Does Ontario set up persons living with bipolar disorder for career success?
By Margaret Janse van Rensburg
The Diagnostic and Statistical Manual 5th edition (DSM-5) classifies bipolar and related disorders as disorders that cause mood fluctuations between a range of depressive states and manic states (Severus & Bauer, 2013). Persons living with bipolar disorder (BD) can have impaired occupational functioning, health-related quality of life and are at a higher risk of suicide, because BD is a chronic affective disorder with recurrent episodes of mood fluctuations (Kleinman, Lowin, Flood, Gandhi, Edgell, & Revicki, 2003). While Kleinman et al. (2003) propose that BD has a prevalence of approximately 1.3%, other literature speculates that persons living with BD make up 5-8% of the general population (Kessler, Akiskal, Ames, Birnbaum, Greenberg, Hirschfeld, & Wang, 2007; Severus & Bauer, 2013).
Persons living with BD face stigmatization. Academic literature cites an associated “economic burden” for the state because of high costs associated with providing care (Cloutier, Greene, Guerin, Touya, & Wu, 2018; Kleinman et al., 2003). In a review of literature on BD and stigma, Hawke, Parikh, & Michalak (2013) found that as a highly stigmatized condition, attitudes and stigma have critical repercussions for the functioning, social support and courses of illness of persons living with BD. The needs of persons living with BD are greater than those of an average citizen. Persons living with BD often require inpatient treatment, outpatient treatment, other psychiatric and psychological services , as well as access to medical care (Geddes & Miklowitz, 2013; Kleinman et al., 2003). A survey by the National Depressive and Manic-Depressive Association in 2000 indicated that approximately 60% of persons with BD were unemployed, including those with college degrees (Bowden, 2005).
A person living with BD may have trouble finding and maintaining work. They are also more likely to have precarious living situations and to be incarcerated (Copeland, Miller, Welsh, McCarthy, Zeber, & Kilbourne, 2009). The person may experience exceptional needs that others do not face. Balancing work with individual psychological, behavioural and medical needs may be difficult. Time off may be necessary to attend medical or therapeutic
appointments, and there may be periods when they may be unable to work due to cyclical phases of mania and depression (Disability Benefits Help, n.d.). Further, persons living with BD may lack support from their families and communities, have inadequate access to healthcare and medication, and face stigma from potential employers (Hawke et al., 2013). This is coupled with the financial hardships of higher medical care and medication costs associated with BD (Williams, Shah, Wagie, Wood, & Frye, 2015).
Could a person living with BD be accommodated in employment to ensure job and income security? Under the Employment Standards Act, a person is entitled to unpaid sick leave if they are employed for two weeks for up to three days in each calendar year. Under the same Act, if they are employed for fewer than six months, they can face termination without notice or termination pay (Employment Standards Act, 2000, c. 41, ss . 50, 54-60). These are minimum standards, and employers can provide more generous sick leave benefits to their employees. The Accessibility for Ontarians with Disabilities Act (2005) identifies that BD constitutes a disability, and thus persons with bipolar disorder are protected under Ontario’s provincial Human Rights legislation (Thompson , 2012). Protection takes the form of “reasonable accommodation.”
Margaret Janse van Rensburg is a recent graduate of Carleton University’s Master of Social Work program and is entering her doctorate in Social Work. She holds an Honours Bachelors of Arts from Wilfrid Laurier University in Archaeology and Medieval Studies and a Graduate Certificate in Autism and Behaviour Sciences from George Brown College. She is committed to social justice and anti-oppressive practice. Her interests include promoting inclusion in work and education, advocating for a social model of disability, and destigmatizing ‘private’ issues, including mental health, disability, women’s safety, and eating disorders.
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Ontario Human Rights Commission. (2016). Policy on ableism and discrimination based on disability. Retrieved from http://www.ohrc.on.ca/en/policy-ableism-and-discriminationbased-disability
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Williams , M. D., Shah, N. D., Wagie, A. E., Wood, D. L., & Frye, M. A. (2015) . Direct Costs of Bipolar Disorder Versus Other Chronic Conditions: An Employer-Based Health Plan Analysis. Psychiatry Online. doi: 10.l 176 /ps.62.9.pss6209_1073