Reasonable Accommodations: An On-line Resource for Employers and Educators

Reasonable Workplace Accommodations for People with Psychiatric Disabilities

By Kim MacDonald-Wilson, M.S., Reasonable Accommodations Project Director,
Center for Psychiatric Rehabilitation, Boston, Massachusetts

July 26, 1997 marked the seventh anniversary of the Americans with Disabilities Act (ADA). This landmark law was enacted with bipartisan support and are designed to open doors for 49 million Americans with disabilities. It prohibits discrimination on the basis of disability in employment, public services, public accommodations, transportation, and telecommunications (The White House, Office of the Press Secretary, July 24, 1997).

With the implementation of the ADA, we have faced critical issues in providing accommodations for people with psychiatric disabilities in the workforce. These issues include the ongoing stigma and discrimination associated with mental illness, verifying who is covered under this law, the question of costs of accommodations, and a lack of understanding about how the ADA applies to people who experience a psychiatric disability.

These issues are fueling a movement to challenge the ADA, especially as it applies to people with psychiatric disabilities. As employers become more aware that the ADA does apply to people with mental illness, information is needed to address issues in hiring and employing people with psychiatric disabilities, and in particular, information about when the ADA applies and when it does not.

The field is not yet at the point of defining the state-of-the-art in developing reasonable accommodations, but a number of initiatives in the past 5 years have expanded the base of knowledge about accommodations. Preliminary findings from the Center for Mental Health Services’ Employment Demonstration project currently underway indicate that accommodations and other supports are the keys to success (Mental Health News Alert, 5/27/97).

The federal government also funds a variety of initiatives to help employers and others to implement the ADA. The President’s Committee on Employment of People with Disabilities and the Job Accommodation Network (JAN) provide practical information and technical assistance on the issues of employment of people with disabilities and accommodations.

In addition, ten regional Disability and Business Technical Assistance Centers (DBTACs) have been created by the National Institute on Disability and Rehabilitation Research (NIDRR) to provide access to low-cost practical information, resources, and technical assistance about the ADA to employers. NIDRR also awarded a 3-year technical assistance grant to the Washington Business Group on Health to develop a database and informational materials on reasonable accommodations for workers with psychiatric disabilities.

Matrix Research Institute recently completed a study of the types of accommodations and issues faced in implementing job accommodations for people with psychiatric disabilities (Granger, Baron & Robinson, 1996).

Since the implementation of the employment provisions of the ADA in 1992, there is now a record of cases that have been brought to the courts by the Equal Employment Opportunity Commission (EEOC) and new enforcement guidance has been published to clarify the interpretation of the law in relation to people with psychiatric disabilities. However, there are still unanswered questions about how accommodations are developed and how to apply the ADA to people who have psychiatric disabilities.

In 1993, the Center for Psychiatric Rehabilitation initiated a study funded by the National Institute on Disability and Rehabilitation Research to examine employment outcomes and characteristics of individuals receiving workplace accommodations through supported employment programs.

For the purpose of the project, reasonable workplace accommodations were defined as those changes an employer makes to a job, the work site, or the environment that enable a qualified person with a disability to participate in the job application, hiring, and employment processes. The thrust of the project was to focus on accommodations actually in use and to define the employer expectations and functional limitations of the employee that led to the need for the accommodation.

In addition, data were collected on the costs associated with the accommodations and the employee, employer, and supported employment service provider characteristics to ascertain the critical ingredients of useful and successful accommodations.

Data were collected for up to 1 year on 194 employees with psychiatric disabilities in 26 supported employment programs in 3 states (Maryland, New Jersey, and Massachusetts). A total of 322 reasonable accommodations were provided by 209 employers (some employees had more than one job and more than one accommodation). Focus groups were also conducted with teams of the employee, employer, and supported employment provider to discuss in depth the process of accommodation.

Study Findings

The types of accommodations most frequently used were categorized into three types including:

  1. job coach assistance in hiring;
  2. general job coach support at the worksite; and
  3. flexible scheduling.

A frequency table highlighting these categories is provided (Table 1).

Table 1
Frequency of Types of Accommodations
(Total # of Accommodations = 322)
Type of Accommodation Percent
Job Coach Assistance in Hiring

  • Job Development:
  • Job Coach Interview Assistance:


General Job Coach Support On Site 23.0%
Flexible Scheduling 21.7%
Changes in Supervision

  • Extra or Modified Supervision:
  • Job Coach Providing Supervision:


Changes in Training

  • Extended Training on Job:
  • Job Coach Training Assistance:



Modified Job Duties 5.6%
Modified Work Environment 0.6%
Tolerance of Behavior 0.3%

  • Accommodations unrelated to Psychiatric Disability:
  • Transportation Assistance:


These accommodations involved the supported employment (SE) provider accompanying an applicant to job interviews, assisting with job applications, answering interviewer questions, providing on-the-job emotional support, and helping an employee with the social skills needed to develop rapport with co-workers and supervisors. In addition, many employees were allowed part-time hours, more frequent breaks, and were permitted to come to work later or leave earlier than other employees.

Under the ADA, employers are only required to provide reasonable accommodations for functional limitations that are due to a disabling condition. In fact, general procedures for developing accommodations suggest first identifying the functional limitations in order to specify needed accommodations (EEOC, 1992).

This is the first study to analyze the functional limitations experienced by the employees. It provided a more thorough understanding of factors that contribute to the need for accommodations.

For those in the study, the most frequent functional limitations were in the areas of social interaction, learning the job, maintaining work stamina or pace, and managing symptoms (Table 2).

Table 2
Frequency of Types of Functional Limitations
Type of Functional Limitation Percent
Interacting with Others

Learning the Job (remembering routine, following instructions, learning job tasks) 25%
Maintaining Work Stamina/Pace 16%
Managing Symptoms/Tolerating Stress 14%
Following Schedule/Attending Work 9%
Solving Problems/Organizing Work 9%
Using Basic Literacy/Language Skills 9%
Concentrating 7%
Assessing Own Work Performance 6%
Interpreting Social Cues/Work Culture 5%
Responding to Feedback 4%
Adjusting to Work/Changes 4%
Transportation/Resource Deficit 4%
Initiating New Tasks 4%
Miscellaneous (physical limitations, lack of experience) 3%

Approximately 56% of the participants in the study had co-occurring medical conditions such as learning disabilities, mental retardation, substance abuse or physical impairments which produced additional limitations in learning, social interaction, and motor or sensory skills. We found that a number of functional limitations were related to academic deficits or language barriers and were not, strictly speaking, related to the employee’s disability.

Nonetheless, often such limitations were accommodated. Out of 322 accommodations provided, only 1 accommodation had a specific cost. This compares to the Job Accommodation Network information reporting 80% of accommodations cost under $500 for people with a variety of disabilities (JAN, 1996) and Matrix Research Institute’s findings that 58% cost nothing, and another 32% cost under $100 (Granger, Baron & Robinson, 1996).

While the majority of accommodations did not require out-of-pocket costs for the employer, there were indirect costs associated with accommodations. For example, SE providers reported that supervisors averaged 5 hours per month of extra time spent with employees and co-workers averaged 9 hours per month.

While the size of the businesses participating in the study varied from under 15 to over 500 employees, the size of the worksite where the employee worked was generally small with the majority employing 25 people or less. Nearly one in five employers had fewer than 15 employees, and would not be required to comply with the ADA.

Eighty-six percent of the employers reported being aware of the ADA and 76% had previous experience in hiring workers with a disability. In addition, we found during the focus groups that several employers had previous experience with individuals with a mental illness, such as a friend, family member, or former employee.

The focus groups created an opportunity to explore the process of developing reasonable accommodations. The issues around disclosure of a disability was a major concern within each group. Employers preferred to have disclosure of a disability in the job interview in order to enhance their ability to respond. However, employees and SE providers expressed their hesitancy to disclose this early, fearing that opportunities for employment would be limited.

In disclosing information, SE providers hesitated to use terms such as psychiatric disability, reasonable accommodation or the ADA for fear of prompting concerns on the part of employers. Often, little information was shared about the disability, but suggestions were offered about how to best interact with the employee and the accommodations needed.

Employers commented frequently about their reliance on the expertise and support of the SE providers. SE providers described walking a fine line between providing support to the employer and encouraging the employer to move toward independently supervising the employee.

Additional finding

from the focus groups suggested that employees, while appreciative of the opportunity to work and relieved that disclosure was handled by the SE provider, were relatively unaware of the ADA, their rights under the law, or what reasonable accommodations were provided by the employer.

SE providers sometimes had difficulty distinguishing between the supports that they provided to the employee and the accommodations provided by the employer. Employers were at times going beyond what is required by law in providing accommodations, but may not have been aware of doing so. It appears that employees, employers, and providers of vocational services to persons with psychiatric disabilities all need more information about what accommodations are, how to develop them, and what is required by the ADA.


The findings of this study demonstrated that consumers are frequently unaware of their own functional limitations and needed accommodations. Providers and employees need guidance to weigh the advantages and disadvantages of disclosing disability and to discuss the disability and its limitations with employers in practical terms. Employers, employees, and service providers need basic information about the implications of the ADA and developing reasonable accommodations.

Also, SE providers can play an important role in assisting supervisors to become competent in defining the essential functions of the job, identifying the functional limitations of employees, developing accommodations, giving feedback, and addressing performance problems.

Describing specific functional limitations may clarify for employers and employees how mental illness affects job functioning and what accommodations address these limitations. Sharing information with employers about the types of accommodations that are most frequently used and that are inexpensive and relatively easy to implement, may allay employer concerns about employing people with mental illness.

Though the employment provisions of the ADA have been in effect for 5 years, the findings of this study suggest that providing reasonable accommodations to persons with psychiatric disability remains a more ambiguous and ill-defined process than for other disabilities. More information and training is needed for employees and employers about the practical aspects of implementing the law.

But for the most frequent arbiters of the ADA for persons with psychiatric disabilities, supported employment providers clearly need training and empirical data to help realize the promise of the ADA for those they serve.


EEOC (1992). A technical assistance manual on the employment provisions (Title I) of the Americans with Disabilities Act. United States Equal Employment Opportunity Commission: Washington, DC.

Granger, B., Baron, R.C. & Robinson, M.C.J. (1996). A national study on job accommodations for people with psychiatric disabilities: Final report. Philadelphia, PA: Matrix Research Institute.

Job Accommodation Network (1996). Benefit-cost analysis of job accommodations. Morgantown, WV: Job Accommodation Network, a service of the President’s Committee on Employment of People with Disabilities.

Reprinted from the Community Support Network News, Summer/Fall, 1994 , 12 (1)

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.