Should You Tell?

"If I had diabetes or cancer, they wouldn't expect me to suck it up and keep going," she said.

She will never tell an employer again. "I just saw the repercussions."

There is more to consider than pure emotion when considering disclosure, however. A drug test or security clearance -- or the law -- might raise the issue. It is important to know what is required and what isn't.

While working in public relations for a Baltimore mayor, the Visiting Nurse Association and other groups, Sheryl Williams hid her bipolar disease and anorexia. "I just feared not being credible. I knew how 'mental patients' were treated," she said. The effort it took for her to hide her illness every day at work left her exhausted, but she managed.

But when she took another job and encountered the inevitable drug test, she knew it would come back positive because of her medications. So she decided to tell. It helped that she had gained the boss's trust after years of doing work on contract for him, she said.

"My boss said, 'Okay, so what?' " Williams said. The human resources director concurred. "I could have just hugged both of them. Now I don't feel as if I am limited at all."

Another reason for disclosure: It allows legal coverage. If a person has a mental illness and does not disclose it to a boss or other official entity at work, the employee can't benefit from the Americans With Disabilities Act.

About 14 percent of all charges filed under the ADA involve mental illness. But an employee who does not disclose a condition loses that legal protection, said Chris Kuczynski, director of the ADA policy division at the Equal Employment Opportunity Commission.

Employers cannot ask in interviews whether someone has a mental illness. They are permitted, however, to ask once a conditional job offer is made, according to Peggy Mastroianni, associate legal counsel with the EEOC. If the offer is withdrawn after an admission is made and the illness does not directly relate to the job, the company can be held liable for violating the ADA. (This is the only law the EEOC enforces that prohibits something being asked in an interview.)

Companies have rights, too. In fact, if an employee creates a problem by doing poor work, the company can take action against that worker if it has not been informed of a mental illness as a potential problem, Mastroianni said. But if an employee's conduct or performance is hindered because he was denied accommodation allowed by the ADA -- a flexible schedule or time off to see a doctor, for instance -- the company might not have the same leeway.

Sometimes, the health-care system reinforces the stigma, allowing endless treatments for a broken leg but a limited number of visits to a therapist.

Legislation was introduced in the Senate last week by Edward M. Kennedy (D-Mass.), Pete V. Domenici (R-N.M.) and Mike Enzi (R-Wyo.) that would allow anyone with health insurance to have equitable coverage for both mental and physical illness. A bill is expected to be introduced in the House soon. So far, 40 states have passed similar laws, including Maryland and Virginia. The District does not have one, according to Andrew Sperling, director of legislative advocacy with the National Alliance on Mental Illness. The organization is lobbying for the Senate bill, he said. "Placing arbitrary limits on treatment for mental illness is just wrong," he said.