I decided my last post needed a follow-up. In the last post, I discussed how employers can conduct psychological screening that could help them identify potentially suicidal and homicidal employees. For jobs that give people the power to endanger the public, I believe such screening is necessary. I noted that I discovered, through reading recent media reports, that airlines don't usually conduct such screening on pilots, which is incredible considering that pilots have the lives of hundreds of people under their power. However, it has occurred to me, after reading additional media reports, that some people may misinterpret employment-based psychological screening as something that keeps individuals from getting the mental health care that they need. The "argument" I've been reading is that people won't obtain mental health care if they think it will lead to loss of employment.
The Americans with Disabilities Act, passed in 1990, forbids discrimination based on disability, under most circumstances. Businesses have to show that employing a person with a disability would impose an unreasonable burden in order to be able to "discriminate" against such applicants or employees.This law means that you can't be fired for a mental health problem or even a substance abuse problem unless it makes you unable to do your job even with treatment and reasonable accommodation. Therefore, if you need to take a month off work to go to a treatment center, your job has to allow you to do so. If you need to leave early one day a week to see a therapist, your job has to allow you to do so.
If, on the other hand, despite your treatment you continue to do drugs and this impairs your work performance or causes disruption to other employees or clients, or creates a hazard, you can be fired. If you come to work late every day because you're too depressed to get out of bed, because you either refused treatment or treatment simply did not work, you can be fired. I believe the ADA is a fair law that has worked well. Someone who is too disabled to work qualifies for federal disability payments but most people with disabilities can work if they receive treatment.
Duty to Warn
Therapists in the US have to abide by something popularly known as "Duty to Warn." If we have a patient who threatens to harm someone else or whose illness puts the public at risk, we are required to break confidentiality to take action to prevent the loss of life or injury to another person. I had to do a "Duty to Warn" some years ago when a psychotic patient came to my office with a plan to kill a relative. In addition, he showed me a recipe for making bombs. I sent him to the emergency room and I also called the police in his relative's town. These are the requirements under "Duty to Warn." Even though I believed the patient was unlikely to act out his homicidal ideas, it didn't matter because it was possible that he would. The hospital re-evaluated him and, if I remember correctly, changed his medication. The patient didn't lose his job (he was a doorman) and no one was killed. (There was no evidence the patient had constructed a bomb or that he was actually planning on doing so). The hospital agreed to continue his treatment on an outpatient basis as it was too much for someone in private practice such as myself.
A colleague of mine years ago had a patient who was a motorman on the subway. The patient had severe panic attacks. My colleague did a Duty to Warn because panic attacks can occur without warning and can be disabling, and the patient was responsible for the lives of hundreds of people on the subway. I don't recall what the end result of this was, but I imagine it was something similar to what happened with my patient: The patient probably took a leave of absence, went on medication and then went back to work if his treatment was effective. In my opinion he should have been monitored by the MTA afterward to make sure he was complying with his treatment. I don't know whether this happened, however.
There are some people who are too sick to be able to safely work at jobs in which they hold the lives of others under their power. Most people who fall into this category are substance abusers, and only a small percentage are people with other clinical problems. Most people with mental health problems are effectively treated and can do most jobs. However, our societies do need ways to screen out people with intractable problems from jobs in which they can put the public at risk.
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