When a Mental Health Crisis Happens at Work

Try to imagine this scenario going down while you’re at work: You’re crawling on the floor on all fours. A feeling of panic is rising in your throat as sweat permeates your clothes. As you crawl across the carpet you’re trying to find the words to explain to your boss that you’re part of a vast, complex plot that will enable you to save the world. If I can pull this off, you think to yourself, I’ll be able to keep my job.

That exact scenario played out for me in 2012. It happened while I was working overnights at a domestic violence program and earning my masters in social work during the day. I’d hit a major bump in my personal life and lost the ability to sleep, which resulted in the manic symptoms of my bipolar disorder poking through my anti-psychotic meds.

Ultimately, at the insistence of friends, I checked into the emergency room. I tried explaining to the hospital staff that I was suffering from “exhaustion,” but apparently that’s not a billable diagnosis and is strictly reserved for use by celebrities’ statements via their publicist. I was admitted instead with a triple-threat diagnosis: paranoia, anxiety and a suicidal gesture. After regaining the ability to sleep during my hospital stay I was then discharged and after taking a few sick days, I went back to work. The executive director at the program soon called me in for a meeting.

I was positive I was getting fired.

To my astonishment, she asked me to explain what had happened and wanted to ensure that I was really ready to return to work. I knew I’d been extremely lucky not to lose my job and vowed to take proactive measures to minimize any future career repercussions if I got symptomatic again.

Psychosis as a Learning Experience

When a Mental Health Crisis Happens at WorkWhat happened to me was perhaps extreme but it taught me a few things about how to both head off a mental health crisis, especially at work, and also how to deal with one when it does happen.

The most important thing, I learned, is understanding how my individual symptoms manifest so that I can take preventative measures. How you experience your particular mental health diagnosis, if you have one, is likely to be very personal, too. For me, I know that if I’m going manic I will need less sleep and I’ll experience more (seemingly profound) delusions, an excessive output of creative endeavors and increased irritability. So I need to pay close attention when any of these signs crops up.

Here are some questions to ask yourself about previous crises, if you have a history of these events:

  • What behaviors did you or your friends or family notice leading up to your previous mental health crisis/crises?
  • Were there any incidents or triggers that increased your stress levels?
  • Did you stop taking your psychiatric medications and/or start self-medicating with drugs and alcohol?

After you’ve had a crisis and have returned to a relatively aware state try to look for red flags that indicated you were in need of increased psychiatric support.

Building Your Support Network

Remember that while you are the expert in your own lived experience with mental illness, it’s very important to build your support network if your ability to be rational becomes compromised. When I’m experiencing manic symptoms my friends and family know that I want them to contact my psychiatrist to see if there are things that can be done to avoid my going to the emergency room.

And while it can be very difficult to talk about your mental illness at work — many people feel very ashamed because mental illness is so misunderstood — you may need to consider sharing something about your diagnosis with your boss and maybe even your colleagues if it’s affecting your ability to do your job. What has worked for me when I’ve talked to a new employer or a new acquaintance about my diagnosis is easing into the conversation through a general discussion about mental illness. I try to suss out their views on mental illness and find out whether they hold any negative stereotypes. I might share that I have a sleep disorder that causes me to become delusional if I don’t get enough sleep. While this is technically true, it’s not as negatively perceived as bipolar disorder.

Yet there will also be times when it’s not safe to disclose that you have a mental illness to the people you work with. I once had an employer who began to look for reasons to doubt my competency on the job after I self-disclosed. I wasn’t symptomatic, but ultimately I was accused of “poor decision-making and was terminated from my position. I went on to file a discrimination claim with the Michigan Department of Civil Rights asserting that I was wrongly terminated based on my disability.

Self-disclosure is always a choice and there are legal protections for workers. The U.S. Equal Employment Opportunity Commission (EEOC) enforces discrimination laws on the federal level. These protections include protection against:

  • unfair treatment because of race, color, religion, sex(including pregnancy), national origin, age (40 or older), disability or genetic information
  • harassment by managers, co-workers or others in your workplace because of race, color, religion, sex (including pregnancy), national origin, age (40 or older), disability or genetic information
  • denial of reasonable workplace accommodation needed because of religious beliefs or disability
  • retaliation against a complaint filed relating to job discrimination, or because you assisted with a job discrimination investigation or lawsuit

If you have a mental illness there may also be expanded discrimination protections based on your state or local jurisdiction. For example, according to the Human Rights Commission, “Twenty-one U.S. states and the District of Columbia [D.C.] have passed laws prohibiting employment discrimination based on sexual orientation, and 18 states and D.C. also prohibit discrimination based on gender identity.”

It’s always good practice to research your jurisdiction’s anti-discrimination laws to ensure that you maximize your recourse if you have a discrimination claim. Additionally, all employees are protected by the Family Medical Leave Act (FMLA), Health Insurance Portability and Accountability Act (HIPAA) and privacy laws.

Most People with Mental Illness Do Work

According to the National Institute of Mental Health, 44 million adults in the U.S. experience mental illness in a given year. So these issues are far from uncommon, yet negative perceptions of mental illness still loom large. In my own experience as a social worker, I have seen many clients with mental illness make progress by using mental health services. While public mental health treatment is greatly underfunded and case loads are large, it’s still worthwhile to seek help if you need it. I have worked with clients who went from having chronic mental health issues to being able to stabilize their mental health and find and keep a job.

The reality is, of course, that people with a mental health diagnosis still face a lot of barriers to stable employment and self-sufficiency. In my experience, these are the best ways that you as a worker can help yourself and fight discrimination of people with mental illness in the workplace:

  • Learn the warning signs of a pending episode
  • Practice self-care
  • Build a strong support network in case a crisis arises
  • Develop an understanding of your legal rights

I am an advocate for the mentally ill, so I believe it is our duty to lobby for better services for people like me who need it, while also educating the public about the realities of having bipolar disorder, anxiety, depression and many, many other types of mental illness. As a society we have a lot of work to do, but together we can foster a climate where people aren’t afraid to seek out the help that they need.

Providing holistic treatment for people with mental illness so that they can keep working and become and stay self-sufficient is the only rational way forward.

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