If you have had some form of mental or emotional illness, you have probably already experienced the need to deal with the discomfort with which some people may respond to your disclosure of the condition. As you approach a job search, you may be particularly anxious about employers' responses to your illness, whether it is a current condition or something that is part of your past. It may be helpful to remind yourself that you already have considerable experience in handling issues of disclosure.

In a perfect world, disclosure would not be an issue, because there would be no stigma attached to mental illness; you could let an employer know that you had been hospitalized for a psychiatric illness two years ago with as little fear of negative consequences as if you let him or her know that you had been in the hospital at that time for a broken leg as the result of a skiing accident. Now federal law offers you protection from discrimination during your job search.

Unfortunately, although the law is on your side, and the stigma attached to mental or emotional conditions is diminishing, it has not disappeared and it is not necessarily predictable where you will encounter it. Since your objective is probably to obtain interesting employment, rather than to prevail in court, you still need to develop a strategy for your job search, whether that involves no, some, or total disclosure of your medical history. This handout will discuss both the situations in which disclosure is not at all optional, and the more complex situations in which you may feel that it is.

The first step in any case is to make sure that your career goals are congruent with your ability to perform the kinds of jobs you are seeking. If you have any doubt at all about whether it would be wise for you to undertake a particular kind of work now, be sure to discuss that question with the therapist or health-care provider who has been treating you. Discuss both whether you could do the job with no modifications, as well as whether you could do it with the "reasonable accommodations," which an employer is now required to make for you.

In order to have this discussion, you need to know a fair amount about the type of work you may be seeking and, equally importantly, about the kinds of environments wwwhere it is performed. Take advantage of the full range of services offered by your campus career center as you seek this information. Most career offices offer individual counseling, libraries of written materials, and presentations. In addition, many have alumni programs which allow you to meet individually with alumni in a wide variety of career fields. In this one-on-one setting, you can ask many "What is it really like?" questions. Should your campus not have such a program, many of the excellent books on career planning which are available in local libraries and bookstores discuss ways of creating these "informational interviews" even without the support of a campus office.

If you are not already aware of the types of work situations which may be problematical for you at this point, discuss these issues with your therapist or health-care provider, then proceed to get first hand workplace information. As you speak with people in the workplace, however informally, you are also beginning to make an impression and establish contacts to which you may wish to return, so give some thought to ways of phrasing questions which will give you the information you need, and yet reflect well on you.

For example, "Is this a stressful job?" is difficult to answer except by throwing back, "What do you consider stressful?" and may give the impression that you can't work well under any degree of pressure. It's better to ask more precise questions, such as, "In this field, is the nature of a workday usually fairly predictable, or does each day bring unexpected new requests?" "Are deadlines usually predictable or unpredictable?" "Can you describe the typical fluctuations in the work cycle?" "How would you describe this work environment?" "What types of people do you think are usually successful at this kind of work?" "How much variety of types of tasks is there in a typical working day?" "On Monday, when you have your calendar set for the week, by Friday, how much has it differed?"

What is stressful varies from one individual to another; one person may be as stressed-out by lack of variety as another is by constant change. However, here are some of the features of jobs which most people may find particularly emotionally or physically challenging.

• Frequent travel, especially between time zones.
• Very long hours; the 12 or more hour workday is the norm in some environments.
• Unpredictable work schedules.
• Too much or too little direction and structure.
• Responsibility for results without the resources required to produce them.
• Low morale among co-workers.
• Lack of control of one's schedule or activities.

It is not necessarily the case that more responsible or higher-status jobs are less stressful than lower-status ones; repeated studies have shown that some of the greatest incidence of job-related stress occurs among some lower level clerical workers.

If, as you inquire about a field, you find it attractive, but it's not something you can imagine doing right now, be sure to ask about other kinds of experience which might be desirable for someone who planned to move into the field at a later point. Most people now make many career changes over the course of a lifetime, so, in most cases, not doing something next doesn't mean you won't have an opportunity to do it later. Also try to get a good sense of how competitive the field is and how well qualified you currently are to enter it and to obtain a position with an employer you are enthusiastic about. Whenever a field is highly competitive, all good candidates, however strong their qualifications, will need to work vigorously to "sell themselves," and to take rejection in stride. So also consider how you manage those demands.

If you might be interested in doing some kind of work with "reasonable accommodations," explore what some of those might be, and whether or not they are realistic. For example, if you are applying for a kind of job which requires that you do a lot of solitary work at your desk, such as computer programming, and your ability to perform the job would be enhanced by an inexpensive screen placed near your desk so that you were not distracted by other people in the work area, that might be considered a "reasonable accommodation," because it would enable you to perform the "essential functions" of the job. On the other hand, asking to be hired for a sales position, but relieved of the responsibility for making personal contact with new customers would not be reasonable, because it would interfere with the "essential function" of the job, which includes contacting potential customers.

If you have determined that you will be able to perform the type of work you are seeking without asking for any accommodations on the part of your potential employer, then you may be in a position to decide whether or not to disclose your condition. If you do plan to ask for accommodations, then you will must have some discussion of why they are necessary. If you think that you do not need to request any, then you may elect to avoid disclosing information about your condition.

Your initial application for most positions will consist of sending a resume and cover letter to a potential employer. In addition, you may be required to complete an application form. In some fields you also provide evidence or your work, such as a portfolio, and, less frequently, take some sort of test. The general rule at this stage of the process is to concentrate on providing information about the job-related skills, experiences, knowledge, and abilities which will interest an employer in interviewing you. When you have a limited amount of space and time with which to get an employer's favorable attention, you do not want to waste it calling attention to medical conditions which will, at the best, be a neutral, rather than positive, factor in motivating employers to want to interview you.

As you plan your job search, make sure that you've lined up three or four people who will be willing to serve as references. Your college or university career center may have a service through which you can place letters of recommendation on file, thus avoiding the need to ask each recommender to write a new letter for everything for which you apply. Whether or not this is the case, you need to be able to give names of people who may be contacted by phone. If anyone who will recommend you is aware of your medical history, discuss with them how you would like them to handle it in their recommendation. Almost always it would be preferable for them to make no reference to it at all. However, occasionally a recommender is so impressed by the way you've h andled a difficult personal situation that he or she mentions it out of a genuine desire to be helpful to you; therefore, it's best to ask the recommender not to disclose any information you wish to keep private.

In most cases there is no reason to refer to your illness in either your resume or your cover letter, and you should not do so. Employers do tend to expect that, from about high school on, you are able to account for your time, generally in connection with a school, an employer, or responsibility for raising children. What should you do if your resume includes "gaps" because of your illness? What if, for instance, you graduated from high school in 1985, you graduated from college in 1993, and there is no dated experience on your resume from 1985 until 1991 (because that was a period of time in which you were unable to work)? The first choice, if practical, is to try to account for the gaps, while honestly, somewhat vaguely. For example, if the only formal work you did for two years was occasional babysitting, you might say, "Child care work, 1989-1991." If you did occasional carpentry work, sang in a church choir, and did occasional office work for a local charity, you might say, "Free-lance construction work and community service, 1989-1991."

While these statements will not be impressive to an employer, they will be reassuring and will help avoid having your resume screened out because some gap of time appeared "suspicious." You may be asked about them in the interview, but you will be able to discuss them in relation to your more impressive achievements. If there is simply no practical way that you can account for your time on the resume and you do have long undated gaps, you may consider omitting dates entirely. This is not a perfect solution, because many employers will interpret the omission of dates as "hiding something." On the other hand, some candidates find that after they begin omitting dates from their resumes they begin getting interviews.

Everything on your resume should be true. On the other hand, a resume is more like a truthful advertisement of your qualifications than it is a fully complete statement about your background. As long as what you say on your resume is true, most people will not view omission of information as deceptive. An application form is another story. Some make it clear that omitting information will be viewed in the same way as would misrepresenting it. Therefore if you are asked to list every position which you have held, you are probably well advised to do so, although phrases like "free lance" or "independent contractor" can still be used if they accurately describe the conditions under which you worked.

The hardest topic on which to advise you is what you should do if an application form includes questions which the ADA now makes impermissible at this stage of the application process. A preliminary application should not ask a question like, "Have you ever consulted a psychiatrist?" but unfortunately, not all application forms have yet been revised to comply with the law, and it may take years before they come into full compliance. So what do you do if you are asked this question, and the answer is "yes"? Ethically, this translates into a decision about whether you are obligated to tell the truth in response to an improper inquiry. Practically, you are free to consider this ethical question only if you are reasonably certain that the information you are trying to conceal will not come to light later.

For instance, if you are currently taking a psychiatric drug and may need to reveal that fact later in the search in order not to test positive for illegal drugs, then you will probably need to answer "yes" to the question when it is asked now. In general if an employer finds that you have misrepresented information on an application, that is grounds for dismissal. In the case of government employment, however, misrepresenting information may also entail criminal penalties. The worst a private employer can do to you is to fire you; the worst a governmental entity can do to you is to prosecute you. An added incentive to tell the truth on government applications is that the sometimes bureaucratic nature of civil service hiring will also tend to assure compliance with the Americans with Disabilities Act.

Feeling that their patients' right to be considered for employment without being illegally stigmatized overrides a patient's obligation to answer an illegitimate question truthfully, some therapists do advise their clients to conceal information even when doing so involves directly answering a question falsely. For instance, Dr. Paul Fink, the former president of the American Psychiatric Association, said in an interview with the columnist Darrell Sifford, "The stigma is there, and to deny it and sacrifice yourself by telling the truth makes no sense...."1 (I'll add footnote when I figure out how). Another strategy (which cannot be guaranteed to be risk-free) is simply to skip the inappropriate questions on an application. We hope, of course, that as e mployers come more fully into compliance, there will be far less need to make this kind of decision.

An interview provides a chance to establish rapport with a future employer, to discuss the contributions you could make as an employee, and to answer the employer's questions about you as a future employee. If you will need to discuss special accommodations, if your illness is obvious from your resume or application, or if you have good reason to believe that the employer has learned of it already, you will want to discuss it at some point in the interviewing process. Whenever an employer may have, or receive, information which may be construed as unfavorable to your candidacy, it will be to your advantage to discuss it directly. That way you have more control over the presentation of the information and can respond to the employer's concerns and quest ions.

Whether or not you think you are likely to need to discuss your illness, however, the main thing which should be discussed in the interview is the job, your qualifications for it, and your interest in it. Preparing for and having a good interview is beyond the scope of this publication, but by all means take advantage of the many good books which are on the market and of any interviewing workshops or practice sessions which may be available to you at your career center. Prior preparation can be the decisive factor that helps you land the job. Below are discussed only the aspects of an interview in which you may need to discuss your illness.

Preparation will be very helpful in this case. Identify the questions which you hope will not be asked, decide how you would like to respond to them, and then practice, practice, practice until the responses you wish to make come naturally. Don't memorize your answers and risk sounding like a recording; rather, simply think about what approach you would like to take, and think of several ways to express it. Whenever someone is uncomfortable about discussing something in an interview, a natural first impulse is to answer a question about it at such length that the interviewer, who may not originally have been particularly interested in the topic, picks up the anxiety, becomes concerned, and continues to question. On the other hand, if you can give a brief, positive answer to the question, the employer may well be satisfied with your answer and go on to the next topic. You should by all means give a true answer, but there are many, many ways to answer a question truthfully without necessarily volunteering information you would prefer to keep private. Let's look at an example. For instance, suppose that you had a semester of very poor grades due primarily because you were experiencing many personal difficulties then. The employer says, "I notice that second semester sophomore year really brought down your grade point average. What happened?" A few examples of poor responses will suffice to show what can go wrong:

• "Well, I was having some problems, which I'd really rather not go into now." (Makes the employer curious about the problems)
• ³I had bad luck that semester and got the worst teachers in the entire university.² (Suggests that you don't take personal responsibility for what you do, but blame any problems on others).

Here are some examples of better responses:

• "Yes, I wasn't giving my coursework enough attention that semester. But I learned from the experience and, as you noticed on my transcript, my grades have been better ever since." (It may be that although it required enormous effort on your part to give your coursework the attention it did receive, it wasn't enough to result in higher grades).
• "I learned one thing that semester which is reflected in my subsequent grades--how important it is to let something challenging be an incentive to work all the harder."(Shows that you can take something positive from a negative experience).
• "That was the semester when I learned that I'd chosen the wrong major; once I started studying something that really interested me, I found the work much easier." (Stresses your interest in and commitment to your subsequent choice of study).

Once you've given a basic answer to the question, it may be wise to take the initiative in turning the conversation toward a topic that you would rather discuss, while still acknowledging the employer's right to take control the general direction of conversation. To continue with the above example, you might go on to say:

• "You'll notice that once I started taking math courses, my grades went up. While I work hard at math, I enjoy its problem-solving aspect. That's why I decided to apply for positions like the one you're filling, where analytical problem-solving skills are key to succeeding in the job."
• Or, "In fact, in every way my last two years of college were the best part of the experience. My junior year was when I first started working at the arts center. Would you be interested in hearing about some of the responsibilities I had there?"

However, while you may hope to avoid discussing your illness by not volunteering unnecessary information, you should also decide ahead of time what you will do if asked point-blank about the information you wish to conceal. While it's actually very unlikely that this will occur, if you know how you will respond to the questions you dread the most, then a major source of anxiety in the interviewing process has been removed.

As a part of the self-assessment discussed earlier, you and your therapist or health-care provider may have decided that you would need to request "reasonable accommodations" in order to be able to perform a certain kind of work. Examples of what reasonable accommodations might be include:

• Altered working hours (For example, coming in an hour late and working an hour late). Whether this is possible will depend on the job. For instance, in an office environment this might be reasonable, whereas it might be impractical for a first-grade classroom teacher.
• Some shelter from visual or auditory distractions in the workspace. A screen around a desk might be considered "reasonable"; remodeling the office most likely would not be.
• More frequent supervisory meetings for the purpose of gaining frequent feedback on work performance.
• Ability to take time from work for medical appointments.

You are best-served to raise these issues after you have had an opportunity to discuss the contributions you can make in the job, that is, after you have given the employer reason to want to hire you. You could conceivably defer this discussion until you have been offered a position, and, in fact, may choose to do so if your request will be relatively minor. For example, if all you feel you will need is more frequent feedback and would like to request, say, weekly rather than biweekly supervisory meetings, then you might wait until you are offered a position to raise the issue. After a receiving a job offer you could ask, as part of the consideration/negotiation stage of the process, something like, "I find that I work best and do my job with the most confidence if I receive frequent feedback. If I take this position, would I be able to meet with you weekly to discuss my work, at least at the outset?"

On the other hand, if you need to request a substantial accommodation, such as altered working hours, it may be better to raise the issue before you are offered the position. The argument for waiting until after an offer would be that, if the accommodation you request would be indeed deemed "reasonable" in terms of the ADA, the employer is almost forced to grant it or risk the possibility of a lawsuit. The argument for not waiting so long to raise the subject is that pressing claims of discrimination is a major personal decision which many people choose not to undertake, and that it is very difficult to have a successful job situation in which you and your boss distrust each other. If someone offers you a job and only then learns that you can't accept it under the conditions you've been implicitly discussing, he or she may feel annoyed that you've suddenly "changed the rules of the game." In the end, the timing of such a discussion is a judgement call, depending upon all nuances of a specific context.

Whenever you choose to have a discussion of accomodations, however, try to be as clear as possible about what you require, and to make the accommodation sound as simple as possible for the employer. For example, if you merely say, "I may need to take extra time off from work," the open-ended nature of the statement will naturally make an employer nervous. On the other hand a statement like:

"For the next 6-12 months, I'll need to take a hour and a half during a working day once a week to keep a medical appointment. I know at the outset I won't have earned any vacation or sick time, and I'll be happy to make up the time, at your convenience, before or after the working day, or during lunch hours,"

sounds unambiguous, easy, and reassuring.

If you can offer references of any sort who can reassure the employer that what you are suggesting will work out, this will be enormously helpful. The references could come from a former employer who has successfully made an accommodation for you, an emp loyer who routinely makes this accommodation as part of its policy (if you are lucky enough to learn of one), a career counselor who has first-hand knowledge of similar situations which have worked out successfully, or anyone else who might be presumed to be objective.

This situation is rare, but, if you face it, your best strategy is to take the initiative in addressing an employer's concerns. Do not give detailed information about past problems, but stress your ability to perform the job at this point in time, and be able to provide references who can attest to your ability to do so. However, bring up the issue later in the interview, after the employer has already had a chance to be favorably impressed with your abilities and interest in the position.

For example, if the interview has gone on for some time, and the employer has not asked you any direct questions about your illness, but seems to make veiled references to it, you might say something like, "I know Bob Jones has already told you that I needed to take a medical leave from my previous position. I wondered whether you had any concerns about that and would like to ask me anything about it." This borders on asking an employer to ask questions which may not, strictly speaking, be legal. You, however, will not be volunteering information about the medical problem, only about your current ability to perform a job. Generally speaking, if an employer has concerns, it is to your advantage to address them. Ideally an employer would respond that h is or her main concern was whether you are now able to perform the job for which you're applying. What would you do, however, if instead he or she says something like, "He did tell me, but he didn't give any details. Exactly what was the problem?"

You are not required to give a detailed answer in this situation, even if you are asked for one. It's preferable to give an answer which defines some boundaries between legitimate and illegitimate questions and conveys a willingness to respond to legitimate inquiries. For example: "It was a problem which has been successfully resolved. I'm sure that I'm now in a position to do everything this position demands. I'd like to tell you my understanding of what it requires and see if I understand it correctly." (This invites the employer to engage in a discussion of the position itself, and shows that you have given serious prior thought to it).

Since some inexpensive drug tests will test positive for almost any substance, someone taking a legally prescribed psychiatric drug is at risk of "flunking." Drug tests are admissible at an earlier stage of the screening process than are physical exams, so someone can be eliminated from consideration at this stage without it's being obvious that a medical condition was the reason. Perhaps they just "weren't as qualified."

Therefore if you are taking legal psychotherapeutic drugs, and are asked to take a drug test by a prospective employer, try to find out what sort of test you will be given and whether or not you will learn its results. If the answers are unclear, you should probably say something like, "I am taking a prescription medical for a condition which will not impact on my job performance. If this causes a positive drug test, I would like to know, so that I can provide you with medical documentation." Make clear that you are not refusing to take the test (which could be grounds for eliminating you from consideration), merely trying to ascertain that its results will be interpreted fairly.

By the time an employer requires a medical examination, you are under the fullest protection of the ADA. If you have a job offer which is contingent upon the successful completion of a medical exam, the job offer can be legally withdrawn only should the examination reveal a condition which would make it impossible for you to perform the job. At this stage, illegal discrimination would be clearest and easiest to protest. If you are asked to release medical records, you may have the option of releasing one set, which make no reference to mental or emotional difficulties, and not volunteering the existence of another, which do. This is what some therapists or health-care providers in fact advise clients to do. On the other hand, if you do not answer questions about your medical history fully and completely, you may risk losing employer-provided insurance coverage, and this is a tremendous risk to take.

What you can do, if you need to reveal some medical data in the exam with a company physician, is to try to ensure that your own mental health care provider provides records, perhaps supplemented by a letter, which stress your ability to perform the work which is required. With this documentation it should be virtually impossible for the employer to legally withdraw a job offer after the examination. It might be useful to tell the physician that you know mental illness is sometimes connected with some stigma and that you know that you are protected under the ADA. Ask the examining physician whether he or she has all the documentation needed to report that you are able to perform the job in question. If the answer is yes, make a note of that. If the answer is no, find out exactly what you would need to provide and obtain those materials. Don't make threats. Simply convey the idea that you know your rights and that of course you're sure the employer will respect them.

Job-hunting is often stressful. Try to find a group of people who will support you through the process. Some members of your informal "team" should be friends or family members who simply care about you, wish you well, and provide encouragement at the i nevitable times of discouragement. Another member should be someone who can give you good advice about how to job hunt and to present yourself effectively; often a counselor at your campus career center can play this role. Keep in touch with your therapist or health-care provider throughout your job-hunt, even if you are no longer in treatment; this person will likely be familiar with issues of disclosure and can give you good advice, as well as provide any documentation you might need. Your search will benefit from the combined support, wisdom, and advice of all these individuals.

Jane L. is now an M.B.A. who works in human resources for "XYZ," a major corporation. At the time she applied for her current position, she was taking lithium for bipolar disorder. Until this job application, she'd never had to consider the issue of disclosure, because it had never arisen in interviews for her previous positions. In one job interview, she'd been questioned about a gap in her resume, and answered that she'd had a health problem, but was fine now, and she was not questioned any further on the issue. XYZ, however, required a physical before confirming an offer of employment they had made to her. The physical it included a detailed questionnaire which asked about mental illess. A drug test was also required. Although its purpose was not to identify psychotropic drugs, some tests do identify lithium.

There was "a lot of angst, because I knew that there was a possibility I could lose the job, which I really wanted." Ms. L. considered going off lithium enough before the test that it would have left her body before the drug test. However, after discussing the situation with her psychiatrist and a lawyer, doing some investigation, and giving the situation some thought, she decided to continue with her medical treatments and to disclose her condition to the physician who performed the company examiniation.

When she discussed the situation with the company physician, he assured her that the bipolar disorder (which, because it was successfully managed, would not interfere with her job performance) would not be revealed to her boss. He also assured her that the drug test which would be used would not identify lithium. When she filled out the medical questionnaire, she decided to give so much detail about the rest of her family's medical history that the information about her bipolar disorder didn't particularly stand out on the page. She "passed" the physical and got the job. She's not entirely certain that the confidentiality has been maintained; however, it hasn't seemed to affect her career with the company.

She's currently not taking lithium, and considering looking for another job right now. In the next job search, she's not entirely sure how she would handle the disclosure issue. On the one hand, "It hasn't hurt me in my current job. The down side of not disclosing is that your illness might be discovered and you could lost the job for dishonesty, and you could make yourself quite vulnerable in terms of insurance. On the other hand, if you don't disclose your illness, no one may never know about it. So much is individual, it's really important to think this question through, to think through the consequences of both disclosing and not disclosing before making a decision. If it's come up, I've always dealt with it honestly, but if there was a way for me not to deal with it, I've avoided it. And, of course, it's easier to be straightforward when you're explaining a situation that was a problem only in the past."

Ms. X first discovered that she had a bipolar disorder while teaching. She has a responsible position at a local university and says that the disability has only affected her job when she had to take a leave of absence. For this reason, she believes that it is not necessary to divulge any information regarding the disability to the employer, unless or until it becomes a disrupting factor in your work. If asked about gaps on a resume, she would recommend that some one with her disability not lie. Rather, she would advise her or him to say that she was ill. When and if it becomes necessary to inform employers about the disorder, she recommends only sharing this information with a very few trusted people. She believes that employers are still not open to hiring people with mental illnesses, despite the passage of the ADA.

Regarding support groups, she believes that, although they may be helpful in some instances, confidentiality is a risk. Moreover, it is easy to become involved in other members' problems. This can make work situations more difficult for you. During a job interview, she advises that you focus on your strong points and know that, as you become m ore self-confident, it becomes a bit easier to disclose information about your illness when necessary.

• Association on Higher Education and Disability (AHEAD)
  P.O. Box 21192
  Columbus, OH 43221
  (614) 488-4972
• Ravid, Renee, "Disclosure of Mental Illness to Employers: Legal Resources and Ramifications,² The Journal of Psychiatry and Law, Spring, 1992.
• The President's Committee on the Employment of People with Disabilities is a good source of information. The Commission also maintains the Job Accomodation Network, which can provide advice and publications about workplace accomodations.

• ADA Information
  (Voice/TDD) (800) 232-9675
  Computer Bulletin Board (800) 342-5526
• The National Institute of Mental Health's Office of Scientific Information, Information Resources and Inquiries Branch, has a list of free publications, including "Plain Talk about the Sigma of Mental Illness," and "Eight Questions Employers Ask about Hiring the Mentally Restored."

• National Alliance for the Mentally Ill provides support, education, advocacy for services, and support for research.

• National Depressive and Manic Depressive Association
  730 North Franklin #501
  Chicago, IL 60610
  (312) 642-0049
  fax: (312) 642-7243
• National Mental Health Association
  1021 Prince Street
  Alexandria VA 22314-2971
  (703) 684-7722; (800) 969-6642
  (703) 684-59968
• National Mental Health Consumers' Association
  311 South Junipier Street, #902
  Philadelphia PA 19107
  (800) 688-4226
  fax: (215) 735-0275