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L'Encéphale
Volume 40, n° S2
pages 91-102 (juin 2014)
Doi : 10.1016/j.encep.2014.04.006
Received : 8 April 2014 ;  accepted : 23 April 2014
La divulgation du trouble mental et les mesures d’accommodements de travail : deux facteurs du maintien en emploi des personnes aux prises avec un trouble mental grave
Disclosure of a mental disorder in the workplace and work accommodations: Two factors associated with job tenure of people with severe mental disorders
 

M. Corbière a, , P. Villotti b, K. Toth c, G. Waghorn d
a École de réadaptation, université de Sherbrooke, campus de Longueuil, 150, place Charles LeMoyne, J4K 0A8 Longueuil, Québec, Canada 
b Département de psychologie et sciences cognitives, université de Trente, via Matteo del Ben 5, 38068 Rovereto, Italie 
c Lawrence Kinlin School of Business, Fanshawe College, 1001 Fanshawe College Blvd., N5Y 5R6 London, Ontario, Canada 
d Queensland centre for mental health research, level 3 Dawson House, The Park, 4076 Wacol, QLD, Australie 

Auteur correspondant.
Résumé

Le maintien en emploi de personnes aux prises avec un trouble mental grave (tel que la schizophrénie) reste la pierre d’achoppement de leur réinsertion au travail. Toutefois, la durée du maintien en emploi peut varier considérablement selon le contexte de travail dans laquelle la personne s’engage (par ex. marché du travail ordinaire, entreprise à économie sociale). Ces différences peuvent s’expliquer en partie par des composantes organisationnelles différentes selon le contexte de travail, telles que la présence de mesures d’accommodements, lesquelles ont souvent pour condition la divulgation du trouble mental en milieu de travail. Cet article vise à documenter ces deux notions, en s’appuyant sur la littérature spécialisée et nos propres recherches. Ces travaux font apparaître que la divulgation du trouble mental est un processus dialectique qui ne peut se résumer « à dire ou ne pas dire ». La divulgation soulève une série de questions : quoi, comment, quand et à qui divulguer son état de santé ? Les raisons évoquées pour divulguer ou non son trouble mental en milieu de travail sont nombreuses, avec des facteurs de nature individuelle, d’autres interpersonnels, d’autres encore dépendant de l’environnement de travail. Ces raisons peuvent être liées à l’anticipation de conséquences positives (par ex. mesures d’accommodements) ou négatives (par ex. stigmate social). Dès que la personne s’interroge sur l’opportunité de donner des informations concernant sa santé sur son lieu de travail, s’engage un processus décisionnel complexe même s’il n’est pas systématique. Une étude récente explore les liens entre la divulgation, la mise en place d’accommodement et le maintien en emploi. Il apparaît que le soutien du supérieur immédiat et des collègues de travail est essentiel au regard d’une liste de mesures d’accommodement et de soutiens naturels. Le conseiller en emploi ou autre intervenant œuvrant dans des programmes de réinsertion au travail peut aider à apprécier les tenants et aboutissants de la divulgation du trouble mental sur le lieu de travail à l’aide d’un « plan de gestion des informations personnelles ». Ce plan permet entre autres de dépasser la notion de divulgation, souvent connotée négativement. En conclusion, la réinsertion professionnelle de personnes aux prises avec un trouble mental n’est plus un vœu pieu, des éléments d’interventions pragmatiques sont à présent disponibles.

The full text of this article is available in PDF format.
Summary

Job tenure for people with severe mental disorders (e.g., schizophrenia) remains a stumbling-block to their work integration. However, the length of job tenure can vary according to the workplace (e.g., provided resources) and the work context (e.g., regular market, social firms). This gap can be explained in part by diverse organisational components, particularly the implementation of work accommodations, which is related to the disclosure of the mental disorder in the workplace. Indeed, in the scientific literature, the principal reason associated with disclosure is in regards to requesting work accommodations. The main objective of this paper is to increase our understanding of the relationships between these three concepts – disclosure of a mental disorder, work accommodations and natural supports, and job tenure – by reviewing the specialized literature and presenting the work of the authors of this paper. To do so, the authors will address the following questions: How do we define ‘disclosure’ of a mental disorder in the workplace and what are the strategies to consider before disclosing? What is the decision-making process related to disclosure in the workplace? How are the three concepts – disclosure of the mental disorder in the workplace, work accommodations and job tenure – intertwined? Finally, how can employment specialists facilitate the work integration of people with severe mental disorders by considering the three concepts mentioned above? Results from a review of the literature show that disclosure of a mental disorder is a dialectical process that goes beyond the question: to tell or not to tell? In fact, it is not a single binary decision. Several components are associated with the disclosure concept, and can be summarized by the questions: What, how, when and to whom to disclose his/her mental condition? Reasons for disclosing his/her mental disorder in the workplace are numerous, characterized by personal, interpersonal and work environmental factors, on one hand. On the other hand, disclosure has potential consequences, both positive (e.g., to obtain work accommodations) and negative (e.g., stigma). A decision-making process takes place when people with a severe mental disorder think about the possibility of disclosing their mental condition in the workplace – a complex decisional process involving the need to evaluate different aspects (i.e. individual, interpersonal and work environmental factors). Also, the literature supports the fact that requiring work accommodations is often related to the disclosure of the mental disorder, when natural supports in the workplace are not available. The literature is scarce regarding the correlations between the concepts of disclosure, implementation of work accommodations and job tenure; however, a more recent study demonstrated this significant relationship, in which the supervisor and co-worker supports are crucial. Employment specialists or counselors recognise the importance of planned disclosure as a means to obtain access to work adjustments in the workplace and to prevent stigma. The employment specialist working in supported employment programs for instance, could adopt with his/her clients a plan for managing the pros and cons of disclosure of the mental disorder in the workplace; this plan is entitled: Managing personal information. It consists of several steps – for example, to collect details of any sensitive information such as diagnosis, to identify work restrictions with the client, to have a common agreement (employment specialists and clients together) on terms to describe work restrictions – to help clients feel empowered and more confident as productive and valued workers. This plan allows employment specialists to work through the disclosure concept, often negatively connoted, and to adopt a more normalising strategy. Furthermore, additional tools for supporting the management of personal information plan could be used such as the Decision-Making About Disclosure Scale, the Barriers to Employment and Coping Efficacy Scale, and the Work Accommodation and Natural Support Scale, to name a few. To conclude, job tenure for people with severe mental disorders is not a pious vow, several pragmatic ingredients for intervening on this issue are now available.

The full text of this article is available in PDF format.

Mots clés : Divulgation du trouble mental, Gestion des informations personnelles, Accommodements et soutiens naturels en milieu de travail, Maintien en emploi, Troubles mentaux graves

Keywords : Disclosure of the mental disorder, Managing personal information, Work accommodations and natural supports in the workplace, Job tenure, Severe mental disorders


1  Le terme « mesure d’accommodement de travail » est utilisé dans cet article en référence à des mesures prises par l’employeur (ou d’autres acteurs de l’organisation) dans le but de faciliter la réinsertion professionnelle des personnes avec un trouble mental. Ces mesures peuvent être la conséquence de l’obligation légale de l’employeur d’accommoder, ou encore relever d’ajustements mineurs ou de soutiens naturels qui ne renvoient pas à l’aspect légal du terme. Les mesures d’accommodements seront donc à saisir dans le cadre de cet article sous une forme générique.
2  Toth K, Corbière M. Decision-Making About Disclosure of a Mental Disorder at Work Scale . Available on request from the first author Toronto (Canada) 2013.
3  Waghorn G. Managing personal information, a guide for interviewers and employment specialists. Unpublished document. The latest version is available on request from the author. Brisbane (Australia) 2013.


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