ABOUT six months ago, Patrick Ross knew things had reached a breaking point at work. An angry email he had sent to a superior — combined with occasional temper flare-ups and brusque interactions with colleagues — was endangering his job of two years as deputy director of communication at the United States Patent and Trademark Office.
So before a scheduled meeting with his boss about these problems, Mr. Ross decided he needed to reveal something he had not told anyone outside his immediate family: He has bipolar disorder.
He wrote down what he wanted to say and gave it to his supervisor the morning before the meeting.
“I didn’t sleep the night before,” Mr. Ross said. “But I decided things had gotten bad enough.”
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Mr. Ross is unusual in that he has chosen to speak publicly about his experience. But he is not unusual as one of 43.7 million adults who suffer from a mental, behavioral or emotional disorder, according to the National Institute of Mental Health. (The statistic does not include substance abuse.) That is more than 18 percent of American adults.
A 2013 Gallup-Healthways Well-Being Index found that diagnosed depression alone costs companies an estimated $23 billion annually in absenteeism.
And while celebrities and others who have publicized their mental health problems have to some extent reduced the stigma, that is not true in the place people spend most of their waking hours — on the job.
“We’re seeing changes in the broader culture, but we’re not seeing it in the workplace,” said Mary Killeen, a senior research associate at the Burton Blatt Institute at Syracuse University.
Some of this is changing. New federal regulations strengthen the law governing the hiring and on-the-job treatment of people with physical and mental disabilities.
The law applies specifically to federal contractors and subcontractors, who account for as much as 20 percent of the nation’s work force. The regulations include requiring employers to encourage employees on a regular basis to voluntarily disclose their disabilities.
But even though the Americans with Disabilities Act forbids companies from firing people with mental health conditions as long as they can do the “essential functions” of the job as determined by the employer, people may not feel safe coming forward.
And there is reason to worry.
DeBorah Ingegno, who now works as a doula, a nonmedical person who assists during childbirth, said that when she was hired at a California health food store a number of years ago, she told her employer that she needed Fridays off. When asked why, “I told her I had a group I had met with and left it at that.”
Her boss then inquired casually several times about what kind of group, and after Ms. Ingegno, who lives in Hartford, Conn., felt more comfortable in the job, she revealed it was a bipolar disorder support group.
While the supervisor initially seemed accepting, a week later, Ms. Ingegno was fired, and told that her illness was affecting her work.
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“I was stunned. I’d been getting ample compliments from the women training me and from my boss herself,” she said. Ms. Ingegno is now self-employed, but were that to change, she said, “I will never again disclose a mental illness to any employer.”
In one recent study of 600 people with disabilities, roughly half involving mental health, about a quarter of the respondents said they received negative responses to revealing their problems — such as not being promoted, being treated differently or being bullied, said Sarah von Schrader, a senior research associate at Cornell University’s Employment and Disability Institute.
That was part of the reason Scott Stossel, editor of The Atlantic magazine, kept his severe anxiety secret for 35 years from everyone but his immediate family until his book “My Age of Anxiety” was published this year.
Mr. Stossel feared “being perceived as weak or crazy, or that I would somehow compromise my professional standing,” he said.
Few will come out in the splashy way Mr. Stossel did. But choosing how to disclose, once you decide to, is crucially important. Employees often feel safer telling their supervisor than informing the human resources department, because they are afraid of having something on their permanent record, Dr. von Schrader said.
The trouble is, she said, supervisors often are not trained in how to respond to such information. They frequently are not aware of the requirements of the Americans With Disabilities Act or even of their company’s policies regarding issues such as flexible work hours.
The Partnership for Workplace Mental Health, part of the American Psychiatric Association, focuses on helping employers increase awareness and reduce stigma, and posts on its website case studies of companies that have introduced programs to address the issue.
Right Direction, a program started last year by the partnership and Employers Health, a national coalition, supplies employers with free fact sheets, posters and articles for company websites and other resources.
Clare Miller, the director, acknowledged that far less had changed in the workplace than in society as a whole, although she said it varied by company. Still, she added, opening up at work is “dicey.”
“If a friend asked me if I should disclose, I would talk about why she wants to,” Ms. Miller said. In some cases, people need to tell a boss because they need accommodations, such as time off to see a psychiatrist, or even 10-minute breaks several times a day to take medication and rest.
Susan G. Goldberg, a psychologist and assistant professor of psychology at Duquesne University, who has studied the issue for years, suggests ing five factors before deciding to make a psychiatric condition known on the job:
■ How supportive is the person you are disclosing to likely to be?
■ What type of culture does the company have? Sometimes big companies are more open, sometimes it’s mom and pops, she said.
■ Do you have a proven track record?
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■ What is happening in the society as a whole? “You probably don’t want to disclose after a mass shooting,” she said, when people tend to connect mental illness with violence.
■ Do you need to disclose everything about the condition, or would it be better to be selective?
The problem too often becomes a Catch-22, experts say. People associate mental health issues with those who act out and do not see those who successfully manage their problems, because they often keep them private. Yet if there is to be more acceptance and understanding of psychological disorders, those are the very people who need to speak out.
And it is known that if a disclosure is accepted positively, “people are much happier,” Professor Goldberg said. “It’s a weight off their chest.” And research shows that systemic efforts to treat depression in the workplace reduce employee absenteeism, increase productivity and are a cost benefit to companies.
Mr. Ross, whose book, “Committed: A Memoir of the Artist’s Road,” was published in October, learned that he had Bipolar II disorder, a less severe form of the illness, when he was 25.
Before his current job, he largely worked autonomously, but new medication he started five years ago gave him the confidence that he could handle a high-pressure government position.
It was more difficult than he had expected. One of the symptoms of bipolar disorder, he said, is that you are not always aware when you are losing control. Now, he said, his boss, who has been very understanding, can notice and perhaps suggest that he take a break or go home.
Mr. Ross says he is grateful for the support, but his job, a political appointment, expires in two years. By coming out, he wonders, “Have I just curtailed future employment activities?”
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