Impact of Stigma on Mental Health in England Workplaces: A Review

This narrative literature review explores the pervasive issue of stigma and discrimination faced by individuals aged 25-40 with mental health problems in the workplace in England. It highlights how societal stigma and prejudicial attitudes contribute to low rates of disclosure, employment inequities, and social isolation among affected individuals. The review delves into the stereotypes surrounding mental illness, the impact on access to mental health services, and the various forms of discrimination experienced by employees, including direct and indirect discrimination. It also examines government strategies and supported employment initiatives aimed at addressing these challenges, ultimately emphasizing the need for greater awareness, understanding, and support for mental health in the workplace. Desklib offers a wealth of resources, including similar solved assignments and past papers, to aid students in their studies.

Running head: NARRATIVE LITERATURE REVIEW
Dissertation on the impact of stigma for people age 25 - 40 with mental health problem in the
work place in England
Name of the Student
Name of the University
Author Note

1NARRATIVE LITERATURE REVIEW
Abstract
There social ‘stigma and discrimination’ associated with mental disorders are widespread and
have been found to create major impacts on preventing individuals from accepting their
mental health problems, resulting in low rates of disclosure. Stigma and discrimination are
both a distal and proximate reason for employment inequities among people suffering from
mental disabilities. Such people often experience direct discrimination due to display of
prejudicial attitudes from their employers or workmates. They are also subjected to indirect
discrimination owing to their ‘historical patterns of disadvantage’, and ‘structural
disincentives’ against opportunities for ‘competitive employment’. Exclusion from the
workforce often erodes self-confidence, creates material deprivation, and results in the
manifestation of a persistent sense of marginalization and isolation among the affected
individuals. Reports from the affected people suggests that social stigma attached to mental
disorders make the difficulties worse and often act as significant barriers in the process of
mental recovery. The general stereotypes views on mental illness held by the society are
focused on the myth that mentally ill person are dangerous and violent and are at an increased
risk of posing harm to themselves and the surrounding people. In addition to reducing
chances for employment, such stigma impedes the process of securing appropriate mental
health services. This narrative literature review will discuss the stigma and discrimination
faced by employees at their workplace in England.
Keywords: mental illness, disorder, stigma, discrimination, employment

2NARRATIVE LITERATURE REVIEW
Table of Contents
Chapter 1: Introduction..............................................................................................................3
Chapter 2: Background and Rationale.......................................................................................7
Context of the study...............................................................................................................7
Rationale................................................................................................................................8
Chapter 3: Research Methodology...........................................................................................11
Research design....................................................................................................................11
Data collection method........................................................................................................12
Search strategy.....................................................................................................................13
Inclusion criteria...................................................................................................................14
Exclusion criteria.................................................................................................................15
Chapter 4: Main findings.........................................................................................................17
4.1 Employer’s attitudes towards people with mental illness in the workplace in England 17
4.2 The stigma and discrimination experienced by the mentally ill employees in the
workplace in England...........................................................................................................21
4.3 Government strategies and supported employment of employees with mental illness, in
England................................................................................................................................25
Chapter 5: Discussion and conclusion:....................................................................................29
References................................................................................................................................32

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Chapter 1: Introduction
Mental illness or mental disorders refer to particular mental or behavioural patterns
that are responsible for causing significant impairment and distress, thereby affecting the
normal functioning of the affected individuals. These illness are either relapsing or might get
manifested in the form of a single episode. In other words, mental illnesses encompass health
conditions that involve a plethora changes in emotion, thinking, or behavior of a person.
Mental disorders are commonly associated with distress and functioning in family, social, or
work related activities (Whiteford et al. 2013). There exists more than 200 forms of mental
illnesses. Some of the most common types of mental disorders include bipolar disorder,
depression, schizophrenia, dementia, and anxiety disorders. The common symptoms often
include changes in the personality, mood, and personal habits of the affected person, which in
turn results in their social withdrawal.
Mental health problems are generally associated with excessive stress that can be
attributed to range of adverse situation or events. Showing similarities with diabetes, cancer,
and heart disease, mental illnesses get manifested in terms of physical, psychological and
emotional outcomes. In addition to environmental stresses, several biochemical imbalances,
genetic factors, or a combination of both might directly result in manifestation of mental
disorders (Maercker et al. 2013). According to DSM-IV, mental disorders is an umbrella term
that refers to psychological patterns or syndromes that are associated with painful symptoms,
thereby contributing to distress, disability or impairment in important areas of functioning,
increased risks of mortality and significant loss of autonomy and dignity. However, mental
illness excludes some of the most common responses that pertain to grief or sudden loss due
to death of a loved one. In addition to the definitions proposed by DSM-IV, changes have
been made in DSM-V that emphasise on the fact that mental health disorders generally reflect
presence of psychobiological conditions (American Psychiatric Association 2013).

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Furthermore, mental illnesses should not only be considered a direct result of conflicts with
the society or social deviance. There are several categories of mental disorder, which in turn
adversely affect different facets of personality and behaviour, thereby making them distorted.
Fear or anxiety generally interferes with the normal functioning of an individual and might
get categorised as an anxiety disorder. Some of the most commonly recognized categories
include generalized anxiety disorder, phobias, panic disorder, social anxiety
disorder, obsessive-compulsive disorder, agoraphobia, and post-traumatic stress disorder
(Nolen-Hoeksema and Rector 2015).
Mental illness most often result in distortions or disorientation in the functioning of
emotion and mood. Mood disorders encompass a group of mental conditions where the
person’s mood gets affected, in addition to onset of melancholia, sustained and intense
sadness, or despair. This is often categorised as major depressive disorder. Prolonged and
milder depression are also known as dysthymia that contains similar physical and cognitive
issues as faced in depression, but with longer-lasting symptoms. Another prevalent mental
illness is bipolar disorder or manic depression, which involves abnormal or unusual mood
states, and shifts in the activity levels and energy, that are manifested alternately with normal
moods (Yatham et al. 2013). Mental disorders are surprisingly prevalent among the youth and
children. Approximately one in seven youth suffer from mental illness at some point in their
lives. Mental illnesses are also universal, and affect individuals of all societies and countries,
regardless of their gender, income, and age. The point prevalence of such mental disorders
among adults at any time is approximately 10%. Similarly, an estimated 20% of all patients
who consult primary health care providers suffer from one or more mental illnesses (Reupert,
J Maybery and Kowalenko 2013).
Stigma and misunderstanding surrounding mental illness are quite widespread.
Despite presence of effective treatments for all mental illnesses, there exist perceptions and

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beliefs that they cannot be treated. Furthermore, one common conception is related to the fact
that people suffering from mental disorders lack common intelligence and are incapable of
making sound decisions. Such stigma often results in rejection, abuse, and isolation of the
disadvantaged people. Within the health system, people are too often treated in institutions
which resemble human warehouses rather than places of healing. Mental health stigma is
generally categorised into two different types, namely social stigma and perceived stigma
(Corrigan, Druss and Perlick 2014). ‘Social stigma’ is characterized by display of
‘discriminating behaviour’ and prejudicial attitudes, which are directed towards people with
poor mental health problems, as a direct manifestation of the psychiatric labels that they have
been bestowed with. In contrast, ‘self-stigma’ or ‘perceived stigma’ refers to the internalizing
of perceptions related to discrimination and prejudice, by the mental health sufferers, and are
found to significantly alter feelings of shame. These result in poor self-esteem and results in a
failure of the affected individuals to lead a successful and purposeful life.
Serious mental illness is therefore considered as two-edged sword. Public stigma
often comprises of reactions of general public towards groups that are biased on stigma about
the patients. Individuals generally fail to agree with the stereotypes that they are aware of.
However, individuals with mental illness, endorse the negative prejudice and stereotypes, as a
result of which they suffer from negative emotional consequences. Prejudice also results in
discrimination that gets manifested in the form of a behavioral reaction (Henderson, Evans-
Lacko and Thornicroft 2013). Such prejudice faced by the individuals, often yields anger,
which in turn can result in display of hostile behavior. In the case of mental disorders, angry
prejudice might also lead to replacing healthcare with criminal justice system or withholding
help. Fear often makes the affected people to adopt an avoidant behavior. Such instances are
most commonly seen in workplaces where the employers do not hire persons suffering from
mental illness. This association between the ‘perceived dangerousness’ of individuals with

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mental illness, and increased ‘social distance’ result in negative health outcomes and also acts
as barriers in the process of mental health recovery. In other words, public health stereotypes
comprise of three basic elements such as, prejudice, stigma and discrimination, in the context
of power difference, which brings about changes in the reaction of the general public towards
the stigmatised individuals (Parcesepe and Cabassa 2013). The narrative literature review will
try to evaluate the impacts of such mental health stigma and prejudice at the workplace of
people aged 25-40 years, suffering from mental illness, in England.

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Chapter 2: Background and Rationale
Context of the study
Mental health problems are considered one of the major causes that contribute to the
global disease burden. Mental illness and behavioural problems such as, anxiety, depression,
and substance use have been identified as the primary drivers of global disability, which in
turn contributes to more than 40 million years of disability among people aged 20 to 29 years.
Major depression has also been recognised as the second leading cause of disability and is
thought to be a primary factor that results in an increase in the worldwide burden of suicidal
ideations (Yang et al. 2014). Working environment and conditions create huge impacts on the
mental health of the employees. Statistical reports also stated that approximately 1 in
6.8 people are more susceptible to experiencing a range of mental health problems at their
workplace (14.7%). Women engaged in full-time employment are found to be nearly twice
prone to suffer from common mental health problems, upon comparison to full-time
employed men (19.8% and 10.9%, respectively). Evidences also suggest that an
estimated 12.7% of all sickness related absence days in the UK are directly correlated to poor
mental health conditions (Mental Health Foundation 2018). There is a need for all work
organizations to fulfil their responsibility of providing support to individuals with mental
illnesses. Research evidences have established strong association between long term
unemployment and the associated detrimental impacts that it creates on the mental health of
the affected individuals.
Results from a survey indicated that 40% of employees feared that revealing presence
of some mental health disorder at their workplace, might jeopardise their career (ONS
2014). The survey was conducted among 2,000 workers, and was commissioned by the
Mental Health Foundation. Findings indicated that approximately 40% of the workers were

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not ready to talk openly about their mental illness, for fear of it affecting their job security or
job prospects. Disclosure of presence of particular mental health disorders at the workplace
have also been found to result in display of ‘discriminatory behaviours’ from the colleagues
and managers such as lack of ‘opportunities for career advancement’, ‘micro-management’,
over inference in the mistakes, social exclusion, and gossip. Manifestation of the stigmas
result in portrayal of two different kinds of discrimination namely, direct and indirect
discrimination (Hcp.med.harvard.edu 2018). While direct discrimination involves overt
prejudicial treatments due to the protected mental characteristics of the employees, it often
denies the employees with appropriate opportunities. On the other hand, indirect
discrimination might also occur when the rules that apply to all employees result in an
inadvertent disadvantaged towards those suffering from mental illness. Individuals suffering
from mental disorders are often persecuted and harassed by display of conduct that violates
the dignity of the former and results in the production of an unpleasant environment where
offensive comments are made about the mental state of the affected person (Drapalski et al.
2013).
It directly results in victimisation of the employee, at the workplace. Researchers also
highlighted four assumptions that underlie workplace stigma, such as, (1) ‘people with mental
illness lack adequate competence to meet work demands’, (2) ‘people with mental illness are
mostly unpredictable and dangerous in the workplace’, (3) ‘providing employment to such
people generally involves an act of charity’, and (4) ‘working is not considered healthy for
such employees with mental illness’. These assumptions often vary in their intensity and
salience based on a plethora of ‘individual’, ‘organizational’, and ‘societal factors’.
Rationale
Research evidences have described social stigma as a major form of disapproval or
discontent of an individual, based on certain socially characteristic grounds, which in turn are

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perceived, and help in distinguishing them from other individuals living in the same society.
Stigma most often creates a change in the behavior of individuals who are stigmatized. Such
people often beign acting in ways that is expected of them by their stigmatizers (Tucker et al.
2013). These changes not only bring about behavioural alterations, but also play an essential
role in changing the beliefs and emotions of such people. Members of such stigmatized social
groups generally face prejudice, which in turn results in the onset of depression. Such stigmas
also put the social identity of the affected people in threatening situations, owing to the
presence of guilt feelings and low self-esteem. According to researchers, stigma was first
explored in the form of a social phenomenon in the year 1895. It was later on defined as
phenomenon whereby individuals with attributes, which are most commonly discredited by
the society become rejected. In other words, stigma refers to the process by which reaction
expected of others spoil the normal identity (Pescosolido 2013). Furthermore, evidences are
also provided by research articles on the fact that Goffman’s theory of social stigma often
considered it as a particular reputation or behaviour that is socially discrediting. Empirical
research on stigma have often associated it with a plethora of mental disorders, which have
most often pointed to manifestation of surprising attitudes, on the part of the general public
(Bos et al. 2013).
Evidences suggest that person who were told about association of prevalent mental
illness with certain genetic basis were at an increased likelihood of increasing their social
distance from person suffering from mental disorders (Corrigan, Druss and Perlick 2014).
Moreover, people displaying stigmatising attitudes towards the mentally ill person also
assume the latter as dangerous individuals. Furthermore, those informed of mental illness and
its link with genetic factors are also more likely to stigmatize the entire family of the affected
person. Although recent research studies have been successful in discovery and the
implementation of effective mental health interventions across the globe, several people with

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mental illnesses fail to seek out necessary help that is required by them for mental recovery.
Approximately 59.6% individuals with some kind of mental illness that includes conditions
such as, anxiety, depression, bipolar disorder, and schizophrenia had reported receiving
appropriate treatment services in 2011 (Lasalvia et al. 2013). Therefore, the negative stigma
surrounding mental illness must be eliminated or reduced to increase the likelihood of the
affected individuals of seeking professional healthcare services.

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Chapter 3: Research Methodology
Research methodology is the third chapter of the dissertation in which the researcher
strives to present a suitable set of systematic steps that will be carried out for the research
study helping the researchers achieve the set goals that have been decided for the research
(Zohrabi 2013). This chapter illustrates a research design, data collection method and a
search strategy in critical details. A conceptual framework describing the structure of the
nature research paper has also been provided at the end of this chapter.
Research design
The research design that has been selected for this paper is a narrative review on
the impact of stigma for people age 25 - 40 with mental health problem in the work place in
England. Now narrative review is a kind of scientific literature reviews. Any scientific
literature review can be defined as the methodological studies that utilize evidence based
practice and search databases to collect relevant and authentic information from the research
articles that have been published before and attempts to compare and contrast the data
provided by different research sources and arrive at a verdict regarding their research
questions and objectives (Lewis 2015). Narrative review can be defined as a specialized kind
of scientific literature review. Elaborating more, narrative literature reviews attempt to
describe and discuss the state of science of a specific topic and segregates the available
information in themes with respect to both theoretical and contextual frameworks. It has to be
mentioned in this context that the narrative reviews do not list the types of databases used or
the evaluation criteria used for the inclusion or exclusion of the articles that are going to be
used in the study. On the other hand, as explained by Savin-Baden and Major (2013), these
review studies comprise of critical analysis of the informative content retrieved from the
literature sources and help the researchers arrive at a particular theme regarding their topic of
interest in the study to be conducted.

12NARRATIVE LITERATURE REVIEW
On a more elaborative note, it has to be mentioned that there are a few considerable
factors that have contributed to the choice of this review design for the conduction of this
study. First and foremost, it has to be mentioned that the narrative review study design
provides the researcher with the opportunity to frame a broad research question so that all the
external and internal factors associated with a particular multifaceted issue within the health
care scenario that has been selected for the research study. As the research topic of this study
focuses on the impact of stigma on the mentally ill individuals in workplace in England
belonging to the age group of 25-40, the broad research question format of a narrative review
provided the opportunity to include all the multifaceted issues associated with topic in the
review. Another very important reason for the selection for this research design for the study
had been the fact that narrative reviews have the scope of variable evaluations; which made it
very easy to incorporate a variety of different research articles with a varied study design and
enhanced the scope of the review study to incorporate as much data as possible on the topic
(Smith 2015).
Data collection method
Data collection is a fundamental part of the research study and there are two different
types of data collection method, primary and secondary modes of data collection. The
primary method involves the collecting the data directly from the primary source of evidence.
The secondary data collection method is not dependent on the first hand resources, rather it
collects data from the second-hand sources that have collected the data from other primary
sources. For this narrative review study, the data collection method has been secondary and
the data collected was qualitative (Kastner et al. 2012). Now data is of two basic type,
quantitative and qualitative. The quantitative data is numerical data that can be represented in
the form of charts, tables and graphs; this type of data is collected using the primary method.
On the other hand, the qualitative data comprises of extensive information that cannot be

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measured, and are generally collected with the help of the secondary data collection method.
No numerical parameters are involved in the qualitative data. As the narrative review utilized
the secondary data collection method, the data collected has been qualitative devoid of any
numerical parameters, and the data was collected from the secondary sources such as the
journal articles researched and retrieved from the data Google scholar. A detailed account of
the steps involved in the process of searching, sorting and collecting the evidences is
illustrated in the search strategy below.
Search strategy:
Search strategy can be defined as the integral part of the research procedure especially
for the scientific literature reviews, including the narrative literature review design selected
for this paper (Aguillo 2012). This section provides a detailed outline regarding the step by
step action that has been taken to conduct research study in their chronological order. First
and foremost, the help of search engine Google was taken to gain a preliminary idea of the
research topic, its severity, the external and internal factors associated with the topic and the
demographic data associated with the selected region, which for this study had been England.
In the next step, a few UK based government websites were also utilized to gain an
understanding of the statistical picture of the health priority that has been selected for the
study. The next step had been arriving at the decision of the database to be used in the
conduction of the research study. The database selected for the narrative review study had
been the Google scholar database, which is also one of the most utilized research databases
for the academic purposes. It has to be mentioned in this context that the rationale behind the
use of the Google scholar is the fact that it is very familiar and extremely simple and easy to
use (Savin-Baden and Major 2013). Along with that Google scholar has a wide variety of
literature available including all different levels of evidences, which makes it the best tool for
any scientific literature study to collect various kinds of literature studies to focus on. Along

14NARRATIVE LITERATURE REVIEW
with that, the choice of the Google scholar as the database helped us conclude the evidence
search procedure much faster and without any hassle due to the systematic and simplistic
navigation and design of the database. Hence, the choice of this database has also been time
saving for the researchers.
The next step had been selection of the key search terms that are going to be utilized
in the research study. The key terms had been selected encompassing the broad scenario of
the research topic and ensuring reaching all external and internal aspects of the issue. The
search terms that had been selected for the study includes, “mental illness”, “disorder”,
“stigma”, “discrimination”, “prejudice”, “England”, “UK”, “adults”, “workplace”, and
“employee”. Along with that, all three types of the Boolean operators have been sued for the
search step such as “AND” and “OR”. The operator “AND” helped in narrowing down the
search results and retrieved hits that contained all keywords that had been given as an input.
The operator “OR” provided search results containing either of the key phrases such as,
stigma or discrimination (McGowan et al. 2016)
Inclusion criteria
Inclusion criteria helped in determining the features or characteristics that prospective
articles must possess if they were to be included in the narrative literature review. The
inclusion criteria for the study is given below:
 Articles published on or after 2010
 Articles published in English
 Full text articles
 Articles that contained information on attitude of employers or business organisations
towards mentally ill people in England

15NARRATIVE LITERATURE REVIEW
 Articles that focused on the discrimination and stigma faced by mentally ill people at
their workplaces in England and its impact on disclosure decision
 Articles that focused on the different government strategies, and frameworks and
support employment opportunities that would facilitate better employment
opportunities for mentally ill people in England
Exclusion criteria
These refer to the characteristics of articles, which disqualify prospective studies from
their inclusion in the narrative literature review. The exclusion criteria is given below:
 Articles published prior to 2010
 Articles published in language other than English
 Unpublished manuscripts
 Abstracts
 Studies that had been conducted in places other than England
 Studies that focused on attitude of employers towards any other disability, apart from
mental illness

16NARRATIVE LITERATURE REVIEW
Figure 1: Inclusion of Articles after Database Searching

17NARRATIVE LITERATURE REVIEW
Chapter 4: Main findings
4.1 Employer’s attitudes towards people with mental illness in the workplace in
England
The attitude of the public and employers of business organisations towards people with
mental disorders are generally negative. These negative attitudes and stereotypes that are
embedded in the societal norms often undervalue and discredit the affected individuals.
According to Little et al. (2011) mental health problems have been recognised as a major
problem in British businesses, and accounted for approximately 442,000 cases associated
with work related illness on an annual basis. The authors also provided evidence that each
individual with mental health problems are generally found to remain absent for 30.6 days on
an average, per year, which accounts more for any other physical abnormalities. The general
attitudes of of seniors towards their employees, with a history of mental health disorder varies
considerably across Europe. The authors collected data from an original survey that was
conducted in March 2006, based on telephonic interviews that focused on employment of
people suffering from persistent mental health problems. Following recruitment of random
sample composed of 500 Finance Directors (FD) or Managing Directors (MD), Chief
Executive Officers (CEO), and 50 Human Resources (HR) directors, a repeat survey was
again conducted in June 2009. A statistical analysis of the responses indicated presence of a
shift towards better recognition of commonly prevalent mental health problems that included
anxiety, depression, stress, phobias, schizophrenia, paranoia, obsessive compulsive disorder,
maniac or bipolar disorder and Alzheimer’s disease, among others. Survey responses
indicated that around 33% employers were of the opinion that none of their employees were
susceptible to the development of mental illness over their lifetime. The responses also failed
to produce any significant changes in presence of formal policies on mental health and stress
in the workplace. While most employees agreed on the fact that the policies were effective in

18NARRATIVE LITERATURE REVIEW
assisting the staff, some talked about the effectiveness of the policies in improving mental
health of the employees. Furthermore, the authors also indicated that either indirect or direct
interviews were held by the company to monitor presence of stress or other factors that might
have contributed to absenteeism of the employees.
Similar findings were also reported by Brohan et al. (2010) who wanted to evaluate whether
employers having previous experience of hiring employees suffering from mental health
problems significantly differ from those lacking such experience relatepreviousd to
knowledge, behaviours and attitudes about mental health in workplaces. The study showed
consistency with other findings which provide evidence for the fact that individuals suffering
mental illnesses are frequently found to report employment discrimination (Cummings, Lucas
and Druss 2013). The authors conducted the study as a part of a larger survey to evaluate the
employer’s attitudes on mental problems. Following randomisation of the employers from
British businesses, a screening was conducted to ascertain their role as decision makers in the
company. The survey used for the study was conducted with the help of Computer Aided
Telephone Interviews and focused on questions that pertained to the total employees with
mental illnesses and presence of effective policies for assisting them. The responses were
statistically analysed using the SPSS software and indicated that medical opinion on fitness,
absence record, job description, and employment records were the most common factors that
created an impact on hiring decisions. Responses of the employers also suggested that they
had several concerns associated with prevalence of mental illness among their employees
such as, safety of others, incapability to handle stress, unpredictable behaviour and concerns
on work performance. Consistencies were found with the previously discussed study in the
fact that most participants were confident of their knowledge regarding the effective mental
health laws at their workplace. The fact that individuals suffering from mental illness are
often stigmatised and fail to secure appropriate employment opportunities was validated by

19NARRATIVE LITERATURE REVIEW
the participant responses, where most agreed on the resistance of employers in hiring such
workers. Moreover, half of the responses suggested that discriminating attitudes from
colleagues were considered as major barriers to employment of people with mental illness,
showing similarities with other findings.
According to Henderson et al. (2013) high levels of ignorance, in addition to poor
preparedness were reported by the survey reported earlier, on dealing with mental health
problems. They focused the research on the fact that the high prevalence of mental disorders
are of essential economic and social interest. The study was based on the survey conducted in
2006 and the repeat survey in 2009. The statistical analysis was conducted for the responses
where the recruited interviewers were asked to state their agreement with the survey
questions. An analysis of the responses that were grouped into ‘agreed’ or ‘did not agreed’
suggested for an increase in the existence of certain formal mental health provisions and
policies in the workplace accommodations. High proportion of the people interviewed
suggested that the potential employees must always disclose presence of mental health
problems in them, prior to their recruitment. However, most of the interviewed people agreed
on the fact that display of negative attitudes from the co-workers were considered as a
significant barrier in the employment of the mentally disadvantaged individuals. Furthermore,
the interviewees also suggested that a great deal of talent often got lost from the British
businesses due to the negative attitudes that they held against employees currently suffering
from, or with previous history of mental illness. Similarly, the respondents were also of the
view that the British business should be provided adequate support to improve the way by
which mental health problems are dealt in at the workplaces.
Similar opinions were put forward by Biggs et al. (2010) who focused their research on the
fact that paid employment related positive benefits for all individuals with serious mental
health needs were not completely known, which in turn contributed to high rates of

20NARRATIVE LITERATURE REVIEW
unemployment among them. The researchers identified the social exclusion faced by the
mentally ill individuals at the society. They were also of the opinion that attitudes of the
employees towards such individuals were under the strong impact of media coverage. They
established strong correlation with the fact that mental illness are most commonly considered
as permanent states, which have no scope for recovery. The authors conducted an interview
of 20 people, equally divided into groups that comprised of directors and business managers.
A random sample was conducted for the business in private and public sectors, contacted
over the telephone. Following distribution of a questionnaire to all individuals, the response
rates were calculated. The results indicated that employers held strong negative beliefs on
employing individuals suffering from mental illness. These employers gave responses that
suggested presence of major concerns on the clinical factors such as, relapse, frequency of
episodes, and control of the illness, its severity, and recovery time after disorder relapse.
They also displayed major concerns regarding different aspects of employee work
performance, which often included work personality, absenteeism, and problems in abiding
by the instructions. The employers also indicated that they often considered employees with
mental illnesses with the need for supervision. Negative perceptions and beliefs were also
held by the business employers regarding the people with mental illness, which in turn was
influenced by a plethora of personal factors such as, ability to deal with finance, likelihood of
injury, issues of trust, handling confidential information, and safety issues in an environment
composed of the children and elderly. Upon questioning them about the accommodations
they would provide for, while hiring a person with mental illness, significantly high rates of
responses were obtained that focused on allowing ‘job sharing’, ‘flexible working hours’, and
‘temporary duty assignment’ to other colleagues, and accommodating ‘sick leave’. However,
few employers were found ‘prepared to pay for transport to work’, or visit their clients. Thus,

21NARRATIVE LITERATURE REVIEW
the literature discussed above indicates that there is a need for the employers to eliminate the
negative perceptions and attitudes that they hold against employees with mental illnesses.
4.2 The stigma and discrimination experienced by the mentally ill employees in the
workplace in England
Mental illness can be defined as the concept that is associated with extreme societal
taboos and discrimination affecting the confidence and self-worth of the employees and often
leads to complications such as isolation and bullying. Researchers are of the opinion that the
impact of this discrimination and social isolation often leads to either the mentally ill
individuals not being able reveal their condition or leaving the job abruptly. Many research
studies have focused on the nature of the stigma and the severity of its impact on the well-
being of the mentally ill employees in the workplace scenario of the UK demographics,
among which 4 articles have been selected to be reviewed in the research studies.
The first article by Brohan and Thornicroft (2010), focusses on the different factors
associated with the factors associated with the stigma or discrimination experienced by the
me4ntally ill employees in the organization scenario. The study highlights the overabundance
of the extremely low employment opportunities for the mentally ill individuals living in
england, The authors have stated the fact that the present job market exposure for people with
mental health issues is extremely alarming. A vast number of job applications from people
with mental illnesses are turned down in the UK demographics. Along with that, it also have
been observed that the evidence available also suggests the fact that many mentally ill
individuals do not even apply for certain positions with the fear or anticipation of being
discriminated against, and as a result the financial independence of the mentally ill population
in the UK has diminished gradually along the years. On the basis of this idea, the authors in
the article have conducted a survey of the employers to best understand their knowledge and
attitude and how it contributes to the overall stigma that the employees with the mental

22NARRATIVE LITERATURE REVIEW
illness face in the workplace scenario. Stigma had ben conceptualized as the amalgamation of
three interrelated concepts, ignorance or misinformation, prejudice and discrimination. 502
employers participated in the program and the result indicated at 17% thought that the mental
health symptoms are a grave threat to the health and wellbeing of the other employees, 14%
were prejudiced against strange and unpredictable behaviour, 20% denied the mentally ill
individuals from any job opportunities due to perception of them having impaired job
performance and 29% were concerned with absenteeism, and 9% were associated with
negative attitude or stigma for the mentally ill employees at work. Hence, from the study, it
can be clearly deduced that the main contributing factors behind the discrimination
experienced when they apply for different job profiles are a few interrelated stigmas. The first
stigma is the fact that people with mental health problems do not have the competence to
meet the professional demands. The second one is that mentally ill are dangerous or
unpredictable in the workplace. The third one is that taking the corporate stress is not healthy
for people with a mental health issue and the fourth one is providing employment for people
with mental illness is an act of charity. Although this study only focuses on the scenario of
job applications and has not provided any insight on the stigma faced while in the workplace.
The second article by the Wheat et al. (2010), the concept of the impact of stigma that
is associate with the workplace scenario and the anticipation of it and how it impacts the
decision to reveal or conceal having a mental illness in the workplace. According to the
research that has been carried out by the authors, the information conveyed supports the
previous article reviewed above. Elaborating more, the authors in the article have illustrated
the fact that employment rate for the mentally ill individuals in the present scenario is
alarmingly low. The authors have also demonstrated the report from the UK national labour
force that while 65% of the adult population with physical health issues were employed, the
figure for the mentally ill individuals are at 20%. Along with that, 90% of the total population

23NARRATIVE LITERATURE REVIEW
of mentally ill adults wanted to return to their jobs, but refrained from doing so due to the
fear of discrimination or were not allowed to join back in. The authors have further discussed
the facts that according to the UK employment survey statistics, one third of the total;
mentally ill adult population have stated that they either have been dismissed or forced to
resign from their jobs after revealing their mental health issue. Along with that, it also have
been discovered that 40% of the mentally ill individuals have been denied from being hired
because of past record of psychiatric treatment. Hence, these information reflects the acute
discri8mination that is experienced by the mentally ill individuals in the England workplace
scenario which has led to the mentally ill individuals wanting to conceal their mental health
status in the workplace. The research study found that even the medical practitioner suggest
to conceal the information from the workplace. And along with that, the data discovered by
the authors in this context reveals the fact that almost two thirds of the individuals dealing
with schizophrenia had been discovered to be concealing their mental health issues from the
workplace with the fear of being sacked or the fear of workplace bullying or stigmatization
due to their illness.
According to the article by Waugh et al. (2017) focusses on the stigma and
discrimination that the mentally unstable employees receive in the health care industry. This
article also supports the views of the previous study that the discrimination, and even the
anticipation of the stigma acts like a pivotal factor behind the decision of disclosure in the
workplace. As per the authors as the employees have the opportunity to experience the
stigmatizing and judgmental attitude towards the mentally ill while working in the health care
facility, their anticipation and fear is even more profound. This qualitative study had taken
the aid of the semi structured interviews i8nvolving 24c health professionals of NHS, and 13
of them worked in the mental health facilities. The results identified five key themes,
“personal experiences and their effect in changing attitudes; perceived stigmatising views of

24NARRATIVE LITERATURE REVIEW
mental illness in other staff members; hypothetical disclosure: factors affecting one’s
decision; attitudes towards disclosure; support in the workplace after disclosure; and,
applying only to those working outside of the mental health field, mental illness is not talked
about”. The authors further illustrated that the past experience of the workers of colleagues
with mental illness had been of seeing them avail variable support from the workplace with
most of the people having judgmental and stigmatizing views regarding the mental illness.
And hence, the fear or anticipation resisted them from disclosing their mental illness in their
workplace.
Brohan et al. (2012), in their article have stated that stigma and discrimination acts as
a considerable barrier to the finding and sustaining job opportunities for the mentally ill in the
UK. This systematic review not only focuses on the disclosure decisions and the impact of
stigma on it, but also the hiring decisions of the employers and the stigma associated with
that. The systematic review utilized 8 bibliographic databases and retrieved articles from the
period of 1990-2010 and the analysis was presented with meta-ethnography with a thematic
analysis of the disclosure beliefs and behaviours of individuals with mental health problem.
The results indicated that the disclosure decision or the decision to not disclose the mental
illness in the employees are the direct indicators of the varied range of stigma or
discrimination faced by the mentally ill employees and the experience of watching former
colleagues face the discrimination. It was discovered by the study that the stigmatizing
attitudes among the colleagues and the employer perception of compromised job performance
or absenteeism is the main reason behind the mentally ill individuals quitting or being forced
to resign. Hence, the fear or anticipation of these two key stigma theme s are the contributing
factor behind the nondisclosure; indicating at the dire need for workplace based awareness
and mental health literacy campaigns reducing the stigma and discrimination awaiting the
mentally ill employees in the UK.

25NARRATIVE LITERATURE REVIEW
4.3 Government strategies and supported employment of employees with mental illness,
in England
People suffering from mental illness have been found to increasingly become vocal in
communicating about their life with the illness and what provides them assistance to move
beyond their roles of the patient. According to Rinaldi, Miller and Perkins (2010)
employment opportunities for most people with mental health disorders are of major concern
for people working in mental health services, due to the fact that these services aim to
introduce rehabilitation and reintegration efforts. They focused on the implementation of the
‘Individual Placement and Support’ (IPS) program for ‘vocational rehabilitation’ of people
suffering from mental illnesses. The IPS approach encompassed a type of supported
employment that was specifically developed for individuals suffering from abnormal mental
health conditions. IPS was underpinned by a range of evidence-based principles, crucial for
determining its success in providing assistance to people for gaining and retaining
employment. The principles of IPS that were commonly implemented in settings containing
mentally ill people were namely, competitive employment, rapid job search, client eligibility,
client preference, ongoing support based on client needs, mental and employment services,
and personalized welfare benefits. The authors also identified several challenges that prevent
successful implementation of the approach in England. One of the common drawback was
associated with the myths prevalent among professionals, and the families of the affected
individuals, with the notion of providing help to people related to gaining employment. The
authors provided evidence for the fact that IPS implementation is generally effective by a top
down approach. Importance of the IPS was directly correlated by the authors with an increase
in employment opportunities for individuals with mental health problems, and for challenging
the myths that consider such people incapable of working in organisations. Furthermore, they
also recognised the need of implementation of an assertive and persuasive leadership.

26NARRATIVE LITERATURE REVIEW
Changing the practice and culture of an organisation should be accompanies with integration
of the vocational issues with the entire organization for helping mentally disadvantaged
people gain employment. IPS implementation was also identified to require active
engagement and commitment of senior clinicians and front-line managers. Presence of an
employment specialist, completely integrated with the clinical team was also identified as one
of the major prerequisites for IPS approach.
Perkins and Slade (2012) investigated the effectiveness of several mental health
policies in England, for preventing or eliminating the rates of unemployment, social inclusion
and reduced wellbeing of person suffering from mental illnesses. They discussed the
implications of the ‘New Horizons- A Shared Vision for Mental Health’ strategy that went
beyond the traditional approaches of treatment and aimed at recognizing the importance of
promoting mental health for improving the lives of all people with mental health problems.
The strategy also identified the necessity of action across government departments, in place
of just mental health services. They also focused on the No Health Without Mental Health
strategy in England, which primarily identified six major outcomes for improving the mental
health of the entire population. Mental recovery of people suffering from illness was
considered an explicit goal and the strategy focused on improving their lives, rather than
reducing the presenting symptoms. The authors also discussed the effectiveness of this
strategy in improving the overall quality of life of the sufferers, by facilitating the self-
management of lives, developing social relationships, and instilling an improved sense of
purpose. Some of the major outcomes related to successful implementation of the
aforementioned strategy was associated with improved physical health, reduction of
avoidable harm, and reduced rates of stigma and discrimination commonly displayed in the
households, and workplaces, thereby improving the employment rates. The authors also
discussed the legislation enforced in England on equality and rights of the disabled.

27NARRATIVE LITERATURE REVIEW
According to the presented evidences, the 2010 Equality Act employers, made it mandatory
for all education providers and employers to bring about reasonable adjustments in their
organisations for the disabled people. They focused on the fact that the UK government
recognised disabled people as individuals with mental health conditions. The fact that people
diagnosed with mental illnesses were not provided with appropriate services and changes in
their workplaces was attributed to the statement that diagnosis of mental illness was not
viewed as any form of disability. Furthermore, the authors also suggested that organisational
commitment was imperative in facilitating the easy recovery of the target population. They
also indicated that workplaces are required to adopt approaches that demonstrate a
commitment towards ensuring presence of an appropriate and conducive work environment
and structure that will promote recovery of the affected people. Transforming the workforce
was recognised as an essential approach by which the expertise and lived experiences of peer
support workers would help in supporting the employees in their journey of recovery.
Similar findings were presented by Heffernan and Pilkington (2011) who recognised
the high rates of unemployment among person with mental illness as significant forms of
social disabilities. They focused their research on the policies implemented by the UK
government in reducing sickness and increasing support for people with poor mental health.
Creation of health oriented services has often been considered difficult by the workplace
organisations. The authors focused the study on a systematic review that aimed to investigate
the effectiveness of the IPS framework in supporting employment of people with mental
disorder in the UK. Main findings from the study indicated that IPS reported high fidelity in
instances where it had been completely implemented across workplace organisations. Upon
integration with the mental health team, the IPS supported employment program was found to
provide assistance to all people with mental illness in achieving a steady, and meaningful
employment at different workplaces. Thus, the authors were successful in emphasising on the

28NARRATIVE LITERATURE REVIEW
fact that IPS is one of the most effective approaches that can be implemented across
workplaces, in the UK context, with the use of dedicated vocational specialists. The findings
of the study suggested that all individuals with moderate to severe mental illness, and with a
willingness to work are eligible for gaining IPS supported employment opportunities. If IPS
is effectively integrated with mental health services in the workplace, it will help the affected
individuals gain employment opportunities, without any discrimination or negative
stereotypes. Thus, the authors of this systematic review were successful in identifying the
role of manor vocational service programs in establishing individuals with mental disorders
into employment. The fact that the IPS focuses on access of competitive employment
opportunities, in place of sheltered employment, and also marks the eligibility of the
employees based on choice, and not on diagnostic functioning was cited as one of the primary
reasons that enhance its success in increasing employment for the target population. Hence,
the eight major principles of the IPS should be effectively implemented across all British
businesses, specifically for the employees suffering from mental illness. This will help the
organisation and the employers to provide continuous job support and systematically develop
relationships based upon the preferences of the employees.

29NARRATIVE LITERATURE REVIEW
Chapter 5: Discussion and conclusion:
The attitude among the employers and the fellow colleagues are the most important
co9ntributors to the discrimination or the stigma that is experienced or even anticipated by
the mentally ill individuals in the workplace scenario, and it has undoubtedly reached
alarming severity in the UK demographics in the present scenario. It has to be mentioned that
the narrative review had been successful in focussing on three key factors or themes
associated with this scenario. First and foremost, the attitude of employers towards mentally
ill employees were discussed in the first theme and how it impacts their hiring decisions. It
has been clearly identified by the narrative review that the perception of the employers of
employees with mental illness is far more negative than the physically ill individuals.
Moreover, the employers of the selected demographics have been found in the review to be
discrediting the mentally ill employees on the basis of absenteeism and impaired job
performance. According to the thematic analysis it was discovered that the perceived threat
from the mentally ill individuals also serve as a considerable contributing factor to the
negative hiring attitude. Although, the studies provided a mixed view on whether the attitude
of the employers were due to their past experience with mentally ill employees or due to
myth, although is most cases preconceived perceptions were found to be the main
contributor. In support, LaMontagne et al. (2014), have stated that the attitude of the
employers of different organizations towards the mentally ill individuals are mainly based on
myths and preconceived notions and it is more common in the privatized corporate
organizations.
The second theme in the review focused on the stigma and discrimination towards the
mentally ill individuals and how it impacts the behaviour and disclosure decisions while
working. A clear theme that was identified in this section was the fact that the anticipation of
the stigma or discrimination often resisted the employees to disclose their mental health

30NARRATIVE LITERATURE REVIEW
condition in the workplace after being diagnosed. Along with that, it was also discovered in
one of the articles that the doctors when approached by the mentally ill patients after
diagnosis also suggested to conceal their mental illness from the workplace even though it is
against the professional ethics and government legislations in the UK. In support, Irvine
(2011) has stated that more than half of the employees after being diagnosed refrain from
discussing anything with their employers regarding their mental illness with the fear or
anticipation of being bullied or discriminated in the workplace which can affect their
employability to some extent. Along with that, it also have been discovered that the mentally
ill individuals prefer to refrain using medical or diagnostic terminologies in the workplace
due to the fear of being stigmatized (Burton and World Health Organization 2010). Hence,
there is need for better mental health awareness so that the common myths and stigmatizing
attitudes can be overcome. The third theme illustrated the implementation of government
strategies and workplace based frameworks can aid the mentally ill individuals. The theme
identified the implementation of the individual placement and support (IPS) program for
vocational rehabilitation of people suffering from mental illnesses. The IPS approach
encompassed a type of supported employment that was specifically developed for individuals
suffering from abnormal mental health conditions. The narrative review discovered that the
implementation of such support frameworks improved the quality of life of the mentally ill
and integrated idea of self-management, social inclusion and enhanced sense of purpose in
the mental illness sufferers. As per the article by MacDonald-Wilson et al. (2011), the
implementation of support frameworks in the workplace not only aided in improving the
quality of life and occupational experience of the mentally ill employees, but also helped in
enhancing awareness among other employees and incorporate compassionate and empathetic
approach towards the sufferers as well.

31NARRATIVE LITERATURE REVIEW
On a concluding note, it has to be mentioned that this narrative review had been
successful in discovering all the key themes associated with the experience of the mentally ill
individuals in the workplace scenario. From the review study, it can be clearly identified that
the mentally ill individuals are extremely discriminated in the employment aspects in both
getting the job opportunity and sustaining it. Moreover, the study could also reveal the fact,
that the fear or anticipation among the mentally ill individuals is so extreme that they often
refrain from disclosing the information regarding their mental health from their workplace.
Along with that, the culture of bullying and discrimination has become extremely deep rooted
in the UK scenario which has even led medical practitioners advising their patients to
disclose their diagnosis from their workplace, despite it being a violation of professional
ethics. Although, the discrimination in the employers and colleagues is mainly found to be
associated with lack of knowledge and awareness in the common people regarding mental
illness and myths, which can be easily overcome with mental health awareness campaigns or
workplace based support frameworks implemented. The study discussed the impact of IPS
framework in the workplace and the positive effects it can bring to improving the quality of
life among the mentally ill employees and also by enhancing the awareness among the
workplace. Hence, there is need for more emphasis on policies and legislations mandating
implementation of such support frameworks in all different organizational domains to
improve the experience of the mentally ill in the workplace and reduce the discrimination and
stigma. Along with that, there is need for more mandatory awareness programs to improve
the attitude of the employers regarding the credibility of mentally ill employees and improve
the percentage of employment.

32NARRATIVE LITERATURE REVIEW
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