I was only three months into a new job when my mental illness began getting in the way of my job performance. My boss told me that I seemed distracted. I knew that I was letting small details fall by the wayside and making avoidable mistakes. She gave me a two-week grace period to shape up before reevaluating my performance, but trying harder at my job wasn’t going to fix things. My distractedness was a symptom of the attention-deficit/hyperactivity disorder (ADHD) I’d been battling since grade school.

For as long as I can remember, friends were always telling me that I was “spaced out” and teachers would say I had trouble taking directions. I started taking an antidepressant in 2017. Although it was prescribed for my obsessive-compulsive disorder, my psychiatrist said it might also help me become more attentive. But since it hadn’t, I took his suggestion and started taking Adderall after explaining my job predicament to him. Here was something I could point to, to show my boss that things would improve.

But when I mentioned this to my psychiatrist in a follow-up email after our appointment, he advised against it. “It will more likely backfire, since she may assume meds won't help or not really know the condition and conclude you're permanently incapable,” he wrote in an email. “If you really think you need to say something, you can say an ‘untreated medical condition’ that’s now being addressed.” Perhaps, he suggested, I could say I’d had an issue with my thyroid. The email struck a nerve. My boss was very understanding when my co-worker, who was outspoken about her diabetes, left early to pick up medication or came in late for a doctor’s appointment. Why should I, and so many others, hide their mental illness at work?

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Since I was 9 years old, I’d been hiding my weekly therapy appointments and blistering anxiety. When I finally started taking medication a few years ago and opened up about my struggles with mental health, I thought I finally shed my layers of stigma. While my doctor had intended to protect me from further stigma, his comment stung. All those feelings of shame, and anger for feeling ashamed, came crawling back. It forced me to worry all over again if people—in this case, my boss and co-workers—would misunderstand my illness.

Turns out I’m not alone. Three in 10 people admit that they are embarrassed to talk about their anxiety or depression. In another survey, less than a third of full-time workers felt at ease about asking for support around their own mental health at work, and only one in four were comfortable talking to their company’s HR and senior leaders on the topic. Less than half of respondents who did manage to speak up described it as a positive experience. In fact, almost 60% of employees have never spoken to anyone at work about their mental health status, according to the Harvard Business Review. Experts say if more employees were aware of and had access to their mental health rights and accommodations, they’d be more willing to speak openly about their mental illness to their employer. Here are important steps to consider if you are interested in pursuing your own mental health accommodations.

Know your rights

Sixty-two percent of missed work days can be attributed to mental health conditions, making it the greatest cause of worker disability in the US, according to a National Alliance for Mental Illness of Massachusetts report, “Bad for Business: The Business Case for Overcoming Stigma in the Workplace.”

To qualify for protection under the Americans with Disabilities Act (ADA), you must be able to show that your mental illness substantially limits your ability to perform major life activities; has substantially limited you in the past, even if it isn’t doing so now; or is perceived by other people as being substantially limiting, even if it isn't.

Peter Frattarelli, chair of the labor and education department at Archer, a Haddonfield, New Jersey-based law firm, explains these categories in more detail. “The first category means that the mental condition impacts the ability of someone to go on with their everyday lives and work,” he said. The second, he explains, protects previously ill employees who are currently being treated. “The third is where the person never really had a disability, but they were thought to have one,” he says. Firing anyone with a past, present, or perceived disability clearly violates the ADA, he concludes.

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But disability discrimination isn’t always clear-cut. Helen Rella, an employment attorney at Wilk Auslander, a New York-based law firm says it’s not considered discrimination if they fire you because the accommodations you’ve requested (for example, taking leave for a year) aren’t reasonable or place an undue hardship on your employer.

To obtain ADA accommodations, you must disclose your mental illness to your employer. Still, your employer does not have the right to access private health information that you choose not to disclose. "Treatment records are confidential under HIPAA," explains Fawn Fitter, the co-author of Working in the Dark: Keeping Your Job While Dealing With Depression. Exceptions kick in when a person with mental illnesses poses a threat to self or others.

What does accommodation mean, anyway?

The ADA requires employers to modify a job, job application process, or work environment to give employees with disabilities just as much opportunity to succeed in the workplace as their non-disabled colleagues. An employee might be granted permission to eat and drink at her desk, for example, so that she can take her medication without having to go to the break room.

Workplace accommodations for someone with a mental illness might include breaks to call a therapist, work-from-home opportunities, or altered work schedules to attend therapy appointments,

Requesting reasonable accommodations to do your job goes through the Human Resources department. (If your company doesn’t have an HR department, contact the U.S. Department of Labor’s Job Accommodation Network for free, confidential advice.)

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If you need an extended leave due to your mental illness and your company has over 50 employees, then you’re legally permitted to take up to three months off under the Family and Medical Leave Act. This allotted time can be broken up in hours per week for therapy.

Only five states offer paid FMLA. “However, many companies have short-term disability insurance as a benefit, so you can get a portion of your pay from your insurance,“ explains Frattarelli.

If you work for a smaller company which doesn’t offer FMLA, you can apply for disability and take, on average, up to six months leave, Frattarelli says. Even if you don’t apply for disability, you’re still permitted to take time off for therapy as long as you explain to HR that you have a mental illness and provide medical proof he says.

Find a comfortable work environment

After landing a new job where my manager and colleagues exuded positivity and offered encouraging words, my performance sharply improved. Sure, I worried about botching assignments when I stopped taking Adderall, but that didn't happen. I felt more comfortable asking my boss for a sick day every now and then because the communication with my teammates from the onset proved to me that the publication valued everyone’s personal time and health. Over time, my therapist and I definitely saw an improvement in my mental health once I felt more confident and rewarded in my new role.

Treatment reduces symptoms of common mental illnesses like depression and anxiety in 75% of people. And more than 80% of employees who do receive treatment report improved job satisfaction. If you're struggling with these issues, find out if your employer offers an employer assistance program or resources through StigmaFree, a campaign sponsored by the National Alliance on Mental Illness.

If you’re not comfortable in your environment, Russell Thackeray, PhD, a UK-based organizational psychologist suggests making a career change that plays to your strengths and interests.

Breaking the ice with your employer

When Thackeray coaches employees on how to speak about mental health at work, he tells them to be “factual and pragmatic,” as if they are talking about a damaged leg or cancer and its effect on their job abilities. Instead of just stating your illness in a meeting with your boss or HR, tell them what you need, he advises. You can say, “Hey, I’m not well at the moment and want to discuss how I can schedule my work over the following weeks until I get better.”

Frattarelli explains that if an employee discloses their mental health issue to an employer, it is usually because they are requesting an accommodation. “Then the topic is out in the open, and there can be a full dialogue over what is going on, what the employee can do or not do, or if they need time off.”

If you want to discuss how to address mental health in the workplace, in general, Thackeray suggests holding a meeting. “During a team meeting, an employee I coached simply piped up, passed around an appropriate brochure, and suggested they spend 10 minutes talking about mental health. Another person I helped, who’s a manager, brought his teams together when his friend had a family member that had committed suicide without any warning.” These meetings are also an appropriate time to address resources and treatment provided by the company or elsewhere.

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Laurise McMillian, an Instagram strategy editor at Refinery 29, made an infographic with phrases to use when you’re speaking about mental health at work. For example, instead of saying “my new medicine got me fucked up,” you can say, “I started some new medication and it has mild side effects. If you see me excuse myself from a meeting or something, just know I needed air or water and I’ll be back shortly.”

If your company isn’t supportive of mental health awareness, remember you can slowly start setting the tone of your company’s culture and become an advocate for yourself. I started dropping the words anxiety, ADHD, and OCD in conversation when my colleague spoke about her diabetes, so my labels would get the attention they rightfully deserve.

Telling your boss about your mental illness is a personal choice. In my case, I didn’t feel that I required an accommodation because I wasn’t taking time off from work. But every now and then I wish I had told my former boss, the one who chided my “underperformance.” Ultimately, I chose to leave of my own volition because I no longer wanted to be part of a company that didn’t value my hard work. And now that I’m in a place where I feel accepted, where I’m playing some small role in changing the conversation around work and mental health, I can be myself, and that feels amazing.

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