Work

Why work may be important to your quality of life

There are key factors that make work (paid or unpaid) a core domain of quality of life for anybody: financial resources, a feeling of purpose and identity, the opportunities to make friends and meet people, a feeling of being involved with others in shared work. Work can provide a structure for daily life, a reason for getting up in the morning and a place to go. These are important to anybody, and often especially so for people who live with chronic health conditions like bipolar disorder, which can make it hard to feel competent and to maintain an orderly structure to your life. Work is a source of structure and grounding that can be invaluable when living with bipolar disorder.

Unpaid work, especially within the home, is equally valuable to paid work. Parenting and caregiving is vital work that is often under-appreciated and not recognized financially. As well, important contributions are made through volunteer work. For example, public schools depend upon the unpaid work of dedicated parent advisory committees or similar organizations.

In this section, we focus upon paid work and the unique challenges that surround it for those who live with bipolar disorder.

Key Messages

What to know about work: 

  • Bipolar disorder can harm working life; unemployment rates high in people with bipolar disorder
  • Many people with bipolar disorder can flourish in the workplace
  • Factors for success at work include good cognition, good work relationships and ability to cope with stigma

Mixed research on work and bipolar disorder

What do we know about the relationship between work and bipolar disorder? The research is actually somewhat mixed. On one hand, some research has shown that unemployment rates in people with bipolar disorder are much higher than in the general population, with around 40-60% of people with the condition being unemployed, often because they didn’t do as well as expected at their jobs (this is called workplace under-performance1). Other studies have found that up to 40-50% of people with bipolar disorder experience a decline in job status and income2. On the other hand, other research has found that job status for those with bipolar disorder stabilizes over about 6 years in a position — even for those with severe forms of the illness3.

Furthermore, the high rate of unemployment found in some studies may be smaller, because it may not include everyone with bipolar disorder. For example, some who are doing well at work may not have told their co-workers or employers that they live with the condition due to fear of stigma in the workplace (i.e., negative stereotypes directed at them at work). People with bipolar disorder have found that stigma can negatively affect their work performance if they do not have a supportive work environment4,5. The good news is that research suggests that improvements in the work environment, such as support from employers and co-workers, can benefit people with bipolar disorder and are, in fact, critical for successful work outcomes6.

A late-twenties Asian man with long black hair with a dyed green streak, and a late-twenties African American woman with long braided hair are sitting in front of a computer, apparently discussing work.

Other factors have been linked with doing better in the workplace when you live with bipolar disorder: having good cognition (the ability to think clearly and reason well), having more years of education, not having been hospitalized often, not being depressed, and not having a personality disorder as well as bipolar disorder7. Research also shows the importance of learning how to navigate mental health stigma in the workplace8, effectively dealing with interpersonal problems at work, and using self-management practices at work. Successfully getting back to work after a bipolar episode can be helped by having a good fit between the person, their job, and their support system; as well as by being in recovery from their mood episode9.

A young black waitress is standing at the cash register and smiling.

How you can take action

You have rights in the workplace as a person dealing with a serious health condition. In many countries, disability and anti-discrimination laws protect the rights of people living with chronic health conditions like bipolar disorder at work. Some laws may require a person to tell (or disclose) their condition to their employer. Disclosure10,11 is a difficult decision, given the reasonable concerns that employers could discriminate against the person disclosing their condition, and the possibility of negative attitudes from co-workers. But on the brighter side, where the workplace culture is a supportive one, supervisors and coworkers can be excellent sources of support.

Using both psychosocial treatments and medication can prevent depressive or manic episodes from turning your life upside down. It’s possible that medication alone may not be enough to help people flourish in their work. While medication is the accepted first-line treatment for people with bipolar disorder, for the best results, medications should be used along with other treatments like psychological and rehabilitative efforts. For example, there are psychosocial and social treatments (that help people with bipolar disorder to improve how well they function socially and at work). Research has shown that supported employment is one way for people to deal with mental health challenges in the workplace12,13,14,15. Supported employment services for people with severe mental illnesses are usually delivered by teams in community mental health agencies who can provide people with support finding work as well as support in their jobs. You may want to speak to your healthcare professional about whether this is an option you could explore.

A middle-aged middle-Eastern man driving a bus.

If you are employed, you may be able to access support through your employer. Using your Employee Assistance Program, if your employer provides one, can really help in keeping and succeeding at a job once you find it. Also, employers are required to provide appropriate changes to the job or the work environment for individuals with health barriers, unless these changes create “undue hardship” on the employer or other employees. In other words, if you ask for job duties that shrink enormously when you’re depressed and expand enormously when your mood is elevated, that might be considered undue hardship to the employer. However, if you request reasonable changes for specific job related issues, that should be provided. Resources that are tailored for employers of people with bipolar disorder can be found in our for Employers section.

A few studies have found that individuals recovering from psychotic episodes link job success to these three strategies: 1) self-monitoring their mental health regularly, 2) actively working to maintain and improve their mental health, and 3) creating connections to others at work16. The last strategy, creating connections at work, is especially worth noting – having good relationships with your manager or co-workers is an extremely important source of support in dealing with bipolar disorder. Finally, it can be extremely valuable to connect with an occupational therapist to develop a work or career plan.  Occupational therapists are trained to help people get back to doing and succeeding in their daily activities and work.

Take Action

How you can take action: 

  • Supported employment, occupational therapy and employee assistance programs may be helpful
  • Give thoughtful consideration to when and how to disclose bipolar disorder at work

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References

  1. Seven actions towards a mental health organization: a seven-step guide to workplace mental health; World Economic Forum’s Global Agenda Council on Mental Health 2014-2016; 2016. Available at: https://www.mqmentalhealth.org/articles/global-agenda-council-mental-health-seven-actions
  2. Marwaha, S.,Durrani, A., Singh, S. (2013). Employment outcomes in people with bipolar disorder: A systematic review. Acta Psychiatrica Scandinavica. 128.
  3. Strejilevich, S.A., Martino, D.J., Murru, A., Teitelbaumn, J., Fassi, G., Marengo, E., Igoa, A., Colom, F. (2013) Mood instability and functional recovery in bipolar disorders. Acta Psychiatrica Scandinavica. 128: 3.
  4. O’Donnell, L., Himle, J. A., Ryan, K., Grogan-Kaylor, A., McInnis, M. G., Weintraub, J., Deldin, P. (2017). Social Aspects of the Workplace Among Individuals With Bipolar Disorder. Journal of the Society for Social Work and Research, 8(3), 379–398. http://doi.org/10.1086/693163
  5. Michalak, E.E., Yatham, L.N., Maxwell, V., Hale, S., Lam, R.W. (2007). The impact of bipolar disorder upon work functioning: a qualitative analysis. Bipolar Disorders, 2007:9, 126-43.
  6. Porter, S., Bejerholm, U. The effect of individual enabling and support on empowerment and depression severity in persons with affective disorders: outcome of a randomized control trial. (2018). Nordic Journal of Psychiatry, 72:4, 259-67.
  7. Tse, S., Chan, S., Ng, K. L. & Yatham, L. N. (2013). Meta-analysis of predictors of favorable employment outcomes among individuals with bipolar disorder. Bipolar Disorders, 16(3): 217-229.
  8. Michalak, E.E., Yatham, L.N., Maxwell, V., Hale, S. & Lam, R.W. (2007). The impact of bipolar disorder upon work functioning: A qualitative analysis. Bipolar Disorders, 9: 126-143.
  9. Tse, S. & Yeats, M. (2002). What helps people with bipolar affective disorder succeed in employment: A grounded theory approach. Work (Reading, Mass.) 19, 47-62.
  10. Cross, W. & Walsh, K. (2012). Star Shots: Stigma, self-disclosure and celebrity in bipolar disorder. In: Barnhill, J. (Ed.). Bipolar Disorder – A Portrait of a Complex Mood Disorder. In: Tech, http://www.intechopen.com/books/bipolar-disorder-a-portrait-of-a-complex-mood-disorder
  11. Corrigan, P. W., Kosyluk, K. A. & Ruesch, N. (2013). Reducing Self-Stigma by Coming Out Proud. American Journal of Public Health, 103: 794-800.
  12. Campbell, K., Bond, G. R. & Drake, R. E. (2011). Who Benefits From Supported Employment: A Meta-analytic Study. Schizophrenia Bulletin, 37: 370-380.
  13. Heslin, M., et al. (2011). Randomized controlled trial of supported employment in England: 2 year follow-up of the Supported Work and Needs (SWAN) study. World Psychiatry, 10: 132-137.
  14. Howard, L. M., et al. (2010). Supported employment: randomised controlled trial. British Journal of Psychiatry, 196: 404-411.
  15. Tse, S. (2002). Practice guidelines: Therapeutic interventions aimed at assisting people with bipolar affective disorder achieve their vocational goals. Work (Reading, Mass.), 19: 167-179.
  16. Woodside, H., Schell, L., & Allison-Hedges, J. (2006). Listening for recovery: The vocational success of people living with mental illness. Canadian Journal of Occupational Therapy, 73(1): 36-43.