This article is excerpted from Chapter 8 of Adult Bipolar Disorders by Mitzi Waltz.

• Preparing for job applications and interviews
  
• Enforcement of nondiscrimination laws
  
• The Federal Rehabilitation Act
  
• Medical leave
  
• Help with getting a job
  
• Career choices
  
• Off-limits occupations
  
• Low-stress work options
  
• 'Out' at work or not?
  

There are two major on-the-job issues for people with bipolar disorders: getting work, and keeping it.

Most Western and Asian countries offer employees at least some protection from disability discrimination on the job. In the US, the Americans with Disabilities Act (ADA) makes it illegal to refuse to hire a person simply because she has, or appears to have, a disability-as long as that disability will not prevent her from doing the job.

Preparing for job applications and interviews

Careful preparation for job applications and interviews can help you avoid job discrimination. Make an honest assessment of your skills and job history when deciding what job to apply for. Working with a job counselor can help you prepare your resume and practice interviewing skills. Apply only for jobs that you are able to do, as employers have the right to reject you if you are not qualified for the job. If you have a choice, choose to work for a company with a large workforce, as it is less likely to discriminate and more likely to offer group life and health insurance.

Interviewers are only allowed to discuss a job applicant's disabilities if they are visible, or if the applicant brings up the topic. Accordingly, you don't need to volunteer information about your mental illness during a job interview.

Monique, a woman with bipolar disorder, says:

"With my current employer (a mental health advocacy group) it has not been a big deal, and I've felt comfortable talking to people here about my mood disorder. But with other jobs that I've had, I have been hesitant and afraid of discussing it. I don't want to be treated differently than any other person,

"I think if it was a position where I felt I was going to stay there and I felt comfortable with my co-workers, I would reveal it-but not at the job interview.

"And even though I have told people here, I haven't told everyone. It's personal, and I want to feel comfortable with the person before we talk about it."

Unless you have specific mental or physical limitations that affect the type of work you are applying for, the fact that you have a bipolar disorder should have no bearing on your qualifications for the job. Knowing your rights, and preparing strategies for your job interview, can make the difference between being hired and being rejected. The following suggestions on how to conduct yourself during a job interview may help.

• Do not volunteer information about your medical history. Employers have the right only to determine if you are capable of performing the job. They do not have the right to ask about personal or confidential information during an interview.

• Under the Americans with Disabilities Act, employers cannot ask about medical history, require you to take a medical exam, or ask for medical records unless they have made a job offer.

• Do not lie on a job application or during an interview. You can be fired later if your dishonesty is uncovered. Instead, answer only the specific questions asked. Try to steer the conversation towards your current ability to do the job, rather than explain your past.

• Do not ask about health insurance until you have been offered a job. Before accepting the job, get the benefits information and review it thoroughly.

• If your medical history becomes an issue after the job offer, get a letter from your physician that briefly outlines your treatment and stresses your current good health and ability to do the job. Ask the doctor to let you review the letter prior to giving it to your potential employer. If your doctor is willing, you might even prepare this kind of letter yourself and give it to your doctor for a signature.

• See the web site of the US Equal Employment Opportunity Commission for the EEOC's technical assistance documents on Pre-Employment Disability-Related Questions and Medical Examinations. The EEOC also has a document on the definition of disability used in federal civil rights (anti-discrimination) laws.

• Both federal contractors and federal aid recipients (hospitals, universities etc.) are required to actively recruit people with disabilities. If you are seeking a job with one of these employers, inquire about its affirmative action program. People who need to take a pre-employment drug screen, or whose jobs require regular screening for drugs, will need to inform the tester about prescription medications they take. In most circumstances this information is not shared with the employer. Americans with Disabilities Act

The Americans with Disabilities Act of 1990 (ADA) prohibits many types of job discrimination based on actual disability, perceived disability, or history of a disability by employers, employment agencies, state and local governments, and labor unions. Any employer with 15 or more workers is covered by the ADA.

In addition, most states and some cities have laws that prohibit discrimination based on disabilities, although what these laws cover varies widely. If your state or city has laws that provide more protections than the ADA, those laws prevail. If the ADA provides more protection than local or state laws, it prevails.

The ADA requires that:

Employer may not make medical inquiries of an applicant, unless:

1. Applicant has a visible disability, or

2. Applicant has voluntarily disclosed his medical history.

Such questions must be limited to asking the applicant to describe or demonstrate how she would perform essential job functions. Medical inquiries are allowed after a job offer has been made, or during a pre-employment medical exam. The employer must provide "reasonable accommodations" unless it causes undue hardship. An accommodation is a change in duties or work hours to help employees during or after treatment, when symptoms are worse, or when new health issues arise. An employer does not have to make these changes if they would be very costly, disruptive, or unsafe. If it seems likely that an increase in symptoms could jeopardize your job, work proactively with your employer to make needed accommodations.

Employers may not discriminate because of family illness. For instance, if your spouse has a bipolar disorder, the employer cannot treat you differently because she thinks you will miss work to care for your spouse or file expensive health insurance claims.

Employers are not required to provide health insurance, but if an employer does offer health insurance, the company must do so fairly to all employees.

Enforcement of nondiscrimination laws

The Equal Employment Opportunity Commission enforces Title 1 of the ADA, the section that covers employment. Call (800) 669-4000 for EEOC enforcement information and (800) 669-3362 for enforcement publications. Other sections of the ADA are enforced by, or have their enforcement coordinated by, the US Department of Justice (Civil Rights Division, Public Access Section.) The Justice Department's ADA web site is http://www.usdoj.gov/crt/ada/adahom1.htm.

In Canada, the Canadian Human Rights Act provides essentially the same rights as the ADA. The Canadian Human Rights Commission administers the act. You can get further information by calling the national office at (613) 995-1151.

If you feel that you have been discriminated against due to your disability or a relative's disability, contact the EEOC, the Canadian Human Rights Commission, or the appropriate agency in your country promptly. In the US, a charge of discrimination generally must be filed within 180 days of when you learned of the discriminatory act. Although you do not need an attorney to file a complaint, an attorney experienced in job discrimination law can help you draft the complaint to make it more likely to be successful.

Leslie, age forty-four, experienced discrimination early in her career, but was not able to combat it, as it occurred before the ADA extended protection to people with disabilities:

"I had a summer hypomania in late 1987 and got transferred to a low-profile position in another department at work.

"When I was depressed again I started withdrawing at work and obsessing on what had happened at the other department. I couldn't concentrate on my work either, and spent a lot of time getting on support newsgroups and e-mail lists.

"My project leader wrote up a humiliating questionnaire for me to fill out about why I didn't say hi to people in the hallways, why I spent so much time on the computer, and other behaviors. My first set of contrite, self-deprecating answers wasn't acceptable. It didn't occur to anyone present at the meeting that followed that my problem might be depression."

"Eventually I got on the right medication. However, the damage at work was done, and when layoffs came around, I went with the first wave.

"My career was going fairly well until I got on the psychiatric meds-many of them trash your short-term memory. Now I have trouble retaining verbal information especially, and keeping a job is very difficult. I was recently fired from my job for requesting accommodations under the ADA."

The Federal Rehabilitation Act

The Federal Rehabilitation Act bans public employers and private employers that receive public funds from discriminating on the basis of disability. The following employees are not covered not by the ADA, but by the Rehabilitation Act.

• Employees of the executive branch of the federal government. (Section 501 of the Rehabilitation Act)

• Employees of employers that receive federal contracts and that have fewer than fifteen workers. (Section 503 of the Rehabilitation Act)

• Employees of employers that receive federal financial assistance and that have fewer than fifteen workers. (Section 504 of the Rehabilitation Act)

Section 504 of the Rehabilitation Act of 1973 includes protections for adults attending school or working for employers who get at least some public funds. That list includes colleges, government bodies, and many non-profits, and may sometimes cover private firms that accept government contracts.

If you live outside the US, talk to a disability advocacy group about the laws that affect you on the job. If you live in one of the nations within the European Community, you can cite European Union civil rights regulations as well as applicable local or national disability rights laws.

The ADA does have a hitch: it only applies if your bipolar disorder presents a significant disability, or if your employer believes that it does-even if that belief is based on misconceptions about mental illness. This has led to a Catch-22 situation for many people with neurological conditions or mental illness: yes, there are drugs available that can treat the symptoms of these conditions, but those drugs don't work consistently for everyone, and may not work at all for some. They also carry with them side effects and dangers.

However, recent Supreme Court cases uphold the idea that if a disability can be corrected with medication, eyeglasses, or other temporary measures, it does not qualify for ADA protection, despite many lower-court cases that say otherwise. Future challenges can be expected in this area of law; indeed, California recently passed a bill that removes the "significant impairment" criteria for persons in that state.

One way around this roadblock is showing that the medication itself creates a disability. Lithium, for example, effectively suppresses mood swings for many people who take it, but it can also cause hand tremors and "brain fog." Slow thinking and shaky hands on the job can be disabling in of themselves, and may qualify you for ADA protection.

An attorney can explain where you stand legally, and may be able to help you fix the problem without going to court. Mediation is an increasingly popular and less costly option.

Medical leave

If you need to be away from work temporarily due to worsening symptoms or treatment needs, you may have legal job protection available to you. Since August 1993, the Family and Medical Leave Act (FMLA) has protected US workers in public agencies or large companies who need a leave of absence. Only employees who have worked 25 hours per week or more for one year are covered, and only if they work for a company with 50 or more employees within a 75-mile radius.

The Family and Medical Leave Act:

• Provides twelve weeks of unpaid leave during any twelve-month period for one's own medical needs or to care for a seriously ill spouse, child, or parent-sometimes you can take intermittent leave, which means shortening your normal work schedule

• Provides twelve weeks of unpaid leave for the birth of a child, or due to placement of a child in your home via adoption or foster care

• Requires employers to continue benefits, including health insurance, during the leave period

• Requires employees to attempt to schedule leaves so as not to disrupt the workplace, and to give thirty days' notice if possible

• Requires employers to put returning employees in the same position or in an equivalent position

The FMLA is enforced by the Employment Standards Administration, Wage and Hour Division, US Department of Labor, and the courts. You can find the nearest Wage and Hour Division office in the US Government pages of your telephone directory. You have up to two years to file a FMLA complaint or a lawsuit if your employer does not abide by the law.

Help with getting a job

For those having trouble getting a job, the public Vocational Rehabilitation (VR) system can be part of the solution. The VR system provides skills assessment, training opportunities, and job placement services for adults with disabilities. However, in many states the Vocational Rehabilitation system is severely overloaded, with wait times for placement ranging from three months to as much as three years. Typical opportunities range from sheltered workshop jobs (splitting kindling wood, sorting recyclables, light assembly work) under direct supervision, to supported placement in the community as grocery clerks, office helpers, chip-fabrication plant workers, and the like. Often people in VR programs work with a job coach, a person who helps them handle workplace stresses and learn work skills. In some cases, the job coach actually comes to work with the person for a while.

Pam, mother of 20-year-old Jakob, says the Vocational Rehab department has helped him move into employment gradually:

"We had never even heard of Vocational Rehabilitation when Jakob left the hospital. His therapist at community mental health sent him there. They had a job counselor who worked with him on his first resume, how to dress, and what interviews were like. They placed him in a part-time file clerk job with a hospital near the community college, and they checked up on him regularly for quite awhile.

"That was perfect: he's been there two years, and now he's taking classes part-time also."

Some public and private agencies may also be able to help with job training and placement. These include your state employment department; the Opportunities Industrialization Commission (OIC); the Private Industry Council (PIC); and job placement services operated by Goodwill Industries, St. Vincent de Paul, and similar service organizations for people with disabilities.

Career choices

All people with disabilities should receive appropriate vocational counseling, including aptitude testing, discussion of their interests and abilities, and information about different employment possibilities. People with the ability to work should not be shunted into dead-end positions that leave them financially vulnerable. This can be a problem when in the VR system: some VR counselors assume that their job is to get you into a job, any job, regardless of your past accomplishments, educational level, or long-term aspirations.

Truthfully, very few career options are off-limits to people with bipolar disorders. If anything, people with bipolar disorders are over-represented in creative careers-art, acting, music, and writing. Many also gravitate toward high-excitement occupations, including brokerage work, the top levels of marketing and sales, medicine, and other jobs that feed their need for challenge and variety.

Of course, the more exciting the job is, the greater its potential for stress and mood swings. That shouldn't dissuade you from pursuing your dreams, but may require lifestyle adjustments to make things work out well.

Off-limits occupations

One door that is barred to most people with a bipolar disorder is the US military. Current regulations prohibit anyone who has ever taken a psychiatric drug from enlisting. If you have never taken medication, the diagnosis itself may not preclude enlistment if you can pass the preliminary mental health screening.

There is ample reason to believe that people who have taken psychiatric medications have entered the military, however, with varying degrees of success. Whether they did not divulge their medication use when enlisting, or whether the officers in charge simply chose to ignore this one "blemish" in an otherwise promising candidate, is an open question. With Ritalin and Prozac now topping the list of childhood prescriptions, it does seem likely that the military will have to take a second look at this policy to keep its ranks filled. Should the draft be reinstituted, the ban will almost certainly have to be lifted.

Other careers that involve firearms may also be off-limits, including work as a police officer or armed security guard. That's because under some gun control laws, a person who has been found mentally ill by a court or who has a "history of mental illness" as defined by the state involved is legally prohibited from purchasing or being licensed to carry a gun. Most police departments also put applicants through a mental health screening process. A person whose bipolar disorder is well-controlled by medication could probably pass one of these, however.

In some states, and under some circumstances, a bipolar diagnosis could cause licensing problems for certain types of professionals. If you are in a profession that requires state licensing, such as law, medicine, nursing, or teaching, familiarize yourself in advance with the rules governing licensure. Under current US disability law, it would not be legal to fire someone simply because he or she has a certain diagnosis-there would have to be some kind of problem behavior or loss of ability involved. However, bar associations and medical boards are currently allowed to suspend or deny professional licenses on such grounds, and so far most challenges have been upheld by the courts.

If a problem related to your illness does occur on the job and you are a licensed professional, there is usually an option to keep your license by entering a diversion program. Each state has its own regulations on diversion. In a diversion program, you practice under supervision, and may need to satisfy treatment or performance-improvement guidelines. If you do well, your license is safeguarded.

Entering a diversion program is voluntary and confidential, although in some states that confidentiality can be breached if program officials feel you pose a danger to others. If you quit or do not comply with the program, you may not be able to enter it again. If you do complete a diversion program successfully, the records are usually destroyed after a specified period of time.

Low-stress work options

The world of high-stress employment is not for every person with a bipolar disorder, including many who initially choose it. You may find that life outside of the fast lane better suits your moods.

Shoshana did not expect to opt for a low-stress lifestyle:

"I lead a much quieter life now, but I'm not sure this would have been my choice. I loved intensity, and wanted to live life intensely-I went into law because it was a field where there was no mandatory retirement at age sixty-five.

"I've not returned to the practice of law, and it doesn't look too likely at this point, since stress triggers off nasty mood swings.

"How ironic it all is."

For some persons, part-time, temporary, or on-call work are the best option. Although these work styles may not offer the same level of financial security as full-time or permanent employment, they do provide more down time and flexibility. For others, a position that offers predictable hours, a steady workflow without too many "crunch periods," and a relaxed atmosphere is sometimes worth taking a cut in pay.

You may be able to take the skills earned in your old high-stress job and apply them to something less hard to handle. For example, lawyers can become legal researchers or consultants, nurses can move from the ER into long-term care, and executives can drop down a rung on the corporate ladder to get out from under long hours and constant changes.

Sometimes an existing job can better meet your needs with a little restructuring. If you find that sleep deprivation caused by frequent travel is affecting your stability, see if you can pass the conference circuit responsibilities on to a co-worker and take on some in-office projects instead. It all depends on how flexible your employer, and you, are willing to be.

You don't have to talk about your diagnosis when making these kinds of changes. Simply tell curious co-workers and friends that you're simplifying your life, want more time for your family, or desire a more satisfying new career direction.

'Out' at work or not?

To tell or not to tell, that's the big work issue for most bipolar adults. Some feel that their employers might see them as unworthy of responsibility or promotion, or worry about how their mental health could affect company operations. Although it's illegal to discriminate on the basis of mental illness, most bipolar adults have personal experiences with job discrimination, or know someone else who has. Your reticence is natural-and may be warranted. In a 1991 Harris poll about attitudes toward people with disabilities, 59 percent of people surveyed said they feel comfortable with someone who is in a wheelchair, but only 19 percent had the same level of comfort with someone who has a mental illness.

If your symptoms are well-controlled, there's probably no reason to tell, unless it is required by company policy. If you occasionally have breakthrough symptoms, you may want to consider confiding in one key person at work. That person need not be your direct supervisor-the personnel department might be a better choice. You can ask the personnel department to place a letter in your personnel file outlining your diagnosis and any accommodations you might need if your symptoms worsen.

Lillian, age nineteen, says:

"Don't be embarrassed about it, but you don't have to tell everyone about it. A friend of mine told everyone when she got the diagnosis. It's not cool, it's not a status symbol, but it's not something to be ashamed of. It's who you are."

If you do have a sympathetic boss, approach the topic with caution. You might try making a joking reference to the illness (on a particularly frantic day, "I think I'm having one of those manic mood swings my doctor warned me about", for instance) to break the ice. Some people have simply left their medication in plain view one day-another conversation opener.

People who feel secure in their ability to manage on the job are often comfortable about addressing the issue forthrightly and openly. It would be wonderful if more people could do so. You can get more information about the legal rights of disabled people on the job, including tips on approaching employers, from the Job Assistance Network (800-ADA-WORK) or the US Department of Justice Hotline (800-514-0301.)

Marcia, age twenty-six, says:

"When it comes to who you should and should not tell, honestly I am still unclear on what is best. All my immediate family and close friends know I am bipolar.

"Actually, I feel like my diagnosis has helped strengthen my relationship with my friends and family. Now that we have identified my symptoms, my family and friends know when it's me and not the illness talking.

"Even though I have been working now at the same company for almost three years, I have not told any of my coworkers about my bipolar disorder. Whether or not that is the right decision, I am still unsure."

Civil rights laws do protect you against workplace harassment based on your disability. As with other types of harassment cases, it's important to let harassers know exactly how you feel about their actions, to keep detailed records of incidents, and to go through any formal grievance procedure your company or labor union has before filing a lawsuit.

Most large firms have a staff member who handles internal complaints of sexual or racial harassment. This is probably the right person to see first if you find that your illness has become the topic of rude remarks, practical jokes, or other cruel actions by fellow employees or supervisors. You should inform this person about your disability, and make it clear that you are bothered by the behavior. This will either bring down the weight of company policy on the offenders, or form the legal basis for a future discrimination claim.