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Accommodation and Compliance Series:
Employees with Bipolar Disorder
By Kendra M. Duckworth, MS

Preface

Introduction

JAN's Accommodation and Compliance Series is designed to help employers determine effective accommodations and comply with Title I of the Americans with Disabilities Act (ADA). Each publication in the series addresses a specific medical condition and provides information about the condition, ADA information, accommodation ideas, and resources for additional information.

The Accommodation and Compliance Series is a starting point in the accommodation process and may not address every situation. Accommodations should be made on a case by case basis, considering each employee's individual limitations and accommodation needs. Employers are encouraged to contact JAN to discuss specific situations in more detail.

For information on assistive technology and other accommodation ideas, visit JAN's Searchable Online Accommodation Resource (SOAR) at http://www.jan.wvu.edu/soar.

Information about Bipolar Disorder

How prevalent is bipolar disorder?

According to National Institute of Mental Health, "more than 2 million American adults, or about 1 percent of the population age 18 and older in any given year, have bipolar disorder" (NIMH, 2002).

What is bipolar disorder?

Bipolar disorder, also known as manic-depressive illness, is a mental illness involving episodes of serious mania and depression (American Psychiatric Association, 1994). Bipolar disorder tends to run in families and is believed to be inherited in many cases. A person's mood can swing from overly "high" and irritable (mania) to sad and hopeless (depressed), and then back again, with periods of normal mood in between. Signs and symptoms of mania include discrete periods of:

Small Triangle Blue Bullet Increased energy, activity, restlessness, racing thoughts, and rapid talking;
Small Triangle Blue Bullet Excessive "high" or euphoric feelings;
Small Triangle Blue Bullet Extreme irritability and distractibility;
Small Triangle Blue Bullet Decreased need for sleep;
Small Triangle Blue Bullet Unrealistic beliefs in one's abilities and powers;
Small Triangle Blue Bullet Uncharacteristically poor judgment;
Small Triangle Blue Bullet A sustained period of behavior that is different from usual;
Small Triangle Blue Bullet Increased sexual drive;
Small Triangle Blue Bullet Abuse of drugs, particularly cocaine, alcohol, and sleeping medications;
Small Triangle Blue Bullet Provocative, intrusive, or aggressive behavior; and
Small Triangle Blue Bullet Denial that anything is wrong (American Psychiatric Association, 1994).

Signs and symptoms of depression include discrete periods of:

Small Triangle Blue Bullet Persistent sad, anxious, or empty mood;
Small Triangle Blue Bullet Feelings of hopelessness or pessimism;
Small Triangle Blue Bullet Feelings of guilt, worthlessness, or helplessness;
Small Triangle Blue Bullet Loss of interest or pleasure in ordinary activities, including sex;
Small Triangle Blue Bullet Decreased energy, a feeling of being "slowed down" or fatigued;
Small Triangle Blue Bullet Difficulty concentrating, remembering, making decisions;
Small Triangle Blue Bullet Restlessness or irritability;
Small Triangle Blue Bullet Sleep disturbances;
Small Triangle Blue Bullet Loss of appetite and weight or weight gain;
Small Triangle Blue Bullet Chronic pain or other persistent bodily symptoms; and
Small Triangle Blue Bullet Thoughts of death or suicide, including suicide attempts (American Psychiatric Association, 1994).

What causes bipolar disorder?

Most scientists now agree that there is no single cause for bipolar disorder, but research is ongoing as to what can lead to the diagnosis (NIMH, 2002).

How is bipolar disorder treated?

Because bipolar disorder is a recurrent illness, long-term preventive treatment is usually recommended, and a strategy that combines medication and psychosocial treatment is often considered the optimal way to manage the disorder (NIMH, 2002).

Bipolar Disorder and the Americans with Disabilities Act

Is bipolar disorder a disability under the ADA?

The ADA does not contain a list of medical conditions that constitute disabilities. Instead, the ADA has a general definition of disability that each person must meet (EEOC, 1992). Therefore, some people with bipolar disorder will have a disability under the ADA and some will not.

A person has a disability if he/she has a physical or mental impairment that substantially limits one or more major life activities, a record of such an impairment, or is regarded as having such an impairment (EEOC, 1992). For more information about how to determine whether a person has a disability under the ADA, visit http://www.jan.wvu.edu/corner/vol02iss04.htm.

Where can employers get additional information about psychiatric impairments and the ADA?

The EEOC (2000) has a publication called "Psychiatric Disabilities and the ADA," which is available online at http://www.eeoc.gov/policy/docs/psych.html.

Accommodating Employees with Bipolar Disorder

(Note: People with bipolar disorder may develop some of the limitations discussed below, but seldom develop all of them. Also, the degree of limitation will vary among individuals. Be aware that not all people with bipolar disorder will need accommodations to perform their jobs and many others may only need a few accommodations. The following is only a sample of the possibilities available. Numerous other accommodation solutions may exist.)

Questions to Consider:

1. What limitations is the employee with bipolar disorder experiencing?

2. How do these limitations affect the employee and the employee's job performance?

3. What specific job tasks are problematic as a result of these limitations?

4. What accommodations are available to reduce or eliminate these problems? Are all possible resources being used to determine possible accommodations?

5. Has the employee with bipolar disorder been consulted regarding possible accommodations?

6. Once accommodations are in place, would it be useful to meet with the employee with bipolar disorder to evaluate the effectiveness of the accommodations and to determine whether additional accommodations are needed?

7. Do supervisory personnel and employees need training regarding bipolar disorder?

Accommodation Ideas:

Large Blue Triangle Bullet Maintaining Stamina During the Workday:

Small Triangle Blue Bullet Allow flexible scheduling
Small Triangle Blue Bullet Allow longer or more frequent breaks
Small Triangle Blue Bullet Provide additional time to learn new responsibilities
Small Triangle Blue Bullet Provide self-paced work load
Small Triangle Blue Bullet Provide backup coverage for when the employee needs to take breaks
Small Triangle Blue Bullet Allow for time off for counseling
Small Triangle Blue Bullet Allow work from home during part of the day or week
Small Triangle Blue Bullet Allow part-time work schedules

Large Blue Triangle Bullet Maintaining Concentration:

Small Triangle Blue Bullet Reduce distractions in the work area
Small Triangle Blue Bullet Provide space enclosures or private office
Small Triangle Blue Bullet Allow for use of white noise or environmental sound machines
Small Triangle Blue Bullet Increase natural lighting or provide full spectrum lighting
Small Triangle Blue Bullet Allow work from home and provide necessary equipment
Small Triangle Blue Bullet Plan for uninterrupted work time
Small Triangle Blue Bullet Allow for frequent breaks
Small Triangle Blue Bullet Divide large assignments into smaller tasks and goals
Small Triangle Blue Bullet Restructure job to include only essential functions

Large Blue Triangle Bullet Difficulty Staying Organized and Meeting Deadlines:

Small Triangle Blue Bullet Make daily TO-DO lists and check items off as they are completed
Small Triangle Blue Bullet Use several calendars to mark meetings and deadlines
Small Triangle Blue Bullet Remind employee of important deadlines
Small Triangle Blue Bullet Use electronic organizers
Small Triangle Blue Bullet Divide large assignments into smaller tasks and goals

Large Blue Triangle Bullet Working Effectively with Supervisors:

Small Triangle Blue Bullet Provide positive praise and reinforcement
Small Triangle Blue Bullet Provide written job instructions
Small Triangle Blue Bullet Develop written work agreements including the agreed upon accommodations, clear expectations of responsibilities, and the consequences of not meeting performance standards
Small Triangle Blue Bullet Allow for open communication with managers and supervisors
Small Triangle Blue Bullet Establish written, long-term and short-term goals
Small Triangle Blue Bullet Develop strategies to deal with problems as they arise
Small Triangle Blue Bullet D evelop a procedure to evaluate the effectiveness of the accommodation

Large Blue Triangle Bullet Difficulty Handling Stress and Emotions:

Small Triangle Blue Bullet Provide praise and positive reinforcement
Small Triangle Blue Bullet Refer to counseling and employee assistance programs
Small Triangle Blue Bullet Allow telephone calls during work hours to doctors and others for needed support
Small Triangle Blue Bullet Provide sensitivity training to coworkers and supervisors
Small Triangle Blue Bullet Allow the presence of a support animal
Small Triangle Blue Bullet Reinforce peer supports

Large Blue Triangle Bullet Attendance Issues:

Small Triangle Blue Bullet Provide flexible leave for health problems
Small Triangle Blue Bullet Provide a self-paced work load and flexible hours
Small Triangle Blue Bullet Allow work from home
Small Triangle Blue Bullet Provide part-time work schedule
Small Triangle Blue Bullet Allow the employee to make up time missed

Large Blue Triangle Bullet Issues of Change:

Small Triangle Blue Bullet Recognize that a change in the office environment or of supervisors may be difficult for a person with bipolar disorder
Small Triangle Blue Bullet Maintain open channels of communications between the employee and the new and old supervisor in order to ensure an effective transition
Small Triangle Blue Bullet Provide weekly or monthly meetings with the employee to discuss workplace issues and production level

Situations and Solutions:

A supervisor of a printing company requested information on how to accommodate an employee who has reduced concentration and memory loss due to mental illness. His duties included operating copy machines, maintaining the paper supply, filling orders, and checking the orders for accuracy. He was having difficulty staying on task and remembering what tasks he had completed. A JAN consultant suggested laminating a copy of his daily job tasks and checking items off with an erasable marker. Another suggestion was to use a watch with an alarm set for every hour as a reminder to check on his other job responsibilities.

A JAN consultant spoke with an employee with bipolar disorder who had difficulty with short-term memory and concentration. The employee worked as a secretary in a busy office. The JAN consultant discussed requesting additional training time, written job tasks instructions, daily checklists, and allowing one hour each day to be off the phones to complete job tasks.

An employee with major depression and bipolar disorder was having difficulties working in a busy central banking office. He needed to manage a large staff of workers, provide customer service, and oversee the daily office management. As an accommodation he requested and received a transfer to a smaller and less busy branch office. The employee maintained his salary and the responsibilities of his leadership role.

Products:

There are numerous products that can be used to accommodate people with limitations. JAN's Searchable Online Accommodation Resource (SOAR) at http://www.jan.wvu.edu/soar is designed to let users explore various accommodation options. Many product vendor lists are accessible through this system; however, upon request JAN provides these lists and many more that are not available on the Web site. Contact JAN directly if you have specific accommodation situations, are looking for products, need vendor information, or are seeking a referral.

Resources

References

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed. Text Revised). Washington, DC: Author.

Equal Employment Opportunity Commission. (2000). EEOC enforcement guidance on the Americans with Disabilities Act and Psychiatric disabilities. Retrieved February 1, 2006, from http://www.eeoc.gov/policy/docs/psych.html

Equal Employment Opportunity Commission. (1992). A technical assistance manual on the employment provisions (title I) of the Americans with Disabilities Act. Retrieved February 1, 2006, from http://www.jan.wvu.edu/links/ADAtam1.html

National Institute of Mental Health. (2002). Bipolar disorder. NIH Publication No. 3679. Retrieved February 1, 2006, from http://www.nimh.nih.gov/publicat/bipolar.cfm#readNow

If you have a question about accommodations and/or the employment provisions of the Americans with Disabilities Act (ADA), click here:
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