an activity in a manner or within a range considered normal (Orme and Costa e Silva, 1995). Employer-defined disability, on the other hand is defined as that which accounts for the additional administrative costs the employer incurs as a result of the sick day or the cost of finding a substitute for the absent worker (Dewa, 2004). 

Workplaces that anticipate providing employee rehabilitation need to have a responsive  environment. The responsive environment through which workplaces provide rehabilitation cost money. Achieving employment for people with mental illness involves focusing on individual enhancement. This builds behavioral coping skills and task ability. The individual is able to manage symptoms and the job is able to increase diversity at the workplace (Akabas, 1994). 

 Depressive disorders have the largest medical plan costs of all behavioral health diagnosis in US. There are implications for the medical benefit plan design, disability plan management, and occupational health professionals’ training (Conti et al, 1994). Depression adversely affects work productivity in form of work absence and reduced performance while at work (Stewart et al, 2003). 

Litigation due to discrimination cases is another means through which mental illness affects productivity. Work is a major determinant of mental health and a socially integrating force. To be excluded from the workforce creates material deprivation, erodes self confidence, creates a sense of isolation and marginalization and is a key risk factor for mental disability.  This in turn may be the cause of stigma and discrimination experienced by people with mental disabilities. Stigma is both a proximate and distal cause of employment inequity for people with mental disability who experience direct discrimination because of prejudicial attitudes from employers and workmates and indirect discrimination owing to historical patterns of disadvantage, structural disincentives, against competitive employment and generalized policy neglect. There are multiple attitudinal and structural barriers that prevent people with mental disabilities from becoming active participants in the competitive labor market (Stuart, 2006).

In talking about the relationship of mental illness and productivity one has to also explore the nesting ground in which mental illness thrives. Addressing mental illness in the workplace is just a tip of the iceberg. the issue of stigma must be addressed at policy, program and community level. We have seen that mental illness is a human condition caused by factors such as: trauma, accidents, racism, subjugation, lopsided laws, inequity, inequality, torture, criminalization and social structures (homelessness and treatment of women). Mental illness affects productivity due to: the different diagnosable mental disorder and how they are treated; work-defined disability; employer-defined disability; utilization and access of workplace rehabilitation facilities. Mental illness as a health condition triggers off stigma and discrimination.  The treatment of women as second class citizens, discrimination and stigma should be given extra attention wherever they rear their ugly heads.

Akabas, Sheila H. 1994. Psychosocial Rehabilitation journal, Volume 17 (3), 91-101.

Chambliss, W.J. et al. 2011. Criminology: Connecting Theory, Research and Practice. McGraw-Hill Higher Education.

Conti, Daniel J. and Burton Wayne.1994. The Economic Impact of Depression in Workplace. The American College of Occupational and Environmental Medicine.

Crowther, R et al. 2001. Helping People with Severe Mental Illness to obtain Work: Systematic Review. BMJ 2001: 322 doi:

Dewa C. et al, 2004. Nature and Prevalence of Mental Illness in the Workplace.

Dorothy Smith Ruiz.1990. handbook of mental Health and Mental Disorder Among Black Americans. Greenwood Publishing Group.

Moodley, R. 1999. Challenge and Transformations: Counselling in a Multicultural Context. International Journal For The Advancement of Counselling. Volume 21, Issue 2, pp 139-152. DOI: 10.1023/A:1005347817892.

Stewart, F. et al . 2003. Cost of lost productive Work Time Among US Workers With Depression. JAMA. 2003: 289 (23): 3135-3144. doi: 10:1001/jama. 289.23.3135.

Stuart, H. 2006. Mental illness and Employment Discrimination. Lippincot Williams and Wilkins, Inc.

Wallace, J.C. et al. 2003. Workplace safety performance: Conscientiousness, cognitive failure, and their interaction. Journal of occupational Health Psychology, Volume 8(4), October 2003, 316-327.

Williams, Donald. 1986. The Epidemiology Of Mental Illness in Afro-Americans.