Exploring mental illness in the workplace:the role of HR professionals and processes

Abstract

In this overview, we introduce a special issue featuring six articles on various aspects related to the role of Human Resource Management in managing mental illness at work. This introduction article starts with an overview of what we know and do not know about mental illness in the context of work and why more insights related to mental illness at work are much needed. The special issue features a unique set of articles that employ different methodologies and approaches to studying mental illness at work. Theoretical perspectives presented include tension-centred theory, ethical HRM, diversity theory, person-job fit, and critical disability studies. The articles outline and discuss HRM policies, practices and strategies used to manage individuals with mental illness, the experiences of individuals with mental illness in the context of work, and includes a review on disclosure of mental illness in the workplace. Recommendations for continued research are presented and a range of theoretical lenses and perspectives are discussed as possible foundations for future inquiry focusing on context, sampling, and methods, as well as further empirical investigations of the full range of stakeholders’ perspectives (i.e. individuals with mental illness; co-workers and peers; and organizational-level factors such as policies, and leaders and HR managers’ perspectives). This special issue aims to enhance our knowledge of the role HRM can play and aspires to spark interest from both scholars and practitioners as an increasing number of individuals are navigating the workplace while managing mental health conditions.

Keywords:

• Mental illness
• mental health condition
• management
• human resource management
• employees
• work

Recent estimates suggest that rates of mental illnesses, such as depression and anxiety, and their consequences, such as suicide, are on the rise globally (Hasin et al., 2018, Swartz, 2015). The American Psychiatric Association (APA) defines a mental disorder as ‘a clinically significant disturbance in an individual’s cognition, emotion regulation, or behaviour that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress in social, occupational, or other important activities.’ While individuals with mental illness have received attention in health-related disciplines, the field of management continues to lag behind (Follmer & Jones, 2018), which is concerning given the number of employees who experience mental illness each year. Ultimately, the lack of organizational research related to mental illness makes it difficult to understand how these individuals navigate the workplace as well as the ways in which Human Resources (HR) professionals and practices could better support these workers.

Increasing the understanding of employees with mental illness is important for both economic and humanistic reasons. From an economic perspective, ample research has shown that employees with mental illness can cost organizations in the trillions of dollars each year (World Health Organization, 2019). Most of these economic losses are attributed to decreased productivity and increased absenteeism rates among employees who have been diagnosed with a mental illness, such as depression or bipolar disorder. Empirical evidence has demonstrated that employees with mental illness often experience decrements in productivity and cognitive functioning (Hennekam et al., 2020; Lerner & Henke, 2008; McGurk et al., 2003), which can have a significant impact on their work-related performance. Organizations that understand what mental illness is and how it can be managed may be better positioned to nurture the strengths of people with mental illness, while minimizing any associated economic costs. Although empirical evidence has demonstrated that mental illness affects productivity, there remains much that scholars do not know about the effects of these disorders on employees’ work outcomes.

The assumption that employees with mental illness are less productive than other workers can contribute to the continued stigmatization of these individuals, as managers often express reservations about hiring those with mental illness (Richards, 2012). Previous research confirms that employees with mental illness are often believed to be unstable, crazy, incompetent, and dangerous to others (Corrigan et al., 2005). Employer concerns about this group of workers encompass social and emotional skills, such as handling criticism and stress, emotional control, and conflict resolution (Hand & Tryssenaar, 2006), along with concerns about safety, job attendance, and performance (Dolce & Bates, 2019). Mental illness is a person-centered experience, and each individual will be affected by their disorder differently, meaning that stereotypical assumptions about workers’ performance could be both inaccurate and harmful for the employees.

Not only does stigma contribute to negative stereotypes, it also increases discrimination toward those with mental illness (Follmer & Jones, 2017), influencing their career trajectories. Studies show that psychiatric disabilities have more significant negative effects on hiring decisions and performance expectations than physical disabilities (Ren et al., 2008; Spirito Dalgin & Bellini, 2008). Employees with mental illness consistently experience lower employment rates, under-employment, and lower wages (Harris et al., 2014; Krupa, 2010; Perkins & Rinaldi, 2002), and often experience thwarted opportunities for career development as they must explain gaps in employment history and/or fluctuating symptomatology associated with their disorders (Harris et al., 2014). In studies of employees with psychiatric disabilities, it was found that low expectations about their work capacity were embedded in policies and programs, propagated from medical and psychiatric personnel, vocational counselors, family members, friends, and the media (Killeen & O’Day, 2004; Wästberg et al., 2018). Emerging evidence also suggests that workplace factors can significantly affect employees’ suicide-related thoughts and behaviours, particularly when organizations are not inclusive (Follmer & Follmer, 2021; Howard et al., 2021). These concerns are directly within the purview of HR professionals who can assist in training managers about attracting, selecting and recruiting employees as well as provide supportive interventions and accommodations to assist those with mental illness throughout their careers.

Workplace adaptations or accommodations refer to ‘changes to the work environment that allow people with disabilities to work safely and productively’ (Equal Opportunity Act, 2010). These accommodations aim to make to make it easier for individuals with mental illness to meet the demands of their job. Although reasonable accommodations are compulsory in many countries, they are often not provided to those who need it (Wang et al., 2011). However, when pertinent accommodations are made available they tend to have a positive impact on individuals with mental illness, as they have been found to be associated with increased productivity and well-being (Mechanic & Olfson, 2016; Villotti et al., 2012).

Creating access to jobs and designing organisations that are inclusive and accommodating for individuals with mental illness yields benefits for both employees and employers. Having stable employment improves individuals’ functioning and recovery by providing structure and stability, contributing to their overall well-being and financial independence (van Niekerk, 2009). Most people with mental illness report that they want to work (McAlpine & Warner, 2015; Twamley et al., 2008) and when they are able to work they report that employment is a source of meaning (Eklund et al., 2012).

Therefore, a social imperative exists to provide individuals with mental illness access to quality employment opportunities. Organisations that attend to the needs of these employees can also experience social benefits. For instance, when employers create inclusive organizations that support those with mental illness, they are likely to see gains in their reputation, improved ambiance and culture, and increased loyalty and commitment from both consumers and employees (Peterson et al., 2017).

Despite evidence that rates of mental illness and suicide are steadily increasing among adults, many of whom are actively involved in the global workforce, organizations are grossly underprepared to manage and respond to employees with mental illness (Shann et al., 2014). Managers and those in positions to make employment decisions lack both conceptual and procedural knowledge that is necessary to support vulnerable employees (Martin et al., 2015). Due to the multifunctional nature of HR, HR professionals have the opportunity to engage in transactional (e.g. record keeping), traditional (recruiting, training), and transformational (e.g. strategic planning) activities (Lepak et al., 2005) – all of which can impact the experiences of employees with mental illness and those who interact with them. In this special issue we draw attention to a group of employees who has been misrepresented and underrepresented in organizational studies.

This special issue has two primary objectives: 1) to increase awareness about employees with mental illness and the role HR plays both in shaping their work experiences and shaping an inclusive climate 2) to identify theoretical perspectives that can be used to systematically and empirically study employees with mental health conditions. To date, much of the research regarding employees with mental illness has been conducted in fields outside of organizational studies (e.g. occupational health, psychiatry, vocational rehabilitation). Due to discipline-specific approaches to conducting research, much of the extant research has focused on providing quantitative or qualitative summaries of employers’ experiences (e.g. absenteeism and number of sick days used; amount of monetary costs associated with mental illness), but often lacks theoretical grounding to explain these experiences. Organisational scholars can continue to make significant contributions in this area of study by using and developing existing theories in the context of employees with mental illness. The collection of articles in this special issue employs different approaches, theoretical lenses and populations to help highlight the challenges of effectively and ethically managing employees with mental illness in ways that allow their best traits and strengths to emerge in the workplace. The special issue represents employees from across the globe and provides unique perspectives from employees with mental illness, HR managers who support those employees, and leaders setting strategic directions. The articles in this special issue provide an important springboard for academics and practitioners to take action and create more inclusive policies and practices focused on the needs of employees with mental health conditions.

Special issue overview

This special issue includes six articles: three articles addressing organizational policies and strategies used to manage employees with mental illness, followed by two articles exploring the experiences of employees with mental health conditions, and ends with a systematic review of mental illness disclosure studies.

In the first article, Quinane, Bardoel, and Pervan investigate CEOs’ and senior leaders’ strategic framing of mental health issues at work using interview data from 26 leaders in Australia. They argue that leaders have a role in shaping organizational responses to mental health conditions. Using tension-centred theory as a foundation (Poole & Van de Ven, 1989), they identify the range of strategies organisations use to respond to such tensions. Their interviews show that leaders hold a variety of perspectives that are inherently in conflict. For example, one tension involves the values of privacy/ignorance against disclosure/safety/compassion. More specifically, employers want to respect employee privacy, so they do not ask about mental health conditions (achieving a kind of purposeful ignorance). This creates a self-reinforcing cycle of ignorance, and precludes organisations from addressing the extent to which workplace stressors may be contributing to poor mental health. At the other pole of the tension are the values of disclosure, safety, and compassion. Leaders understand that their employees want to feel safe and valued, and believe that they owe their employees a response that promotes compassion. Despite this, the authors find that leaders tend to settle in favour of the privacy response since the best practices for responding to mental health conditions are not clear, and it seems easier to remain unaware because it limits leaders’ obligations to respond. Additional interrelated tensions in their findings relate to the opposition between whether the organisation can or cannot help with mental health conditions, and whether addressing mental illness is an individual or social/organizational responsibility. The authors suggest that a more effective synthesis response is possible in which employers collect anonymised data on employee mental health from their EAP programs regarding how many employees at each location are using the EAP, the extent of their utilization, and, if possible, for the EAP to identify workplace factors contributing to mental illness. These findings could then be used to improve job designs that may be exacerbating stress and poor mental health. We note that these suggestions would have to be implemented carefully, since employees are understandably concerned about any sharing of their personally identifiable information, and such efforts could have a chilling effect on EAP participation.

The second article by Kalfa, Branicki, and Brammer looks at how HR managers support employees with mental health conditions. Their data comes from interviews with 40 HR managers in Australia, and the conceptual framing of their study is ethical HRM (Greenwood & Freeman, 2011). They ask what the implications are of transactional, benevolent, ethical, and unethical HRM approaches for managing employee mental health conditions. They suggest that HR responses to mental illness vary in terms of levels of employee engagement and employee agency, and are influenced by organisational culture, job demands, and employee-manager relationships. They find that both transactional and benevolent HRM approaches and associated managerial actions can unintentionally stigmatize employees with mental health conditions through two types of structural stigma: business-based structural stigma and care-based structural stigma. Structural stigma occurs when HRM interventions inhibit an employee’s engagement or agency due to their mental health condition. Importantly, these kinds of stigma are unintentional, produced in the daily management of organisational norms and policies. Reassuringly, they find no evidence in their data of unethical HRM in the context of managing mental illness. Their practical implications are that training managers in best practices to respond to mental illness could raise the overall competence levels to support employees, and that organisations might consider focusing mental health programs on all employees to avoid further stigmatisation of employees with mental illness.

The third article by Richard, LeMaire, and Church Morel investigates HRM practices in the context of sheltered workshops in France. They ask: how do sheltered organizations adapt their HRM practices to individuals with mental health conditions? Drawing upon diversity theory, the authors apply identity blind versus identity conscious perspectives (Konrad & Linnehan, 1995) to explain the experiences of individuals in the sheltered workshops. The data from their study comes from 36 semi-structured interviews, non-participant observation, focus groups, and informal interviews at four sheltered workshops. By their nature, sheltered workshops are identity conscious since they are designed for employees with developmental disabilities. Yet, the staff at these workshops are aware of the need for flexibility and adaptation for employees with mental health conditions. Their findings show that sub-group identity blind practices are favoured when the structural constraints of the organisation do not provide the flexibility to adapt, and when organisational resources do not exist to create a more customised response. Sub-group identity conscious practices are implemented when organisation members share the perception of the need for adaptation, and when the organisational framework allows such flexibility. Extending Konrad and Linnehan (1995) framework, they also identify a third category of response: individual-conscious practices. In these practices, HR professionals blur professional and personal boundaries, crossing the boundaries of their organisation’s formal practices to develop customised responses to the specific interactions occurring with a specific employee. These responses happen when the employee’s behaviours stretch organisational practices beyond their breaking point, such as when the individual’s behaviours result in a workplace crisis of some kind. They suggest that these creative individual-conscious strategies may help preserve the spirit of diversity policy implementation.

Turning from HR policies and practices, the next two articles focus on the experiences of employees with mental health conditions. The fourth article by Hennekam, Follmer, and Beatty investigates how mental illness influences employees’ career decisions and their ability to perform job-related tasks. Their data comes from two qualitative studies. Using open-ended survey questions, study 1 sampled 257 employed people with diagnosed mental illness, drawn from a mixture of networks and professional associations, and study 2 used 15 semi-structured interviews. Most participants in the studies had more than one mental illness. The authors were especially interested in the more functional and positive aspects of mental illness in the workplace, offering a counterpoint to the dominant view in the research that mental illness is primarily a problem. Applying a person-job fit perspective, their findings suggest that individuals with mental health conditions self-select into sectors that fulfill their needs, tapping into the positive characteristics associated with their mental illness and thereby achieving good needs-supplies fit. The positive aspects of mental illness reported by participants in the study were being perfectionistic, organized, detail oriented, and hard-working. They felt they could bring unique perceptions and alternative views to their work. They also felt they were more empathetic, patient, and understanding to coworkers and customers. However, the employees in their sample also felt susceptible to high stress levels and workloads which could negatively impact their psychological well-being, resulting in poor demands-ability fit. The findings of this study underscore the importance of matching personal strengths to specific job requirements, and offering accommodations and training to help employees with mental illness navigate the workplace.

In the fifth article, Edan, Sellick, Ainsworth, Alvarez-Varquez, Johnson, Smale, Randall and Roper study how employees with mental illness perceive HRM and its impact. Their sample comes from interviews and surveys with 77 consumer-workers in Australia working in the mental health care field. Consumer-workers are people using their lived experience of mental illness in their work. In the context of mental health care, these workers are able to provide peer support to patients, as well as individual and systems advocacy. Their study’s theoretical lens was informed by critical disability studies, and they involved those who were previously and currently employed as consumer workers in collaborative co-production of their research design, data collection, analysis, and interpretation of the findings. Data collection included online surveys, semi-structured interviews, and a focus group. Their study found a general lack of understanding of the role and its purpose; inequity in pay rates, workplace conditions, and training and development; as well as employment precarity and difficulties around disclosure, stigmatisation and discrimination. Their participants felt included in their workplaces at some level, but also experienced significant forms of marginalisation, exclusion, and discrimination; this is especially surprising and disappointing given that the co-workers of these consumer-workers were mental health experts working in care facilities. Participants were conscious of the psychiatric gaze, which they felt shaped others’ interpretations of their comments and actions, sometimes damaging their credibility and power. The authors note the inherent power differentials between medical and consumer knowledge, concluding that HR systems and staff seemed ill-equipped to respond to a role that purposefully crossed the boundary between provider and consumer, and of which there was limited understanding.

The final article in the special issue by Hastuti and Timming offers a systematic review of mental illness disclosure in the workplace. The authors identified 62 empirical studies related to workplace disclosure of mental illness, primarily from the fields of psychiatry, health, occupational health, rehabilitation, and psychology. Their sample includes studies from multiple perspectives, including those of the employee with mental illness, their supervisors and co-workers; as well as HR managers and employers, and mental health practitioners. Based on their review, their conceptual model on workplace disclosure of mental illness shows both external and internal antecedents to disclosure. The external factors are organisational, supervisor, and coworker support, along with perceived stigma. The internal factors are self-stigma and a range of individual differences, such as symptomology and self-management. Disclosure affects outcomes such as access to accommodation and support programs, helping behaviours, psychological well-being, and employment success. They conclude that disclosure of mental illness is a complex, continuous process that includes signaling and information exchange. The authors offer suggestions for future research to improve the field’s understanding of the complex processes shaping disclosure.

Future directions

This collection of articles draws attention to a group of employees that has traditionally been excluded from management research: employees with mental illness. The articles in this special issue draw attention to the structural, organisational, and individual constraints that influence the work experiences of employees with mental health conditions, and the insights reported can aid HR managers in shaping policies and procedures to better protect employees’ mental health and well-being. Although these studies help in filling the knowledge gap, there remain many avenues for research related to mental illness in the workplace.

Organisational researchers have the opportunity to increase the understanding of employees with mental illness by drawing upon and expanding existing theoretical perspectives to make sense of their workplace experiences. Testing theories using employees with mental health conditions may identify unique boundary conditions and mediating mechanisms that contribute to continued theory refinement. Below, we provide an agenda for future research that can be used to stimulate academic attention toward employees with mental illness.

Context, sampling and methods

This special issue provides data from geographically dispersed samples, yet, the study questions and designs did not explicitly focus on cross-cultural comparisons. In general, scholars know little about how mental illnesses are defined, viewed and managed in various cultural contexts. Cultural beliefs and attitudes about mental illness influence how these individuals are perceived and treated in the workplace (Opare-Henaku & Utsey, 2017). The extant literature suggests that the ways in which individuals manage their mental illness is partially dependent on their ethnicity, and that treatment options are often dictated by cultural, religious, and spiritual beliefs (Misra et al., 2021). Cultural traditions and expectations can also influence the extent to which mental illness is deemed to be stigmatising (Zolezzi et al., 2018; Zhang et al., 2020), which can impact employees’ willingness to disclose their mental health condition to others, to seek workplace accommodations, or to receive medical treatment for their disorder. It cannot be assumed that employees with mental illness manage their conditions in universal ways, meaning that the extent to which individuals choose to treat, accept, and disclose their mental illness will vary substantially across employees. Understanding these cultural distinctions is a crucial component of creating organisational policies and interventions, as some organisations may need more initial training on dispelling stereotypes in addition to recommendations for creating employee resource groups. Apart from cultural perceptions, there are also variations in legal considerations across geographic contexts. For instance, rules surrounding disclosure, accommodations, and discrimination will impact organisational policies, which in turn, will have a trickledown effect on how HR managers approach and interact with employees with mental illness.

To understand the work experiences of employees with mental illness, it is necessary to expand the scope of how employment is defined. Employees’ access to and experiences within the workplace are likely dependent upon the type of employment they hold. For instance, some countries provide sheltered or supported employment such as social workplaces or integration trajectories aimed to enhance the integration of individuals with mental illness. Social workplaces seem promising when it comes to finding and maintaining employment, as previous research in Italy has found (Corbière et al., 2011). Social enterprises help individuals with severe mental disorders reduce their self-perceived internalised stigma and increase their confidence in a workplace context (Villotti et al., 2018). Similarly, research in Australia has shown that individuals with mental illness perceive that such workplaces contribute to their sustained employment, and they were satisfied with their interactions with supervisors and co-workers, their schedule, and the tasks they were being asked to do (Williams et al., 2012). Yet, it is not fully known why these programs are successful. Systematic comparisons of traditional workplaces with supportive employment programs could help illuminate strategies that enable organisations to be more inclusive. Moreover, insight is needed to understand how sheltered or supportive employment programs impact employees’ career trajectories and employability in the traditional labour market. For instance, how do hiring managers perceive an employees’ experience with sheltered employment? Do these supportive employment programs help or hinder employees’ efforts to enter the traditional labour force?

Much of the existing research on employees with mental illness has been conducted in fields outside of management, such as psychiatry, psychology, occupational health, and rehabilitation studies, which employ distinct methods, perspectives, and assumptions; these differences are both helpful and limiting in the study of employees with mental illness. To move the field forward, there is a need for interdisciplinary research whereby researchers can integrate theoretical perspectives and employ diverse methods to bring about novel insights (Follmer & Jones, 2018). Many of the studies in this special issue utilized qualitative inquiry methods, which are appropriate when ‘all of the concepts pertaining to a given phenomenon have not been identified… and further exploration of the topic is necessary to increase understanding’ (Corbin & Strauss, 2014, p.7). Given that the study of mental illness and work is early in its life stage among organisational scholars, these qualitative approaches are helpful in better understanding the lived experiences of employees with mental health conditions. However, as this area continues to evolve and mature, the use of quantitative inquiry methods will be necessary to test the underlying relationships and theoretical assumptions derived from the existing empirical work. Multi-level studies that investigate the interrelated and intersectional nature of factors on individual, biological, organisational, social, societal and legal levels are needed to grasp the complexities of mental illness in a workplace context (Fried & Robinaugh, 2020). Moreover, longitudinal research would be very helpful to track how perceptions and behaviours evolve over time. Lastly, many of the existing research studies and those included in this special issue, draw data from one source (e.g. employees, HR managers), which precludes researchers from understanding the interactions and interrelations among multiple organisational stakeholders.

Individual perspectives

To advance the study of employees with mental illness, more research representing employees’ perspectives and experiences is needed, especially given the complexity related to managing a mental illness from day-to-day. One of the most fundamental decisions employees make centers around disclosure of one’s mental illness, as this affects who knows about the mental illness and the support services available to the employee. The article from Hastuti and Timming in this special issue provides a review on the disclosure decision of individuals with mental illness, including its antecedents and consequences. This review provides a foundation for understanding disclosure in the context of mental health conditions and opportunities for multiple future research directions. Disclosure is not a one-time decision but rather a decision that must be made repeatedly over time; thus, understanding the situational factors that motivate someone to disclose is needed. Using advanced methods such as daily diary studies or experience sampling methods may be useful in capturing the nuances of these decisions across time. Additionally, most research involving disclosure is conducted from the standpoint of the individual with mental illness; focusing more research on the targets of disclosure could help identify disclosure strategies that result in positive perceptions and outcomes for those with mental illness.

Related to disclosure decisions are the strategies individuals employ to manage their identities and cope with their mental health conditions in the workplace. Coping, defined as the cognitive and behavioural efforts made to master, minimize, or tolerate stressors (Lazarus & Folkman, 1984), is a relevant theoretical perspective when studying mental health conditions in the workplace (Taylor & Stanton, 2007). Which strategies do individuals use, which ones are successful, and under which circumstances? How are these coping strategies related to HRM practices, for example flexible work options or job design?

While mental illness represents a unique social identity (Follmer & Jones, 2018), it is just one of many social identities that a person holds. Employing an intersectional approach may be useful for understanding how individuals navigate multiple identities in the workplace, particularly when they maintain more than one stigmatized identity (Weaver et al., 2016). Research in this area is growing, for example looking into the intersection of mental illness and ethnicity (Nazroo et al., 2020), gender (Dubke & Corrigan, 2021) or age (Gmitroski et al., 2018). Such investigations are likely to uncover how individuals may be marginalised in multiple ways and how they navigate their multiple minority status. Relatedly, it is important to acknowledge that mental illnesses are heterogeneous – varying from diagnosis to diagnosis, and even between people with the same diagnosis. Thus, expanding research with more discretely defined mental illness diagnoses will be helpful so that organizations might provide more tailored and relevant support to individuals with mental illness.

To date, much of the research related to mental illness and work has focused on identifying the negative stereotypes of mental illness and the costs of mental illness for organizations. An alternative is to draw upon the tenets of positive psychology, investigating the ways in which mental illness can yield positive outcomes for individuals and organizations.

Positive psychology interventions in organizations are increasingly common (Meyers et al., 2013) and the time seems ripe to study such interventions related to mental illness in the workplace. Strength use is a relatively new perspective that would help individuals to turn one’s condition into a positive force at work (Bakker & van Woerkom, 2018). Indeed, individuals with mental illness have unique attributes and skills that they can bring to the workplace, though relatively few studies have examined how employees themselves benefit from it. Positive beliefs about mental illness can be defined as ‘perceptions of specific positive qualities, benefits, or advantages individuals associate with their disorder(s) or symptoms’ (Forgeard et al., 2016, p. 198). While we know that work can actually benefit them, under which circumstances can work be a positive force? Hennekam, Beatty, and Follmer adopted person-job fit as their theoretical lens when studying how the (mis)match between one’s characteristics and demands of the job plays out. This has implications for HRM, as a proper fit could yield positive outcomes for both organisations and employees with mental health conditions. However, more work is needed to understand how organizations can increase fit and the extent to which mismatches in fit affect employee outcomes. For instance, are certain types of fit more important for individuals with mental illness? Similarly, what unique skills and perspectives do individuals with mental illness bring to the workplace? What is the role of a job coach to reach these positive outcomes?

Lastly, much of the work on individuals with mental illness is conducted at a single time point – typically, when they are actively employed – capturing only a snapshot of their careers. Yet, many decisions are made across time that influence employees’ career trajectories, so research is needed to understand how career decisions unfold across time. Selection, optimization, and compensation (SOC) theory which focuses on the ways in which individuals prioritize goals, maximize performance, and adapt to limitations (Burnett-Wolle & Godbey, 2007) can be applied to provide insights on how individuals successfully navigate their careers across their lifespan. By examining these processes within individuals with mental illness, it may be possible to identify personal strategies and occupational interventions that promote long-term success and well-being (Demerouti et al., 2014; Müller et al., 2016).

As one example, the transition from school to work is an important step in one’s career, and this process may be especially challenging for those with mental illness. Researchers can shed light on these experiences by investigating both the support systems and barriers that exist for individuals as they transition into the workforce for the first time. We know that for young individuals with complex needs, including mental illness, the provision of training, work practices, therapeutic support and a supportive work environment improves their employability and smoothes the transition from school to work in the UK (Hart et al., 2020). Existing studies have shown that organisational support, a consultative and supportive leadership, workplace accommodations, and advice from co-workers seemed to facilitate the transition to work for individuals with autism spectrum disorder, while challenges included difficulties to manage stress, social relationships and distractibility (Hedley et al., 2018). Yet, it is expected that these experiences would be impacted, to some degree, by an individual’s specific diagnosis and the symptomatology associated with their disorder.

As another example, individuals with mental illness often move in and out the labour market as they manage their disorders, which may result in them having more transitions than employees without mental illness. Researchers can provide greater insight into how employees and employers can successfully navigate the transition from sick leave to work, and vice versa. While we know that individuals who receive Individual Placement Support (IPS) such as job coaching are more likely to regain employment in the competitive labour market than individuals without such support (Viering et al., 2015), identifying additional support mechanisms would be helpful in aiding employees with mental illness to sustain employment over time. The role of HR in these processes is particularly important. How should organisations re-integrate individuals with mental illness after a period of illness and what is the role of one’s direct manager and co-workers in this process? Importantly, how can these processes be implemented while also protecting the privacy of the employee?

Many employees with mental illness may opt to become entrepreneurs to fulfill their employment needs. Exploring individuals’ choices to become entrepreneurs provides a fruitful avenue for future research. For instance, do employees’ motivations to pursue entrepreneurship stem from an inability to find stable employment elsewhere or is it perceived as an opportunity to obtain the flexibility they need to manage their mental illness? (Wiklund et al., 2018). Further, individuals with disruptions in their employment and education history may see self-employment as an attractive option because it affords more opportunity for self-care (Ostrow et al., 2019), though the movement between traditional work and self-employment requires greater empiric investigation. Given the heterogeneity within the population of individuals with mental illness, it would be interesting to know if people with particular mental illnesses are more attracted to and successful in entrepreneurship.

Co-workers and peers

Existing work has demonstrated that negative stereotypes of employees with mental illness exist (Follmer & Jones, 2017), but less is known about how others in the workplace perceive the treatment and support given to those with mental health conditions. To advance the field, it is important to capture the perspectives of all organisational stakeholders, as these perspectives likely to contribute to the organisation’s overall culture and climate. One line of inquiry involves the study of how workplace accommodations are perceived by co-workers and how they react to it, as they seem to play an important role in the reintegration of individuals with mental health conditions at work (Dunstan & Maceachen, 2014). Theoretical lenses related to fairness perceptions such as equity theory or organisational justice theory would help understand the dynamics that are at play when organisations provide reasonable workplace accommodations to individuals with mental illness. Empirical research has shown that when individuals with disabilities received accommodations and perform well, the accommodations are perceived as unfair to others (Paetzold et al., 2008). Thus, applying existing theoretical lenses to better understand when and how accommodations are perceived as fair will be useful for improving the work experiences of those with mental health conditions.

Additionally, the field of allyship is evolving in organizational studies (Wessel, 2017) and can provide many interesting insights into how individuals without mental illness can positively influence the workplace experiences of those with mental illness. For instance, how does the presence of allies in the workplace affect employees with mental illness? What specific strategies can allies use to improve the organizational culture? And how can allies help to address discrimination and mistreatment?

One way to advance the study of employees with mental health conditions is to move beyond identifying the stereotypes and stigma associated with this identity. Indeed, ample evidence suggests that mental illness remains one of the most stigmatized identities in society (Mannarini & Rossi, 2019). Rather, drawing upon prominent theories (e.g. stigma theory, stereotype content model, theory of prejudice) could be useful in unraveling why these negative belief systems develop and identify ways to effectively diminish them in the workplace setting. For instance, research that focuses on training interventions to reduce stigma or identifying how personal interactions exacerbate or diminish negative perceptions with those with mental illness would certainly help move the field forward.

Organisational level

Research that focuses on organizational policies and procedures also provides a rich opportunity for advancing the field, and is particularly pertinent to HR managers and departments. Many of the articles in this special issue are focused on understanding how organisations can improve their efforts to be more inclusive of employees with mental health conditions. Although inclusivity is touted as being important, much more work is needed to understand how it can be achieved. Although HR managers implement policies and practices, they do not work in isolation, and more research is needed to uncover how organisational leadership and culture support or hinder HR managers’ efforts. What is inclusive behaviour in the context of mental illness, and how can it be promoted? What about inclusive leadership and the creation of an inclusive climate? Additionally, HRM involves training initiatives, which are needed to help managers and other employees better understand mental illness (Martin et al., 2015). Empirical tests could be conducted to determine the extent to which established training processes and theories (e.g. contact theory; transfer of training; theory of planned behaviour) adequately apply to mental health training.

HR managers are an integral part of shaping the experiences of employees with mental illness. While the articles in this collection identify the functional importance of HR, more work is needed to better understand how employees with mental health conditions are affected by traditional HR policies and to identify effective practices suited to support these employees. From a human resource management perspective, much more work is needed to understand how organisations can accommodate employees with mental illness. In this vein, theories related to person-job fit, job crafting, and job characteristics theory may prove useful in matching employees’ qualities with the job requirements, which can aid efforts to attract, recruit and retain individuals with mental illness.

More emphasis should be placed on evaluating the merits of specific HR practices such as job design, and flexible work options and accommodations for employees with mental illness, like the possibility to work from home, quiet workplaces, counseling services, or fewer interactions with others. In what ways do these systems operate differently for individuals with mental illness? How effective are these practices in helping employees to manage their mental health conditions?

Additionally, assistive technology is being put forward as an interesting tool to enhance the labour market participation of individuals with mental illness and help them function optimally (Gitlow et al., 2011). Understanding how these technologies can be used by both managers and employees is greatly needed. For instance, how might these technologies assist employees with mental health conditions in completing their work? Likewise, how can HR managers use the technological advancements to their advantage in order to enhance the retention and inclusion of these individuals?

Of particular importance is the notion of applying an ethical perspective of HRM to the management of employees with mental illness. This theoretical angle was used by Kalfa, Branicki and Brammer as they examined how HR managers support employees with mental illness in Australia. An ethical stance to HRM makes assumptions about the roles and responsibilities of organisations, HRM and managers as well as the rights of employees who struggle with mental health conditions. More research is needed to explore the ethical implications of HR practices and processes in organisations.

HR professionals undoubtedly play an important role in shaping employees’ career experiences, and can directly affect the treatment of employees with mental illness. The HR function is also vital for establishing accommodations for employees. On a long-term basis, it might be necessary to alter specific job requirements in order to increase person-job fit. One way to proactively shape employee’s tasks and functions is through job crafting, the informal, employee-initiated approach to job re-design. Individuals with disabilities seem to engage in job crafting behaviours that help them to develop their careers and enhance their engagement (Brucker & Sundar, 2020). Moreover, job crafting has been suggested as a way to promote the return to work of individuals with mental illness in a sustainable way, that is, without contributing to relapses (Etuknwa et al., 2019). However, research has yet to use this promising concept to study individuals with mental health conditions. We need more insights in how individuals with mental illness craft their own jobs that suit them best and how HR can support them.

To aid organisations in overcoming barriers to inclusivity, researchers could draw upon theories of power lenses (French & Raven, 1959; Raven, 1993). Power lenses such as tension centered theory as adopted in this issue by Quinane, Bardoel, and Pervan in their study on the ways in which leaders and CEOs strategically framed mental illness in their organisations, seem relevant. Indeed, dominant discourses and the production and reproduction of issues related to power lead to tensions that CEOs, managers and individuals with mental illness themselves have to deal with. Bourdieu’s concepts could be used to study how inequalities in the labour market for individuals with mental illness are created, sustained, reinforced. This would provide a dynamic perspective as it shows how and why the labour market position of individuals with mental illness is difficult to change. Related to this comes the issue of empowerment as a way to induce much-needed change (Richard & Hennekam, 2020). The article by Edan, Sellick, Ainsworth, Alvarez-Varquez, Johnson, Smale, Randall and Roper in this issue focuses on mental health consumers as experts in the provision of care. However, despite their expertise, power differentials between the knowledge of those mental health consumers and medical staff could be felt. Empowering such individuals in order to reap the benefits of their first-hand experiences and expertise would clearly be beneficial for organisations.

Diversity theories, such as identity-conscious versus identity-blind perspectives are helpful to inform HRM as to how to create an inclusive workplace. Richard, LeMaire and Church Morel used this perspective in their study on the role of HRM in sheltered workshops in France and found that individual-conscious practices that blend formal and informal responses to employees with mental illness are an adaptive response that appears to support the organisation’s diversity goal. Further, it has been argued that a climate of inclusion can arise when an organisation’s diversity management programs explicitly incorporates social identity into its HR decisions (Li et al., 2019).

Disclosure statement

No potential conflict of interest was reported by the authors.