Medicalizing the Disclosure of Mental Health: Transnational Perspectives of Ethical Workplace Policy Among Healthcare Workers

• DOI: http://doi.org/10.1002/wmh3.317
• Date: 01 December 2019
• Published date: 01 December 2019

424

doi: 10.1002/wmh3.317

© 2019 Policy Studies Organization

Medicalizing the Disclosure of Mental Health:

Transnational Perspectives of Ethical Workplace Policy

Among Healthcare Workers

Susan Rauch

The disclosure of mental health conditions in the health‐care workplace is a global concern that

presents many challenges during the prehiring and posthiring process. Even more concerning is the

transnational variance in workforce policy that stigmatizes and marginalizes prospective employees

who disclose mental health conditions, even those who are not substance abusers or addicts. In the

United States, nurses who disclose mental health diagnoses are expected to enroll in substance abuse

monitoring or peer assistant programs designed specifically for and mostly attended by addicts.

Comparatively, global perspectives indicate that the (non)disclosure of mental health in the workplace

is similarly stigmatized and medicalized, aka inappropriately labeled. This paper examines the med-

icalization of mental health workplace policy from a global perspective (United States, Australia, and

New Zealand). Online narratives are presented as examples that question and criticize the social

justice of medical workforce policies including the consequences of (non)disclosure.

KEY WORDS: mental health disclosure, transnational workplace policy, bipolar stigma

Introduction

If my colleagues knew that I was bipolar, I fear …I would viewed as the “impaired

physician.”… My hard‐earned credibility would be gone.”(Fiala, 2004)

Health professionals diagnosed with mental health illness experience many chal-

lenges in the workplace, from conflicting attitudes and barriers of colleagues to policies

of self‐disclosure. Around the globe, nurses with diagnoses of bipolar disorder must

contend with their local governing bodies’often stigmatizing policies surrounding the

disclosure and treatment of mental illnesses. Many countries, such as New Zealand and

Australia, implement government‐regulated workforce mental health support and well‐

being policies. In Australia, the governing body for nurses is the Australian Health

Practitioner Regulation Agency (AHPRA), and in New Zealand, it is the New Zealand

Council of New Zealand. However, many health‐care organizations and nursing boards

within the United States continually instill fear of discrimination, marginalization, and

stigma among employees diagnosed with bipolar disorder. Nurses in the United States

health‐care system who disclose bipolar disorder continually feel medicalized and

marginalized by workplace policies primarily designed for addiction and substance

abuse (allnurses.com). Mandatory disclosure or nondisclosure of bipolar disorder in a

U.S. medical workplace could also mean the difference between nurses retaining their

job and licensure despite perceived violations of human rights and disability law. The

laws regarding patient privacy are not absolute, for example, when an RN licensee

voluntarily discloses to the state nursing board his or her psychiatric history. Within the

current medical discourse of mental health, the social justice and consequences of health

professionals (non)disclosure in the workplace, therefore, needs further consideration.

In this article, I examine nursing board policies and peer assistance programs,

particularly those in the United States, that report, monitor, and provide counseling

support to nurses facing disciplinary action due to substance abuse or with mental

health diagnoses. This study relies on a 3‐month conversation among nurses with di-

agnoses of bipolar disorder, who converse within the nursing forum “Nurses with

Disabilities”(allnurses.com). In particular, I examine the rhetorical content of their

conversations to learn more about how nurses resist the medicalization of bipolar dis-

order in the workplace in efforts to overcome peer stigma, and how they argue for more

equitable workplace policies. The analysis of the discussion forum further explores the

social circumstances of (non)disclosure of mental illness in the workplace including

attitudes, perceptions, and barriers experienced by individuals diagnosed with bipolar

and other mental health illnesses (Joyce, McMillan, & Hazelton, 2009; Marwaha,

Durrani, & Singh, 2013; Peterson, 2007; Tei‐Tominaga, Asakura, & Asakura, 2014).

Literature Review

A review of the literature identifies organizations that offer psy-

chointerventions such as peer assistance or monitoring programs designed for the

treatment of health professionals with substance abuse or addiction (Mumba, 2018;

Throckmorton & Etchegaray, 2007; Trossman, 2003). The literature also reveals

studies relevant to the stigma and marginalization of mental health and workplace

policy (Holladay, 2017; Marwaha et al., 2013; Tei‐Tominaga et al., 2014). Very few

studies, however, examine how health professionals are affected by workplace

policies that medicalize disclosed mental illness of health‐care employees (Joyce

et al., 2009; Mumba, 2018).

Public perception of mental health is further misinterpreted by how stigma is

internalized publicly within society (Howland, Levin, Blixen, Tatsuoka, & Sajatovic,

2016; Latalova et al., 2013; Pescosolido, 2013). Oftentimes, mental health diagnoses

such as bipolar disorder are defined by how society defines and stereotypes as a

specific type of condition (Howland et al., 2016; Pescosolido, Manago, & Monahan,

2019; Pescosolido, Martin, Lang, & Olafsdottir, 2008). According to Howland et al.

(2016), the psychological consequences of “internalized stigma”can negatively and

socially affect how patients function within the workplace (p. 174). Pescosolido

et al. (2008), in their research on the “Framework Integrating Normative Influences

on Stigma (FINIS),”discuss how enacted norms internalized within workplace

policy contribute to “equality and inequality”(p. 437). Howland et al. (2016)and

Pescosolido et al. (2008)both argue for a change in the mindset within social

systems. To reduce the internalized stigma of mental health illness in the

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