A diagnosis of a mental illness—either yours or a family member’s—can upend your career. Your condition may get in the way of your ability to do your job well, or, even if it doesn’t, you may need to make special arrangements to get the care you or your loved one needs.
And disruptions can prove costly. Workers with depression lose nearly six hours of productivity a week at work, according to a 2003 study published in JAMA. According to a 2013 Gallup survey, full-time workers with depression miss an additional 4.3 days of work a year compared to their counterparts without depression, while a American Journal of Psychiatry report found that workers with serious mental illness earn about 40% less than those with no such problems.
Read MONEY’s special report: The High Cost of Coping
No two paths are the same. Stan Brodsky, 71, was walking to the shower one morning 15 years ago when a sinking feeling stopped him in his tracks. “I just couldn’t do it,” says Stan. “I had to get back in bed.”
Brodsky, diagnosed with serious depression, was fortunate. His therapy costs were held in check thanks to his insurance, while his company essentially told him to take the time he needed to get well.
But then there’s Linette Murphy. She first knew something was wrong when her daughter Sapphira was three-and-a half. “I received calls from daycare saying that she was throwing chairs, having temper tantrums that lasted for hours, and banging her head against the wall,” Murphy recalls.
Sapphira was diagnosed with disruptive mood dysregulation (or bipolar disorder) at age four. Over the decade that’s followed, Murphy has spent tens of thousands of dollars, and countless hours, caring for her child. In doing so, she’s sacrificed career advancement over and over again.
“I have willingly taken two demotions, and a cut in pay of about $25,000, so that I could move from my corporate headquarters in Orlando to New England, to better schools for my daughter and to be closer to family so they could help with her care,” Murphy says. “I have turned down a promotion every single year for the last eight years so that I can effectively juggle my career and being her mom.”
What Brodsky and Murphy’s stories underscore is that there is no way to predict how a mental illness will affect your career. And since you may not know how your employer will respond, you may be cautious about revealing your condition in the first place.
What’s more, a condition like depression or anxiety can be a hidden disability, which puts the onus on you to manage the conversation. In fact, one study found that those with a less apparent disability are more concerned with their jobs than those will more obvious symptoms are. They fear they’ll be fired or not hired and won’t be offered a promotion, according to a 2013 study in the Employee Responsibilities and Rights Journal, which polled 780 people with disabilities ranging from a mental health condition to a hearing impairment.
The most common reason people with any disability gave for not informing an employer was a fear of being fired, not hired or missing out on a promotion. Only a quarter of those with mental health symptoms feel that “people are caring and sympathetic to persons with mental illness,”according to the Centers for Disease Control and Prevention.
To navigate your work environment no matter your condition, follow this guide.
Know Your Rights
If you can do your job but need some flexibility or specific accommodations, you’re most likely entitled to receive them.
The Americans With Disabilities Act, which applies to companies with more than 15 employees, covers a psychological disability if it “substantially impairs one or more major life activities” and you can do the job “with or without reasonable accommodations.”
That means you could request adaptable start times and schedules, a specialized work area to reduce noise or distraction, and working from home, among other possible accommodations.
Request your reasonable accommodations in writing from your company’s HR department. (You can find a sample letter on the Job Accommodations Network’s website.) If you feel as if your employer is not responsive to your needs, you can file a complaint with the Equal Employment Opportunity Commission.
Take Advantage of In-House Help
Most large and midsize companies offer employee assistance programs, says Aon Hewitt senior senior health and wellbeing consultant Denise Heybrock. You, or your family members, will receive a few free sessions of confidential counseling, generally five to eight, and help finding more permanent in-network care if you need longer-term assistance.
Assess the Culture
If you suffer from, say, bipolar disorder or depression, but don’t need a special schedule or similar adjustment, you may want to think long and hard before disclosing your illness.
“Do you feel good about the culture in your organization?” asks Carolyn McClanahan, a medical doctor and Jacksonville, Fla., financial planner. “Have you seen your organization help people go through issues like your facing?”
If the answer is no, or if your company seems to be looking for an excuse to reduce payroll, you might be better off not disclosing your illness to your supervisor—or even the employee assistance program—unless you absolutely have to.
“There’s a lot of fear. People equate mental health with danger and violence,” says Sade Ali, senior associate in the behavioral health technical assistance center of the Altarum Institute. “There’s still a lot of struggle around seeking care and being identified as someone with challenges.”
Be Willing to Be Flexible
Open a line of dialogue with your employer if you need to alter your schedule. MaryEllen Joyce, much like Linette Murphy, had two full-time jobs: coordinating care for her son, who suffered from substance abuse and depression, and working as a business manager for a Massachusetts marketing company.
The responsibility of her son’s care fell squarely on Joyce’s shoulders, which meant she had fewer hours in the day to do her job. So she and her boss settled on a deal: Three days a week she’d leave at 2 p.m., and in exchange her pay would be cut by a third. While the trade-off was difficult to swallow, it allowed Joyce to drive to her son’s therapeutic school visits, wrangle with insurance providers, and keep her job.
Her son has made progress, she says, and things have started to settle down, letting Joyce invest more in her career. “It was hard fought, but I got my full-time job back,” Joyce says. “I was rewarded by getting more responsibility.”
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