When does stigma turn into discrimination? Mental illness stigmas are negative attitudes and assumptions about people living with mental health problems, including the damaging and inappropriate stereotypes that we are dangerous, incapable, or socially undesirable. As someone living openly with bipolar disorder, I encounter these painful beliefs all of the time. Research shows that people living with mental illnesses face many different kinds of microaggressions – subtle comments or gestures that target people with hurtful, stigmatizing messages. For instance, when I first told a colleague about my mental disorder he responded in a sing-song voice saying, “Oh wow, you’re doing so well!” Though he meant it as a compliment, this remark implied that the typical expectation was that someone with my condition would not be doing well. That makes this a microaggression because it reinforced negative ideas about my mental illness. These kinds of demeaning incidents, by themselves, hurt but they do not necessarily amount to discrimination. Discrimination happens when someone is treated differently in a damaging way because of their mental health impairment.
Dan Berstein, MHS
The Americans with Disabilities Act (ADA) makes it illegal for organizations to turn someone away or provide them disparate treatment on the basis of them having a mental impairment, even if it turns out the person did not actually have a mental health problem. This is because discrimination is based on what is in a person’s mind when they are treating you differently, so it is their beliefs about you that matter even if they were wrong about whether you really had a disabling mental health need. Unfortunately, mental illness discrimination is common. Because people often do not understand it is wrong to treat someone differently based on their mental illness, there are sometimes even written policies that inadvertently recommend treating people improperly.
How Can You Notice if Someone Is Treating You Differently Based on a Mental Health Problem?
There are a few key ways that mental illness discrimination tends to happen, including privacy violations, disparate treatment, screening, and problems providing requested reasonable accommodations.
A. Recognizing Inappropriate Questions That Violate Your Privacy
The first type of mental illness discrimination may occur when someone violates your privacy protections by asking questions that are not legal or appropriate to ask, such as if an employer starts seeking details of a possible psychiatric disability as part of their hiring conversations. The Equal Employment Opportunity Commission (EEOC) has a list of questions that are not okay to ask employees, including asking someone whether they have a disability, asking about their medications, and asking more generally what their impairments are. You can view the EEOC’s list at https://www.eeoc.gov/laws/guidance/enforcement-guidance-disability-related-inquiries-and-medical-examinations-employees.
It can be helpful to be mindful of protecting your personal health information. For example, I have consulted with some people who took medical leaves at their workplaces without realizing they did not have to share the full details of their mental health conditions. Their human resources contacts facilitating the leave offered to help file the paperwork for the disability insurance company, without disclosing that the employer had no legal right to access this information. Had these people sent the forms to their human resources department instead of directly to the insurance company, some folks at their workplace would have seen their doctor’s full description of their psychiatric symptoms. There are many institutional processes that seem supportive, and often are meant to be, but also can result in your sharing more information than an organization is legally entitled to receive. Therefore it can help to be careful and aware when sharing your private mental health information to make sure any disclosure remains your choice. You have every right to tell people you would like to keep your information private as much as possible, and to ask why it is necessary to share with them.
B. Noticing Different Treatment Based on Mental Health Problems
Another way people may treat you differently is if they secretly try to change their normal way of doing things because they have heard you have a mental illness, or because they have guessed you are showing related symptoms. Any kind of different treatment that puts you at a disadvantage or different tier of service relative to other people may be discrimination. I work as a mediator, and some practitioners follow guidance to try to notice if parties show signs of personality disorders so they can provide those individuals with a different, more limited conflict resolution process. In this model, parties suspected of showing personality disorder traits are offered less opportunities for discussions of insight, feelings, or the past – all done secretly, with the mediators being advised to never reveal they have profiled the parties as showing symptoms of “high conflict” mental impairments. Because professionals may make these kinds of changes without disclosing them, it is important to stay aware of times you may be treated differently from normal procedures. You can access the Mental Health Safe Project’s guide to noticing and responding to this kind of discrimination from mediators at https://bit.ly/NoticeMediatorDiscrimination. You can also find more general resources about noticing when people may be discriminating against folks with mental health problems by labeling them “difficult,” “high conflict,” or “toxic” by visiting www.mhsafe.org/toxic.
C. Seeking Help After Being Turned Away Due to Mental Illness
Beyond times that someone is asking you invasive questions, or providing disparate treatment, there are also times they may actually decline service based on their assessment that you have a mental health problem. While it is often legal for clinicians to refer you to specialists for treatment, and therefore decline to treat you based on your specific diagnosis or situation, it is not okay for most businesses to ever turn someone away based on their mental illness diagnosis. Yet sometimes there are published policies that do advise professionals to turn folks away for this reason. Many professionals who turn someone away know better than to say it is for a reason that violates civil rights laws – so they could make excuses rather than say it is because of your mental health problem, or your race, or your gender. It can therefore be helpful, if you are wondering about why someone declined to offer you services, to ask to review the organization’s policies or to seek legal help. If you believe that your mental health problem is a reason you have been turned away from service, then you can also learn about filing ADA Complaints or access other resources at https://mhsafe.org/discrimination/
D. Speaking Up When Reasonable Accommodation Requests Are Mishandled
People can also discriminate against individuals with psychiatric disabilities by not providing reasonable adjustments to their normal procedures. If you have a psychiatric disability, the ADA generally makes it illegal for organizations to refuse your reasonable accommodation requests unless they can credibly claim it is an undue hardship, fundamental alteration, or direct threat or they have provided a suitable alternative to your request. I seek some reasonable accommodations under the ADA as part of my work. When I travel as a speaker, I ask hotels to help me identify and block off their quietest room for me to help me manage the sleep needs from my mental illness. I also generally ask that people let me know when they have received my e-mail messages and if they plan to reply so I do not end up having obsessive, intrusive thoughts about whether to follow up. These two requests cost nothing for someone to provide, yet it can still be difficult for me to receive them. The following are some ways a reasonable accommodation request might be mishandled:
- The organization takes an inordinately long time processing the request
- The organization requests more information about your disability than they are legally allowed to ask for
- The organization agrees to provide the requested accommodation, or a suitable alternative, but underdelivers once they actually implement it
- Employees, managers, classmates, or teachers observe the accommodation and respond with retaliation, hostility, or other backlashes
Reasonable accommodations are a legal right and not a favor, perk, or gift. To learn more about them, and how to ask for them in the workplace, visit the US Department of Labor’s Job Accommodation Network at www.askjan.org
Staying Aware Without Being Judgmental
Mental illness discrimination can sadly be common, but the perpetrators often do not know what they are doing. Stigma can be so embedded that people may be acting routinely, or they may believe, paternalistically, that they are helping. Some research suggests that people often cannot realize they are discriminating against people based on mental illness, as compared to other marginalized groups. That means that it is safe to assume that folks are not acting deliberately or maliciously, even though their conduct can be burdensome and hurtful. Therefore, it might be helpful to approach them with a friendly tone when informing them of problems. It may also be possible to try mediation if there is a significant conflict.
Of course, whether it happens intentionally or not, there is no excusing stigma and discrimination. Hopefully, the tools from this article can help you notice and respond when it happens.
Dan Berstein founded MH Mediate to help people use dispute resolution skills to improve how they talk about mental health and resolve conflicts. MH Mediate’s Mental Health Safe Project provides free resources to address everyday mental illness discrimination. Visit www.mhsafe.org to learn more or e-mail Dan at dan@mhmediate.com with questions and feedback.
