Definition of psychiatric and mental health conditions and common diagnoses
Psychiatric and mental health conditions are terms that describes a broad range of mental and emotional conditions. These conditions refer to one portion of the broader ADA term “mental impairment” and are different from other covered mental impairments such as impaired cognitive ability, organic brain damage, and learning disabilities. The term ‘psychiatric disability’ is used when a psychiatric or mental health condition significantly interferes with the performance of major life activities, such as learning, working, and communicating, among others.
Someone can experience a psychiatric condition over many years. The type, intensity, and duration of symptoms vary from person to person. They come and go and do not always follow a regular pattern, making it difficult to predict when symptoms and functioning will flare-up, even if treatment recommendations are followed. Symptoms of psychiatric conditions are often effectively controlled through medication and/or psychotherapy, and may even go into remission. For some people, the condition continues to cause periodic episodes that require treatment. Consequently, some people with psychiatric conditions will need no support, others may need only occasional support, and still others may require more substantial, ongoing support to maintain their productivity.
The most common forms of psychiatric and mental health conditions are anxiety disorders, depressive disorders, bipolar disorders, and schizophrenia-spectrum disorders. Brief introductory information about these conditions is presented in this section for educational purposes only. The National Institute of Mental Health has excellent information about these disorders provided in simple language. https://www.nimh.nih.gov/health/topics/index.shtml
Anxiety Disorders
Anxiety disorders, the most common group of psychiatric conditions, are characterized by severe fear or anxiety associated with particular objects and situations. Most people with anxiety disorders try to avoid exposure to the situation that causes anxiety. Anxiety disorders can include Panic disorders, or the sudden onset of paralyzing terror or impending doom with symptoms that closely resemble a heart attack as well as phobias which includes excessive fear of particular objects, people, or situations.
Depressive Disorders
Depressive disorders are characterized by a depressed mood most of the day, nearly every day, a lack of interest in activities, slowing down of thought and physical movement, fatigue, feelings of worthlessness, inability to concentrate, among others. These conditions often involve changes in how you feel, think and handle daily activities such as sleeping, eating and working. Depressive disorders can vary in severity and intensity. With appropriate treatment many people with depressive disorders improve substantially. There are several types of depressive disorders.
Bipolar and Related Disorders
Bipolar disorders (formerly called manic depression) causes unusual shifts in mood, energy, activity levels, concentration, and the ability to carry out day-to-day tasks. There are three types of bipolar disorder. All three types involve clear changes in mood, energy, and activity levels. These moods range from periods of extremely “up,” elated, irritable, or energized behavior (known as manic episodes) to very “down,” sad, indifferent, or hopeless periods (known as depressive episodes.
Schizophrenia Spectrum and other Psychotic Disorders
Schizophrenia-Spectrum Disorders are highly complex, and few generalizations hold true for all people diagnosed with schizophrenia spectrum disorders. However, most people initially develop the symptoms before the age of 30. Typically, these disorders are characterized by thoughts that seem fragmented and difficulty processing information. Symptoms of schizophrenia disorders are categorized as either “negative” or “positive.” Negative symptoms include social isolation or withdrawal, loss of motivation, and a flat or inappropriate affect (mood or disposition). Positive symptoms include hallucinations, delusions, and thought disorders.
With guidance from the Diagnostics and Statistics Manual – DSM-V, 2015, American Psychiatric Association; National Institute of Mental Health, Mental Health Information web page.
Examples of disclosing a psychiatric or mental health condition
The Equal Employment Opportunity Commission (EEOC) has published Enforcement Guidance on the ADA and people with psychiatric conditions. In it, the EEOC states that someone who has a psychiatric condition can tell their employer about their situation using plain English language and not technical medical terms. This means that the employee is not required to use certain terms, such as clinical diagnoses to disclose a psychiatric condition and request accommodations. Some examples of the terms and phrases that an employer may hear are:
- I have a medical condition that requires more frequent breaks to do my work.
- I need some time off or a leave of absence because I am stressed and depressed.
- I take medication for a disorder that makes it difficult to get up early in the morning.
If the employee’s need for accommodation is not obvious to the employer, the employer can ask for documentation of their limitations by a professional. Similarly, most teachers may not have specific information about the diagnosis, but Disability Services Offices in colleges and universities require professional documentation of the disability. You can read a Summary of the EEOC Guidance on this site in the Laws section or read the full text on the EEOC site.
How psychiatric and mental health conditions can affect functioning in work and school
The Centers for Disease Control and Prevention recognizes that mental health in the workplace is an important topic and have suggested the ways in which poor mental health can affect the employee.
Poor mental health and stress can negatively affect employee:
- Job performance and productivity.
- Engagement with one’s work.
- Communication with coworkers.
- Physical capability and daily functioning.
Depression is associated with higher rates of disability and unemployment.
- Depression interferes with a person’s ability to complete physical and cognitive job tasks.
- Many employees with depression don’t receive treatment to address depression symptoms.
Taken from the CDC: https://www.cdc.gov/workplacehealthpromotion/tools-resources/workplace-health/mental-health/index.html
In addition, the following issues have been noted about work performance:
The irregular nature of psychiatric conditions – The somewhat unpredictable nature of psychiatric conditions may create problems in establishing or maintaining consistent work or school patterns. Some individuals may need time off for medical appointments or to recuperate. The irregular nature of psychiatric conditions might also impair an individual’s performance.
Stress associated with non-disclosure– Anxiety often accompanies the effort to hide a condition and its symptoms. Many individuals do not disclose a condition for fear of stigma and discrimination. This fear may be compounded if an employee feels that a job or their standing in school is in jeopardy.
Side effects of medications– Despite their effectiveness for many people, medications also can have side effects that create difficulties at work or in school. Each person has an adjustment period after starting, changing the dose of, or stopping medication. Some of the most common side effects include:
- drowsiness
- dizziness
- dry mouth
- nervousness
- headaches
- shakiness
- confusion
- weight gain
Interrupted education or training – Many people first develop symptoms of a psychiatric or mental health condition between the ages of 15 and 25 and traditional educational or vocational training may be delayed. This may affect their credentials for jobs or educational programs.
Co-morbidity – Research suggests that a large portion of adults with psychiatric conditions also have had a substance use/abuse disorder during their lives. In addition, many adults who have had substance abuse disorders have had one or more psychiatric conditions during their lifetimes. Treatment and accommodation in these cases address both the effects of substance abuse as well as the effects of the person’s psychiatric condition.
Note: The information contained in these pages is for educational purposes only, and is not legal advice. Individuals should contact the appropriate legal resources for specific legal advice regarding their particular situations.