People with bipolar often face workplace challenges. The right job, possibly with accommodations, can bolster well-being. But stepping back, temporarily or permanently, can be essential for stability.

Suzanne G. of Westmont, Illinois, made one of the toughest decisions of her life in 2019 when she left a 25-year career as a corporate paralegal — and the nearly six-figure salary that came with it — because of her Bipolar 1 symptoms.

Suzanne then began part-time work at a call center to earn a bit of money, which went well until she was given an encyclopedic set of new rules. Calls were going to be monitored, and slips-ups meant negative reviews. She started feeling a pit in her stomach every time she clocked in.

“Just the knowledge that somebody was going to be evaluating the call — and that there were all these things I couldn’t say or do — made my anxiety ramp up,” she recalls. “Sitting in the parking lot for 10 or 15 minutes before going in the building devolved into me lying in bed and saying, ‘I can’t do this again.’”

Suzanne realized it was in her best interest to quit the call center, too, although it wasn’t easy to let go, given that she was raised never to leave one job without having another lined up.

“I thought I was letting my family down and letting myself down,” she recalls. “It took a while for me to be comfortable putting my Mental Health first.”

Managing Bipolar Symptoms Can Be a Full-Time Job

Apart from needing the income, our jobs often are a major part of our identity. “So, what do you do?” is one of the first questions strangers ask when introduced. It seems an obvious inquiry given that, on average, adults spend 90,000 hours — about one-third of their lifetime — at work.

But the topic can be a sore spot for those living with bipolar. Mood symptoms may make it difficult to keep a job, much less advance in the workplace. For some, like Suzanne, the financial security of having a paying job must be weighed against the constant risks of triggering an episode. When people say that managing their illness is a full-time job, it’s no joke.

Yet there are rewards to be had, even if you aren’t able to secure a full-time job.

Research has linked satisfying work to higher self-esteem, a stronger sense of identity and purpose, and the gratifying feeling of contributing to society. Plus, work routines provide daily structure that promotes greater stability.

In fact, an article published in 2020 in Epidemiology and Psychiatric Sciences called employment “a critical mental health intervention.” Co-author Robert E. Drake, MD, Andrew Thomson Professor of Health Policy and Clinical Practice at the Geisel School of Medicine at Dartmouth in Hanover, New Hampshire, argues that advancing employment opportunities should be a central goal of treatment because it improves the quality of life, social relationships, and a host of other benefits “consistently” and “without harmful side effects.”

In addition, evidence links employment to a lower short-term risk for psychiatric hospitalization.

That said, securing those advantages outside of a traditional full-time job scenario is possible. There’s no official definition for what constitutes productive, pleasing work. That can be a top-tier supervisory position, a post at a fast food drive-thru, or any number of options that offer a paycheck.

Overcoming Workplace Challenges With Bipolar Disorder

On the face of it, statistics paint a grim picture of bipolar and joblessness. Some statistics suggest that just 10 to 15 percent of people with bipolar have paid employment. However, a systematic review of studies on the subject, published in a Scandinavian peer-reviewed medical journal in 2013, put that figure closer to 60 percent — or 6 in 10 people with bipolar gainfully employed. The percentage was even higher among those newly diagnosed. 

Even so, that same analysis also linked bipolar with a slide in occupational status over time.

Lisa O’Donnell, PhD, an assistant professor at Wayne State University School of Social Work in Detroit and a clinical social worker in private practice, investigated aspects of bipolar in the workplace in both her 2016 dissertation and a team investigation published in the Journal of the Society for Social Work and Research in 2017.

Among the findings: As many as 80 percent of employees with bipolar experience vocational impairments — difficulty preparing for, obtaining, or keeping employment in a job consistent with abilities, aptitudes, and interests — despite education levels higher than the general population.

Those who experience depression and cognitive dysfunction are more likely to have lower job satisfaction, more issues with absenteeism, and lower work quality. While higher levels of mania initially were associated with improved attendance, mania ultimately had negative effects on attendance, overall work functioning, and work performance.

Bipolar and Work Attendance: What to Know

Mood episodes impact not only the ability to carry out job duties but also relationships with co-workers and supervisors. Mania may bring about poor judgment and impulse control, an inability to concentrate, hostility, and grandiose thinking. Depression may make it exhausting to interact with others, much less remember details, make decisions, or just get out of bed and get to work.

Jennifer C. of Phoenix, Arizona, lost three jobs due to bipolar episodes.

“I would be in bed sick for days [with depression] and not be able to even call in to work to say I wasn’t going to be there, which is how I lost one job,” she says.

Jennifer lost another job due to mania: “You lose total track of time. A day or two would go by and I wouldn’t even realize I missed work.”

Since going AWOL at work increases the risk of getting fired, Dr. O’Donnell suggests planning for simple workarounds. 

“Even if it’s copying and pasting a previous email to say, ‘Hey, I’m sick today. I’m not going to be able to come in. I’ll let you know about tomorrow,’ or, ‘Can you get someone to cover my shift today because I’m sick?’ Just let somebody know,” she advises.

O’Donnell notes that mood-related behaviors aren’t always to blame when things get rocky at work. Social stressors such as isolation, conflict with others, and derogatory treatment often play a role in job satisfaction and retention.

“A lot of the issues that people with bipolar have reported in the workplace have been related to discrimination and stigma — not necessarily to their condition,” says O’Donnell, whose current research continues to explore interpersonal influences on job success for those with mood disorders and anxiety.

Substance abuse, sleeping disorders, and medication side effects also contribute to challenges holding down a job, she adds.

Going Back to Work With Bipolar Disorder

Sometimes achieving a stable, healthy life means steering clear of a full-time, lock-step work schedule. Some people safeguard flexibility by starting a home business or running a service-oriented enterprise such as housecleaning, pet-sitting, or dog-walking. Others switch to part-time work that leaves more time for self-care. 

Then there are individuals who need to make a clean break — whether temporarily or long-term.

After her third job loss, Jennifer stepped away from the workforce to focus on managing her symptoms. She committed to seeing a therapist and sticking to a medication regimen. 

After two years, she felt secure enough in her stability to take a job as an administrator for a national discount retailer. While she knows her downtime was necessary, she welcomes having job responsibilities and being an active part of a team again.

“My days now have more meaning,” she says. “Instead of sitting at home going in and out of episodes, feeling isolated and lonely while trying to cope, this gets me out of the house. I feel like part of the world again.”

Of course, paid work isn’t the only type of work that’s valuable. Volunteerism has been shown to have similar benefits for reducing anxiety and depression, according to the University of Maryland Medical System. Contributing time and talent to a cause you value provides purpose, structure, and an opportunity to meet people who share your interests, all at your own pace. 

Figuring out the level of stress you can realistically handle without triggering mood symptoms or disruptive episodes will go a long way toward knowing where you fit in the job market — or whether you fit at all.

To Work or Not to Work? When To Leave a Job to Focus on Your Mental Health

Former mechanic Mark B. of Mesa, Arizona, used to “zoom up and down” before he went on full disability. The strain that came from repairing commercial lawn and garden equipment for big landscaping companies kept him “seemingly manic all the time during the busy season,” he says.

He’d rarely sleep. He would be irritable with his wife. His stomach stayed in knots.

“Even though I was making good money, I was miserable,” he says. “I have an emotional support animal, a big dog, and even he didn’t want to hear me talk anymore.”

Mark emphasizes that his decision to go on disability took time.

“It was a big step and a slow process,” he says. “But one day I just said ‘I can’t do this.’ I don’t know what that trigger was, but it had been loading up for a long time.”

Mark and his wife now get along on her income and his disability payments. He pitches in by taking care of the house and their four pets. He also spends a lot of time with his guitar. (“I can play anything from ‘Amazing Grace’ to ‘Highway to Hell,’” he says.) Now that he’s more relaxed, he reports, his manic symptoms have mostly plateaued.

Is Bipolar Disorder Considered a Disability for Work?

Whatever your reason for wanting to work — whether it’s for a sense of fulfillment or to pay the bills — there are supports available to help you be successful.

Those supports are seriously needed, given that two-thirds of people with serious psychiatric disorders want competitive paid employment, according to psychiatrist William Torrey, MD, a professor and chair in the psychiatry department at Dartmouth-Hitchcock and the Geisel School of Medicine at Dartmouth College. Dr. Torrey was involved in early studies on a type of vocational rehabilitation called supportive employment.

Supportive employment was developed to provide training and assistance to people with disabilities, including mental health conditions, so they can function well in the workplace. Torrey points out that since the early 1990s, there have been 28 case-controlled studies showing this method to be especially effective in helping people obtain and maintain jobs.

A similar principle is codified in the Americans with Disabilities Act (ADA), which requires employers to provide reasonable work accommodations. Sometimes, even small changes can go a long way toward job success.

Accommodations may include:

• Flexible hours
• Regular breaks 
• Time off for treatment
• Working from home
• A work environment free from distractions

“This is not to prevent problems from happening, because the reality is that they will,” explains O’Donnell. “It’s to put things in place so there’s not a negative impact on your work status.”

There are limits, however. For example, employers are not required to provide indefinite leaves of absence and tolerate erratic attendance and behavior.

Disclosing Bipolar Disorder at Work

A psychologist told Janet M., of Charles Town, West Virginia, that she didn’t need to disclose her specific diagnosis of bipolar 1. Instead, she should simply tell her employer: “I have a mental illness.”

Janet, who does administration accounting and analysis work for the federal government, wound up being moved to a different office to avoid a distracting co-worker. On difficult days, she’s able to leave work early or work a full day from home.

Although ADA protections require documenting a disability, the level of documentation depends on the situation and employer. Janet’s advice is be confident in your abilities to do the job you’re in, even if that required some accommodations. 

If accommodations are not available due to the nature of the work, consider working with a vocational psychologist specially trained in helping people with a disability find a job or career.

Bipolar Doesn’t Mean Giving Up on Career Dreams and Aspirations

While it might be prudent to forgo a position that prevents adhering to a regular sleep schedule — one requiring frequent trips between the United States and Dubai, for example — nothing needs to be off the table without careful thought, says Torrey.

“Some people with bipolar can successfully manage extremely stressful, high-responsibility jobs, so a diagnosis in and of itself doesn’t eliminate anything,” Torrey continues. “Our dreams and aspirations in life are what draw us forward and bring us meaning. The aim should be to put in the supports and strengths and skills for what you want.”

And, as Jennifer has found, doing what you like to do gives each day more significance.

Suzanne returned to school to study American history — something she has long wanted to do — and is in the midst of a new job search. This time around — with a more confident, happier outlook — she’s looking for positions in which she can be more autonomous than in her previous positions, such as writing grant applications from home or working in a research lab or think tank.

“This opens up a whole new range of jobs I could do that mesh much better with my diagnosis,” she says. “The bipolar impacts how I work, but it doesn’t mean that I can’t work. I’m the one in control, and that’s a big difference.”

Bipolar and Employment: A Guide to Thriving in the Workplace

Here are a few things to keep in mind when trying to get — and keep — a job:

The choice is yours. Disclosing that you have bipolar is a highly individualized decision. You’re under no obligation to discuss a diagnosis during the hiring process.

Flexibility matters. Consider the hours required and potential stress level, and whether a part-time position may suit you better than full-time work.

Creativity counts. Many people with bipolar thrive when they have a chance to be creative on the job — or when they take on a work schedule that allows time for creative pursuits outside of work.

Be communicative. Notify someone when you won’t be able to make it in. “You can say, ‘I’m taking sick leave because I’m unable to perform at the level this job deserves,” says Torrey. In doing so, “you’re emphasizing that the job is important and you care about what the company is trying to achieve.”

Find the Best Resources

The more you know, the more support you can receive.

• Become familiar with laws that protect people from discrimination due to disability. Check out:
  •  Americans with Disabilities Act
  •  Family and Medical Leave Act
  •  Social Security Administration

• Find state-based resources for connecting employers with candidates with disabilities through the Employer Assistance and Resource Network on Disability Inclusion.

• Check out the answers to questions about workplace accommodations at the Job Accommodation Network.

Editorial Sources and Fact-Checking

• One Third of Your Life Is Spent at Work. Gettysburg College News. 

• Krauss S, Orth U. Work Experiences and Self-Esteem Development: A Meta-Analysis of Longitudinal Studies. European Journal of Personality. July 2021. 

• Drake R, Wallach M. Employment Is a Critical Mental Health Intervention. Epidemiology and Psychiatric Sciences. November 2020. 

• Luciano A, Metcalfe J, Bond G, et al. Hospitalization Risk Before and After Employment Among Adults With Schizophrenia, Bipolar Disorder, or Major Depression. Psychiatric Services. June 2016. 

• Marwaha S, Durrani A, Singh S. Employment Outcomes in People With Bipolar Disorder: A Systematic Review. Acta Psychiatra Scandinavica. September 2013. 

• O’Donnell L, Himle J, Ryan K, et al. Social Aspects of the Workplace Among Individuals With Bipolar Disorder. Journal of the Society for Social Work and Research. Fall 2017. 

• The Health Benefits of Volunteering. University of Maryland Medical System. 
  
• The Americans With Disabilities Act (ADA) Protects People With Disabilities From Discrimination. U.S. Department of Justice Civil Rights Division.

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