Originally published in the December 2022 issue of The Pennsylvania Psychologist
Since the pandemic, workplace mental health has become a topic of interest. Companies focused on mental health will have an easier time attracting talent, as employees view mental health as one of the most important factors when considering a job offer (Deloitte, 2022; Lyra, 2022; Modern Health & Forrester Consulting, 2021). People with chronic illnesses face unique workplace challenges. With 60% of the population reporting at least one chronic illness (Centers for Disease Control and Prevention, 2022), these employees make up a significant portion of the workforce.
Workers have little faith that their companies can assist these employees. A recent survey showed 59% of workers believe management is not competent in supporting employees with chronic health conditions, and 88% of those surveyed believe they themselves are not competent either (Cancer and Careers, 2019). With support, people with chronic illnesses can contribute just as much as their peers, and maintaining a stable job can prevent their health from deteriorating, as unemployment is associated worse mental health outcomes (Strandh, et. al., 2014) and alarming increases in mortality (Gerdtham & Johannesson, 2003).
Many individuals with chronic illness are too healthy to qualify for disability but not healthy enough to work the same way as their peers. As a result, they face discrimination in hiring and promotion decisions. They find themselves trapped in jobs because they need to maintain health insurance (Chute & Wunnava, 2018). And even if they find gainful employment, they continue to face stigma and may struggle to maintain consistent schedules. They experience a taxing process of impression management and rely on compensatory behaviors, such as pushing through the pain and working long hours – behaviors that could exacerbate their illness (Beatty, 2012; Beatty & Joffe, 2006).
Workplace stress is often a topic in therapy for people with chronic illnesses, but the literature provides clinicians with little guidance. Cognitive Behavioral Therapy (CBT) can benefit their overall mental health (Ehde et al., 2014; Taylor, 2006;), but CBT has not demonstrated particular effectiveness in reducing their workplace stress (Bergström et al., 2012; Dalgaard, et al., 2017). One promising study (McGonagle et al., 2014) demonstrated that a brief coaching intervention improved self-evaluations and resilience, but this study did not look at other outcomes, such as performance ratings. Obviously, more work needs to be done, and this should a focus of research moving forward.
Future research should also include qualitative studies (Beatty, 2012). Many people find a sense of purpose in work, and changes in their ability to work can lead to a feeling that their life has lost a source of meaning. Many symptoms of chronic illness are invisible. The choice of whether to disclose one’s illness is complex, and learning to advocate for oneself can be challenging. Qualitative research could help psychologists integrate these shifts in identity, meaning, and goals into the therapeutic process.
Given the lack of research, it is difficult to make treatment recommendations, but some strategies appear promising. Clinicians can help clients acknowledge their work limitations, process their feelings about disrupted career goals, and develop an alternative vision for their professional future. Alongside that vision, clinicians should work with clients to develop a realistic plan to achieve their new career goals. Clinicians should develop a basic knowledge of employment laws to assist their clients in understanding their rights. Assertiveness training could help clients feel empowered to advocate for themselves.
Beyond therapy, psychologists should also consult to organizations. Many organizations assume they do not need a special approach for those experiencing a chronic illness, offering employees the same accommodations they offer those who are acutely ill – namely, sick leave and short-term work reductions. This leads to uncomfortable situations where employees with chronic illnesses have to reapply continually for temporary accommodations (Beatty & Joffe, 2006).
There is a clear need for workplaces to acquire greater awareness of chronic illness. Psychologists could address this by collaborating with other health professionals to offer workshops on various health conditions, their potential impacts on job performance, and best practices for accommodation. To amplify the voices of those with chronic illness, psychologists could partner with Employee Resource Groups (ERG). An ERG is a volunteer based, employee-led group within a company that advocates on diversity issues. These groups should include employees with chronic illnesses in their membership and develop a platform that incorporates their concerns.
Psychologists could also collaborate with Human Resources (HR) departments to create a formal set of policies for addressing chronic illness. HR should be encouraged to offer clear guidelines on accommodations and how they can be requested. At the same time, research suggests that HR should grant managers the latitude to negotiate informal arrangements with their team members based on their unique needs (McGonagle, 2021). It may also be beneficial for HR to create alternative career paths that allow people with chronic illness to advance, but without taking on types of work that could worsen their health.
Changes to policy must be accompanied by a supportive organizational culture. Psychologists could facilitate this culture shift through coaching leaders. General coaching around emotional intelligence provides a strong foundation of skills to build trust and engage in open, honest conversation. Psychologists could build on this foundation by coaching leaders on how to apply these skills with employees who have a chronic illness (McGonagle, 2021).
With rates of chronic illness set to increase, society as a whole has an interest in addressing these workplace issues. Companies have a financial interest, as chronic illnesses already costs the United States 19.6% of its Gross Domestic Product – much of which is related to lost productivity. That cost will only increase as time goes on (O’Neill Hayes & Gillian, 2020), and it could be minimized through proper accommodation and support. Workers with chronic illnesses have a personal stake, as they want meaningful employment (Meister & Wollfrey, 2021). Psychologists are uniquely positioned to be a voice for change, but to do so we must challenges ourselves to speak directly to the challenges faced by those with chronic illness – in clinical settings and beyond.
Works Cited
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