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Mental health disabilities in the workplace: exploring human resource professionals’ practices

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Mental health disabilities in the workplace: exploring human resource professionals’ practices

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Mental Health Disabilities in the Workplace:
Exploring Human Resource Professionals’ Practices
by
Kindra Lynn Bartz

Rossier School of Education
University of Southern California
A dissertation submitted to the faculty
in partial fulfillment of the requirements for the degree of
Doctor of Education

May 2022

© Copyright by Kindra Lynn Bartz 2022
All Rights Reserved

The Committee for Kindra Lynn Bartz certifies the approval of this Dissertation

Monique Datta
Eric Fecht
Helena Seli, Committee Chair

Rossier School of Education
University of Southern California
2022

iv

Abstract
This study explored HR professionals’ assets and barriers in providing support and diminishing
workplace challenges for employees with mental health disabilities. Using a mixed-method
approach, this study surveyed 75 human resources (HR) professionals and interviewed seven
about their perceptions of providing support to employees with mental health disabilities. This
study identified three key findings: (1) the perceived training inadequacies of direct managers,
supervisors, and HR professionals, (2) the challenges associated with providing accommodations
for employees with mental health disabilities, and (3) HR professionals’ challenge of balancing
organizational profitability with supporting employees with mental health disabilities. Based on
these findings, three recommendations were identified: (1) provide direct managers, supervisors,
and HR professionals with specific training and best practices to support employees with mental
health disabilities, (2) provide better resources and specific best practices for HR professionals
on how to best provide accommodations for mental health disabilities, and (3) create alignment
between employee wellness and organizational profitability.

v
Dedication
To my mom, Lyric Lynn. My best friend and my biggest fan.

vi
Acknowledgments
First, I would like to thank Dr. Helena Seli for supporting me through this process, for
your constructive feedback, and most of all for reassuring me that I could do this when you could
tell I was losing confidence. Also, I would like to thank Dr. Monique Datta for serving on my
committee and giving me feedback that undoubtedly made me a better writer knowing the “paper
shredder” was on my committee. I want to thank Dr. Eric Fecht for not only serving on my
committee but for really teaching me to write a literature review. As my framing instructor, you
set me up for success in this program, and I am grateful.
I want to thank my classmates. It has been an honor to work with such a talented group of
people. I am particularly grateful to my reading group for your impeccable teamwork and
endless text chains that helped me through even the toughest of days. And to so many of my
other classmates who took the extra time and care to check in with me. You know who you are,
and you all showed up for me and kept me feeling connected and motivated. I feel lucky to be
walking away with some amazing friendships I have no doubt will be lifelong.
And lastly, I want to thank my family. You kept believing in me when I did not always
believe in myself. I am beyond lucky to have your love and support.

vii
Table of Contents
Abstract .......................................................................................................................................... iv
Dedication ....................................................................................................................................... v
Acknowledgments.......................................................................................................................... vi
List of Tables ................................................................................................................................. ix
List of Figures ................................................................................................................................. x
Chapter One: Overview of the Study .............................................................................................. 1
Background of the Problem ................................................................................................ 1
Context of the Study ........................................................................................................... 3
Purpose of the Study and Research Questions .................................................................... 3
Importance of the Study ...................................................................................................... 4
Overview of Theoretical Framework and Methodology .................................................... 5
Definitions........................................................................................................................... 5
Organization of Study ......................................................................................................... 6
Chapter Two: Literature Review .................................................................................................... 7
Types of Mental Health Disabilities ................................................................................... 7
Mental Health Disabilities in the Workplace .................................................................... 11
Legislation Protecting People with Disabilities ................................................................ 20
Conceptual Framework ..................................................................................................... 30
Summary ........................................................................................................................... 32
Chapter Three: Methodology ........................................................................................................ 33
Research Questions ........................................................................................................... 33
Overview of Methodology ................................................................................................ 34
The Researcher.................................................................................................................. 36
Data Sources ..................................................................................................................... 36

viii
Ethics................................................................................................................................. 44
Chapter 4: Results and Findings ................................................................................................... 46
Participating Stakeholders ................................................................................................ 47
Research Question 1: What External Factors Such as State and Federal Law
Influence HR Professionals in their Role of Supporting Employees with Mental
Health Disabilities? ........................................................................................................... 50
Research Question 2: How Do Organizational Factors such as Policies,
Procedures as well as Organizational Culture Influence HR Professionals’ Ability
to Support Employees with Mental Health Disabilities? .................................................. 54
Research Question 3: What is the HR Professionals’ Knowledge of Mental Health
Disabilities?....................................................................................................................... 59
Research Question 4: How do Motivational Factors such as Self-Efficacy,
Perceptions of Barriers, and Self-Regulation Impact HR Professionals in
Supporting Employees with Mental Health Disabilities? ................................................. 64
Chapter Five: Recommendations and Discussion......................................................................... 73
Discussion of Findings and Results .................................................................................. 73
Recommendations for Practice ......................................................................................... 76
Limitations and Delimitations........................................................................................... 81
Recommendations for Future Research ............................................................................ 82
Implications for Equity ..................................................................................................... 83
Conclusion ........................................................................................................................ 83

ix
List of Tables
Table 1: Data Sources 35
Table 2: Interview Participants 48
Table 3: Participant Accommodations Findings 63
Appendix A: Survey Protocal 91
Appendix B: Interview Protocal 95

x
List of Figures
Figure 1: HR Professionals Supporting Employees with Mental Health Disabilities 31
Figure 2: Survey Participants’ Years Working in HR Positions 48
Figure 3: HR Professionals’ Perception of the Effectiveness of the Laws to Support
Employees with Mental Health Disabilities 49
Figure 4: HR Professionals’ Opinion of Organizational Priority for Employees 64
with Mental Illness

1

Chapter One: Overview of the Study
Discrimination of the disabled in the workplace has been extensively researched and
discussed, but the COVID-19 global pandemic has put a spotlight on mental health disabilities.
The World Mental Health (WMH) survey conducted by the World Health Organization (WHO)
of nearly 85,000 people in 17 countries found that 30 percent of the population has a mental
illness, such as generalized anxiety disorder, major depressive disorder, and bipolar disorder
(Jones, 2011; Wang et al., 2007). Despite an increase in mental health services and laws to
protect against workplace discrimination, more than two-thirds of people with a mental illness do
not receive treatment for their disease (Wang et al., 2007), and most employees with mental
health illnesses do not request accommodations in the workplace (Brohan et al., 2014; Toth &
Dewa, 2014). According to Toth and Dewa (2014), stigma prevents employees from disclosing
mental illness and receiving the necessary accommodations to be successful at work,
demonstrating that support for individuals with mental illness in the workplace is a problem.
Lack of workplace support for employees with mental health illness creates a barrier to
accommodations, negatively impacting job attainment, achievement, and advancement (Brohan
et al., 2014; Jones, 2011; McGonagle & Barnes-Farrell, 2014; Sharac et al., 2010). Due to the
rise in mental illness and the stigma associated, workplace disadvantages people with mental
health illness are important to address and research.
Background of the Problem
Mental illness, also called mental health disorder and mental health disability, are broad
terms used to describe conditions that affect mood, thought, and behavior (Center for Disease
Control [CDC], 2018). Mental illness encompasses a wide range of conditions from debilitating
disorders to mild illnesses with relatively low adverse impact (CDC, 2018). People with
2

disabilities often face stigma, that is, negative and unjust beliefs, and discrimination, which is the
prejudicial treatment of a protected class, in the workplace (Brohan et al., 2014; Toth & Dewa,
2014). While all people with disabilities face workplace discrimination, mental illness stigma
and discrimination are particularly rampant (Fox et al., 2016). Legislation such as the United
States Americans with Disabilities Act (ADA) of 1990 and the United Kingdom (UK) Equality
Act of 2010 protects against discrimination and gives people with disabilities the right to
workplace accommodations, but employees must disclose their disability to their employer to
receive accommodations (ADA, 1990; UK National Archives, 2013).
Studies have found that disclosing mental illness to supervisors helps to ensure
employees receive accommodations (Brohan et al., 2014), but there are many reasons why
people that are mentally disabled choose not to disclose in the workplace. People with mental
illness are more likely than those without mental illness to be unemployed or underemployed,
which is a position inferior to their ability and credentials, and often face hostility and
diminished job responsibilities if they take a leave of absence for mental health reasons (Brohan
et al., 2012; Sharac et al., 2010). Furthermore, disclosing mental illness has been shown to
damage both working and personal relationships with coworkers (Brohan et al., 2012; Hanisch et
al., 2016; Jones, 2011). In a 2014 qualitative study of participants with mental illness,
participants reported that when they disclosed their mental illness to coworkers, they were
treated differently, or as having low intelligence, by colleagues (Brohan et al., 2014). A lack of
mental health literacy, that is, an ability to recognize psychological distress and intervention
tactics in the workplace causes negative stigma and employee isolation, but company programs
designed to improve this are uncommon (Moll, 2014). Mental health in the workplace is
important to address because disclosing a mental health disorder often prevents a person who is
3

disabled from receiving necessary accommodations which negatively impacts employment, job
satisfaction, job opportunities, and income (Brohan et al., 2014; Sharac et al., 2010) and human
resources (HR) professionals are the gatekeepers to workplace accommodations (Cowan et al.,
2021).
Context of the Study
This study will focus on for-profit organizations across the United States with over
10,000 employees and specifically, on the HR professionals in these institutions. Private sector,
for-profit organizations were chosen for this study because their primary mission is financial,
which presents unique challenges to balancing employee wellness. The main function of Human
Resources Management (HRM) is to effectively carry out the policies and procedures of the
organization (Cowan et al., 2021). There are two HRM perspectives, the “harder” approach that
considers the employee an organizational resource, where employee well-being is only
significant as it benefits the organization and the “softer” approach that views employees as the
avenue for the organization to achieve its goals (Cowan, et al., 2021, p. 478). Support provided
by HR professionals for employees with mental health disabilities is highly dependent upon the
organization’s HR policies. The HR approach in large, for-profit institutions varies significantly
by the organization and directly impacts the behavior of HR professionals (Cowan et al., 2021).
Purpose of the Study and Research Questions
The purpose of this study is to explore HR professionals’ assets and barriers in providing
support and diminishing workplace challenges for employees with mental health disabilities.
1. What external factors such as state and federal law influence HR professionals in their
role of supporting employees with mental health disabilities?
4

2. How do organizational factors such as policies, procedures as well as organizational
culture influence HR professionals’ ability to support employees with mental health
disabilities?
3. What are the HR professionals’ knowledge of mental health disabilities?
4. How do motivational factors such as self-efficacy, perceptions of barriers, and self-
regulation impact HR professionals in supporting employees with mental health
disabilities?
Importance of the Study
It is important to understand and increase HR professionals’ support of employees with
mental health disabilities for several reasons. First, HR professionals’ support can enhance
confidentiality for people with mental health disabilities which encourages people with
disabilities to disclose their disability to receive necessary accommodations (Reynolds, 2019;
Toth & Dewa, 2014). Second, the lack of knowledge about mental health disabilities contributes
to career disadvantages for people with disabilities and creates a less diverse workplace
(Potgieter et al., 2017). An HR professional can destigmatize mental health disabilities and
accommodations by providing education for staff on the importance of inclusion. Third,
prejudicial HR practices contribute to the disadvantages in career success and advancement for
people with mental health disabilities (Potgieter et al., 2017). HR professionals can have a direct
influence on HR policy or create HR policy (Cowan et al., 2021). And lastly, HR professionals
can ensure people with mental health disabilities know their rights to take leave to receive
treatment for their mental health disability (ADA, 1990; UK National Archives, 2013).
5

Overview of Theoretical Framework and Methodology
The theoretical framework for the study is social cognitive theory (SCT). SCT theorizes
that the interactions between people, environment, and behavior are reciprocal in nature
(Bandura, 2000). SCT can be used to provide insight into the reciprocal interactions between
personal, behavioral, and environmental factors and how they impact HR professionals’ ability to
support employees with mental health disabilities. To provide a comprehensive understanding of
the factors that HR professionals face in supporting employees with mental illness, this study
will use a mixed-method approach. Specifically, an explanatory sequential approach will be
implemented with a survey conducted first, followed by individual interviews.
Definitions
Human Resources Management (HRM) definitions vary based on the organization. It is
often defined as a strategic way of managing employees but can also be simply a renaming of the
function formally referred to as ‘personnel’ that processes employee payroll, employee benefits,
and other employee-related paperwork (Cowan et al., 2021). It is also used as an overarching
term to encompass all ways in which an organization responds to the actions of people as
individuals and as a group (Cowan et al., 2021).
Employees with mental health disabilities require support in the workplace. Support
refers to any assistance employees with mental health disabilities in receiving accommodations
and being treated fairly in the workplace (Brohan et al., 2012; Hanisch et al., 2016; Jones, 2011).
Employers often have what is referred to as Employee Support Programs (EAPs) which are
programs are “employer-sponsored programs designed to help individuals resolve acute but
modifiable behavioral health issues” (Attridge, 2019, p. 626). Employees are protected by the
Family Medical Leave Act (FMLA) to take job-protected for specific family and medical reasons
6

with continued health coverage as though they are not on leave for up to 12 weeks (Family
Medical Leave Act [FMLA], 2020). This is not paid unless the employee has earned personal
time off (PTO) or vacation or sick leave days.
Organization of Study
Five chapters are included in this study. This chapter provided the reader with the key
concepts and terminology commonly found in a discussion about mental health illness and
human resources management (HRM). The goal of the study, the stakeholders, as well as the
initial concepts of social cognitive theory were introduced. Chapter Two provides a review of
current literature surrounding the scope of the study. Topics including the stigma of mental
health disabilities in the workplace, the impact of that stigma, factors that impact HR
professionals from providing support to people with mental health disabilities, and HR best
practices will be addressed. Chapter Three reviews the assumed reciprocal interactions between
people, environment, and behavior introduced in Chapter Two, as well as connecting these with
a methodology for the selection of participants, data collection, and analysis. In Chapter Four,
the data and results are assessed and analyzed. Chapter Five provides solutions, based on data
and literature, for analyzing the internal and external interactions as well as recommendations for
an implementation and evaluation plan for the solutions.

7

Chapter Two: Literature Review
Mental health disabilities encompass a wide range of disorders and the ability to function
in the workplace. This chapter will provide an overview of the types of mental health disabilities
and reviews the impact and implications in the workplace for people with mental health
disabilities. It will also provide context from previous empirical research of the challenges
people with mental health disabilities face in the workplace, including lack of support and
education on mental health disabilities, stigma, discrimination, and the impact of workplace
conditions on people with mental health disabilities. This chapter will also provide context
surrounding the impact of HR policies and procedures, laws, and leadership on people with
mental health disabilities. Finally, this chapter will present the conceptual framework for the
study.
Types of Mental Health Disabilities
There are five groups of mental health disabilities including mood and anxiety disorders,
personality or psychotic disorders, disordered eating, and substance abuse. Mental health
disabilities range from low-functioning psychotic disorders to more easily hidden but often
deadly eating, substance, or mood disorders (U.S. Department of Health and Human Services,
2015a). In the absence of personal experience, most of the information about mental health
comes from the media (Ballenger, 2012). Receiving information from the media can be
problematic because mental illness encompasses a wide range of conditions that are not well
understood, leading to a misunderstanding of mental health disabilities (U.S. Department of
Health and Human Services, 2015a).

8

Mood Disorders and Anxiety Disorders
Mood and anxiety disorders are mental health disabilities that distort a person’s
emotional state and interfere with their ability to function. According to the Mayo Clinic (2021),
mood disorders include major depressive disorder, bipolar disorder, and generalized anxiety
disorder and are characterized by a lack of interest in life events and prolonged periods of
depressed mood. People with mood disorders often experience insomnia or excessive sleeping,
excessive eating, or loss of appetite, and tend to run in families (Tazawa et al., 2019). Mood
disorders include depression, bipolar disorder anxiety disorder, seasonal affect disorder (SAD),
and self-harm. According to the U.S. Department of Labor Employment and Labor
Administration, mood disorders, also referred to as affective disorders, are characterized by a
lack of interest in important parts of life and feeling sad all the time and are the most common
types of mental health disabilities. According to Stein and Sareen (2015), generalized anxiety
disorder is chronic and persistent worry about topics such as finances, family, health and is often
unaccompanied by depression or substance abuse. While mood disorders impact performance for
people with mental health disabilities at work, personality, and psychotic disorders also impact
the workplace by interfering with job performance.
Personality Disorders and Psychotic Disorders
Personality disorders and psychotic disorders are long-term thoughts and patterns that are
unhealthy and inflexible. Personality disorders are patterns of behavior, feelings, and thinking
that can interfere with a person’s ability to live a healthy life (U.S. Department of Labor, 2014).
A personality disorder, or abnormal personality, refers to a person’s inability to cope and adapt
to the challenges of life (Emmelkamp & Meyerbröker, 2019). People with psychotic disorders,
such as schizophrenia, lose touch with reality and experience a range of extreme symptoms. For
9

example, people with psychotic disorders may hallucinate and see things that are not real or have
delusions and believe things that are not true (U.S. Department of Labor, 2014). Personality and
psychotic disorders can make it difficult for people with these mental health disabilities to
function in the workplace, but trauma-related disorders have a similar effect.
Trauma-Related Disorders
Trauma-related disorders are a set of emotional and behavioral problems resulting from a
traumatic, or stressful experience. According to Morganstein et al. (2017), mental or emotional
trauma or mental injury encompasses a range of distress responses directly linked to a traumatic
event or stressful event. Post-traumatic stress disorder (PTSD) involves a person spontaneously
and uncontrollably reexperiencing symptoms of the traumatic memory that can present as
nightmares or flashbacks (Norrholm & Ressler, 2009). PTSD can have an impact on an
individual’s ability to perform job duties. After a traumatic event, distress reactions are common,
including fear, anger, detachment, insomnia, and irritability (Morganstein et al., 2017).
PTSD does not impact all people who experience a traumatic event. According to Goldmann and
Galea (2014), approximately 10-20% of people who experience a traumatic event will develop
PTSD. Trauma-related disorders can be caused by a vast array of traumatic events, but the cause
of eating disorders is not as clear. Eating disorders will be discussed next.
Eating Disorders
Eating disorders are classified as having an unknown cause and are characterized by a
variety of abnormal or disturbed eating habits and can impact both women and men. According
to the National Eating Disorder Association (NEDA, 2018), there are three common types of
eating disorders. The types are anorexia nervosa or food restriction; bulimia nervosa or eating
and then purging; and binge eating disorder which is repeated and uncontrolled overeating. The
10

cause for an eating disorder is unknown, but according to the NEDA, it is a combination of
biological and psychological factors (NEDA, 2018). Biological factors including hormones and
genetics and psychological factors such as low self-esteem and negative body image lead to
disordered eating (NEDA, 2018).
Eating disorders are one of the most common mental health disabilities among women
(Udo & Grilo, 2018). According to Udo and Grilo (2018), disordered eating is almost twice as
likely in women than men. NEDA (2018), found that approximately 10 million females and 1
million males suffer from disordered eating in the United States. Disordered eating can also
cause impairment. In a 2017 study conducted by Udo and Grilo, over 61% of people with
bulimia nervosa, 30% of people with anorexia nervosa, and 54% of people with binge eating
disorder reported social impairment, struggling to get along with others, or difficulty fulfilling
responsibilities. While stigmatized, eating disorders are a widely recognized mental health
disorder, but substance abuse disorders are often not recognized by people outside the medical
field. Substance abuse disorders will be discussed in the following section.
Substance-Abuse Disorders
Substance abuse disorders can have negative consequences on those with the disorder,
their families, and communities but the risk can be significantly reduced through early
intervention. According to the Substance Abuse and Mental Health Services Administration
(SAMHSA, 2015), substance abuse, or excessive, current use of substances causing impairment,
occurs when the recurrent use of alcohol and drugs causes significant impairment and causes
failure to function in typical daily activities. Social attitudes and the negative impact substance
abuse has on communities make substance abuse a complex public health issue (SAMHSA,
2015).
11

In youth, other mental health disorders increase the risk of comorbidity with substance
abuse. According to a 2017 study on adolescent mental illness, childhood attention deficit
hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), conduct disorder (CD),
and depression increase the risk of developing substance-related disorders and risk could be
significantly mitigated through early intervention (Kazemi et al., 2017). People with substance
abuse disorders are often not the only ones impacted by their disorder. According to Kazemi et
al. (2017), people with substance abuse disorders, their families, communities, and the general
public are negatively impacted. All these types of mental health disabilities create challenges in
the workplace and discrimination, stigma, and lack of support system are among the most
significant factors.
Mental Health Disabilities in the Workplace
Mental health disabilities encompass a wide range of disorders that range from high
functioning individuals who can work to lower functioning people on disability who are unable
to work. They often experience discrimination and stigma in the workplace (Brohan et al., 2012;
Fox et al., 2016). When people with mental health disabilities decide to disclose their mental
health disability to receive accommodations, coworkers often avoid working with them and they
are given less-desirable projects (Hanisch et al., 2016; Jones, 2011). This stigma often leads to
people with mental health disabilities self-stigmatizing which can impact work performance
(Brohan et al., 2013), and lead to negative economic impacts such as lack of upward
occupational mobility (Brohan et al., 2012; Sharac et al., 2010). Stigma and self-stigma also lead
people with mental health disabilities to be less likely to seek treatment, especially services
provided in the workplace (Reynolds, 2019; Toth & Dewa, 2014).

12

Discrimination Due to Mental Health Disabilities
People with mental health disabilities are discriminated against in the workplace which
leads to unemployment, lack of promotion, and lower salaries (Brohan et al., 2012; Pescosolido
& Boyer, 2010; Sharac et al., 2010). Discrimination is damaging to the success of people with
disabilities, particularly invisible disabilities, such as mental health disabilities, and
discrimination creates a less inclusive workplace (Brohan et al., 2012; Fox et al., 2016).
Research findings highlight that both overt and covert workplace discrimination is damaging to
people with mental health illness, but covert discrimination is particularly difficult to combat
(Brohan et al., 2012; Jones, 2011). Less information is known about covert discrimination
because it is more challenging to identify and mitigate, but it is no less detrimental to people with
mental health illnesses (Brohan et al., 2012; Fox et al., 2016; Jones, 2011; Sharac et al., 2010).
People with mental illness are more likely than those without mental illness to be
unemployed or underemployed, which is a position inferior to their ability and credentials.
Specifically, employees with mental illness often face workplace hostility and diminished job
responsibilities if they disclose their mental illness or take leave for mental health reasons
(Brohan et al., 2012; Sharac et al., 2010). Discrimination based on mental illness can also impact
whether a person with mental illness attempts to advance in their career (Sharac et al., 2010).
This can be partially attributed to mental health disabilities having a negative impact on income
and promotion opportunities as well due to discrimination damaging the individual’s self-
efficacy (Jones, 2011; Sharac et al., 2010). People diagnosed with anxiety, or another mood
disorder are more than 10% less likely than their peers to be employed (Mental Health First Aid,
2015).
13

In a 2009 study, recruiters in Canada made the false assumption that people with mental
illness cannot perform their job duties and doubted the validity of mental health disabilities
entirely (Krupa et al., 2009). The study demonstrates that recruiters assume that people with
mental health disabilities cannot be successful in the workplace making them less likely to hire
people with disabilities (Krupa et al., 2009). Studies show that concealment of mental illness is
more common than its disclosure, as is the case for several other chronic illnesses such as
irritable bowel syndrome, arthritis, and musculoskeletal pain (Munir et al., 2005; Peters &
Brown, 2009). Mental health disabilities are often underreported due to stigma or fear of stigma
(Brohan et al., 2012). Mental illnesses rank among the least reported and the most stigmatized
medical conditions in the workplace (Dimoff & Kelloway, 2013; Peters & Brown, 2009). Overt
discrimination in the workplace is a problem for people with mental health disabilities, but
stigma remains one of the biggest challenges they face.
Workplace Stigma Related to Mental Health Disabilities
Employees with mental health disabilities may not disclose their disability in the
workplace for fear of stigma and the impact on their reputation as a high performer (Fox et al.,
2016; Toth & Dewa, 2014). Mental illness stigma silences those with mental health disabilities
from disclosing. According to De Lorenzo (2013), arguably the most significant result of stigma
is silencing employees with mental health disabilities. As a result of fear of the stigma associated
with disclosing, employees with mental health disabilities often do not receive accommodations.
Employees’ fear of stigma and discrimination often discourages or prevents disability disclosure
in the workplace. A 2014 study conducted by Toth and Dewa found that 85% of participants
defaulted to nondisclosure due to fear of stigma. Mental illness stigma prevents employees from
disclosing their disability because employees anticipate discrimination and workplace stigma if
14

they disclose their mental illness, even if they have not yet experienced it (Fox et al., 2016).
Participants in a 2014 study reported that unless there was clearly defined assurance in their
place of employment of a benefit to disclosing their mental illness, they would choose not to
disclose (Toth & Dewa, 2014). Employees with mental illness also have lower job satisfaction
because of workplace stigma, which has been shown to cause job performance strain and social
isolation (Reynolds, 2019).
In recent years, the public has become more accepting of mental illness as a disability
(Pescosolido & Boyer, 2010). In a 2010 comparison study over 10 years, the public has become
between 6-12% more accepting of mental illness as a disability (Pescosolido & Boyer, 2010).
Mental health disabilities are often labeled as “burnout” as it has very similar to feelings of
depression and is often used in the workplace to avoid the stigma of mental health disorders
(Pescosolido & Boyer, 2010, p. 531). This burnout characterized similarly to depression is
caused by workplace conditions including the stress of conflicting demanding deadlines, work-
life balance conflict, lack of autonomy, and poor leadership (Hartley et al., 2014). Substance
abuse in particular carries a significant stigma with the public. While 9% of people have become
more accepting of alcoholism as a disability over the past 10 years, sociomoral attitudes
decreased by 16%, and were more likely to consider people with substance abuse disorder as
having “bad character” (Martin et al., 2000, p. 208). Substance abuse creates a stigma that
negatively impacts employees with mental health disabilities by preventing them from disclosing
their disability in the workplace and receiving accommodations, but the economic impact is
significant for both employee and employer.

15

Impact of Disclosing a Mental Health Disability to Managers
While disclosing to managers can be beneficial in gaining access to accommodations, it
can also cause them to doubt an employee’s abilities in the workplace. One of the positive
outcomes of disclosing is that it can assist people with disabilities to gain access to the necessary
accommodations (Brohan et al., 2012). Studies have found that disclosing mental illness to
supervisors helps to ensure employees receive accommodations, but the fear of stigma prevents
them from disclosing (Brohan et al., 2014; Jones, 2011). Mental health disorder disclosure often
damages critical workplace relationships which are required for employees to receive necessary
accommodations (Jones, 2011). Managers and colleagues of people with mental health
disabilities may question an employee’s reliability which impacts the work they are assigned.
Brohan et al. (2014) found that the perception of lackluster work ethic and the impression
of being unreliable makes coworkers less likely to collaborate with people who have known
mental health disorders. Being excluded from the team collaboration often leaves the employees
with mental health illnesses without the necessary support to complete tasks and therefore, they
may be assigned less-desirable projects (Brohan et al., 2014). Disclosing substance abuse in the
workplace can be particularly difficult because employers’ lack of knowledge about mental
health disabilities can lead employers to distrust employees with mental health disabilities and
cause them to relapse (Brohan et al., 2014; Smook et al., 2018). According to Smook et al.
(2018), misunderstanding of substance abuse as a disability in the workplace, the stigmatization
of addiction, and employees concealing of the problem due to these circumstances creates high-
risk situations that may cause relapses. Disclosing a mental health disability to a manager can be
damaging to the employee or it can be helpful, but the problem lies in the employee being forced
to decide to disclose before knowing which outcome will occur (Fox et al., 2016; Toth & Dewa,
16

2014). Studies indicate that perceptions and attitudes of colleagues about people with mental
health disabilities have a negative impact on people with mental health disabilities (Brohan et al.,
2014; Smook et al., 2018).
Colleagues’ Perceptions and Attitudes towards People with Mental Health Disabilities
Perceptions and attitudes of colleagues toward people with mental health disabilities lead
employees to be less successful in the workplace. According to Jones (2011), a person with a
mental health disability’s social network is negatively impacted by disclosing their mental health
disability. Disclosing mental illness can damage interpersonal relationships for a person with a
mental health disability (Brohan et al., 2012; Hanisch et al., 2016; Jones, 2011). Research has
shown that disclosing can damage both working and personal relationships with coworkers,
however, not disclosing puts employees at a disadvantage because they need to disclose to
receive necessary workplace accommodations (Jones, 2011).
Colleagues also often make negative assumptions and are less likely to collaborate with
people with mental health disabilities. Fox et al. (2016) suggested that coworkers and employers
of people with mental illness view them as less competent than those without mental illness. In a
qualitative study of health care workers with mental illness, participants said they were labeled
by coworkers as “crazy or lazy” if they disclosed their mental illness to colleagues (Moll, 2014,
p. 138). According to Brohan et al., (2014) perception of lackluster work ethic and impression of
unreliability makes coworkers less likely to collaborate with people who have known mental
health disorders, which often leaves the employee without necessary support and given less
desirable projects.
In addition, colleagues who do not have mental health disabilities often have the attitude
that employees with mental health disabilities who disclose to receive accommodations are
17

receiving special treatment in the accommodations for their disability (Peters & Brown, 2009).
The employees without mental health disabilities may be envious of the accommodations,
assuming that mental health disabilities are not real disabilities, but merely an excuse to receive
unwarranted special treatment (Peters & Brown, 2009). Reynolds (2019) found that employees
with mental health disabilities become isolated and taking time off for treatment damaged the
employee’s reputation with colleagues. Studies have shown that successful treatment of mental
illness often requires time off work to receive treatment, but when an employee takes a leave of
absence for mental health reasons, they often face hostility from coworkers and become isolated
(Brohan et al., 2012; Hanisch et al., 2016). Disclosure of mental health disorders to colleagues
can damage important social networks in the workplace and can impair success in the workplace.
Self-stigma, or internalization of negative public perceptions, can also have a major impact on
workplace success.
The Impact of Self-Stigma in the Workplace
As a result of the stigma associated with mental health disabilities, people with these
disabilities often self-stigmatize which damages their success in the workplace. People with
mental health disabilities often self-stigmatize because of the stigma surrounding mental health
disabilities by internalizing the prejudices and stigma (Brohan et al., 2010). Self-efficacy, or
confidence in one’s ability to perform a task, is damaged by fear of stigma about their disability
should colleagues find out. According to De Lorenzo (2013), employees’ fear of stigma damages
their self-efficacy when people with disabilities self-stigmatize, because they lose confidence in
their abilities to do their job duties which can cause further challenges (De Lorenzo, 2013). This
internalization of stigma often creates underperformance due to presenteeism, which is coming
18

to work unwell (Nogues & Finucan, 2018). According to Nogues and Finucan (2018),
presenteeism is more costly than absenteeism, or absence from work without explained reason
People with mental health disabilities’ self-stigma can impact their job performance.
McGonagle and Barnes-Farrell (2014) found that people with mental illness internalize the
notion that their job performance is inferior to those without mental health disorders, which often
has a negative impact on performance in the workplace. Self-stigma as a result of mental health
disability stigma has a negative impact on job performance, but it can also impact an employee
with a mental health disability from taking advantage of workplace healthcare services.
Underutilization of Healthcare Services at Work
Individuals with mental health disabilities often do not utilize workplace resources
available due to fear of the stigma of being considered unstable and unable to perform their job
duties. This fear of stigma is the primary reason for not disclosing mental health disabilities in
the workplace and using available workplace mental health disability resources (Reynolds, 2019;
Toth & Dewa, 2014). According to Dimoff et al. (2016), mental health training tailored to
organizational leaders can provide people with mental health disabilities with better access to
resources. When managers are properly trained in mental health triage and referrals, they can
support employees who are struggling (Dimoff et al., 2016). The COVID-19 pandemic created a
need for better availability of telehealth services (Zhou et al., 2020). Advances in telemental
health services have made it feasible to deliver mental health services and offer an opportunity
for employers to provide resources to employees confidentially, but data demonstrate that
resources continue to be underutilized (Zhou et al., 2020). People with mental health disabilities
can then gain the skills and confidence to engage in the resource-utilization process. Failing to
take advantage of workplace healthcare services may cause employees with mental health
19

disabilities to be less successful in the workplace, which often leads to an economic impact for
both employee and employer. The indirect economic impact of mental health disabilities is
discussed in the next section.
Economic Impact of Mental Health Disabilities in the Workplace
Mental illness stigma results in negative economic outcomes for both employers of
employees with mental illness and the employees themselves. Most employees with mental
illness do not receive accommodations in the workplace for fear of workplace stigma of
incompetence, and as a result, job performance suffers (Toth & Dewa, 2014). Alcohol and drug
abuse can also have a negative impact in the workplace through poor work performance,
problems such as unhealthy conflict and insubordination, and an increase in workplace
injuries (Spicer & Miller, 2016). Workplace function is related to the level of cognitive function
and severity of symptoms in people with mood disorders (McIntyre et al., 2015). In a regression
study conducted from 2008-2013 of people diagnosed with major depressive disorder, the
severity of depression symptoms had the most significant negative relationship with workplace
function, followed by cognitive function which is required for people to become and remain
employed (McIntyre et al., 2015). Workplace stigma leads to poor job performance and
insubordination, and conflict in the workplace can negatively impact people with mental
illnesses’ salary and career advancement (McIntyre et al., 2015).
Career trajectory can be negatively impacted for a person with a mental health disability.
Potgieter et al. (2017) found in a qualitative research study of individuals with disabilities that
people with invisible disabilities such as mental illness, experience career advancement
challenges and reach premature career plateau. People with mental health disabilities earn a
lower income than their peers due to this lack of career advancement (Brohan et al., 2014).
20

Mental health disabilities can have a negative economic impact on employers as well.
According to Bastien and Corbière (2018), mental health disabilities can cost employers
significantly. Major depressive disorder specifically represents a significant economic burden
estimated at $210 billion in the United States in 2010 (Bastien & Corbière, 2018). While there
are negative economic implications for people with mental health disabilities and their
employers, there are laws designed to protect people with mental health disabilities. The next
section will cover legislation in place that protects people with mental health disabilities.
Legislation Protecting People with Disabilities
While education and positive working conditions provide support for people with mental
health disabilities some laws protect people with disabilities, but they are not always successful.
Federal laws are intended to protect people with mental health disabilities from discrimination
(ADA, 1990; U.S. Department of Labor, Employment & Training Administration, 2014).
Federal laws and state laws can impact how organizations, specifically HR professionals within
these organizations support employees with mental health disabilities in the workplace. The next
section will cover how federal laws impact employees with mental health disabilities.
Federal Laws Impacting Employees with Mental Health Disabilities
Federal laws are designed to protect employees with disabilities, including mental health
disabilities, but a lack of understanding of employee rights for both employees and HR
professionals can impact accommodations and job performance. In the United States, the
Americans with Disabilities Act (ADA) provides overarching protections for people with
disabilities, but in 2014 Workforce Innovation and Opportunity Act (WIOA) was passed with
bipartisan support (ADA, 1990; US Department of Labor, Employment & Training
Administration, 2014). WIOA supersedes the Workforce Investment Act of 1998 and builds on
21

the Adult Education and Family Literacy Act, the Wagner-Peyser Act, and the Rehabilitation Act
of 1973 (ADA, 1990; U.S. Department of Labor, U.S. Employment & Training Administration,
2014). Employers have a legal obligation to provide reasonable accommodations for people with
disabilities (ADA, 1990; UK National Archives, 2013). This can offer protection, but the
employees must disclose their mental health disability to their employer and provide
documentation to receive accommodations (ADA, 1990). As a result of concern of stigma, many
employees choose not to disclose their mental health disability at work, leaving employees
unable to request accommodations, despite being legally entitled based on their disability (ADA,
1990; Toth & Dewa, 2014).
Government contracts can provide some equity and employer accountability for people
with disabilities. United States Federal contractors are required to have seven percent of their
workforce identifying as having a disability (Bruyère, 2016). Federal actions can be put in place
to help employees. In 2006, Canada did its first-ever mental health study, which lead to the
creation of a Mental Health Commission to focus national attention on mental health which later
released the 2012 mental health strategy to meet the needs of people with mental illness and their
families. As a result, employees continue to face discrimination in the workplace even after laws
have been passed (Phillips, 2016). According to Phillips (2016), over 25 years since the
Americans with Disabilities Act has passed with almost no improvement in employment rates or
employers’ problematic views of employees with disabilities. Federal legislation can provide
protections for employees with mental health disabilities, but federally funded state-run
programs can also provide services to help job seekers with mental health disabilities find and
keep employment. The next section will focus on the impact of state programs on the support
provided for employees with mental health disabilities.
22

State Programs to Support People with Disabilities
Federally funded state programs are designed to assist employees with disabilities,
including mental health disabilities. Federal financial resources have recently been allocated to
states that could assist people with disabilities gain and keep employment. In 2014, the
Workforce Innovation and Opportunity Act (WIOA) was passed, designed to increase job-
seekers access to employment, training, and support in matching them with skilled workers
employers need through grants to states (U.S. Department of Labor, Employment & Training
Administration, 2014; Employment & Training Administration ETA, 2014). The WIOA is
designed to assist people with disabilities in getting jobs. According to the U.S. Department of
Labor (2014), the U.S. Department of Education has two core programs to help people with
disabilities get jobs, including federally funded state vocational rehabilitation programs and adult
education and literacy programs.
Federal legislation has called upon states to provide better training. This recent legislation
puts the onus on states to enhance their vocational rehabilitation (VR) agencies to support people
with disabilities, emphasizing work-centered training, improving working relationships with
employers, and providing employers with additional support (U.S. Department of Labor,
Employment & Training Administration, 2014). States are required to use WIOA funds to
support people with disabilities. According to the federal Employment and Training
Administration (ETA), state vocational rehabilitation (VR) agencies must use 15% of their
federal award to provide pre-employment transition services to people with disabilities.
Legislation can have a positive impact on people with mental health disabilities, but well-
equipped HR professionals are people in the workplace and can make an impact on the success
23

of employees with mental health disabilities. The following section will outline the theoretical
and conceptual framework for this study.
Theoretical and Conceptual Framework: HR Professionals’ Role in the Context of Social
Cognitive Theory
Social cognitive theory (SCT) theorizes that person, behavior, and environment are
reciprocal (Bandura, 2000). SCT considers a person’s cognitions, social influences and
environment, and physical environment to predict behavior (Bandura, 2000). Bandura (2000)
theorized that change in behavior and learning is caused by self-efficacy, or an individual’s
belief of their capability to perform a particular behavior to achieve the desired outcome, as well
as by models, or observing others. Social cognitive theory emphasizes that social support has a
significant impact on motivation and enhancing learning (Bandura, 2000). The environment at a
for-profit organization including policies, procedures, and training on mental health, as well as
ease of access to disability accommodations all impact the HR professionals and their behavior.
The HR professionals themselves and their behavior also have an impact on the organizational
environment, as the relationships are reciprocal.
Influences Related to the Environment
Environmental influences impact HR professionals’ ability to support people with mental
health disabilities. Organizational influences such as HR policies and procedures impact
individuals within the organization and individual HR professionals also shape the policies and
procedures of the organization. Other environmental influences include the organization’s
education on mental health disabilities and how individuals influence the organization’s
education. Accommodations are another environmental influence that impacts how HR
professionals can support people with mental health disabilities.
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Organizational HR Policies and Procedures
The organizational policies and procedures that HR professionals must follow impacts
how employees with mental health disabilities are supported in the workplace. HR training for
supervisors can have a positive impact on people with disabilities (Li et al., 2001). Li et al.
(2001) found that a total of 38% of supervisors reported lost work time had decreased since the
training and 28.8 % reported no change. According to Dimoff and Kelloway (2019), mental
health training tailored to organizational leaders can provide leaders with the skills and
confidence to engage in the resource-utilization process and support employees who are
struggling. HR practices that include specific mental health disability training can be an effective
way to support people with mental health disabilities, but even well-intentioned practices can
have unintended consequences.
HR professionals largely have good intentions in supporting people with mental health
disabilities, but their behaviors do not always reflect this. According to Cardona (2019), there is
a gap between HR professionals’ intention to support people with disabilities, and their actions to
provide support. HR policy and procedures impact employees with mental health disabilities, but
an organization’s education for HR professionals also has a significant impact. This study
explores how internal influences, such as HR policies and procedures impact HR professionals’
ability to support people with mental health disabilities.
Organizational Education on Mental Health Disabilities
Educating employees on mental health disabilities reduce stigma in the workplace but
providing effective training for employees remains a challenge. Studies have found that stigma
can be reduced through education and inclusion (Brohan et al., 2012; Kaye et al., 2011;
Pescosolodido et al., 2010). Reconfiguring stigma reduction strategies may require providers and
25

advocates to shift to an emphasis on competency about mental health disabilities and inclusion
tactics (Kaye et al., 2011; Pescosolodido et al., 2010). There is a lack of disability services and
HR professionals are not equipped to support these employees due to a lack of training.
Organization-wide education on mental health decreases stigma and creates a more
conducive environment for those with mental health disabilities to disclose (Brohan et al., 2013).
According to Brohan et al. (2013), employees felt they need to establish a level of trust at work
and prove their abilities to perform before disclosing. If employers establish trust with
employees, employees are more likely to disclose their mental health disability and are eligible
for accommodation (Brohan et al., 2013). The average employers provide little to no education
on mental health disabilities. A 2011 study conducted by Kaye et al. found that HR professionals
reported that the most effective way to improve the hiring and retention of employees with
disabilities is increased and improved training on disabilities for supervisors and managers. It is
not only the lack of training but also the quality of the training that lacks empirical testing.
The type and quality of diversity training impact success. According to Phillips (2016),
diversity training lasting 4.5 to 6 hours is sufficient to effectively change attitudes towards
diversity. According to Phillips et al. (2016), while literature exists on diversity training about
disabilities, less than 1% of those are empirically validated. This absence of peer-reviewed
research translates to not enough studies to determine if diversity disability training is effective at
mitigating employee outcomes (Kaye et al., 2011; Phillips, 2016). According to Phillips et al.
(2016), there are not enough studies conducted on disability diversity training interventions to
determine if they have positive effects on employment-related outcomes with the limitations on
the effectiveness of disability diversity training practices. The level of knowledge that HR
professionals possess is an important factor in providing support for employees with mental
26

health disabilities, but an organization’s ability to provide suitable accommodations for people
with mental health disabilities is critical. This study explores how disability training
interventions can impact employees with mental health disabilities in the workplace.
Organizational Provisions of Mental Health Disabilities: Accommodations in the Workplace
The support and quality of accommodations provided by HR professionals for people
with mental health disabilities are largely dependent on the organization’s culture. HR is the
department responsible for providing accommodations during the recruitment stage, onboarding,
and during employment in most organizations (Cardona, 2019). This means employees must
disclose mental health disability to HR to receive workplace accommodations. Participants in a
2014 study reported that unless there was clearly defined assurance in their place of employment
of a benefit to disclosing their mental illness, they would choose not to disclose (Toth & Dewa,
2014). While institutions of Higher Education often have a Disability Resource office for
employees, in the private sector, few employers have a specific disability resource office (Singsa
et al., 2019). As a result, HR employees and managers take on this responsibility typically
without any training on mental health disabilities or disabilities in general (Singsa et al., 2019).
HR professionals are often only trained to support people with physical disabilities, but
not well-trained on how to support people with mental health disabilities. Literature highlights
that the lack of knowledge about disabilities contributes to workplace disadvantages for people
with mental health disabilities and the quality of disability accommodations (Potgieter et al.,
2017). Providing appropriate accommodations is a crucial part of HR professionals supporting
people with mental health disabilities, but other influences have an impact. This study explores
how accommodations for employees with mental health disabilities can impact their success in
the workplace.
27

Influences Related to Person and Behavior
Employees and their behaviors are influenced by HR professionals’ knowledge of mental
health disabilities. When HR professionals have greater knowledge about legal protections and
workplace intervention strategies for people with mental health disabilities, they are better able
to provide support to employees (Iwanaga et al., 2019; Nogues & Finucan, 2019). While this is
helpful to current employees, this knowledge has not been shown to make hiring and recruitment
practices more equitable (Dolce & Bates, 2019). Employers also must demonstrate value in
providing an equitable workplace and recruitment of people with mental health disabilities to
effectively change HR professionals’ behavior.
HR Professionals’ Knowledge of Mental Health Disabilities
Increasing HR professionals’ knowledge of mental health disabilities can have a positive
impact on the success of employees with mental health disabilities. Educating HR professionals
on Mental Health First Aid (MHFA) is a timely and effective way for organizations to support
employees with mental health disabilities in the workplace (Nogues & Finucan, 2019). Work-
focused therapies such as one-on-one coaching on specific work performance issues can improve
job performance for people with mental health disabilities (Nogues & Finucan, 2019).
Conversely, misinformation about disability contributes to lower employment rates among
people with disabilities (Phillips et al., 2016).
HR knowledge of ADA and mental health disabilities generally have a positive impact on
employment, but studies have shown this is not always true. According to Iwanaga et al (2019),
knowledge of the Americans with Disabilities Act (ADA) had no impact on hiring and people
with disabilities were still hired at a significantly lower rate. HR professionals are less likely to
hire candidates who disclose a mental health disability during the recruitment process than those
28

who do not disclose a mental health disability (Dolce & Bates, 2019). In a 2019 study conducted
with focus groups of HR professionals, the professionals reported screening out candidates who
revealed a disability before they made it to the interview stage (Dolce & Bates, 2019). A lack of
knowledge of HR professionals can have a negative impact on the hiring of people with
disabilities (Dolce & Bates, 2019). In a study conducted by Dolce and Bates (2019) HR
professional cited their lack of knowledge about mental health disabilities as a reason to avoid
hiring people with disabilities. This study explores the impact of HR professionals’ knowledge
about mental illness, organizational policy regarding mental illness, and laws protecting people
with mental health disabilities in the workplace. It also examines how this knowledge impacts
employees with mental health disabilities from the perspective of the HR professionals but
further explores how HR professionals’ self-efficacy and organizational values influence their
ability to provide support.
A theme that emerged throughout the literature is that there is no universally agreed-upon
set of best practices for leaders and HR professionals in supporting people with mental health
disabilities in the workplace. Training and education are often used but are inconsistent amongst
organizations and professionals (Dimoff et al., 2016). Despite inconsistent models for best
practices in providing workplace support for people with mental health disabilities, positive
organizational culture around psychological well-being is accepted by most leaders as critical
(Goetzel et al., 2021). Leadership with a willingness to share personal experiences, along with
access to comprehensive mental healthcare benefits, with policies and practices protecting
employees from discrimination and innovation to remove barriers are well received by leaders
and employees (Goetzel et al., 2021). While there are not currently streamlined best practices,
there is potential for improvements in the future as the HR Research Institute at HR.com, the
29

largest network of HR executives, has a newly appointed Advisory Board that is working to
develop best practices through primary research as well as advise on key areas to conduct
research within the about employee health and well-being, mental health, and stress in the
workplace (HR.com, 2021).
HR Professionals’ Motivation to Support People Mental Health Disabilities
HR professionals are often tasked with providing support for employees with disabilities,
including mental health disabilities with little or no training (Attridge, 2019). Their support is
critical for people with mental health disabilities because these programs include mental health
programs as part of their other duties regardless of specific mental health training (Attridge,
2019). Social cognitive theory argues that if the value of the desired behavior is evident, then
people will be motivated to change their behavior (Bandura, 2000). Applying Bandura’s social
cognitive theory (SCT) in the context of this study, in order for HR professionals to support
people with mental health disabilities, they must see it as a core aspect of their role. Similarly, in
order for HR professionals to effectively address the needs of employees with mental health
disabilities, they need to be confident in their ability to do so. According to Bandura (1986), an
individual’s self-efficacy predicts the degree to which they engage with and persist at tasks. SCT
predicts that HR professionals with higher self-efficacy will be more likely to engage in
supporting employees with mental health disabilities because they are more likely to persist even
if the task is challenging and new. Therefore, if HR professionals see supporting employees with
central to their position and have high self-efficacy, Bandura’s (1986) SCT suggests that they are
more likely to provide support to employees with mental health disabilities. This study examines
HR professionals’ self-efficacy and value related to providing support to people with mental
health disabilities.
30

Conceptual Framework
Social cognitive theory (SCT) suggests that a person’s behavior influences, and is
influenced by, personal factors and their environment. In the context of this study, the
environment of HR professionals has a significant impact on the HR professionals’ knowledge
and motivation, and their subsequent behavior. If the environment, or organization, does not
support mental health literacy by providing essential training for HR professionals, they will not
be equipped to provide support to people with mental health disabilities (Dolce & Bates, 2019).
Conversely, if HR professionals are not educated on mental health disabilities, then they are not
likely to become advocates for support for people with mental health disabilities (Kaye et al.,
2011; Pescosolodido et al., 2010). The behavior of some HR professionals could also negatively
impact other HR professionals, through modeling the dismissal of people with mental health
disabilities. A human resource professional could also impact the environment of the
organization by continuing the same policies and procedures and resisting change.
The literature revealed that stigma, fear of stigma, and discrimination prevent many
employees from reporting mental illness and receiving necessary accommodations that will make
them more successful in the workplace and save organizations money (Brohan et al., 2012;
Jones, 2011). When the working environment enhances education on de-stigmatization,
discrimination from coworkers and managers of people with mental health disabilities for HR
professionals, they can provide support to employees with mental health disabilities (Brohan et
al., 2012; Hanisch et al., 2016; Jones, 2011). When HR professionals have models and
appropriate training, this improves the self-efficacy of the HR professional which could lead to
better support and less self-stigmatization which in turn improves job performance of people
with mental health disabilities (Attridge, 2019). Adequate mental health disability training
31

frequently leads to employees with mental illness having improved job performance, more
opportunities for promotion, and less absenteeism which would create an economic and
community benefit for both the employee and the employer (Brohan et al., 2014; Jones, 2011;
McGonagle & Barnes-Farrell, 2014; Sharac et al., 2010).

Figure 1
HR Professionals Supporting Employees with Mental Health Disabilities

Note. Based on Bandura’s (2000) Social Cognitive Theory.

Person
HR Professionals’
Self-efficacy
Value for supporting
employees with mental
health disabilities
Behavior
HR Professionals’
Actions
Supporting employees with
mental health disabilities

Environment
Organization
Education of HR
Professionals about
mental health
disabilities
32

Summary
Many mental health illnesses are classified as disabilities through legislation, but it
provides limited support for employees with mental health disabilities. Stigma, discrimination,
self-stigmatization, and the decision to disclose mental health disability to receive
accommodations all impact a person with a mental health disability’s success in the workplace
(Brohan et al., 2012; Hanisch et al., 2016; Jones, 2011). HR individuals at for-profit
organizations are often the contact through which people with mental health disabilities receive
accommodations (Singsa et al., 2019, Toth & Dewa, 2014). This can be problematic when an
organization does not educate HR professionals who are often the gatekeepers to the
accommodations they legally and ethically should have a right to access (ADA, 1990; Toth &
Dewa, 2014). Whether intentionally or not, organizations not providing this training for HR
professionals leaves them unprepared to support people with mental health disabilities and
damaging their self-efficacy to provide support (Brohan et al., 2012; Hanisch et al., 2016; Jones,
2011; Singsa et al., 2019). The literature showed that education reduces stigma and
discrimination in the workplace for people with mental health disabilities, but few organizations
have allocated resources to do this (Singsa et al., 2019). For a change in behavior, HR
professionals who make up the organization need social support along with a boost to their self-
efficacy to improve the assistance of people with mental health disabilities (Bandura, 2000;
Brohan et al., 2012; Singsa et al., 2019).

33

Chapter Three: Methodology
This chapter will review the research questions that will be used in this study and provide
the proposed methodology. It will provide an overview of the methodology, including details of
the data collection methods, both qualitative and quantitative methods, that will be used in this
mixed-method study. It will cover the positionality of the researcher, potential researcher biases,
and the personal, social, and behavioral impact of HR professionals on employees with mental
health disabilities. The chapter will review the data analysis strategies used to increase the
validity and reliability of the quantitative part of the study, and the approach to maximize the
credibility and trustworthiness of the qualitative portion. Finally, it will explain the protocols in
place to ensure the ethical treatment of participants.
Research Questions
1. What external factors such as state and federal law influence HR professionals in their
role of supporting employees with mental health disabilities?
2. How do organizational factors such as policies, procedures as well as organizational
culture influence HR professionals’ ability to support employees with mental health
disabilities?
3. What are the HR professionals’ knowledge of mental health disabilities?
4. How do motivational factors such as self-efficacy, perceptions of barriers, and self-
regulation impact HR professionals in supporting employees with mental health
disabilities?

34

Overview of Methodology
This section provides an overview of the research methodology used to collect data for
the study. Research methodology describes the driving philosophy, rationale for inquiry, and
criteria for examination (Bailey, 1994). It is the process by which researchers select the means to
address the research questions (Crotty, 1998). This study was guided by an explanatory
sequential model, defined as a quantitative data collection and analysis process that informs the
subsequent qualitative data collection (Creswell, 2015). The benefits of the mixed-methods data
collection approach are that it allows depth of understanding since there is not a single approach
utilized (Creswell et al., 2011). This method was chosen because using both quantitative and
qualitative data provide breadth and depth of knowledge about the impact of mental health
disabilities in the workplace. When the limitations of qualitative and quantitative analysis are
removed, varied perspectives can further address the problem of practice.
The quantitative data collection method, a survey, was distributed through social media
using Qualtrics due to ease of collection and access to a wide network of HR professionals.
Survey research gathers primary data from a representative sample through a verbal or written
form (Mathiyazhagan & Nandan, 2010). Advantages of conducting a survey include quick data
collection, access to a large number of participants, and enhanced accuracy (Mathiyazhagan &
Nandan, 2010). The interviews served as the qualitative data collection method to provide a
better understanding of the experience of the HR professionals in the workplace than the survey
could provide. Interviews allow the researcher to understand participant thoughts and feelings by
gaining access to their unique perspective (Merriam & Tisdell, 2016). Conducting interviews
helps ascribe meaning to the identified problem through individual or group understanding
35

(Creswell, 2015). Creating opportunity for a large sample size and the capability to explore
individual stories makes mixed methods the best design for this study.

Table 1
Data Sources
Research Questions Survey Interviews
1. What external factors such as
state and federal law influence
HR professionals in their role of
supporting employees with
mental health disabilities?

X
2. How do organizational factors
such as policies, procedures as
well as organizational culture
influence HR professionals’
ability to support employees with
mental health disabilities?

X
3. What are the HR professionals’
knowledge of mental health
disabilities?

X
4. How do motivational factors such
as self-efficacy, perceptions of
barriers, and self-regulation
impact HR professionals in
supporting employees with mental
health disabilities?

X

36

The Researcher
As the researcher, I distributed the survey electronically and conducted the interviews
over Zoom. Based on my positionality as a person with a mental health disability, I could have
been triggered by responses to the interview questions. To mitigate this, I prepared by
conducting several test interviews to get used to asking and hearing the answers to the questions
included in my interview protocol (Robinson & Leonard, 2019). I included a list of probing
questions to be as natural and neutral as possible. As a doctoral student, I could have impacted
the study because most of the HR professionals will not have terminal degrees, and this might be
intimidating and demonstrate privilege. However, I am not an HR professional, so the
participants were treated experts to encourage honest and open answers. I also dressed in a way
that is not distracting or formal as to not potentially distract the interviewee from feeling
comfortable in providing honest feedback (Robinson & Leonard, 2019). With my privileges as a
White person, it is important to acknowledge that some Black and Indigenous people of color
(BIPOC) might not have felt comfortable being open to me, so I made conscious efforts during
my interviews to be friendly and neutral (Robinson & Leonard, 2019). In addition, as a cisgender
woman, it is important to note that other gender identities might not have felt comfortable
speaking with me.
Data Sources
For this study, a mixed-method approach was used. A quantitative survey was used to
gather a wide range of perspectives (Robinson & Leonard, 2019). The survey was also be used to
locate participants for the qualitative portion of the study, so the interviews were conducted after
the survey is completed. The surveys took place over three weeks, followed by the interviews
taking an additional four weeks to conduct interviews.
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Method One: Survey
A survey, or series of questions, is a data collection method used to gain new information
not available from other sources (Robinson & Leonard, 2019). Conducting a survey allowed for
an inexpensive method of data collection (Creswell & Creswell, 2018). For this study, the survey
included questions about the impact of HR professionals’ knowledge and behavior when
supporting employees with mental health disabilities in the workplace. Specifically, it addressed
the HR professionals’ perceptions of stigma, their knowledge of mental health disabilities, and
their experience of how the organization influences both their knowledge and behavior.
Participants
Participants were located through a snowball sampling method, which is a method where
participants are asked to assist in identifying participants, through professional social networks
(Robinson & Leonard, 2019). The participants were HR professionals within corporate, for-profit
organizations. They are the appropriate group because HR professionals are the individuals who
directly interact with employees with mental health disabilities. Selecting employees with mental
health disabilities as participants would have been problematic because this is a potentially
vulnerable population and participation could be potentially harmful or triggering to those
individuals.
Instrumentation
The instrument was a survey containing 13 closed-ended, Likert-type items and four
open-ended questions on the impact of mental health disabilities in the workplace. The survey
was short to encourage completion but has even-anchored closed-ended questions where the
participants are forced to choose between agreement and disagreement to encourage them to take
more time considering their answers (Robinson & Leonard, 2019). The survey centers around the
38

research questions which focus on how a person’s behavior impacts their environment, and the
environment impacts the persons’ behavior. The survey addressed HR professionals’ perceptions
about their knowledge of mental health disabilities and their self-efficacy related to providing
support for employees with mental health disabilities. The term mental illness was used in the
survey, instead of mental health disability, because it is a more commonly used term and is easier
for participants to understand. The survey remained anonymous to encourage participants to
provide the most candid responses possible (Robinson & Leonard, 2019). The survey protocol
and survey are located in Appendix A.
Data Collection Procedures
The survey was distributed through online social networks such as LinkedIn, Facebook,
personal networks, and using hashtags about mental health. The survey was circulated using a
link to the Qualtrics online survey and was open for three weeks. An online survey provided an
effective way to obtain a large number of possible participants in the target population and
provided simple data reporting options to analyze data (Robinson & Leonard, 2019). The survey
took participants between five to 10 minutes to complete, intentionally kept short so participants
are more likely to complete it (Creswell & Creswell, 2018; Robinson & Leonard, 2019).
Participants were not required to answer any questions, except the consent to participate at the
beginning of the survey. At the end of the survey, there was an independent link for participants
to volunteer for the interview and to provide contact information, keeping their survey data
anonymous (Robinson & Leonard, 2019).
Data Analysis
The data was easily accessible through reports using Qualtrics. Quantitative data was
analyzed using descriptive statistics including means, standard deviation, and frequencies to
39

report the percentages of participants who agreed, agreed more than disagreed, disagreed more
than agreed, or disagreed with each question. Utilizing descriptive statistics provided a means to
effectively communicate numerical survey results to the reader for utilization in evidence-based
solutions (Marshall & Jonker, 2010). The survey provides a high-level overview of external and
internal organizational impacts, as well as a basic understanding of the knowledge level and self-
efficacy of HR professionals’ ability to provide support to people with mental health disabilities.
The explanatory sequential method requires quantitative data to be collected and synthesized
before qualitative collection can begin (Terrell, 2012). The results of the first phase of data
collection were utilized to inform subsequent participant interview follow-up (Terrell, 2012).
Responses to open-ended questions will be used to identify any interesting patterns of thought or
experiences shared by the participants during interviews or thematic coding and analysis.
Validity and Reliability
To ensure validity and reliability, the survey needed to accurately measure the specific
variable that could be replicated with consistent results. The survey went through peer review
pretests and a review by the dissertation committee took place during the proposal stage to
enhance validity and reliability. The study aimed to obtain a large sample size to be
representative of the target population and to increase reliability, which was accomplished by
collecting 75 surveys (Salkind, 2014). Not all survey respondents answered every question, as
the request for consent was the only required question on the survey. Clear instructions and
language increased validity and reliability because ambiguity of instructions or questions stems
causes the respondent to draw on their knowledge which may not all have been the same
(Salkind, 2014). The three types of validity are context, content, and criterion (Heale &
40

Twycross, 2015). For this study, I focused on content validity, which is the extent to which the
instrument sufficiently addresses content as it relates to the variable (Heale & Twycross, 2015).
Method Two: Interviews
Conducting interviews helped to more fully understand the meaning of the survey results
and explore the knowledge of HR professionals’ familiarity with mental health disabilities. As
the researcher, I asked questions about knowledge of mental health and support behaviors
towards employees with mental health disabilities. A quantitative survey alone may have failed
to distinguish the nuances of a participant’s experience, perceptions, and knowledge of a subject
matter so conducting interviews, in addition, may help develop a more detailed picture (Weiss,
1994). As a result of this, the mixed method of surveys and interviews can provide clarity to
understand complex organizations and concepts.
In this study, participants who volunteered through an online survey were interviewed
over Zoom in order to gain a more in-depth understanding of the knowledge and ability within
their position as HR professionals to support employees with mental health disabilities.
Interviews included HR professionals representing diverse demographics, including gender, race,
and ethnicity but due to the sensitive nature of the subject matter and the narrow job profile for
participants, more white female participants were accepted (Creswell & Creswell, 2018;
Robinson & Leonard, 2019).
Participants
The participants chosen for this study are HR professionals working for corporate, for-
profit organizations. For-profit, corporate organizations were chosen because their primary
mission is profit-driven. The profit-driven mission may be difficult to balance with people-
centric policies and practices. The sample includes participants who are new HR professionals as
41

well as seasoned professionals currently working in HR. Their titles included HR professional,
HR vice president (VP) of people, chief operating officer (CEO) of people, HR business
partners, HR directors and similar HR titles. This group of corporate HR professionals were the
appropriate group because HR professionals are directly interacting with people with mental
health disabilities. Government employees, including military personnel and HR professionals in
the non-profit sector were not included, due to the vast differences in the organizational context.
Dissimilar to government and nonprofit organizations, private sector organizations have a
primary mission of profitability, leading to the potential for financial gains to outweigh other
priorities. Qualtrics was used to administer the survey electronically. Survey participants who
indicated they are interested in participating in the interview were be given a separate link at the
end of the survey to maintain their anonymity of survey responses (Rubin & Rubin, 2012). I also
offered a $25 Amazon gift card as an incentive to participate in the interview. The goal was to
obtain seven to 10 interviews, to provide sufficient qualitative data acceptable level for saturation
to align responses with the guiding questions and seven interviews were conducted (Creswell &
Creswell, 2018; Robinson & Leonard, 2019). Since I did not get enough interview volunteers
from the survey link, I used my personal network to recruit additional HR professionals who met
my criteria. All interview participants were sent the survey and completed it prior to being
interviewed.
Instrumentation
The interview protocol employed a peer-reviewed semi-structured format of 15 open-
ended questions, that provided the topical framework for the interviews. The questions along
with a series of probes was designed to elicit detailed responses about HR professionals’
experience, providing support for employees with mental health disabilities. The open-ended
42

questions elicit rich, qualitative data responses avoided leading questions and questions that
could have been answered with a yes or no response. A semi-structured interviews was used to
gain in-depth information about the experience of HR professionals in supporting employees
with mental health disabilities. The flexible structure allowed participants to respond to open-
ended questions freely, and probed when appropriate (Johnson & Christensen, 2015). The
interviews expanded upon the information that was collected in the survey and asked participants
to reflect on their personal experiences and self-efficacy for providing support to employees with
mental health disabilities in the workplace. Due to the sensitive nature of the topic of mental
health, in the semi-structured approach, participants were asked probing questions for more
information based on observed participant comfort level. Similar to the survey, the interview will
focus on the conceptual framework, which are the factors that influence HR professionals’ ability
to provide workplace support to people with mental health disabilities. This included both
external and internal organizational influences and addresses the self-efficacy of HR
professionals in their knowledge of mental health disabilities and providing support for
employees with mental health disabilities. As in the survey, the term mental illness is used in
place of mental health disability, because it is a more universally used term and will be easier for
the participant to understand. The interview protocol is in Appendix B.
Data Collection Procedures
The interviews primarily took place over Zoom and took between 45 minutes to one
hour. To be respectful of the participants’ time, I kept the interview focused on the questions,
using probes to get more detailed data as necessary (Creswell & Creswell, 2018). The semi-
structured approach was the best way to determine the HR professionals’ level of knowledge
about mental health disabilities without leading them. The participants were asked if they were
43

comfortable with the interview being recorded and the researcher taking some short notes, for
purposes of accurate data collection.
Due to the sensitive nature of the subject matter of mental health, participants were
informed that they were able to end the study at any time to prevent any triggers or potential
harm (Rubin & Rubin, 2012). Data was gathered following permission from the Institutional
Review Board (IRB) at the University of Southern California. This study falls under the exempt
research category, so while no signature was needed, informed consent pages were provided to
participants. The University of Southern California (USC) Institutional Review Board (IRB) that
was given to participants can be found in Appendix C.
Data Analysis
To analyze interview data, the study’s conceptual framework, grounded in social
cognitive theory (SCT) and the interactional relationships between HR professionals as
individuals, their behavior, and the environment surrounding them, was used as the foundation.
Researcher notes were carefully analyzed looking for trends to use as codes. The Zoom
transcripts were then downloaded into Microsoft Word, imported into Atlas software, and coded
based on keywords and emerging trends (Creswell & Creswell, 2018). Once trends were
identified, a keyword search of all interviews was conducted to locate quotes that highlight
trends and the number of occurrences of each trend. A final review of the interviews was done to
look for more unexpected findings. A semi-structured interview approach without tightly
prescribed protocols prevented the researcher from leading participants and influencing emerging
themes. The raw data was transcribed by Zoom and was simplified into manageable pieces and
then compared against the entire sample group to reveal patterns of thought or ideas.

44

Credibility and Trustworthiness
The use of both survey and interview provided multiple sources of data to ensure
credibility (Merriam & Tisdell, 2016). My positionality as the researcher was disclosed by
informing the participant of any biases or assumptions made as a result (Merriam & Tisdell,
2016) while also recognizing that I cannot be completely unbiased when collecting data
(Maxwell, 2013). According to Merriam & Tisdell (2016), credibility and trustworthiness are the
researcher’s way of creating confidence in the data collected in qualitative research. Ability to
apply the research in another context, or transferability, collection neutrality, and dependability,
or the extent to which another researcher could repeat the study with consistent findings were all
critical during data collection (Creswell & Creswell, 2018; Merriam & Tisdell, 2016). While the
intention was to interview seven -10 interviews, additional data could have been collected had
the interviews not provided saturation or complete answers to research questions, but that was
not necessary for this study (Merriam & Tisdell, 2016). The researcher’s interpretation of the
qualitative data could have a direct impact on credibility (Merriam and Tisdell, 2016). I
minimized this impact by remaining as neutral, and as non-distracting as possible while being
both friendly and professional to have the least possible impact on the data being collected
(Merriam & Tisdell, 2016; Robinson & Leonard, 2019).
Ethics
Throughout the study, ethical considerations were anticipated (Creswell & Creswell,
2018). To ensure that participants were not harmed during the study, as the researcher, I
conducted all interviews myself, tried to be respectful and honest with participants, protected
participants’ confidentiality, and was careful not to exploit participants by harming them or
affecting the findings (Rubin & Rubin, 2012). To mitigate harm to human beings, institutional
45

review boards (IRBs) and professional societies that maintain a formal code of ethics helped to
guide my methodology as the researcher (Glesne, 2011; Rubin & Rubin, 2012). Study
participation was voluntary and was kept confidential (Rubin & Rubin, 2012). In the interviews,
verbal permission was requested before starting the Zoom or voice recordings (Rubin & Rubin,
2012). If verbal permission to record was not granted by the participant, I would have taken
careful notes and expand on them directly following the interview when the information was still
fresh, but this was not necessary. All data was saved on an external hard drive kept by myself,
the primary researcher in a locked drawer in a private residence.

46

Chapter 4: Results and Findings
The purpose of this study was to explore HR professionals’ assets and barriers in
providing support and diminishing workplace challenges for employees with mental health
disabilities. With the rise in mental illness and the stigma associated, workplace disadvantages
people with mental health illnesses are important to address and research. The study used
Bandura’s (2000) social cognitive theory (SCT) to explore the impact of external factors on HR
Professionals’ ability to support employees with mental health disabilities. It also explored the
impact of organizational factors, HR professionals’ knowledge of mental health disabilities, and
self-efficacy in supporting employees with mental health disabilities. The following four
research questions guided the study.
1. What external factors such as state and federal law influence HR professionals in their
role of supporting employees with mental health disabilities?
2. How do organizational factors such as policies, procedures as well as organizational
culture influence HR professionals’ ability to support employees with mental health
disabilities?
3. What are the HR professionals’ knowledge of mental health disabilities?
4. How do motivational factors such as self-efficacy, perceptions of barriers, and self-
regulation impact HR professionals in supporting employees with mental health
disabilities?
First, this chapter reviews the data collection approach used in this study and the
rationale. Next, it will present the participating stakeholders, providing an overview of
participants for both the survey and interview. An analysis of survey results and qualitative
findings will follow. After this is established, each research question will be addressed with
47

survey results and qualitative findings. Lastly, a summary of the results and findings are
presented.
Trends in survey results were identified when more than 50 percent of respondents
answered in a similar manner. Survey participants were given the option to skip questions, but
survey response options offered no neutral choice. A priori codes were used to guide the
interview analysis and additional codes were developed throughout the analysis stage. A topic
was considered a theme in the interview process when at least half of the participants mentioned
the topic in their interview.
Participating Stakeholders
The 75 survey participants were all HR professionals at various stages of their HR careers
working in the private sector. To assure anonymity, no demographic information was collected
from survey participants. Consent to participate and confirmation that they were HR
professionals working in the private sector were the only required survey items. All seven
interview participants were HR professionals who have worked in HR for at least one year.
Participants represented a variety of organizational types and sizes but all were from the private
sector.
Survey Participants
The participants were HR professionals within corporate, for-profit organizations. They
are the appropriate group because HR professionals are the individuals who directly interact with
employees with mental health disabilities. For-profit organizations were chosen due to their
primary mission being financial, which is unique to the private sector. Seventy-five HR
professionals completed the surveys, but only about half of the participants answered each
question due to the sensitive nature of the subject. Participants took the survey first, and then
48

some volunteered for the interview. Survey participants included less than 20% of HR
professionals with less than 3 years of experience, about 35% with between five and 10 years of
experience, and almost 50% of professionals with 10 or more years of experience as shown in
Figure 2.

Figure 2
Survey Participants’ Years Working in HR Positions

0 2 4 6 8 10 12 14 16 18 20
10 or more
5-10
2-3
0-1
Years
49

Interview Participants
The participants chosen for the interview were also HR professionals working for
corporate, for-profit organizations. Participants either volunteered at the end of the survey, or
were someone my colleagues or I knew personally, and I connected with through LinkedIn and
email. The sample includes one new HR professional and two mid-level professionals but the
other 4 participants were seasoned senior-level HR professionals. Participants will be referred to
by number as shown in Table 2. Participant numbers were assigned randomly to preserve
anonymity.

Table 2
Interview Participants
Participants Years in HR HR Position Category
Participant 1 20+ Senior-level professional
Participant 2 20+ Senior-level professional
Participant 3 2 New professional
Participant 4 5 Mid-level professional
Participant 5 15 Senior-level professional
Participant 6 8 Mid-level professional
Participant 7 18 Senior-level professional

50

Research Question 1: What External Factors Such as State and Federal Law Influence HR
Professionals in their Role of Supporting Employees with Mental Health Disabilities?
Using both quantitative surveys and qualitative interviews, two themes were identified to
answer the first research question. These two themes were the following: (1) the critical role
played by laws in HR professionals’ support of employees with mental health disabilities, and
(2) the impact of the worldwide COVID-19 pandemic on HR employees’ ability to support
employees with mental health disabilities. According to participants, these external factors, the
laws, and the COVID-19 pandemic play a role in how HR professionals can provide support to
employees with mental health disabilities. Both will be discussed in-depth in the following
section.
Theme 1: Critical Role of Laws in HR Professionals’ Support of Employees with Mental
Health Disabilities
Overwhelmingly in both the survey and interview, participants felt federal and state laws
were essential to protecting people with mental health disabilities. While participating HR
professionals understood the laws to protect people with mental health disabilities, they
communicated their perceptions that many direct supervisors and employees had less knowledge
of their own legal rights and that of their employees. The findings from the interviews showed
that the participants felt the pandemic had a significant impact on employee mental health.
Survey Results
Of the HR Professionals surveyed, over 70% agreed that state laws help protect people
with mental health disabilities in the workplace. Participants also agreed that federal laws had a
positive impact on supporting people with mental health disabilities 60% of the time as shown in
Figure 3.
51

Figure 3
HR Professionals’ Perception of the Effectiveness of the Laws to Support Employees with Mental
Health Disabilities

Interview Findings
All seven HR professionals participating in the interviews communicated their
understanding of the laws that protect people with disabilities including mental health
disabilities. Participant 4 emphasized, “I think that [the laws] states are now passing that go
above and beyond federal are really great.” Despite improvements in legislation, four
participants reported that managers and employees were less aware of the laws. Participant 1
disclosed that in her previous company “when a manager starts having issues with someone, they
just want them out, they don’t want to deal with it.” She went on to say that she would first
encourage empathy, but “that usually didn’t work so I would say, okay, but this is the law.”
Participant 1 clarified that this is in direct contrast to her current organization which she
characterized as the “polar opposite” of that. She described her current organization as “giving a
lot of grace given to the person and wanting to help them get to where they need to be
Federal Laws
State Laws
0 10 20 30 40 50 60 70 80
Disagree Agree
52

successful.” Participant 2 commented that in his current position and stated that his organization
resides, people seem to have “a very high awareness of the law.” He added, “I have found people
are very familiar with FMLA and use it actually on a per capita basis higher than I’ve ever seen
before in my career.” Participant 2 attested that managers’ lack of awareness of the laws put an
additional burden on HR employees:
I’d say probably a disproportionate amount of value would be placed on the HR
department supporting employees with any kind of medical issues mental or otherwise,
because our managers historically haven’t been especially capable at navigating those
more challenging issues.
Participant 2 discussed the positive impact that HR professionals can make but stressed
the importance of all employees being competent and sharing in the responsibilities of providing
support to people with mental health disabilities.
Summary
Participants felt federal and state laws were critical to protecting people with mental
health disabilities. Participants communicated their perceptions that direct supervisors and
employees often do not know enough about how the laws protect people with mental health
disabilities to be self-advocates. They expressed that this puts extra labor of providing support
for the growing population of employees with mental health disabilities on HR. They suggested
that training for direct managers on the laws and resources for supporting employees with mental
health could be a solution to providing better support for employees with mental health
disabilities and taking some of the additional workload from HR employees.

53

Theme 2: Impact of COVID-19 Pandemic on Employee Mental Health
Six of the seven participants reported that the COVID-19 pandemic had a negative
impact on employees’ mental health. The participants communicated that the pandemic made
support for employee mental health an even more essential part of the workplace. Participants
also reported the labor to support these employees through the pandemic largely fell on HR
professionals.
Interview Findings
All seven interview participants indicated that COVID-19 had a negative impact on their
employees’ mental health and support services became more critical during this time. According
to Participant 2, it became particularly apparent during the pandemic that HR employees are the
main resources for direct managers. He explained that the “key to supporting people with mental
health disabilities would be to better equip the managers on the frontlines” to support employees
with mental health disabilities. He went on to say that “COVID added a layer of stress to
everyone’s mental health and the struggle that many workers have faced throughout this
pandemic, and you know the relevance of mental health in the throes of it.”
Participant 4 felt COVID-19 had some positive impact on coworker empathy. She
pointed out that due to the pandemic, “half of your friend group and family group experience
these issues, you might not be best friends with Joe your coworker, but you know Amy your best
friend who’s dealing with this hasn’t turned into like a crazy raging beast.” Participant 2
acknowledged that his company responded to the impact of the pandemic on employees by
launching an “employee relief foundation so helping to make sure they had access to that for
short term financial pressures associated with the pandemic which can lead to mental health
issues.”
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Summary
Participants communicated that they felt the worldwide COVID-19 pandemic had a
significant impact on employee mental health and the need for services. They reported
experiencing an increased need for mental health services because the stress of the pandemic
exacerbated mental health illness among employees. Despite the challenges of additional
employees experiencing mental health illness, one participant felt the surge in cases of mental
health disabilities had the positive impact of promoting empathy. She cited empathy as a primary
skill needed to support employees with mental health disabilities, and with the increase in mental
health illness during the pandemic she pointed to empathy as a particularly critical skill for HR
employees. Participants also felt that the main source of support for people with mental health
disabilities during the pandemic was themselves as HR professionals and three of seven
interview participants reported that this presented a challenge for them to balance the additional
labor with other job duties.
Research Question 2: How Do Organizational Factors such as Policies, Procedures as well
as Organizational Culture Influence HR Professionals’ Ability to Support Employees with
Mental Health Disabilities?
Using both quantitative surveys and qualitative interviews, two themes emerged in
answering the second research question. These two themes were the following (1) the challenge
for organizations within the private sector to balance the financial health of the company with the
emotional well-being of the company, and (2) the effectiveness of employee support programs.
Theme 3: Organizations Must Balance Employee Well-Being and Profits
The study’s data communicated the participants’ perception that organizations within the
private sector have the challenge of balancing profits with providing a positive, healthy
55

employee culture. Four out of seven participants acknowledged that it was often difficult to
weigh what benefitted the company in the short term with what was best for employees.
Participants expressed that putting employee well-being and support of people with mental
health disabilities and profitability is possible, but it takes longer to see the impact of the
investment in people.
Survey Results
Participants were split when asked about their organization making supporting people
with mental illness a priority. Most survey participants indicated their organization makes
supporting employees with mental health disabilities a priority. However, it is only a slight
majority, as 46% felt a lack of organizational priority given to mental illness as shown in Figure
4.

Figure 4
HR Professionals’ Opinion of Organizational Priority for Employees with Mental Illness

54%
46%
Priority Not Priority
56

Interview Results
The majority of participants reported that they felt HR is in the middle of trying to
balance organizational profitability and promote positive employee culture and well-being.
Participant 5 explained that “we will support and give resources all day long as long as it’s in the
best interest of the business right or if we’re held to that by law.” She continued by stating that
from an organizational standpoint, “we would absolutely [provide support] if we had a current
employee who came to us needing an accommodation but it’s always a balance.” She explained
that it is often in the best financial interest of the business to be “people-centric,” not only
because of the work they do but also because employee retention and wellness are profitable but
investing in employee wellness “has a slow return on investment (ROI), so sometimes it is harder
to sell to other executives looking at the bottom line.”
Six participants reported that while their current company recognized that employee well-
being can make a company more profitable, many expressed that their previous employers did
not hold this same view. Participant 4 expressed that if she “were to be interviewed at their
previous company her answers would differ greatly.” She felt at her previous company that while
the company had some employee wellness programs, employees were “almost discouraged from
utilizing them” by leaders within the organization.
All seven interview participants cited little to no training offered to them in their current
position specifically on supporting employees with mental health disabilities. Despite this, they
overwhelmingly felt they had a better understanding than the rest of the company. Participant 2
attested that, “there are lots of manifestations of the extent to which our people practices didn’t
keep up and it manifested itself and employee relations issues and turnover.” He described a
possible solution as “bringing up the competence and capability of our leaders and frontline
57

managers, just to manage and to lead people and so we’re still on that journey.” All seven
participants welcomed more support from their organization and training, reporting that if they
received more training, it was because they sought it out on their own. Participant 1 disclosed
that they were “not discouraged from finding additional training, but it was up to each staff
member to seek it out.”
Summary
Participants reported that organizations within the private sector have the challenge of
balancing generating company profits with a focus on employee wellness, such as allowing for
flexible time off and costly mental health services. They reported feeling conflicted when
considering the best interest of the company in the short term with what they perceived was best
for employees and the company long term. Participants felt that prioritizing employee well-being
and support of people with mental health disabilities and profitability can be aligned, but the
positive impact of the investment in people takes longer to assess than short-term financial gains.
Theme 4: Effectiveness of Employee Support Resources
According to participants, organizations offer a wide array of programs and resources for
employee mental health. Employee Assistance Programs (EAP) are resources for employees to
utilize and often have mental health components but vastly differ by organization and are often
underutilized. Participants offered solutions in the survey and in the interviews to help
organizations provide better, more accessible resources for employees with mental health
disabilities.
Survey Results
Several survey participants reported that there is a lot of room for improvement in
employee mental health resources. Another survey participant emphasized that companies should
58

work to “lower deductibles and copays on mental health therapies.” Three survey participants
recommended that an outside company that specializes in mental health for all staff would be
beneficial. Companies focusing on helping employees find a “real work/life balance” was
another suggestion given by a survey participant. Despite these findings, almost 90% of survey
participants agreed that their organization’s policies had a positive impact on employees with
mental health disabilities.
Interview Results
While viewed as valuable, interview participants felt that EAPs were not robust enough
in most cases. Almost 60% of participants reported more sufficient EAPs had only recently
become available. Participant 4 explained that EAPs have “probably gotten 1000 times better
over the last couple of years,” but felt that they remain insufficient. The senior-level HR
professional participants reported currently working at an organization with strong EAPs, but
that they had to improve it significantly when they started at the organization. Participant 1
articulated that she stays in their current role she is listened to at her organization, and that is not
something they had experienced in 20+ years working in HR. She recommended changes to
health plans, the organization acted and “built health insurance plans with lower deductibles and
copays for mental health services” which made her feel like she could really “advocate for and
support her employees.”
According to over half of the participants, little or no training was offered to them on
how to support employees with mental health disabilities in their current position on supporting
employees with mental health disabilities unless they pursued it personally. Participant 2
explained that some general ADA training predated his time with the company, but had not been
updated and, “we don’t offer training per se on how to handle mental health issues.” Participant 7
59

added that he was “self-taught, and learned as [he’s] gone through life,” which he attributed to
the lack of formal training offered throughout his career.
Summary
The study’s data communicated the participants’ perception that organizations offer a
wide array of programs and resources for employee mental health. EAPs and other resources are
available for employees with mental health components, but the resources available vary by
organization and are often underutilized. Through the open-ended survey questions and
interviews, participants offered solutions to help organizations enhance resources for employees
with mental health disabilities but pointed to a lack of formal training on mental health
disabilities as a barrier to supporting employees with mental health disabilities.
Research Question 3: What is the HR Professionals’ Knowledge of Mental Health
Disabilities?
Using qualitative interviews, a theme was identified to answer the third research question.
The theme surrounds HR professionals’ knowledge of supporting employees with mental health
disabilities. According to participants, HR professionals are forced to rely heavily on their own
personal experiences to gain the knowledge needed to support people with mental health
disabilities. The participants also communicated that they often took initiative to start working
with an employee with a mental health disability with the direct manager to find suitable
accommodations to try to mitigate further damage to employees with mental health disabilities.
Theme 5: HR Professionals’ Knowledge for Supporting Employees with Mental Health
Disabilities
Participants described their personal experiences with having people with mental health
in their personal life and how that has had a positive impact on their ability to provide support for
60

employees with mental health disabilities. According to participants, it would be a struggle for a
new HR professional or manager with no direct experience with mental health illness to navigate
supporting people with mental health disabilities. They communicated that having personal
knowledge about mental health disabilities would also be helpful when navigating how to best
provide accommodations. Over 40% of interview participants highlighted the importance of
recognizing the signs that an employee might need support, and how to offer it to them in an
approachable way. While participants reported relying on personal experiences to support
employees with mental health disabilities, none of the participants mentioned diversity training
that included mental health disabilities. Two participants mentioned diversity training, but when
probed said it covered disabilities but not specifically mental health disabilities.
Survey Results
Survey participants communicated that they had personally had a wide variety of mental
illnesses disclosed to them. Participants reported depression and anxiety as the most disclosed
mental health disability, followed by bipolar disorder, attention deficit hyperactivity disorder
(ADHD), and post-traumatic stress disorder (PTSD). While these were the most frequently
disclosed mental health disabilities, participants also reported addiction and substance abuse
were disclosed to them.
Interview Results
According to participants, most of the information they had about supporting employees
with mental health disabilities stemmed from their own personal experiences. Participant 1
revealed that her father suffered from a mental health illness and that this experience gave her
more patience and empathy for employees who came to her for support with mental health in the
workplace. She added that when it came to supporting employees with mental health disabilities,
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“my father had a lot of mental health challenges so it’s near and dear to my heart, so sorry, I’m
going to advocate from day one on that.”
Participant 5 mentioned that increasing her knowledge of how to best support people with
mental health disabilities “really came down to empathy.” She cited empathy as a very important
trait in an HR professional and stipulated that if the HR professionals and direct supervisors
“came from a place of empathy” formal accommodations were often less necessary. Participant 7
attested that connecting the employee and direct supervisor when the employee felt comfortable
doing so had been an effective method of providing less formalized accommodations. The
participant added that it helps the direct supervisor to understand the mental illness better and
become more “open to flexible working accommodations.”
According to the majority of participants, recognizing the signs that an employee needs
to be reminded of the resources available is a critical step in supporting employees with mental
health disabilities. Participant 7 explained that he recently met with an employee he noticed
“seemed to be personally struggling.” During the meeting, she disclosed a mental illness and
clarified that she had been diagnosed by a physician. Participant 7 reported asking, “why didn’t
you tell us this, and she says well it’s not something I’m not proud of, I’m embarrassed.”
Participant 7 acknowledged that the employee was “worried y’all will use it against me.”
Participant 1 pointed out that she learned the importance of recognizing the signs of an employee
in distress after he took a promotion and was struggling. She divulged that she “had a coworker,
he was appearing like he was overwhelmed in his job and had kind of tough home situation to
you, but I went to my boss twice” and suggested some support was needed but no steps were
taken, and the employee later committed suicide. She stressed she learned the importance of
advocating as a result of that incident:
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Getting vocal about it and reaching out to somebody and helping or talking to them about
it, and you know who knows what his deciding factor wise, but it definitely made me a
lot more proactive with it to try to make sure that never happens again.
According to participants, once a need for an accommodation is established, they can
support employees with mental health disabilities navigate getting accommodations as shown in
Table 3. Participant 1 communicated accommodations for mental health disabilities were
difficult to navigate, but most are requiring more time off and flexibility. While Participant 4 felt
there are ways to help employees get the time and flexibility they need in a more informal way.
Participants felt that recognizing the signs of an employee struggling with a mental health
disability, approaching them with empathy, and then being an advocate for accommodations was
the best approach.

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Table 3
Participant Comments about Accommodations
Participant Quote
Participant 2
“Requests for accommodations usually it pertains to
leave right people needing leave to attend to whatever
their issue is…”
Participant 4
“To improve retention of newer employees that might
not be eligible for FMLA yet, [we offer] an unofficial
sort of mini FMLA, like a leave of absence program for
those people should they need it.”
Participant 1
“…somebody needing to move their hours around so
they can get to their therapy appointment or it’s often
about more about the time off and flexibility.”
Participant 6
“We try to keep accommodations informal whenever
possible and allow our employees flexibility to go to
appointments, or whatever they need for their wellness
Participant 5
“I have not had anybody approaches in my tenure and
said I have mental illness, I need an accommodation
here’s my diagnosis, we haven’t dealt with them”
Participant 1
“a specific communication style with a person
[triggered an employee with a mental health disability]
and they weren’t getting that from management, so they
went the ADA route to make sure that their manager did
some training and work through that.”

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Summary
According to participants, experiences they have had with employees with mental health
disabilities in the workplace, and with family and friends can have a positive impact on their
ability to provide support for employees with mental health disabilities in the future. They felt
less experienced HR professionals or direct supervisors without personal experience with mental
health illness would have additional challenges supporting people with mental health disabilities.
They expressed that personal knowledge about mental health disabilities would also be helpful in
knowing how to guide employees and direct managers through providing accommodations for
employees with mental health disabilities.
Research Question 4: How do Motivational Factors such as Self-Efficacy, Perceptions of
Barriers, and Self-Regulation Impact HR Professionals in Supporting Employees with
Mental Health Disabilities?
Using both quantitative surveys and qualitative interviews, two themes were identified to
answer the fourth research question. The two themes were the following (1) most HR
professionals surveyed and interviewed reported high self-efficacy about mental health
disabilities, but they attributed it to their own personal experience as opposed to the training they
received in the workplace, and (2) mental health stigma in the workplace is still present and
negatively impacting employees receiving support.
Theme 6: HR Professionals’ Self-Efficacy in Supporting People with Mental Health
Disabilities
According to participants, their self-efficacy in supporting people with mental health
disabilities originated with themselves. Participants indicated that personal experiences
supporting family and friends with mental health disabilities increased their self-efficacy in
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supporting employees with mental health disabilities. They also indicated that training
opportunities they pursued personally increased their self-confidence in providing support.
Survey Results
Self-efficacy on knowledge of mental health disabilities was split, with only 62%
indicating that they were confident in their personal knowledge about the various types of mental
health disabilities. However, over 80% of survey participants felt confident in their ability to
support people with mental health disabilities as shown in Figure 2. While participants felt
confident in their ability to support people with mental health disabilities, over half of
participants indicated that they felt that mental health support was not a central part of their role
as an HR professional.

Figure 2
HR Professionals’ Self-Efficacy in Supporting Employees with Mental Health Disabilities

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Interview Results
According to five of the seven interview participants, they had positive self-efficacy in
supporting people with mental health disabilities but felt they could do more. Participant 4
asserted that “I would probably say I am 90% confident” in providing support to employees with
mental health disabilities. She also expressed concern that there may be areas said she would not
feel comfortable. She continued by saying that “no matter how much you’ve seen, random out of
the blue stuff that you’re like oh, my goodness, would I be good in [supporting employees] that
situation.” Participant 3 specified that supporting people with mental health disabilities often
creates stigma with coworkers which can lead to isolation from coworkers. Participant 1
communicated that “improper support from HR can damage someone if it is not done
appropriately.” Participant 4 explained that they did not always feel confident in their skills and
getting “too involved” could even sabotage the employee with mental health disabilities and lead
to the employee quitting.
Two participants provided another perspective and noted that employees often came to
them with mental health challenges, and they had to set boundaries or professional lines were
crossed. Participant 7 revealed that employees often “feel comfortable sharing a lot of personal
information with [him].” He added that he learned from a counseling mentor and would try to
emulate her methods but expressed that he was “not overly confident that I’m always doing the
right thing, but I’m confident that I want[ed] to do the right thing.” Participants also expressed
concern about not being medical professionals themselves, so despite their experience and self-
efficacy as HR professionals supporting employees with mental health disabilities, they felt that
some of the support employees asked of them moved beyond their scope and into what they saw
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as more medical roles. Participant 1 described her experience as a fine line for empathetic HR
professionals:
I will say I probably get a little too invested, sometimes with people. So that’s a little
hard, because people at the same time, need to help themselves and get medical support
to put their best foot forward as well, and you know there’s one occasion where I think,
sorry, but I was kind of taken advantage of in the situation.
Participants reported high self-efficacy in providing support to employees with mental
health disabilities in the workplace, but also expressed concerns about the expectation to provide
support beyond what they felt was appropriate to their role in HR.
Summary
Participants reported that their confidence and self-efficacy in supporting people with
mental health disabilities were grounded in their own life experiences. They felt that personal
experiences supporting family and friends with mental health disabilities increased their
confidence in supporting employees with mental health disabilities. Participants also indicated
that training opportunities they pursued independently of their specific job duties increased their
self-efficacy in providing support to employees with mental health disabilities.
Theme 7: Mental Health Stigma in the Workplace
According to participants, although there have been advances in knowledge, training, and
improved mental health resources, significant stigma still exists in the workplace. Participants
provided suggestions to help destigmatize mental health disabilities. Another concern
participants communicated was the need to help ease employees’ fears of disclosing a mental
health disability through confidentiality and protection from discrimination.

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Survey Results
One survey participant suggested that the “best thing we can do is have leaders open up
about their own mental health to destigmatize it.” Another survey participant recommended that
companies “normalize mental health challenges and increase educational offerings” to mitigate
the stigma. One survey participant suggested that employers “treat [people with mental health
disabilities] with respect and dignity and ensure their privacy.” The same participant added that
they should “receive services appropriate for their age and culture, understand their treatment
options and alternatives [and employers should encourage care that doesn’t discriminate on the
basis of age, gender, race, or type of illness.”
Interview Results
According to participants, the stigma surrounding mental health is still problematic for
the success of people with mental health disabilities in the workplace. Participant 5 emphasized
that “it’s a hard pill to swallow sometimes because they probably feel weak or vulnerable, or
more than that worried about their job if they disclose.” Participant 4 described her conversations
with employees with mental illness explaining that in these issues, employees are worried about
“retaliation, and when you need to send an employee to us [HR] there’s not like a magic word
like the employee doesn’t say, I need an accommodation because I have anxiety.” Participant 1
communicated that many employees she had worked with were fearful of the results of using
services. She compared the fear of the stigma of using FMLA or disclosing a mental health
disability to the retaliation associated with making workers’ compensation claims. Participant 1
explained that employees are “fearful of using FMLA is kind of like making a worker’s
comp[ensation] claim [because] they feel like they’ve heard these horror stories of people being
fired because of filing a claim.”
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Summary
Participants communicated the need to ensure confidentiality so employees would feel
comfortable disclosing their mental health disability and receive assurance that they would be
protected from workplace discrimination. Participants felt that there have been advances in
knowledge, training, and improved mental health resources, but significant stigma about mental
health still exists in the workplace. Participants also provided suggestions to help destigmatize
mental health disabilities such as educational opportunities and creating a culture that promotes
care and compassion.
Perceived Employer Disadvantages
Findings emerged concerning the perceived negative impact of employing people with
mental health disabilities. These findings did not elevate to the level of a theme but were
significant due to their unexpected nature and will be acknowledged in this section. All interview
participants reported working in positive environments for employees with mental health
disabilities, but several suggested there were disadvantages or negative impacts for organizations
employing people with mental health disabilities. None of the interview participants mentioned
the advantages that employing people with mental health disabilities has on diversifying the
workplace.
Misuse of Disability Resources
One HR professional interviewed had concerns about the authenticity of an employee’s
disability. Interview participant one mentioned perceiving a concern that employees were
“faking” their mental health disability to “take advantage of the system and get special
treatment.” This finding furthers the stigma of mental health disabilities and damages the success
of employees with mental health disabilities in the workplace. Regardless of whether this is a
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misuse of the laws protecting people with disabilities or only a perceived misuse, the perception
of misuse creates barriers to support and accommodations for employees with mental health
disabilities.
Employer Burden
Participants alluded to the burden that employing people with mental health disabilities
has on employers. Participant five mentioned intermittent FMLA as having a negative impact on
employers, despite acknowledging that this flexible leave might be the best accommodation
option for an individual employee. Participant five said while intermittent FMLA was protected
by law, it was not “in the best interest of employers.” The participant expressed that while this
may be an accommodation helpful for employees with mental health disabilities, this type of
unpredictable schedule was a burden for employers and not something HR should advise.
Participant six described his perception of how people with mental health disabilities can cause
conflict in the workplace. He explained that coworkers were often frustrated by working with
people with mental health disabilities because it was confidential and described the workplace
conflict between managers, coworkers, and employees with mental health disabilities. He
recounted working with “multiple PTSD staff members that they would have outbursts and it’s
easy to get mad at those people or not like them.” Participants did not highlight the benefits of
employees with mental health disabilities creating a more diverse, inclusive workforce, but
instead focused on tolerating mental health disabilities in the workplace out of compliance with
the related laws. While these findings are delimited to three participants and therefore do not
constitute a theme, they are included due to their unexpected nature.

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Summary of Results and Findings
Using quantitative surveys and qualitative interviews, seven themes were identified to
answer the research questions. The first two themes answered the first research question. The
first theme was the critical role played by laws in HR professionals’ support of employees with
mental health disabilities. Both survey and interview data indicated that participants felt federal
and state laws were essential to protecting people with mental health disabilities. The second
theme focused on the impact of the worldwide COVID-19 pandemic on HR employees’ ability
to support employees with mental health disabilities. Participants felt these external factors, the
laws, and the COVID-19 pandemic play a role in how HR professionals provide support to
employees with mental health disabilities.
The third and fourth themes answered the second research question. The third theme was
the challenge for organizations within the private sector to balance the financial health of the
company with the emotional well-being of the employees. While four of seven interview
participants felt having a positive organizational culture while remaining profitable was possible,
they communicated that the impact of investing in people had a slow return on investment (ROI)
and was therefore often overlooked by decision-makers. The fourth theme, also to answer
research question two, focused on the direct managers’ perceived effectiveness of employee
support programs. Several survey participants reported the need for improvement in employee
mental health resources. The interview participants felt EAPs alone were insufficient resources
to support employees with mental health disabilities. The fifth theme surrounds HR
professionals’ knowledge of supporting employees with mental health disabilities and answers
the third research question. Participants shared experiences of being forced to rely on their own
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personal experiences to support people with mental health disabilities because there was a lack of
training in the workplace.
The final two themes answer the fourth research question. The sixth theme centers around
HR professionals reporting high self-efficacy about mental health disabilities but attributing it to
their own personal experience as opposed to the training they received in the workplace. The
final theme is that participants reported that mental health stigma in the workplace is still present
and negatively impacts employees receiving support. In addition to the seven themes, this
chapter also pointed to the unexpected findings for employers on the perceived disadvantages of
employing people with mental health disabilities. Chapter five will offer recommendations based
on these findings.

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Chapter Five: Recommendations and Discussion
Chapter Five discusses the study’s results and findings and compares the findings with
the information presented in the literature review. Secondly, recommendations to address the
problem of practice are outlined, including surrounding the key findings from the study reviewed
in this chapter. Next, this chapter discusses the limitations, delimitations, and recommendations
for future research. Finally, in the context of the USC Rossier School of Education mission,
implications for equity are discussed.
Discussion of Findings and Results
Three key findings are discussed in detail in the following section. First, participants
communicated their perceived inadequacy of their own training as well as the training of direct
managers and supervisors on mental health disabilities. While the data showed that participants
felt both groups needed training, the participants indicated that the training needed for each
group differed. Participants felt that HR professionals had an adequate understanding of mental
health disabilities but needed formal training on best practices for supporting employees with
disabilities. However, participants felt that the employees’ direct managers needed more
fundamental mental health disability training about types of mental health disabilities and
available resources for employees with mental health disabilities. The second finding is the
challenges associated with providing accommodations for employees with mental health
disabilities. While most interview participants had assisted with a mental health disability
accommodation, they did not feel fully qualified to suggest accommodations or when to suggest
specific resources due to a lack of training. And lastly, the role HR plays in balancing promoting
organizational profitability and supporting employees with mental health disabilities will be
discussed.
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The Perceived Inadequacy of Training for HR Professionals and Direct Managers on
Mental Health Disabilities
According to participating HR professionals, their experience has been that an
organization’s employees’ direct managers and supervisors are unfamiliar with the laws
protecting employees with disabilities. Participants felt that most of the support for employees
with mental health disabilities was passed onto HR professionals by the employees’ direct
managers and supervisors, but that when direct managers and supervisors are trained correctly,
they can provide the necessary support to employees with mental health disabilities. Dimoff and
Kelloway (2019) found that mental health training tailored to organizational managers can
provide these leaders with the skills and confidence to engage in the resource-utilization process
and support employees who are struggling. Training direct managers and supervisors on types of
mental health disabilities and resources available to employees could shift some of the workload
associated with supporting employees with disabilities from HR professionals.
Similarly, the training participants felt was lacking for direct managers, participants
communicated their feelings that HR employees are also not receiving training on how to support
employees and direct managers with mental health disabilities. HR professional participants
reported that they rely on their own personal experiences because they have not received any
formal training in the workplace. Despite a lack of formal training, most study participants
reported high self-efficacy as HR professionals in supporting employees with mental health
disabilities. In the absence of formal training, they did, however, express concern that some HR
employees with no personal experience in their private life with people with mental health
disabilities might leave them unprepared to support employees with mental health disabilities. As
research has shown, a lack of personal experience with mental health disabilities can be
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problematic in providing support for employees with mental health disabilities, because in the
absence of personal experience most of the information people have about mental health comes
from the media, which is often extreme and exaggerated, leading to misunderstandings about
mental health disabilities (Ballenger, 2012). The literature supports mental health disability
training for direct supervisors, citing a positive impact on employees with disabilities, HR
professionals are often tasked with providing support for direct supervisors with little or no
training themselves (Attridge, 2019; Li et al., 2001).
Challenges in Providing Accommodations for Employees with Mental Health Disabilities
According to participants, it is difficult to know what accommodations will assist in
employee success. Participants suggested flexibility and time off for appointments were among
the most common requests but reported that they were not confident in their ability to guide
employees with mental health disabilities toward the best accommodations due to lack of
training. The literature highlights that the lack of knowledge about disabilities contributes to
workplace disadvantages for people with mental health disabilities and the quality of disability
accommodations (Potgieter et al., 2017). This gap in training leaves an opportunity for
organizations to improve their support of employees with mental health disabilities by providing
and training HR professionals on mental health accommodation resources.
Participants also communicated that they felt it was likely that many employees were not
disclosing their mental health disability for fear of stigma and therefore did not ask for
accommodations. Research has shown that if employers establish trust with employees,
employees are more likely to disclose their mental health disability and become eligible for
accommodation (Brohan et al., 2013). Efforts such as organization-wide education on mental
health to decrease stigma can create a more conducive environment for employees with mental
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health disabilities to disclose (Brohan et al., 2013). Lastly, employees would be encouraged to
disclose a mental health disability and receive necessary accommodations if it were
communicated that they would receive appropriate accommodations free from repercussion and
discrimination (Toth & Dewa, 2014).
HR Professionals’ Balancing Between Prioritizing Organizational Profits with Supporting
Employees with Mental Health Disabilities
Participants felt that supporting employees with mental illness can conflict with
organizational priority to be profitable. According to participants, investing in people has a slow
return on investment (ROI), making it difficult to allow organizational leaders to see the long-
term benefit of investing in employees. One participant argued that convincing organizational
leaders to invest in employees presents a challenge for HR professionals because organizational
leaders see the short-term goal to be immediately profitable and fail to see the long-term
financial benefit the HR professional participants observed from their years of experience
investing in employee well-being. While most participants reported feeling confident in their
ability to support employees with mental health disabilities, over half of the participants
indicated that they felt that supporting employees with mental health was not a central part of
their role as an HR professional. While the majority of HR professionals did not view supporting
employees with mental health disabilities as central to their HR role, this study and the literature
did not provide alternatives (Brohan et al., 2013; Nogues & Finucan, 2019).
Recommendations for Practice
There are three recommendations identified to address key findings. The first
recommendation is to provide direct managers and HR professionals with specific training to
support employees with mental health disabilities. The training for these groups should not be
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the same, as direct managers should have a basic understanding of mental health disabilities and
how to provide support in their role, and HR professionals should receive more in-depth training
on how to support management and employees through assisting these direct managers in
providing employees with mental health disability accommodations. The second
recommendation is to provide better resources for HR professionals on how to provide effective
accommodations for employees with mental health disabilities. Finding appropriate
accommodations for invisible disabilities can often be challenging and HR professionals need
resources to provide the most effective accommodations to support employees with mental
health disabilities. The third and final recommendation presented is to work to create alignment
between employee wellness and organizational profitability.
Recommendation 1: Provide Managers and HR Professionals with Suitable Training to
Support Employees with Mental Health Disabilities
According to the findings in this study, providing direct managers and supervisors, and
HR professionals with training to support employees specific to their position is essential to the
employees’ success of supporting employees with mental health disabilities in the workplace.
HR professionals participating in the study reported that direct managers and supervisors had a
lack of self-efficacy and knowledge of mental health disabilities, resulting in the supervisors not
recognizing the signs of an employee struggling with mental illness, or supervisors immediately
passing the employee onto HR professionals without any attempt at intervention. Bandura (2000)
theorized that change in behavior and learning is caused by self-efficacy, or an individual’s
belief of their capability to perform a particular behavior to achieve the desired outcome.
According to participants, direct managers’ lack of self-efficacy is contributing to their lack of
support for employees with mental health disabilities. Training on types of mental health
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disabilities could improve self-efficacy for direct managers making them more likely to support
employees with mental health disabilities. Participants reported that as a profession, HR
professionals also needed training on how to support direct managers and supervisors, which
would ultimately support employees. Bandura (2000) also theorized that change in behavior and
learning is caused by models, or by observing others, if given appropriate training, HR
professionals could model the behaviors desired of direct supervisors to best support employees
with mental health disabilities and avoid them being passed on to HR before it becomes
necessary.
The type and quality of diversity training also impact the success of the training. The
literature suggested that diversity training lasting 4.5 to 6 hours is sufficient in effectively
changing attitudes towards diversity and therefore provides an appropriate benchmark for
organizations (Phillips, 2016). Training should provide HR professionals with greater knowledge
about legal protections and workplace intervention strategies for employees with mental health
disabilities, so they are better able to provide support to both direct managers and employees
with mental health disabilities as needs for additional support arise (Iwanaga et al., 2019; Nogues
& Finucan, 2019). Implementing mandatory Mental Health First Aid (MHFA) and work-focused
therapies such as one-on-one coaching on specific work performance problems for HR
employees and direct supervisors creates a support system best conducive to supporting
employees with mental health disabilities in being more successful in the workplace (Nogues &
Finucan, 2019). Best practices should be developed by professionals in the field and could be
communicated through professional HR organizations’ conferences and social media. It is
difficult to create universal best practices in the context of the field of HR rather than a particular
organization but using an established evaluation model will help to identify deficiencies. Clark
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and Estes’s (2008) gap analysis model can be used to evaluate knowledge, motivational, and
organizational influences that impact HR professionals’ ability to provide support for employees
with mental health disabilities. The results of this gap analysis can be used by industry HR
leaders to establish a toolkit of universal best practices for supporting employees with mental
health disabilities and would provide guidance that could be used throughout the field.
Recommendation 2: Provide Resources for HR Professionals on Providing
Accommodations for Mental Health Disabilities
This study’s data indicated that participants felt that providing resources for HR
professionals on how to best provide accommodations for mental health disabilities would better
support employees with mental health disabilities. According to participants, HR employees
must recognize when there is a need for accommodations and then have access to the relevant
resources to help facilitate providing the accommodations in the workplace. Studies show that
HR professionals with greater knowledge about legal protections and workplace intervention
strategies for people with mental health disabilities are better able to provide support to
employees with mental health disabilities (Iwanaga et al., 2019; Nogues & Finucan, 2019).
As an organizational influence, accommodation resources and training on how to best
support employees with mental health disabilities will impact both behavior and self-efficacy of
employees (Bandura, 2000). Bandura (2000) theorized that high-self efficacy leads to learning
and behavior changes, meaning that improved self-efficacy for HR employees through training
and increased resources on best practices for mental health disability accommodation could lead
to better accommodations for employees with mental health disabilities. The best practices
toolkit for providing support for employees with mental health disabilities in the workplace
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mentioned in the previous section should also include best practices for providing
accommodations.
Recommendation 3: Work to Align Investment in Employee Wellness with Organizational
Profitability
Participants in this study communicated the alignment of organizational profitability with
an investment in employee wellness best supports employees with mental health disabilities and
provides a sustainable way to ensure support for employees with mental health disabilities.
Participants suggested creative solutions that promote employee wellness and cost the
organization significantly less, such as granting short-term leave to new employees not yet
eligible for FMLA to improve new employee retention and avoid costly turnover. The literature
demonstrated that not supporting employees with mental health disabilities can be costly, as
major depressive disorder alone represents a significant economic burden estimated at
$210 billion in the United States in 2010 (Bastien & Corbière, 2018).
Study data also showed that HR professionals did not feel that supporting employees with
mental health disabilities was central to their role as HR professionals but did not provide a
solution to this support gap. Social cognitive theory argues that if the value of the desired
behavior is evident, then people will be motivated to change their behavior (Bandura, 2000).
Applying Bandura’s social cognitive theory (SCT) in the context of this study, for HR
professionals to successfully support employees with mental health disabilities, the organization
must place value on supporting employees with mental health disabilities and HR professionals
need to see supporting employees with mental health disabilities as a core aspect of their role.
This study reinforced the need to support people with mental health disabilities in the
workplace. In the study, COVID-19 as a pandemic emerged as a factor that has contributed to an
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increased need for mental health services for employees in the workplace. The pandemic created
a need for advancements in telehealth which research has shown to be particularly effective in
delivering mental health services (Zhou et al., 2020). Telemental health provides an opportunity
for employers to provide support to their employees in a cost-effective, confidential way. Studies
have shown that mental health online leads to improved employee retention and productivity for
people with mental health disabilities (Zhou et al., 2020).
Limitations and Delimitations
In this study, as in all studies, there were limitations or things the researcher cannot
control, and delimitations or choices that may have implications on the data collected. Potential
limitations included HR professionals not wanting to take the survey, not feeling comfortable
taking the survey, or might not self-report accurately about their treatment of employees with
mental health disabilities in seeking social desirability. The interviews took place on Zoom rather
than in person, because of geographic constraints and safety protocols of the COVID-19
pandemic. Conducting the interviews over Zoom is another limitation because it may have
impacted the study. In-person interviews might have felt less formal and made participants more
likely to speak openly.
There are also delimitations or choices made by the researcher that may have
implications on the data collected. Given the participant population selected, an HR professional
might have had little or no experience working with people with mental health disabilities. There
may have been other people within an organization that more closely work with people with
mental health disabilities that were missed in the sampling because they were not identified as
HR. Additionally, the focus was on the experience of the HR professionals themselves and not
on the direct experience of employees with mental health disabilities, which could have led to
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skewed data. This indirect perspective impacted the data collected but was necessary due to the
topic’s sensitive nature. All seven interview participants reported their current positions were at
companies with a healthy climate for providing support for people with mental health disabilities
but four of seven reported negative past experiences working at organizations that they felt did
not support people with mental health disabilities. The fact that all HR professionals interviewed
reported a healthy climate for providing support for employees with mental health disabilities
likely had an impact on the findings of this study. Lacking the perspective of HR professionals
currently at organizations that do not provide support for people with mental health disabilities
limits the generalizability of this study. And finally, surveys were distributed online because it
was convenient, but it also may have narrowed the pool as some HR professionals might have
ignored it, filled out only some questions, or not had home access to a computer and internet to
complete it or access to a computer or internet connection strong enough to participate in an
interview.
Recommendations for Future Research
Future research on the effectiveness of mental health accommodations from the first-hand
account of employees with mental health disabilities would be valuable. This should be
conducted by a medical professional to ensure ethical data collection and participants are not
harmed. Based on the data gathered in this study, HR professionals expressed the problem of
improper manager training in supporting employees with mental health disabilities. This study
provided the perceptions of HR professionals of their own ability to support people with mental
health disabilities, but further research from the perspective of managers’ and supervisors’ self-
efficacy and ability to provide support to employees with mental health disabilities would be
beneficial. The data in this study also found that HR professionals did not see providing support
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for employees with mental health disabilities as central to their role, which leads to the need for
further research to answer the question: if supporting employees with mental health disabilities is
not a central role of HR, which role is responsible for this support? And finally, based on the
findings in this study that there is still a significant stigma associated with mental health
disabilities in the workplace, additional research on how the stigma can be reduced is necessary.
Implications for Equity
Equity for employees with disabilities is essential to their success in the workplace and in
their lives. Ensuring equity and protection from discrimination against people with mental health
disabilities during the hiring stage. Research has shown that disclosing a mental health disability,
particularly during the hiring process often results in the candidate with the mental health
disability being screened out before they have made it to the interview stage (Dolce & Bates,
2019). If people with mental health disabilities are unfairly eliminated before the interview stage,
then they will continue to be unemployed or underemployed at a higher rate than their peers
without a mental health disability (Brohan et al., 2012; Sharac et al., 2010), resulting in lack of
equity.
Conclusion
This study focused on supporting employees with mental health disabilities in the
workplace from the perspective of HR professionals. Bandura’s (2000) social cognitive theory
was used to frame the problem of discrimination and stigma of mental health disabilities and
make recommendations to help mitigate these issues. This study identified three key findings: (1)
the perceived training inadequacies of direct managers, supervisors, and HR professionals, (2)
the challenges associated with providing accommodations for employees with mental health
disabilities, and (3) HR professionals’ challenge of balancing organizational profitability with
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supporting employees with mental health disabilities. Three recommendations were identified:
(1) provide direct managers, supervisors, and HR professionals with specific training and best
practices to support employees with mental health disabilities, and (2) provide better resources
and best practices for HR professionals on how to best provide accommodations for mental
health disabilities, and (3) create alignment between employee wellness and organizational
profitability. While this is not an exhaustive list of recommendations, it identifies areas of
improvement for HR professionals and organizations to improve the support for employees with
mental health disabilities in the workplace. Due to the negative impact that discrimination and
stigma have on the workplace success of people with mental health disabilities, it is critical that
organizations work together to make the workplace more inclusive for all people. HR
professionals are the primary source of support for employees with mental health disabilities in
the workplace, as a result, a best practices toolkit and presenting studies about mental health
disabilities in the workplace and at conferences with HR professionals are necessary next steps.
Without the buy-in of HR professionals and the necessary resources in place, the stigma and
discrimination of people with mental health disabilities will continue to harm people with mental
health disabilities and remain a barrier to equity.

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95

Appendix A
Survey Protocol
You are invited to complete a brief survey as part of Kindra Bartz’s doctoral study on
human resources (HR) professionals’ ability to provide support to employees with mental health
disabilities. The purpose of the study is to understand your experiences as a HR professional in
the context of supporting employees with mental health disabilities by providing
accommodations and ensuring their fair treatment in the workplace. For the purpose of this
study, support is defined as HR professional’s role as gatekeepers to accommodations and
providing accountability for the employees and organization to follow policies and state and
federal laws. Results will be aggregated and used to identify recommendations on how to
improve support of employees with mental illness by HR professionals. The survey should take
about 5-10 minutes to complete. There are no right or wrong answers. Your honest responses
will be the most helpful to the study. You may skip any question you do not wish to answer, and
you may stop the survey at any time. All responses are anonymous. If you agree to participate
in the survey, please click “Continue” below:

Question
Open
or
closed?
Level of
measure
ment
Response options
(if close-ended)
Research
question
Conceptual
framework
1. How long have you
been in HR?
Closed Ratio 0-1 years, 2-3
years, 5-10 years,
10 or more years
Warm-up

2. What is your current
role within HR?

Open

Varies

Warm-up

96

3. Policy and procedure
within my organization
as a whole positively
impacts my ability to
support employees with
mental illness.
Closed Ordinal agree, agree more
than disagree,
disagree more than
agree, disagree
RQ 2 Organizational
influences

4. Policy and procedure
within my department
positively impacts my
ability to support
employees with mental
illness.
Closed Ordinal agree, agree more
than disagree,
disagree more than
agree, disagree
RQ 2 Organizational
influences

5. As an HR
professional, I am
confident in my ability
to support employees
with mental health
disabilities
Closed Ordinal agree, agree more
than disagree,
disagree more than
agree, disagree
RQ 2 Motivation (self-
efficacy) &
organizational
influences
6. Supporting employees
with mental illness is a
central part of my job as
an HR professional.
Closed Ordinal agree, agree more
than disagree,
disagree more than
agree, disagree
RQ 2 Motivation
(value) &
organizational
influences
7. I am confident in my
knowledge about the
different types of mental
illness.
Closed Ordinal agree, agree more
than disagree,
disagree more than
agree, disagree
RQ 3 Motivation (self-
efficacy) &
knowledge
8. What types of mental
illness have employees
you have worked with
disclosed?
Open Varies RQ 2, 3 Organizational
influences &
knowledge
97

9. The values of my
organization positively
impact my support of
employees with mental
health illnesses.
Closed Ordinal agree, agree more
than disagree,
disagree more than
agree, disagree
RQ 2, 3, 4 Organizational
influences
10. My organization
encourages me to
support employees with
mental illness.
Closed Ordinal agree, agree more
than disagree,
disagree more than
agree, disagree
RQ 2, 4 Organizational
influences
11. My organization
makes supporting
people with mental
illness a priority.
Closed Ordinal agree, agree more
than disagree,
disagree more than
agree, disagree
RQ 2, 4 Organizational
influences
12. State laws
positively impact my
ability to support
employees with mental
illness.
Closed Ordinal agree, agree more
than disagree,
disagree more than
agree, disagree
RQ1 External
influences
13. Federal laws
positively impact my
support for employees
with mental illness.
Closed Ordinal agree, agree more
than disagree,
disagree more than
agree, disagree
RQ1 External
influences
14. What programs or
training, if any, does
your organization
currently have to
support employees with
mental illness?
Open Varies RQ2 Organizational
influences
15. I recommend that
my organization do the
following to better
support our employees
with mental illness.
Open Varies RQ 2, 4 Organizational
influences

98

Appendix B
Interview Protocol
Introduction to the Interview:
I am Kindra Bartz, and I am a student at USC working on my dissertation. Thank you
very much for agreeing to talk to me today. Your perspective is really valuable to this study. I
am going to take a couple of notes to make sure that I capture your perspectives accurately, so I
can come back to them if necessary. I’d also like to record if that’s okay with you? The purpose
of the recording is to make sure I capture your perspectives accurately. Only I will have access to
the recording, and it’s just a way for me to go back to what you’ve said to make sure that I’m
capturing your perspectives. Would that be OK with you?
I am interested in learning more about HR and how HR professionals, like yourself,
function within the private sector. Specifically, I am hoping to hear about your experiences in
supporting people with mental illness. By support, I mean assisting employees with mental
health disabilities in receiving accommodations and being treated fairly in the workplace. This
interview is completely confidential and will not be tied to you or your organization in any way.
I appreciate your time and you agreeing to this interview. It should only take about 45-60
minutes, but you can always skip a question or end the interview early at any point for any
reason. Can I answer any questions for you before we get started?

99

Interview questions Potential probes
RQ
addressed
Conceptual
framework
concept

1. How did you get started in
Human Resources?

Warm-up

2. What is your current role within
human resources?
Have you held any other
positions within HR?
Warm-up
3. What other roles have you held
professionally?
How has your previous work
history impacted your work in
HR?
Warm-up
4. What are the different types of
mental illnesses employees may
have?
What do you think most
employees at your organization
would say about working with
employees with mental illness?
RQ3 Knowledge &
stigma
5. How do you feel your
organization’s values impact
your ability to provide support to
employees with mental illnesses?
How does that impact your
support of employees with
mental illnesses?
RQ2 Organizational
influences
6. How do policies within your
organization influence the
support of employees with
mental illness?
How do you feel about the
support for employees with
mental illness that is available
within your organization?
RQ2 Organizational
influences
7. Tell me about how laws impact
your ability to support
employees with mental health
disabilities.
RQ1 External
influences
8. How do you feel employees with
mental illness are supported
within your organization?
Do you feel other HR
professionals within your
organization would feel
similarly?
RQ2 Organizational
influences
9. How does your organization
influence your ability to support
employees with mental illness?
RQ2 Organizational
influences
100

10. How confident are you in your
ability to support employees with
mental health illnesses?

Why do you think that is?

RQ3

Motivation
(self-efficacy)
& stigma
11. What does your organization do
to encourage HR employees to
support employees with mental
illness?
How effective is this in
motivating HR employees to
provide support?
RQ4 Organizational
influences
12. What value do you think your
organization puts on supporting
employees with mental illness?
RQ 2, 4 Organizational
influences
13. Tell me about an experience
where you successfully provided
support for an employee with
mental illness.
What do you think prepared you
to provide this type of support?
RQ 2, 3 Motivation
(self-efficacy)
&
organizational
influences

14. What procedures do you think
your organization needs to best
support people with mental
illness?
How do you think most HR
professionals within your
organization feel?
RQ2 Organizational
influences
15. Can you tell me about a
challenge you had supporting an
employee with mental illness?
How do you feel about the
support you are provided your
organization?
RQ 2 ,3 ,4 Motivation
(self-efficacy),
organizational
influences, &
stigma

Conclusion to the Interview:
Thank you again for your time. As I said before, your perspective is valuable to this
study. I want to be respectful of your time, but do you have any follow-up questions before we
finish up? As a reminder, everything you shared here is completely confidential. You also have
my contact information should you have questions later.

101

Appendix C
Information Sheet for Exempt Research

University of Southern California
Rossier School of Education
3470 Trousdale Pkwy, Los Angeles, CA 90089

INFORMATION SHEET FOR EXEMPT RESEARCH

STUDY TITLE: Mental Health Disabilities in the workplace: The impact of human
resources professionals

PRINCIPAL INVESTIGATOR: Kindra Bartz

FACULTY ADVISOR: Helena Seli, PhD

You are invited to participate in a research study for a doctoral dissertation. Your
participation is voluntary. This document explains information about this study. You
should ask questions about anything unclear to you.

PURPOSE
The purpose of this study is to explore HR professionals ’ experiences and perspectives
in supporting employees with mental illness. You are invited as a possible participant
because you are a human resource (HR) professional in a corporation with over 10,000
employees.

PARTICIPANT INVOLVEMENT
If you decided to participate, you will be given an anonymous, short online survey. You
and your organization will not be tied to your survey in any way. You also have the
opportunity to do an online interview should you chose to participate. You will be given a
separate link at the end of the survey to preserve anonymity. You will be asked if the
researcher can take notes and record the interview. You can choose to decline the
recording and still participate in the interview.

PAYMENT/COMPENSATION FOR PARTICIPATION
If you chose to participate and complete the interview, you will be offered a $50 Amazon
gift card for your participation in the interview.

Version Date: 5.2.21 Page 101 of 112
USC IRB Information Sheet Template Version Date: 07/27/2019

102

CONFIDENTIALITY
The members of the research team, and the University of Southern California
Institutional Review Board (IRB) may access the data. The IRB reviews and monitors
research studies to protect the rights and welfare of research subjects.

When the results of the research are published or discussed in conferences, no
identifiable information will be used. The information will be kept confidential and will be
destroyed after the study is complete. Any Zoom video recordings will also be destroyed
when the study is published in the Spring of 2022. Participants will be referred to in all
transcripts and data by number with no organizational affiliation attached.

INVESTIGATOR CONTACT INFORMATION
If you have any questions about this study, please contact Kindra Bartz, the primary
investigator at kbartz@usc.edu or 785.760.0565, or USC faculty advisor Helena Seli at
helena.seli@rossier.usc.edu.

IRB CONTACT INFORMATION
If you have any questions about your rights as a research participant, please contact the
University of Southern California Institutional Review Board at (323) 442-0114 or email
irb@usc.edu.

Version Date: 5.2.21 Page 2 of 112
USC IRB Information Sheet Template Version Date: 07/27/20

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Asset Metadata

Creator Bartz, Kindra Lynn (author)

Core Title Mental health disabilities in the workplace: exploring human resource professionals’ practices

School Rossier School of Education

Degree Doctor of Education

Degree Program Organizational Change and Leadership (On Line)

Degree Conferral Date 2022-05

Publication Date 04/20/2022

Defense Date 04/14/2022

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag human resources,Mental Health,OAI-PMH Harvest

Format application/pdf (imt)

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Seli, Helena (committee chair)

Creator Email kbartz@usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-oUC111037426

Unique identifier UC111037426

Document Type Dissertation

Format application/pdf (imt)

Rights Bartz, Kindra Lynn

Type texts

Source 20220421-usctheses-batch-931 (batch), University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the author, as the original true and official version of the work, but does not grant the reader permission to use the work if the desired use is covered by copyright. It is the author, as rights holder, who must provide use permission if such use is covered by copyright. The original signature page accompanying the original submission of the work to the USC Libraries is retained by the USC Libraries and a copy of it may be obtained by authorized requesters contacting the repository e-mail address given.

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA

Repository Email cisadmin@lib.usc.edu