Disability and employment – overview and highlights

ABSTRACT

Due to the expected decline in the working-age population, especially in European countries, people with disabilities are now more often recognized as a valuable resource in the workforce and research into disability and employment is more important than ever. This paper outlines the state of affairs of research on disability and employment. We thereby focus on one particular group of people with disabilities, that is to say people with mental disabilities. We define disability according to the International Classification of Functioning, Disability and Health (ICF) of the World Health Organization, by that recognizing that disability results from the interaction of person and environment. Key issues, including the complexity of defining disability, the legal situation in Europe and North America concerning disability at work, and barriers and enablers to employment, are discussed. For each of the topics we show important findings in the existing literature and indicate where more in-depth research is needed. We finalize with a concrete research agenda on disability and employment and provide recommendations for practice.

KEYWORDS:

• Disability
• employment
• work ability
• mental disorders
• stigmatization
• ICF

The World Health Organization (2011) reports that about 15% of the world’s population has a disability. Some would even argue that this is a low estimate given the various ways in which disability is defined across countries. For consistency reasons, we define disability according to the International Classification of Functioning, Disability and Health (ICF) of the World Health Organization (WHO, 2001), attributing to disability as a complex concept with multiple dimensions. It is “the umbrella term for impairments, activity limitations and participation restrictions, referring to the negative aspects of the interaction between an individual (with a health condition) and that individual’s contextual factors (environmental and personal factors)” (WHO, 2011, p.4). Thus, when talking about people with disabilities, we recognize that people can be disabled by environmental factors as well as by their bodies, stressing that disability is not equal to the medical concept of body or functional impairment, but refers to the interaction of person and environment.

In terms of employment and participation on the labour market, persons with disabilities are an underemployed group of the workforce (Colella & Bruyère, 2011). In countries with civil rights legislation, unemployment rates are approximately twice what they are for people without disabilities and it can be assumed that rates are even worse in countries without such law, despite the fact that many of these people can work and want to work (Macias, DeCarlo, Wang, Frey, & Barreira, 2001). Moreover, high unemployment among people with disabilities coexists with shortages in distinct sectors on the labour market particularly in many European countries due to demographic changes and the retirement of the baby-boom generation (Organisation for Economic Co-operation and Development, 2010). Accordingly, a number of European countries anticipate a considerable decline in the working-age population by 2020 (European Commission, 2008; Linz & Stula, 2010). Furthermore, most industrialized countries are facing an ageing workforce which makes the incidence of disability due to chronic illness among workers more pronounced (Truxillo & Fraccaroli, 2013). As the workforce ages, dealing with disability will become more of an issue than it is today. Up to one-third of the European regions will be negatively affected by these demographic changes in terms of declining competitiveness. The extent to which these developments will affect economic growth depends considerably on labour participation (European Commission, 2008). Due to the expected decline of the working-age population, especially in European countries, people with disabilities are now more and more recognized as a valuable resource in the workforce in both the private and public sectors.

Poverty rates are also considerably higher for individuals with disabilities on a world-wide basis (WHO, 2011). The issue of disability and employment has taken centre stage on the global arena because it spans several areas of the United Nations Sustainable Development Goals, in which the confrontation of extreme poverty in its many manifestations is the number one goal (United Nations Department of Economic and Social Affairs, 2016) . With the passing of the United Nations (U.N.) Convention on the Rights of Persons with Disabilities (UNCRPD; United Nations General Assembly,  2006) there is now international contextual support for pursuing the interests of persons with disabilities. In addition to concerns over the economic benefit of greater inclusion of persons with disabilities in the workforce, there are humanitarian reasons for this concern as well. The fact that work is beneficial for health and well-being of people is long known in work- and organizational psychology. For people with disabilities, employment is particularly important, because having a disability often means being socially isolated (WHO, 2011). Being employed is one opportunity to reduce this isolation and an important tool to reduce poverty (Schur, 2002). Research evidenced that work remains important and meaningful for persons with disabilities and keeps its health promoting effects over time (Saunders & Nedelec, 2014). However, it should be noted that employment is not always inherently beneficial (Broom et al., 2006). Especially when natural supports in the workplace are missing and job requirements do not fit the worker’s capabilities (Williams, Fossey, Corbière, Paluch, & Harvey, 2016), work can also be a cause for mental ill-health. Recently, the job requirements in the workplace have increased or changed. Particularly the requirements on social skills expanded considerably and make it increasingly difficult for workers with disabilities to perform competently (Organisation for Economic Co-operation and Development, 2012; Zijlstra, Van Ruitenbeek, Mulders, & Van Lierop, 2017) . Although many researchers all over the world are engaged in these issues, work is missing that examines how disability may be viewed differently in different cultural contexts and what impact any such differences may have on adopting an international perspective. To this end, the idea of a common position paper was realized in order to foster systematic, international collaboration by work- and organizational psychologists.

In this position paper, research in the field of work- and organizational psychology on disability and employment is summarized and future directions will be highlighted. We specifically focus on mental disorders as impediment to workplace inclusion. In the literature a distinction is made between common mental disorders, which include adjustment, mood, and anxiety disorders, and severe mental disorders such as schizophrenia or bipolar disorders. Severe mental disorders are associated with long-term disability, while common mental disorders are linked to short-term disability. Most prevalent in the labour force are the so called common mental disorders (Corbière, Negrini, & Dewa, 2013). The reason why we focus on mental disorders is that persons experiencing mental health problems have the most substantial problems when it comes to return-to-work or work integration in the regular labour market. According to contemporary data, around 27% of the European working-age population suffers from a mental disorder in a clinical sense (WHO, 2017). The lifetime prevalence is even higher and reaches up to 50% in the average OECD country (OECD, 2014). Furthermore, disabilities related to mental disorders predominate in inflow statistics of new recipients of disability benefits and numbers constantly increased in recent years (OECD, 2015). Approximately, one-third to one-half of all new disability benefit claims are due to mental ill-health and the rates are even higher for young adults where the proportion goes up to over 70% (OECD, 2012). Mental disorders are related to sick leave or reduced work ability (Dewa & Lin, 2000; Esposito, Wang, Williams, & Patten, 2007; Lidwall, 2015) and are therefore to a large degree associated with disability. Thus, mental disorders are responsible for a considerable loss of potential labour force, high numbers of unemployed persons, high prevalence of absenteeism due to sickness, and a high incidence of presenteeism or reduced productivity at work (OECD, 2012). The costs associated with the loss of work productivity due to mental disorders or presenteeism, which is the paradox that people go to work despite complaints and ill-health (Aronsson & Gustafsson, 2005), surpass several billion dollar annually (OECD, 2015). Furthermore, disability claims have almost doubled in the last decade for employees with mental disorders (OECD, 2010) and usually result in long periods of absence from work or eventual relapses (OECD, 2015).

This paper deals with three key issues, identified by the authors as highly relevant in the field of disability research. For each of the following topics, the state-of-the-art in terms of research-based knowledge is briefly pictured, followed by an outlook on the future. First, the complexity of defining disability will shortly be discussed. This debate is vast and we will only present information that is important for the definition of disability at work. Additionally, methods for the assessment of disability, relevant in terms of eligibility for workplace accommodations and welfare benefits, will be examined. Second, the particular law situation in Europe and North America will be reviewed, focusing on legislation that fosters the integration of people with disabilities into the labour market. As a third topic, barriers and enablers to workplace integration will be taken up. People with disabilities often fail to stay in an organization for a sustained period of time because of a lack of access to and supports in the workplace. This part of the paper also deals with the employers’ perspective, particularly the employers’ attitudes. Employers play a crucial role in hiring, managing and retaining employees with disabilities. Their work and engagement, their attitudes and openness to diversity are prerequisites for the successful inclusion of people with disabilities in the workplace. Employers are able to change and improve disability practices by demonstrating leadership and providing guidance (Bruyère, Erickson, & VanLooy, 2004). We conclude with future perspectives on how to bring this area of research forward.

Definition of disability

According to the U.N. Convention on the Rights of Persons with Disabilities, “persons with disabilities include those who have long-term physical, mental, intellectual or sensory impairments which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others” (UNCRPD, 2006: article 1, purpose). This very general definition of disability serves as groundwork for several disciplines in research. Also psychologists are more and more concerned with issues related to health impairments and the effects on reduced societal participation. Due to an ageing workforce, somatic and mental health issues become more pronounced and therefore attract growing notice to especially work- and organizational psychologists. Somatic and mental disorders do not only present in symptoms (i.e., body/functional impairment), but regularly affect activities, capacities and participation, thus result in disability. Many workplaces hardly accept any form of deviating behaviour especially related to performance. Therefore, illness-related participation disorders are specifically relevant in the domain of work (Muschalla, Vilain, Lawall, Lewerenz, & Linden, 2012). The type and degree of disability at work result from both, the body or functional impairment as such but also the work context, which are the work demands and the work environment the person with impairment is confronted with. For that reason it is necessary to not only consider the specific, work-related activities and capacities of a person with a somatic or mental disorder, but also account for the disabling factors within the environment of the person when defining disability.

The ICF-model

The International Classification of Functioning, Disability and Health, ICF (WHO, 2001) is the most commonly cited model to define disability and provides a standard language and a conceptual basis for the definition and measurement of health and disability. It differentiates between (a) impairments of body function and structure, (b) activity and capacity limitations, and (c) participation restrictions (see Figure 1). Impairments, limitations, and restrictions refer to deviating behaviour or functioning of a person in comparison to what is generally accepted as normal or most frequently occurring in the population. A person can for instance not carry out certain activities required at work while others can or normally do. As an example, a person with a hearing impairment as a result of an illness is restricted in communicating with colleagues who use verbal language as their tool to interact with each other. However, no disability exists when a task requires no talking or listening to others. Accordingly, a body or functional impairment as such does not automatically cause a disability (Wiersma, Dejong, & Ormel, 1988). Disability is thus an umbrella term for body or functional impairments, activity and capacity limitations and participation restrictions. A disability exists only when the degree and type of impairment cause difficulties in a certain environment with particular activity or capacity demands, such as in the work environment. In this case, we refer to a participation impairment, which means that a person cannot fulfil certain demands due to his/her body or functional impairment.

Figure 1. The current ICF-Model (WHO, 2001) in comparison to the former ICIDH-Model (WHO, 1980).

Cited according to Linden, Baron, Muschalla, and Ostholt-Corsten (2015)

An important new aspect that the ICF-model has put on the agenda (in comparison to the earlier model of the ICIDH; WHO, 1980) is the interaction between a person and the environment. Disability is no longer seen as an abnormal state or defect of a person, but disability may originate from a deficient person-environment-fit. In this new understanding of disability, no person with a body or functional impairment is disabled as such, but only when being in an environment which does not fit the persons reduced or deviating abilities and capacities. Thus, disability depends on the dynamic relationship of a person’s health impairment and contextual factors. Hence, an important message of the ICF-model is: a person (with body or functional impairment) is not disabled, but becomes disabled by the context. Besides many others, the work environment is certainly an environment with potential for causing disability in employees with chronic (mental) health impairments, because of its high demands for the person and low tolerance for deviation. Organizational changes claim more and more flexibility and adaptability from employees and require skills that are generally difficult to meet for employees (Semmer & Jacobshagen, 2010). Particularly, cognitive and social demands have increased and are often forming an insurmountable obstacle for people with mental disorders. Furthermore, many technical developments (such as automation and robotization) that are meant to speed up and facilitate work processes, replace tasks especially suitable for people with disabilities (Zijlstra & Nyssen, 2017). The ICF-model attaches importance to the role of the environment, thereby emphasizing its up-to-date relevance.

In the course of this position paper, the term “disability” will be used as an umbrella term for any type of impairment, activity and capacity limitation and participation restriction, in line with the suggestions of the WHO (2011). We thus refer to the negative aspects of the interaction between an individual (with a health condition) and that individual’s contextual factors (environmental and personal factors). This is due to the fact that “disability” may have been defined in different ways in the studies which are reported here.

Description and measurement of disability

There are many instruments for the assessment and operationalization of activities/capacities and participation (impairments) on different levels. Examples are the Activity of Daily Living Scale (ADL; Katz, Ford, Moskowitz, Jackson, & Jaffe, 1963), the World Health Organization Disability Assessment Schedule (WHO-DAS-II; WHO, 2004), the Personal and Social Performance Capacity Scale (PSP; Morosini, Magliano, Brambilla, Ugolini, & Pioli, 2000), or the Index for Measurement of Impairment in Participation (IMET; Deck, Mittag, Hüppe, Muche-Borowski, & Raspe, 2007; Muschalla et al., 2012), to mention just a few.

The description and measurement of work (dis)ability in more detail is an important new topic in work- and organizational psychological research. Lederer, Loisel, Rivard, and Champagne (2014) provide an overview of several definitions of work ability and MacDonald-Wilson, Rogers, and Anthony (2001) operationalize the concept and review methods of assessing work functioning of people with psychiatric impairments. Until now, work ability and work ability deficits are commonly measured as global work ability, like it is done with the Work-Ability-Index (Tuomi, Ilmarinen, Jahkola, Katajarinne, & Tulkki, 1994). On the other hand, very detailed capacity description assessments are available (e.g., Fleishman & Reilly, 1992; National Center for O*NET Development, 2017; Peterson et al., 2001). An internationally validated short observer rating which allows assessing work-relevant psychological capacity and participation impairments on thirteen psychological capacity dimensions is the Mini-ICF-APP (Linden, Baron, & Muschalla, 2010; Molodynski et al., 2013; Muschalla, 2016). The tool is proposed to be used as standard tool for the objective assessment of work ability in rehabilitation medicine in Germany (Deutsche Rentenversicherung Bund DRV (Hrsg), 2012) and for socio-medical judgments in Switzerland (SGVP; Marelli, 2012). The rating covers work-relevant dimensions of social activities (contact with others, assertiveness, group capacity, dyadic interactions), decision-making and judgment, endurance, applying expertise, flexibility, adherence to regulations, planning and structuring of tasks, proactivity, self-care, and mobility. For each dimension, the degree of illness-related participation impairment (i.e., disability) can be described depending on individual role demands in the person’s professional life. As an example, an employee with a social phobic anxiety disorder may be unable to work when tasks require initiating contact with others, such as a sales person needs to do. With the same social phobic symptomatology, the employee may be able to work and even achieve good results in an office work setting without the need to initiate contact with clients. The Mini-ICF-APP-rating offers a way to think impairment relational, in dependence of the context. The rating dimensions are not only useful for the description of the type and severity of impairment, but also for planning interventions (e.g., training of social competencies) or workplace adjustments (e.g., in terms of reduced requirements for contacts with thirds).

Besides new means to assess disability, also new approaches to advance the actual integration at work have been developed. In the last couple of years, several vocational and rehabilitation services and programmes have been implemented on a national and international level. These services support people with especially mental disorders in recovering and maintaining meaningful social roles, including the role of the worker (Corbière & Lecomte, 2009). Traditional services follow the “train and place” approach (Corrigan, 2001): first, persons are taught how to live with their symptoms and how to overcome their disability; only then they are placed in vocational and independent-living situations where they are supposed to apply their newly acquired skills. Sheltered workshops, clubhouse, and transitional programmes are examples of prevocational activities or traditional psychiatric rehabilitation models that follow this philosophy. The evidence nowadays supports the opposite approach, namely “place then train” (Corrigan, 2001), which aims at placing individuals in real-work situation prior to offering them specific training. This reinforces people with disabilities to achieve their vocational goals. Training is offered on-site, with ongoing support provided as needed, and the job is selected according to the person`s abilities and interests. Within this approach, supported employment and IPS programmes are recognized as an evidence-based practice (Drake & Bond, 2014; Suijkerbuijk et al., 2017). Social firms are also promising services in helping people with disabilities to find and maintain employment (Villotti, Zaniboni, & Fraccaroli, 2014; Zaniboni, Fraccaroli, Villotti, & Corbière, 2011).

Legislation

In many European countries, the need to take a step forward in the integration of people with disabilities has been recognized and the aim to create an inclusive labour market has been determined. An inclusive labour market can be defined as a labour market in which everyone can participate regardless of any form of disability or vulnerability, therefore including disadvantaged and low productive workers who contribute to the best of their abilities (Edzes, Rijnks, & Van Dijk, 2013). One of the biggest challenges that policy makers face today is to prevent social exclusion on the labour market for low productive workers due to mental or physical disabilities (OECD, 2010). However, the impact of anti-discrimination legislation, such as the Americans with Disabilities Act (ADA), is ambiguous and there is no evidence yet that satisfactorily reports an increase in employment for people with disabilities after the implementation of such legislation.

Legislation in Europe

The majority of European Countries has ratified the U.N. Convention on the Rights of Persons with Disabilities (UNCRPD, 2006). Countries that adopted the Convention committed themselves to develop and carry out policies, laws and administrative measures that secure the rights recognized in the Convention and to abolish laws, regulations, customs and practices constituting discrimination (Article 4). In terms of employment, the Convention determines that persons with disabilities have equal rights to work and gain a living. Discrimination in job-related matters is prohibited, and the promotion of self-employment, entrepreneurship and starting one’s own business is required. Furthermore, organizations need to ensure that workers with disabilities are provided with reasonable accommodation at work (Article 27).

Besides the Convention, many European countries have also established individual anti-discrimination legislation, such as the Equality Act in the United Kingdom, the Disability Discrimination Act in the Netherlands, or the Social Code IV in Germany. For people with disabilities those acts often include the concept of reasonable accommodations at work that employers need to provide. A reasonable accommodation is generally defined as job adjustments or modifications in the workplace that enable a person with disability to successfully perform the working task efficiently and productively, or to enjoy equal benefits and privileges of employment. The definition of the duty varies, but is usually subject to the limitation that it should not create an unreasonable burden for the employer. In terms of effectiveness, there is not much known about steps that have been taken to evaluate efforts. Data on persons with disabilities are difficult to acquire in almost every country and specific data on their employment situation are even harder to find. In order to draw conclusions on the effectiveness of the Convention and anti-discrimination legislation, data are lacking that specify if and how the Convention helped to improve the employment status of people with disabilities.

Besides the anti-discrimination legislation, several European countries have chosen another way of dealing with high unemployment of people with disabilities. An approach that has been implemented, for instance in Germany, France, Austria, Belgium, Italy, Spain and Poland, is a disability quota system which forces companies to employ a minimum percentage of people with disabilities. Quotas range from 2% in Spain to 7% in Italy. Most countries adopted a quota of 5% of the workforce. However, many of the quota systems allow for a fine that organizations can pay and that releases them from fulfilling the quota. Thus, organizations either obey the inflicted rules or, in the event of non-compliance, pay a penalty usually in the form of a tax per month for each place not filled, ranging from 0.25 to 4% of the monthly pay-roll of firms (Wuellrich, 2010). In order to respond to legal changes, organizations evaluate the disability status of their contemporary workers and assess if they already fulfil the critical value. A study by Fietz, Gebauer, and Hammer (2011) shows that in many companies, due to demographic changes, older employees compete with applicants with disabilities in a sense that both groups are dependent on workplace accommodation. However, those workplaces might be available only in limited numbers. As the retention of jobs for employees who are already employed in the organization has priority, creating new workplaces and recruiting new workers with disabilities is challenging for organizations. Thus, the quota system contributes little to new occupations for people with disabilities (OECD, 2010).

In terms of quota commitment, this form of legislation might pressure employees to disclose their disability as this supports their employer to attain the quota (this issue will be discussed later in this paper). These required registration and classification processes have been disapproved and represent discriminating treatment themselves (Fuchs, 2014). Unfortunately, even in countries that currently operate a quota system, the employment rate of people with disabilities is still considerably lower compared to the employment rate of non-disabled people (Shima, Zólyomi, & Zaidi, 2008; WHO, 2011). Moreover, a quota system can have the adverse secondary effect of provoking negative attitudes towards people with disabilities by employers, immediate supervisors, co-workers, and unions. Companies that are constrained to submit to a quota often experience people with disabilities as a strain rather than a valuable contribution to their workforce and non-disabled workers may perceive the quota job placements as creating an unfair division in the labour market (Niehaus & Bauer, 2013; WHO, 2011). For the person with a disability, a quota system primarily provides an opportunity to become employed, but at the same time might contribute to the experience of self-stigma and might have detrimental effects on a person’s self-esteem. The quota system creates the impression that people obtain employment just because of the prevailing legislative system, and not because of their qualification for a certain job.

In sum, anti-discrimination legislation in Europe may influence the employment status of people with disabilities in various ways. The readiness to declare a health problem may rise due to the augmentation of rights and public awareness, but at the same time fewer people may perceive themselves as being work disabled once they accessed the job market and strengthened their employability (Bell & Heitmueller, 2009). Organizations commonly perceive such policy as a burden and feel constrained to obey to the inflicted rules. However, in Austria an increase in tax as penalty for non-compliance considerably increased firms’ demand for workers with disabilities, which may be an indication that policy makers should aim at boosting employment of workers with disabilities in terms of a further rise in the non-compliance tax (Wuellrich, 2010). Furthermore, strategies need to be developed that allow for a better coordination between involved stakeholders, such as employers, employees, institutions and service providers. More support and incentives might increase employment efforts as well (Fuchs, 2014). In an overall European context, it nonetheless remains questionable if a quota system helps to create an inclusive labour market that offers comparable chances to everyone. Enforcement of legislation is therefore only as effective as the specific awareness among involved parties about their rights and duties (Bell & Heitmueller, 2009).

Legislation in the United States and Canada

In the United States, the federal law protecting the fundamental civil rights of people with disabilities is the The Americans with Disabilities Act (1990). Inspired by an anti-discrimination policy, the ADA posits for all individuals with mental and/or physical disabilities equal opportunities and full integration in the workplace. In particular, the first Title of the ADA prohibits any form of discrimination against people with disabilities in all employment-related activities, such as hiring, pay, or benefits.

Similar to the legislation in European countries, also under the ADA legislation, employers are required to provide employees with disabilities reasonable accommodations. The ADA law requires that accommodations for workers with disabilities are successfully implemented. However, making concessions to the employer, the accommodation needs to be indispensable and should not represent an “undue hardship” to the employer, by being for example too expensive considering resources and circumstances. Undoubtedly, the availability of reasonable accommodations in the workplace is a key factor to the inclusion of individuals with disabilities in the labour market. The scientific literature repeatedly demonstrated that work accommodations can make the difference between job loss and a successful employment experience. For example, work accommodations have been reported as vital for maximizing the capabilities of people with disabilities to participate in the workforce (Williams et al., 2016), to maintain their jobs (Corbière et al., 2014a), to increase workplace productivity (Solovieva, Dowler, & Walls, 2011), and to enhance overall job satisfaction (Villotti, Corbière, Zaniboni, & Fraccaroli, 2012). At the same time, anti-discrimination legislation and work accommodations seem to be insufficient to fully guarantee the integration of individuals with disabilities at work. In fact, as noted by Bjelland, Burkhauser, Von Schrader, and Houtenville (2011), the employment picture of people with disabilities has not changed in the United States since the ADA has been implemented. If it holds true that the U.S. workforce has become widely more diverse by integrating protected groups of workers under the ADA such as females, minorities, or older employees, the employment rates for people with disabilities are still unacceptably low (Toossi, 2012; Weathers & Wittenburg, 2009). The reticence to hire people with disabilities can be explained by stigmatizing believes about this group of people (e.g., Krupa, Kirsh, Cockburn, & Gewurtz, 2009), discrimination in hiring (e.g., McMahon et al., 2008), and the perception that work accommodations are too costly (e.g., Domzal, Houtenville, & Sharma, 2008). These believes remain persistent despite studies showing that the majority of accommodations cost little or nothing, while having positive outcomes such as enhanced productivity and increased overall organizational well-being (e.g., Solovieva et al., 2011).

Numerous employers in the United States are also obliged to adhere to The Rehabilitation Act of 1973 (The Rehabilitation Act of 1973, 1973). This is a disability non-discrimination and affirmative action law aimed at promoting the employment and retention of employees with disabilities in the sectors of federal agencies and federal contractors/subcontractors. More specifically, this law prohibits discrimination against qualified people with disabilities, and requires federal employers to hire and retain individuals with disabilities, with the goal of 7% employees with disabilities within their workforce. The Rehabilitation Act also authorizes funding for numerous disability-related purposes and activities, such as vocational rehabilitation services, independent living programmes, and training and research activities.

Finally, worth mentioning is the Architectural Barriers Act of 1968 (ABA, 1968), that requires buildings and facilities constructed with Federal funds or leased by a Federal agency to respect standards for physical accessibility. With the passing of the above-mentioned laws, employment discrimination against people with disabilities in the United States has been reduced, and a larger amount of employment opportunities has arisen. However, employment outcomes for people with disabilities continue to lag substantially behind those of people without disabilities (Blanck, Adya, Myhill, Samant, & Chen, 2007). Unfortunately, still nowadays, the vast majority of working-age adults with disabilities face structural and attitudinal barriers that constrain their access to steady employment opportunities.

In Canada, the rights of people with disabilities are protected by the U.N. Convention on the Rights of Persons with Disabilities (UNCRPD, 2006), which has been ratified in 2010. Human rights and protection against discrimination in the area of employment are also guaranteed by Federal acts and programmes, such as the Canadian Human Rights Act (Canadian Human Rights Act, R.S.C., 1985) and the Employment Equity Act (Employment Equity Act, 1995). The CHRA prohibits discrimination based on physical or mental disability, and states that employers have a duty to accommodate employees and avoid discrimination. The obligation for reasonable accommodations is limited only by the proof of undue hardship, and it forces organizations to take into account the needs of workers with disabilities. The EEA encourages employers to achieve workplace equity and create opportunities for individuals with disabilities by removing barriers to employment. The Government of Canada also promotes the labour market participation of people with disabilities with several funding programmes.

Alongside Federal Acts, Canadian provinces have their own disability legislation and programmes to integrate people with disabilities into the labour market and assure employment equity and opportunities. For instance, in the province of Québec, the Contrat d’intégration au travail (Ministère du Travail, 2017a) promotes the employment of individuals with disabilities by supplying grants and the Programme de subvention aux entreprises adaptées (Ministère du Travail, 2017b) supports businesses that hire people with disabilities who experience difficulties when working under ordinary conditions. Thus, rather than imposing a quota system, such as in many European countries, the province of Québec supports a voluntary approach via the promotion of training and rehabilitation programmes (Laflamme & Nadeau, 2011). The philosophy behind this approach is the belief that individuals with disabilities are professionally competitive if they are integrated in a work environment which is adapted to their needs (O’Reilly, A, 2003). Concluding, although legislation varies across provinces, employers have the legal duty to provide workers with disabilities reasonable accommodations.

Barriers and enablers to employment

In this section, we discuss research on barriers and risk factors associated with mental ill-health at work and summarize what we know about enablers to employment. Often barriers and enablers are two sides of the same story and determine each other. For example, an employer might be open towards hiring people with disabilities or might have negative associations with the employment of workers with disabilities. The employer’s attitudes towards hiring people with disabilities can thus either represent a barrier or an enabler. Another example is policies which are developed to protect employees with disabilities against unfair dismissal. These are often well-intentioned, but in fact might even prevent employers from hiring a person with a disability (Niehaus & Bauer, 2013; WHO, 2011). We will therefore discuss both, barriers and enablers, together. However, compared to our knowledge about barriers, we possess to a far lesser extent empirical evidence of factors that facilitate the (re-)integration, as research often focuses on the identification of problems rather than on solutions.

Despite human rights legislation, anti-discrimination laws, as well as programmes and services devoted to offer employment support and opportunities to individuals with disabilities, they still face significant barriers in the area of employment (Prince, 2010). Work integration of people with disabilities is in fact a dynamic process of interaction among different factors, including individual characteristics (e.g., competences), but also the nature of the job, the characteristics of the work environment, as well as the availability of supportive services and accommodations. Over recent decades, social and health sciences have identified the role of social, psychological and physical barriers that impede the (re-)integration of people with disabilities into the workforce. There are several ways to look at those barriers. One possibility is to categorize barriers within the person and within the environment. This, however, entails a more differentiated view on both clusters, considering for instance high- and low-qualified employees, trainees, and so on, just as different political and societal framework requirements. Moreover, characteristics of a person interact with the environment, making systematization difficult. Another way to classify barriers is to look at different stages of the integration process. Most predominantly appear those barriers that actually prevent a person with a disability to enter the labour market or those that impede the return-to-work process. For instance, Pearson, Ip, Hui, and Yip (2003) found evidence that applicants disclosing their disability in their application documents, were invited less frequently to job interviews than applicants with a similar profile but without a disability. Further, barriers that hamper a person to perform at a maximum level at work play a pivotal role for the success of an integration process. In a study by Corbière, Mercier, and Lesage (2004), the Barriers to Employment and Coping Efficacy Scale (BECES) was validated among job seekers with mental disorders. They found five clusters of barriers, namely self-competence/self-confidence (e.g., poor work experience, low productivity), external factors (e.g., competition, employers’ prejudice), anxiety/amotivation, health (e.g., medication side effects, stress), and work adjustment (e.g., pressure, lack of support). Yet, there is no uniform approach to classify barriers and define clear categories.

In general, barriers or risk factors for workers with mental disorders are related to the design, organization and management of work, as well as to the social context of work. Thus, they include organizational characteristics and interpersonal relationships at work (Corbière et al., 2013). Examples for such barriers include among other things a lack of health and safety policy, inappropriate work schedules, misunderstanding disability, erroneous beliefs and lack of knowledge, fear, personnel practices and policies, poor teamwork, non-inclusive organizational culture, and missing communication between applicants and companies. Moreover, many political stakeholders and employers do not acknowledge people with disabilities as a valuable resource in their workforce (e.g., Niehaus & Bauer, 2013). Below we will review a selection of barriers and discuss how we can counteract them.

Attitudes towards workers with disabilities

One of the most significant barriers that workers with disabilities face when entering the workforce are co-workers’ and supervisors’ attitudes and stereotypes (Colella & Bruyère, 2011). Several studies that investigate the attitudes of the general population towards people with disabilities report that people often feel a high degree of social distance towards people with disabilities (Angermeyer & Dietrich, 2006; Aromaa, Tolvanen, Tuulari, & Wahlbeck, 2011; Tanaka, Inadomi, Kikuchi, & Ohta, 2004). In the work environment, this perception of a social distance can translate into a biased view about the capacities of employees with disabilities (Burge, Ouellette-Kuntz, & Lysaght, 2007; Ross, 2004; Scheid, 2005) in a way that persons with disabilities are perceived as helpless, having no capacities to develop (Prins, 2013), and being unable to effect a similar level of performance as their colleagues. The performance of a colleague with disability seems to be one of the biggest concerns of employees in an organization. Individuals who believe that a co-worker with a disability is responsible for an increased job-difficulty and a higher workload, have lower expectations towards this co-worker and more negative reactions and attitudes concerning employees with disabilities in general (Burge et al., 2007; Scherbaum, Scherbaum, & Popovich, 2005; Vornholt, Uitdewilligen, & Nijhuis, 2013). Commonly, people seem to rely on stereotypes they have about people with disabilities when predicting future work performance (Colella & Varma, 1999). This even accounts for high-qualified university graduates with a disability, regardless of their obvious qualification (Niehaus & Bauer, 2013). Such negative biases were also found to be prevalent under conditions in which the performance of the employee with a disability had direct (positive) consequences for the rater (e.g., for receiving a reward) (Colella, DeNisi, & Varma, 1998).

Negative attitudes towards people with disabilities are often accompanied by a misunderstanding of disability, such as distrust and fear of co-workers or managers concerning the disability. Individuals with mental disorders are especially vulnerable to experience such mistrust and belong to one of the most stigmatized groups in our society because their disability is invisible and their skills and handicaps not immediately ascertainable (Bos, Kanner, Muris, Janssen, & Mayer, 2009). This can result in several (negative) consequences in the workplace, such as the denial of necessary workplace accommodations (Toth & Dewa, 2014). People with mental disorders are attributed as being dangerous, deviant, and aggressive, which evokes fear and irritation in others (Bos et al., 2009). The higher the level of stigmatization of the disease, the more likely it is that the affected person will experience discrimination (Beatty & Kirby, 2006). Stigma comprises stereotyping, prejudice, and discrimination, whereas discrimination is the behaviour that results from negative stereotypes (Dijker & Koomem, 2003). For persons with mental disorders, fear of stigmatization is a particular concern (Toth & Dewa, 2014), as well as a need for active coping (Muschalla, Fay, & Seemann, 2016).

Employers’ attitudes

Employers have an outstanding role when it comes to the work integration of people with disabilities. Although the legislation in many countries forces them to employ people with disabilities, still many employers decide against hiring workers with disabilities. The reasons for such a decision are manifold. Besides a common lack of knowledge concerning disabilities in general, employers are often not aware of the workers’ needs and are not informed about how to accommodate them at work. Concerns employers regularly report regarding the accommodation process are costs and training time to be devoted to employees with disabilities.

Studies conducted on the employers’ perspective have reported positive as well as negative attitudes towards the employment of individuals with disabilities. On the positive side, employers have been found to be in favour of recruiting people with disabilities, especially those employers having previous experiences (Chan et al., 2010; Copeland, Chan, Bezyak, & Fraser, 2010; Unger, 2002). On the other side, studies highlighted that employers lack confidence in people with disabilities’ level of productivity and quality in terms of performance (McCary, 2005), and more generally in their employability – that is, the capacity of an individual to adapt to the needs of and changes in the labour market – and fear associated costs (Kaye, Jans, & Jones, 2011; see Waterhouse, Kimberley, Jonas, & Glover, 2010; for a review). Employers express concerns related to the quantity and quality of work done by people with disabilities and fear low flexibility and high levels of absenteeism (Diksa & Rogers, 1996). Additionally, employers worry about people with mental disorders being insufficiently motivated to work, or being unable to manage anger and follow instructions (Rao, Horton, Tsang, Shi, & Corrigan, 2010).

Colella and Bruyère (2011) report on “aesthetic anxiety” to refer to the phenomenon of anxiety that an employer may have related to the negative perception about their business; in the sense that individuals with disabilities would make the business look less attractive in the eyes of consumers. Consequently, employers may be less willing to hire people with disabilities. However, a good match between the applicant and the job can make a real difference for an employer concerning the decision to hire a person with a disability (Fraser, Ajzen, Johnson, Hebert, & Chan, 2011; Gilbride, Stensrud, Vandergoot, & Golden, 2003; Smith, Webber, Graffam, & Wilson, 2004). Employers also attach importance to knowledge and information about disabilities, and a good and stable communication with disability employment agencies or an expert to be contacted in case of problems arising at the workplace (Kaye et al., 2011). Some researchers advanced the hypothesis that employers’ attitudes towards hiring people with disabilities may depend on the size of their organization. In particular, in a study conducted by Fraser et al. (2011), employers of smaller businesses perceived individuals with disabilities as less qualified and less likely able to perform tasks competently compared to employers of bigger companies, where employees with disabilities were more likely to be accepted. These results were supported in a study conducted by Jasper and Waldhart (2012), where a general pattern of openness towards hiring people with disabilities appeared to increase with company size as well. Employers appreciate being informed about a disability and all related consequences, such as in how far the disability affects the worker (Tse, 2004). Employers are in charge of establishing a trusting workplace climate that facilitates disclosure of a disability, and should be able to maintain contact with health agencies in order to receive support from specialists if needed. Thus, employer’s attitude and openness, their previous contact and experiences in employing individuals with disabilities, are main factors that influence whether the outcome of workplace inclusion is positive or negative.

However, even when employers are willing to hire and accommodate people with disabilities, also other challenges and barriers may arise in the practical process of integrating future employees with disabilities into work. For example, employers may lack resources to support individuals with disabilities at work, and may be under pressure in terms of profit and productivity (Shankar et al., 2014).

Strategies to overcome negative attitudes

To overcome negative attitudes, stigmatization, and discrimination, it is necessary to develop a framework for disability that allows for generalization and examine how people understand disability. Furthermore, organizational members need to be educated about disability and its consequences for a person in a work environment. Broadening this conclusion to the societal level, a generally enhanced awareness of people with disabilities as a substantial part of the workforce in organizations might counteract psychological barriers also within work teams. Political stakeholders can contribute to this process by underpinning the urgency of workplace integration in times of an ageing workforce and skill shortages so that prospective employers recognize the profit they can gain. This process can be supported by the publication of best practice examples and the allocation of supportive structures (Niehaus & Bauer, 2013). Furthermore, meta-analyses of the psychiatric disability literature on stigma change have demonstrated that contact is even superior to other approaches, such as education. It can be argued that exposure is the cure of stigma (Corbière, 2014).

Job requirements

Besides the attitudes and stereotypes of colleagues and an exclusive work environment, also the job itself can constitute a barrier towards the successful (re-)integration of workers with mental disorders. Examples for such barriers are long working hours, work overload, work pressure, and the effects of these factors on personal lives. Michie and Williams (2003) found these barriers to be significantly related to and indicative of absence from work. In fact, work demands have expanded in recent years, making access to labour participation increasingly difficult for people with disabilities. The Sixth European Working Conditions Survey reveals that in general many people complain about increasing work intensity (Eurofound, 2016). Alongside these barriers, employees with disabilities as well as employers report bureaucratic hinders and complain about the confusing plurality of funding agencies and contact persons with indistinct responsibilities. These factors at least slow down the implementation of required workplace accommodations and thus the (re-)integration process, but might also completely disrupt the efforts from both sides (Niehaus & Bauer, 2013).

The perception of barriers

In addition to the barriers ascribed to colleagues or the work environment, persist those barriers that originate from the biased and subjective perception of barriers on the part of the employees with disabilities themselves. These include the anticipation of stigmatization. Concerning access to work, people with disabilities more frequently anticipate stigmatization than they actually experience it (Angermeyer, Beck, Dietrich, & Holzinger, 2004). Furthermore, finding and keeping work constantly require planning and decision-making processes, representing a barrier especially for people with mental disorders (Corbière et al., 2004). Excessive demands might also diminish a person’s confidence and self-efficacy necessary to overcome barriers (Bassett, Lloyd, & Bassett, 2001; Corbière et al., 2017). Further, people with disabilities might experience barriers caused by side effects of medication such as stiffness, tremors, or difficulties in concentration (Corbière et al., 2004), that in turn alert colleagues and supervisors and possibly evoke stigmatization. During a return-to-work process the worker’s perception of obstacles and self-efficacy beliefs about overcoming such difficulties can be monitored using the Return-to-Work Obstacles and Self-Efficacy Scale (ROSES; Corbière et al., 2017). The scale is a valid instrument to predict return-to-work within six months and can be used at key points during the clinical intervention to assess a person’s progress in terms of self-efficacy (Corbière et al., 2017).

Conclusion

The above mentioned presents a global overview of the most predominant barriers that workers with disabilities experience, but the actual list of barriers is far more extensive and includes important factors such as supervisor or leadership issues, work conflict, or organizational culture and climate. We conclude, that there is still a great need for high quality studies that assess barriers that people with disabilities face when entering the labour market and that find relevant prognostic factors of long-term disability claimants. Primarily those factors that are sensitive to change provide possibilities for the use of intervention and prevention strategies to shorten the duration of non-productive time and facilitate return-to-work (Cornelius, Van Der Klink, Groothoff, & Brouwer, 2011). Only when barriers are transcended, steps to inclusion can be taken and both, people with disabilities and the organization, may experience positive outcomes. The leading concern of work- and organizational psychologists regarding these barriers should be to bring the message across to companies and organizations to support and guide them in the process of setting the stage for employees with disabilities. However, even though there have been many attempts to foster the integration of people with disabilities by public policy and legislation aimed at enabling workplace inclusion, little has changed to date. The challenge for disability researchers, and especially psychologists concerned with this topic, is therefore to develop a better understanding of stereotypes, stigma, and expectations held about people with various disabilities and examine how to best counteract these issues.

Disclosure

Employees diagnosed with a chronic illness, a mental disorder or another disability often encounter the problem of how to deal with their condition at the workplace and whether they should communicate it to their employer or colleagues. Disclosure of a specific health condition can be defined as the process of informing others verbally about oneself and one’s health condition (Brohan et al., 2012). Among researchers, the topic ‘disclosure of a disability at work’ provoked controversial debates in the past (e.g., Corbière, Villotti, Toth, & Waghorn, 2014b; Nelissen, Vornholt, Van Ruitenbeek, Hülsheger, & Uitdewilligen, 2014; Santuzzi, Waltz, Finkelstein, & Rupp, 2014). Therefore, we briefly comment on this topic here.

Especially mental disorders evoke the conflict of the decision whether, when, how, and to whom to disclose the disorder, in particular because mental disorders are invisible and, in theory, also concealable. Disclosure is also influenced by factors such as self-identity, personality, context and previous experience (Santuzzi et al., 2014). The legal situation to disclose a disability at work differs in European countries. For instance, in Germany or the Netherlands there are no legal obligations to inform the employer about a mental disorder as long as the impairment does not result in any endangerments at the workplace. Also in the United States, a job applicant does not have to disclose a disability to an employer. Only when receiving a job offer, an individual may lawfully be asked disability-related questions (The Americans with Disabilities Act, 1990). However, disclosure is an essentially important and even necessary consideration for a job applicant with a disability for two reasons (Brohan et al., 2012). First, the health condition might be progressive or may require medical examinations and therapy (Bundesarbeitsgemeinschaft der Integrationsämter und Hauptfürsorgestellen (BIH), 2013), such as that the employee might need to schedule medical appointments during working hours. Second, potentially necessary accommodations can only be implemented if the employer has knowledge of the disability; especially when natural supports in the workplace are not available. And indeed, the request for work accommodations is the primary reason for disclosing one’s disability (Corbière et al., 2014b).

Thus, meeting the requirements of both, the disease and the professional activity, is a constant challenge for a person with a mental disorder. When needs cannot be met, or are not compatible with work demands or work tasks, the affected person’s well-being and performance may suffer. Thus, the person becomes work disabled. This in turn may cause the person again to deal with the question whether to disclose the condition at the workplace or not (Munir, Leka, & Griffiths, 2005). The decision-making-process is a very complex process and an individual risk-benefit analysis that includes possible positive and negative consequences of (non-)disclosure (Jans, Kaye, & Jones, 2012). Positive outcomes of disclosure could for instance be social support, technical adjustments of the workplace, flexible working hours or a change of work tasks, thereby promoting stable or increased performance and well-being (Böhm, Baumgärtner, & Dwertmann, 2013). Possible negative consequences are especially related to responses from the social working environment, such as social insecurity, changed behaviour and negative attributions (like being unqualified and less efficient) or stigmatization of co-workers or supervisors that could have a negative influence on the person’s career and likewise well-being (Beatty & Kirby, 2006; Santuzzi et al., 2014).

To counteract negative consequences of disclosure, a trusting and inclusive atmosphere (workplace culture) should be established in order to increase the readiness to make health and disease a subject of discussion at work (Munir et al., 2005; Niehaus, Marfels, Vater, Magin, & Werkstetter, 2008). Additionally, employment specialists or counsellors can facilitate the process of planned disclosure as a means to obtain access to work adjustments in the workplace and to prevent stigma (Corbière et al., 2014b).

Concluding, even though people with a concealable stigma are protected by law against discrimination, many do not disclose because they fear stigmatization. Without significant rethinking of organizational cultures that shape the values and the character of a workplace, changes in legislation and workplace policies will result in little progress towards reducing the stigma associated with disability or in creating a positive work environment for all employees.

Future perspectives (specific for Europe)

This paper reviews several topics that are already well established in psychological research, but still require further attention. Research and practice in this field are closely interwoven. In the following, we will highlight future perspectives concerning theoretical and practical aspects respective disability and employment.

What is needed in research?

First, we would like to draw attention to the initial question concerning the definition of disability. It seems necessary that we accomplish a more differentiated understanding of impairment as such on the one hand and disability in terms of the ICF on the other hand. This means that “disability” should conceptually be distinguished from the illness and body or functional impairment within the person. Instead, disability should be treated as a possible consequence of the negative interaction of the illness and the demands of the context. Therefore, three different levels of impairment need to be distinguished when speaking of disability. The first level addresses the illness or symptoms as such (in terms of the ICF this is called body or functional impairment), which are defects in body functions or structure. The second level describes activity and capacity impairments and defines what a person is (un)able to do with a body or functional impairment. The third level encompasses participation impairments or “disability” and refers to the (disabling) interaction between a person and the environment. By focusing on the influence of the context, the ICF (WHO, 2001) offers a concept of disability as caused by the interaction of health impairment and environment (and not only due to the impairment in the person). Disability then causes a participation problem. This new definition of disability represents a change of mind because disability can no longer be seen as a trait of a person, but rather as a problem in terms of physical, social, and attitudinal barriers. Moreover, it represents a shift in responsibility, in that now society bears the responsibility to overcome such barriers, not the individual. Therefore, it is crucial that this mind shift not only takes place in theories and frameworks and is known only by a small group of experts, but becomes known on a broad societal level. Especially work- and organizational psychologists are in charge of spreading knowledge and initiate change in terms of attitudes and related behaviours, such as with health campaigns. Furthermore, the quality of public data needs to be enhanced on a very concrete level in terms of the definition and operationalization of the concept disability, such as that data is in accordance with the ICF definition of disability.

Also in terms of policy systems more research and a more active role of work- and organizational psychologists is required. It is important to thoroughly evaluate whether policies implemented actually protect the rights or promote the employment of people with disabilities or if they in practice even have contrary effects. We need to understand how such paradox effects of positive discrimination can be prevented. In general, policies need to pay greater attention to keeping people in the labour force and preventing them from moving onto a lifetime benefit.

Future research on the impact of legislation should in addition explore the negative effects of reasonable accommodations that by law need to be provided for the worker with disability. Research has revealed that accommodations in general have beneficial effects for the worker in question in terms of sustainable employment. However, reactions of co-workers, the influence on employer’s attitudes, fairness perceptions, and other possible consequences on the work environment of the worker with disability have not yet been investigated. In two theoretical papers Colella and colleagues (Colella, 2001; Colella, Paetzold, & Belliveau, 2004) investigate the impact of workplace accommodations on fairness perceptions of colleagues. However, empirical evidence is still lacking.

Further, the literature points to the fact that employment plays a central role in the recovery from mental disorders (Center, 2011) and is linked to a decrease in psychiatric service costs (Luciano, Bond, & Drake, 2014). In this context, more studies are needed that explore the cost-effectiveness for return-to-work and that provide detailed cost-benefit analyses. Do people with mental disorders cost less to society if they work?

We would also like to push forward research in the field of workplace enablers. An important enabler of job acquisition in competitive employment is the employment specialist (Corbière et al., 2011). Together with a client’s active job search behaviour, the employment specialist’s competencies, especially in relational skills to establish solid working alliances with clients, are strong predictors for job acquisition of people with severe mental illnesses (Corbière et al., 2017). Another example of an important enabler is the organizational culture or climate that can constitute to more inclusiveness, inclusive attitudes and behaviours of the members of an organization. In the diversity literature, the link between a positive, organizational climate and inclusiveness has already been established. A positive climate leads among other things to job satisfaction, a sense of inclusion, work group identification, openness towards change, openness to others and knowledge sharing in teams (Groggins & Ryan, 2013; Hofhuis, Van Der Rijt, & Vlug, 2016; Luijters, Van Der Zee, & Otten, 2008). However, evidence that the same or similar mechanisms hold true also in disability research that especially focusses on mental disorders, is still lacking. Besides the theoretical foundations of such climate, also more research is needed that brings forward the implementation of an inclusiveness climate.

Besides its focal interest in barriers to employment, research has also strongly focused on limitations of workers with disabilities instead of stressing their capacities. However, the (re-)integration of employees with mental disorders should focus on overcoming disability at the workplace itself instead of being based on alleviating symptoms in for instance psychotherapy. One solution would be to implement training and interventions at the workplace itself that focus specifically on the capacities of the employee. Additionally, authority should be added to the modification of work role demands or the implementation of work accommodation, as people are not always trainable to a maximum level of performance per se. Instruments are needed that allow to describe activity, capacity and participation impairments in relation to work demands (e.g., like the Mini-ICF-APP; Linden et al., 2010) in order to deliver a realistic estimate of what people with disabilities may be able to do respective future employment. This also raises the issue of employee selection and available selection tools. Many assessment tools are not applicable for the group of people characterized by a lower education and/or mental disabilities, making it difficult for organizations to find and employ people with disabilities.

As a last point we would like to raise the issue of study designs. Mental illness has high recurrence rates (OECD, 2015), which makes the need for longitudinal studies extremely important. We need studies with longer retention periods and more follow-up measurements. For example, a recent Cochrane review (Suijkerbuijk et al., 2017), assessing interventions for obtaining and maintaining employment in adults with severe mental illness, indicated that job tenure of people with a severe mental illness in the regular labour market could substantially vary in duration according to the longitudinal design, from 13 weeks in studies with short-term follow-up to almost 33 weeks in long-term follow up (>1 year).

What is needed in practice?

Concrete, practical suggestions for an improved integration of people with disabilities in the labour market are difficult to map because the European setting is very diverse. However, several general remarks can be put here. First, the role of different social actors needs to be clarified and the responsibility for the assessment of the work ability of a person needs to be assigned. In order to do so, experts are needed who are able to assess the work ability (and possibly inabilities) of sick-listed employees. A possible source of expertise is represented by primary care or occupational physicians. Also psychological psychotherapists might contribute to this process when expertise is needed concerning work ability and mental disorder (this is currently discussed in Germany). In the return-to-work process of employees, they can evaluate which work demands the person with a chronic health impairment is (un)able to fulfil. Therefore, occupational physicians or psychotherapists need expertise in describing capacity and participation disorders in a differentiated way, so that others (e.g., the supervisor or employer) can understand if the employee is able to perform certain tasks or if any accommodations are needed. Additional, integrating relevant information from different sources is the basis for work ability judgments. Clear communication channels between involved players and systems (i.e., personal, workplace, healthcare, and compensation systems) are needed. Together, the employee, medical expert, employer, supervisor, and union representative are able to conclude reasonable means for the return-to-work process (Corbière et al., 2015). Possible solutions might be a stepwise reintegration, a qualitative change of work duties, assistive equipment at the workplace, or any other return-to-work supportive means. This also requires good routines for communication so that relevant information is transferred from the physician to the workplace (in agreement with the employee). In this context, it is important to mention that the supervisor does not need to know what the diagnosis of the illness is, but rather which activities an employee can or cannot fulfil at work due to the functional impairment. Therefore, in the occupational health practice, concepts for work ability descriptions in terms of capacity (rather than symptoms) are needed (Linden et al., 2010; Molodynski et al., 2013; Muschalla, 2016).

Essential are also initiatives that aim to create work for people with disabilities, instead of adhering to existing functions in an organization that are hard to staff with workers with disabilities. An example of an innovative approach to create work for people with disabilities has been developed and implemented in the Netherlands (Van Ruitenbeek, Mulder, Zijlstra, Nijhuis, & Mulders, 2013; Zijlstra, Mulders, & Nijhuis, 2009). This new method is called “Inclusive Redesign of Work” and is tailored to a group of people with a large distance to the labour market. This population is characterized by a low education and/or mental or physical disabilities and is unable to participate in the labour market without support. The aim of the method is to create non-complex work in regular organizations to facilitate work participation of people with disabilities. The method is based on an analysis of work processes and redesign principles which eventually enable organizations to make optimal use of all work capacity and talent available on the labour market. The underlying principle is “task differentiation”, which means that tasks are being designed with different levels of complexity and for people with various levels of capacities. Thus, aimed for creating or designing “simple jobs” again (Zijlstra et al., 2017). The method has shown to be effective for the creation of suitable work for a large group of people with disabilities in different types of organizations (Van Ruitenbeek et al., 2013) and represents a new way of thinking about work and work positions in organizations.

Furthermore, interventions are needed for employers, supervisors and other included actors designed to reduce fear and precariousness towards mental disorders. It might be useful to communicate basic knowledge on mental disorders, which is that mental disorders are a rather common phenomenon and not a mystical phantom. Important stakeholders should be aware of the fact that mental disorders are the reason for most long-term sick leaves but that they can be treated even though these disorders are chronic. Work in general is a health promoting factor – also, and maybe even especially, for people with mental disorders. Therefore, more attention at work is needed for people with mental disorders and finding the right person-job-fit is especially relevant for these employees. The emphasis should thereby be placed on the strengths and abilities of employees. Necessary accommodations should be put into practice accordingly which make the adaptation of job roles to the needs of the person easier. Generally speaking, the public awareness for the labour force potential of people with disabilities needs to be raised in order to promote inclusive workplaces. Shared positive experiences and examples of best practices can help to reduce fear and stigma among employers and co-workers and might lead to an increase in employment of people with disabilities. This holds true for politics in a wider sense as well. Work- and organizational psychologists need to tackle the task to educate politicians and stakeholders in their use of suitable strategies for the activation and recruitment of a skilled and inclusive labour force. These strategies should pursue the reduction of barriers towards employment and initiate counteraction.

Concluding thoughts

Research on disability and employment has a long history and much is already known about the dynamics between both topics. However, there are also areas that especially work- and organizational psychologists can and have to push forward in order to support the workplace inclusion of people with disabilities. We not only need a new understanding of disability, but we also need to take new perspectives to make a contribution to the field. Three particular areas stand out, which are accommodation, the ageing workforce, and the impact on human welfare (Colella & Bruyère, 2011). Further, more needs to be known especially about the situation of people with mental disorders and the impact of the disorder on functionality and work capacity. Therefore, it is necessary to understand the dynamics between mental health and work and the impact of various institutions, systems and policies (Organisation for Economic Co-operation and Development, 2012). Likewise, policy can and must respond more efficiently to the demands of the labour market inclusion of people with mental disorders. We need workplaces with tolerances for persons with mental disorders or other chronic health problems, since working conditions have changed and capacity disorders and sick leave due to mental disorders increased. To countermand this dysfunctional development, we need organizations and workplaces that embrace diversity especially in terms of employees’ capacities (Zijlstra et al., 2017). In this position paper, we provided an overview of the current status of disability research. We hope to have shown that this area of research is highly relevant in times of societal transformations and want to bring out that it has already achieved much. It is up to us to stay active, curious and keen to make further progress in those many future research questions that remain. We want to encourage researchers to explore this topic more deeply and share knowledge with a broad community of researchers and practitioners, thereby moving this area of research forward within the next years.

Acknowledgements

This position paper is the result of a small group meeting on “Disability and Employment – Integrating research streams and facilitating international collaboration” that took place at Maastricht University in October 2014. The meeting was sponsored by the EAWOP, the Faculty of Psychology and Neuroscience and the Department of Work and Social Psychology of Maastricht University.

Disclosure statement

No potential conflict of interest was reported by the authors.