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

AuthorSusan Rauch
Date01 December 2019
Published date01 December 2019
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 healthcare 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
If my colleagues knew that I was bipolar, I fear I would viewed as the impaired
physician.”… My hardearned 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 selfdisclosure. Around the globe, nurses with diagnoses of bipolar disorder must
contend with their local governing bodiesoften stigmatizing policies surrounding the
disclosure and treatment of mental illnesses. Many countries, such as New Zealand and
Australia, implement governmentregulated 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 healthcare 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
healthcare system who disclose bipolar disorder continually feel medicalized and
marginalized by workplace policies primarily designed for addiction and substance
abuse ( 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 3month conversation among nurses with di-
agnoses of bipolar disorder, who converse within the nursing forum Nurses with
Disabilities( 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; TeiTominaga, 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; TeiTominaga et al., 2014). Very few
studies, however, examine how health professionals are affected by workplace
policies that medicalize disclosed mental illness of healthcare 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 stigmacan 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
Rauch: Medicalizing the Disclosure of Mental Health 425

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