Should You Tell?

Putting mental-health problems on the same footing as physical illnesses may help more people make the disclosure because it might encourage treatment. It also might help blunt the stigma that surrounds the diseases.

That stigma might have kept Kay Redfield Jamison, a professor of psychiatry at Johns Hopkins University, from disclosing her bipolar disorder years ago, but she had no choice. As a medical student seeking hospital privileges, she had to inform her employer.

The chairman at the University of California at Los Angeles, where she was working when her illness became apparent, "never suggested I not compete or leave academic medicine," she said.

"He said learn from it, teach from it, write from it," Jamison said. "But I do not offer these up as typical examples. They are exemplary."

One study conducted by the Boston University Center for Psychiatric Rehabilitation showed the difficulty of deciding what to disclose. Some study participants said it was empowering to go to work, feel like everyone else, and not tell anybody they had a mental illness, said Zlatka Russinova, one of the study's authors. But other people who were initially afraid to disclose but later told a supervisor "felt really empowered to be open," she said. "It's a personal choice."

Some like that they educate or help others when they disclose. Those are powerful incentives, up to a point.

"The vast majority are saying to themselves, 'Why would I ever disclose? Everybody's afraid of people with mental illness,' " said Stephen Hinshaw, chairman of the psychology department at the University of California at Berkeley and author of "The Mark of Shame: Stigma of Mental Illness and an Agenda for Change." "But that only perpetuates shame, ignorance and an inability to proactively take steps to ease the situation."

Employers have a different incentive to encourage disclosure. They can save money when they help employees get treatment because though they may pay more for insurance, they may get a more productive and loyal worker in return.

The National Institute of Mental Health recently released a study showing that slightly increasing the care for a worker's depression would actually save employers money.

Most of the savings come from increased productivity when employees are able to get treatment, said author Philip Wang, director of the division of services and intervention research at NIMH, who conducted the study while researching at Harvard University. Companies often "think of health benefits as dumping resources into an endless black hole, and they get nothing back," he said. "But here's an area that's currently untapped."

In the study, a hypothetical group of 40-year-old workers with depression were referred to treatment. Savings from reduced absenteeism and employee turnover due to the intervention began to exceed costs of the program by the second year.

Mastroianni, the EEOC attorney, suggests that employers put policies in place that explain the ADA rules and outline what the company offers someone who might have a mental illness. This should help create a comfortable atmosphere in which workers can be honest.

But the consensus remains: There is no one right answer on disclosure.

"It is completely personal," said Williams, the public relations employee. "People have to feel it's the right time and right place. I could never say in a thousand years that you should or shouldn't. This was not easy for me. I came to this decision gradually and only did it at work because I was made to feel extremely comfortable."