Journal of Vocational Rehabilitation 45 (2016) 327–336 327

DOI:10.3233/JVR-160833
IOS Press

Psychologically healthy workplaces,

disability management and employee
mental health
Wendy A. Codutia,∗ , Cayte Andersonb , Kat Luic , John Luib , David A. Rosenthald , Norman Hurshe
and Young-An Raf
a The Pennsylvania State University, University Park, PA, USA
b StoutVocational Rehabilitation Institute (SVRI), University of Wisconsin-Stout, Menomonie, WI, USA
c Metropolitan State University, St. Paul, MN, USA
d University of Wisconsin-Madison, Madison, WI, USA
e Boston University, Boston, MA, USA
f Handong Global University, Pohang, South Korea

Revised/Accepted January 2016

Abstract.
BACKGROUND: Mental health (MH) in the workplace affects employers financially through the increased use of health
care, disability leave plans and a loss of productivity (Ritter, Reif & McGuire, 2009).
OBJECTIVE: Increases in the prevalence of MH requires a better understanding of how employers can create workplaces that
are psychologically healthy and decrease the impact of MH, such as disability management (DM) programs. Understanding
how the workplace culture contributes to, or alleviates, the impact of MH in the workplace is critical.
CONCLUSION: Disability management programs, combined with psychologically healthy workplaces, are important for
ensuring that people with MH conditions have the supports in place through their employer to remain at work, or return to
work. However, understanding successful integration of new employees with MH conditions is also important as a supportive
workplace impacts the likelihood of continued employment.

Keywords: Psychologically healthy workplaces, mental health, disability management, workplace culture

1. Introduction 2011, p. 215). Vocational rehabilitation (VR) profes-

As the incidence rates of mental health (MH) have
increased so have the financial burdens for employers
and the need for increased supports in the work-
place for individuals with MH conditions. Increases
in workplace mental illness are a “growing concern
to the disability community” (Wagner & Harder,
∗ Address for correspondence: Wendy A. Coduti, Department
of Educational Psychology, Counseling and Special Education,
311 CEDAR, The Pennsylvania State University, University Park,
PA 16802, USA. E-mail: wac16@psu.edu.
sionals providing direct support to individuals with
MH conditions, need to be competent in identify-
ing workplace culture, practices, and programs that
support MH. In addition, VR must also recognize
employment settings and practices that contribute to
increases in MH conditions for employees (or poten-
tial employees). Often underestimated is the impact
that the employment environment has on employees
with MH conditions and the employers’ responsibil-
ity for the onset, or exacerbation, of MH conditions in
their own workers through a poor work environment.

1052-2263/16/$35.00 © 2016 – IOS Press and the authors. All rights reserved
328 W.A. Coduti et al. / Healthy workplaces, DM and employee mental health
Understanding the impact of the workplace culture
and creating psychologically healthy workplaces is
an important factor in decreasing the impact of MH
and ensuring continued employment for those with a
MH condition.
Disability management programs have been
around since the 1980’s (Harder & Geisen, 2011)
and have focused heavily on physical impairment in
the workplace and mitigating employer exposure to
costly expenses through programs designed to keep
injured employees at work, or to help them return-
to-work quickly. Disability management principles
can also be applied to MH conditions to decrease
costs and the likelihood of unemployment. Wag-
ner and Harder (2011) report that DM professionals
are “being called upon to provide information about
intervention and accommodation” for MH in the
workplace (p. 215), meaning professionals working
in this area need to recognize and become skilled in
workplace MH.
Culture of the workplace is an important factor
in employers adopting practices of psychologically
healthy workplaces and implementing DM strategies.
A culture that values its’ employees, and understands
the impact positive and negative work environments
can have on employee MH, can go a long way in
ensuring healthier work environments. In this paper
we will explore organizational features of psycho-
logically healthy workplaces, disability management
programs, and the interplay between the two, includ-
ing impact on employee mental health.
2. Mental health in the workplace
Whereas organizations are becoming more aware
of psychological health issues, high rates of men-
tal illness in the United States (U.S.) suggests that
workplaces are facing many barriers creating psycho-
logically healthy workplaces. Approximately 20% of
the adult U.S. population is diagnosed as having a
significant MH issue (National Institute of Mental
Health [NIMH], 2013). In a given year, 18.8 mil-
lion American adults (9.5% of the adult population)
will experience a depressive illness, 2.2% will expe-
rience symptoms of bipolar disorder, 1.1% will have
schizophrenia (NIMH, 2013), and schizoaffective
disorder will affect 1% of the U.S. adult popula-
tion (NIMH, 2013, National Alliance on Mental
Illness [NAMI], 2012). The World Health Organi-
zation (WHO) has documented the fact that mental
illnesses are the leading causes of disability world-
wide (WHO, 2011). Depression alone accounts for
one third of all who experience mental illness world-
wide (WHO, 2011).
There are significant environmental barriers such
as workplace stigma and work disincentives, which
are disability-related factors that diminish return-
to-work outcomes for persons with mental illness
(Baron & Salzer, 2002). In addition, there are often
insufficient community resources to provide ade-
quate psychiatric vocational services for persons with
mental illness. Despite a myriad of challenges and
barriers to employment, many individuals experi-
encing mental illness are successfully employed at
competitive jobs (Cook & Razzano, 2000; Drake,
Becker, & Bond, 2003; Rogers, Anthony, Toole, &
Brown, 1991). Persons with psychiatric disabilities
who are not working report that they want to work
and usually can be successful in integrated employ-
ment settings if appropriate community supports exist
(Bond, Drake, & Becker, 2008; Cook & Razzano,
2000). Workplace discrimination is also heightened
for persons with psychiatric disabilities because they
experience increased stigma, the lowest employa-
bility rankings, and the largest wage differential to
productivity rankings when compared to persons with
physical disabilities (Baldwin & Johnson, 1994).
2.1. The cost of mental illness in the workplace
The Agency for Healthcare Research and Quality
(2009) cites that the cost of mental health care in the
U.S. is higher than the cost of cancer care. However,
unlike cancer, much of the cost associated with men-
tal illness is not the cost of direct care, but the loss
of income due to unemployment, expenses for social
supports, and a range of indirect costs due to a long
term, pervasive illness that often begins early in life.
Data from 2010 estimated the global cost of mental
illness at nearly $2.5 trillion (two-thirds in indirect
costs), with a projected increase to over $6 trillion by
2030. To put this in context, the entire global health
spending in 2009 was $5 trillion. The annual GDP
for low-income countries is less than $1T. The entire
overseas development aid over the past 20 years is
less than $2T (Bloom, et al., 2011).
A World Economic Forum (WEF) report also
provides comparisons across non- communicable dis-
eases (NCDs) to provide the context of the drivers
of global costs and economic burden. Mental health
costs are the largest single source; larger than cardio-
vascular disease, chronic respiratory disease, cancer,
or diabetes (WEF, 2011). In fact, mental illness is
 W.A. Coduti et al. / Healthy workplaces, DM and employee mental health
projected to account for more than half of the pro-
jected total cost of NCDs over the next twenty years.
It is also important to consider that persons experienc-
ing mental illness are more susceptible to developing
cardiovascular disease, respiratory disease, and dia-
betes, and the true costs of mental illness must be
even higher (Bloom, et al., 2011).
Mental illnesses are the largest single driver to all
health care costs (WEF, 2011). Consider one of the
costliest illnesses to employers, bipolar disorder. A
study published in 2008 by Laxman, Lovibond and
Hassan, collected data on a sample of 761 workers
with bipolar disorder and 229,145 workers without
bipolar disorder. The annual cost of healthcare for an
employee with bipolar disorder was $6,836 more than
the control group average ($9,983 vs. $3,147). The
costs were not primarily associated with the cost of
direct care because many physical health conditions
are comorbid with bipolar disorder, so the group with
bipolar disorder scored higher costs in every mea-
surable health care cost category. The absentee rate
for the bipolar group was 18.9 workdays per year,
while workers without bipolar disorder missed 7.4
workdays. Because the number of missed workdays
was so large, many in the bipolar group spent time
on short-term disability, adding increases in insur-
ance premiums and ratings to the cost of lost days of
work. Worker compensation 2008 costs also were sig-
nificantly higher. In terms of productivity, the output
of the workers with bipolar disorder was 20 percent
less than that of those without the illness. This was
affected by the decrease in performance brought on
by working while cycling through a depressive or
manic episode (Laxman et al., 2008).
2.1.1. Additional costs associated with mental
health
Businesses and DM professionals are proficient at
addressing employee physical health, yet promoting
employee MH is often ignored. The financial bur-
dens of depression, anxiety, and emotional disorders
are among the greatest of any disease condition in the
workforce (Johnston, Westerfield, Momin, Phillippi,
& Naidoo, 2009). Globally, a fifth to a quarter of
employees go to work every day with a mental illness
(Lorenzo-Romanella, 2011). Health care research has
shown the impact of mental illness on work perfor-
mance, however, many employers and researchers
are unaware of the value that quality mental health
care poses for employees and organizational costs
(Langlieb, & Kahn, 2005).
329
The effects of mental health issues in the workplace
span beyond what was previously only identified on
a spreadsheet through costs associated with absen-
teeism. Presenteeism includes characteristics of lost
productivity including lower concentration, energy
level and quality of work (Hargrave, Hiatt, Alexander
& Shaffer, 2008). Since many people with men-
tal illness feel stigmatized, many do not disclose
their condition to their employer. In fact, Lorenzo-
Romanella (2011) states that many of the reasons
for absenteeism and presenteeism are not under the
employees control and even when an invisible dis-
ability, such as mental illness, is cause for poor
performance and increased absenteeism, employees
still will not disclose their condition.
Schultz and Edington (2007) reported on stud-
ies finding that for many chronic health conditions,
lost productivity costs were higher than costs asso-
ciated with medical care. Specific to employees with
psychiatric diagnoses, Hargrave et al. (2010) found
that 80% of lost productivity costs were associated
with presenteeism with the remainder attributed to
absenteeism whereas for individuals with depression,
50% of lost productivity time was attributed to hav-
ing major depression (Stewart, Ricci, Chee, Hahn, &
Morganstein, 2003).
A study by Stewart et al. (2003) found that costs
for loss productivity in employees with depression
was estimated at $44 billion per year, which was
an excess of $31 billion per year when compared to
employees without depression. Compared with other
disease groupings, it was found that depression, anx-
iety and emotional disorders were the fifth costliest,
with 47% of costs related to direct costs and 53%
linked to indirect (Johnston et al., 2009).
2.2. Addressing mental health in the workplace
Related to psychologically healthy workplaces,
successful interventions and programs (including
DM programs) that address MH in the workplace
show parallel similarities, as shown in Table 1. For
example, Lorenzo-Romanella (2011) addresses bar-
riers for employees to disclose MH conditions to
employers; however, employers can address men-
tal health in the workplace by incorporating flexible
work arrangements and short breaks from work as
options for employees. Flexibility in the workplace
is linked to healthy workplaces since it encourages
work-life balance and increased health and safety.
Employee assistance programs (EAP), which sup-
port healthy workplace through work-life balance,
330 W.A. Coduti et al. / Healthy workplaces, DM and employee mental health

Table 1
Relationship between healthy workplaces and successful DM programs
Psychologically Healthy Psychologically Healthy Successful DM Program DM Program Benefits for
Workplaces Benefit Workplace Benefits for Components Benefit organization
Employees Organization Employees
Higher morale Improved quality, Active participation of Improved employee relations
performance and employees during process and morale; participation in
productivity process
Improved ability to manage Reduced absenteeism, Avoid long term absences Reduced employee turnover
stress presenteeism and turnover from work; resume and lost time
activities sooner
Increased job satisfaction Fewer accidents and injuries Retain productive Create safer, more
employment and job cooperative workplaces
security; maintain job skills
Better physical and mental Ability to attract and retain Retain benefits and insurance Retain experienced
health top-quality employees eligibility and pension employees; utilize for
packages non-work illness
Enhanced motivation Improved customer service Maintain income Boost overall productivity
and satisfaction and company image
Lower health care costs Lower health care costs Lower health care costs Manage workplace costs;
increase employee
awareness of costs for
injury and illness; reduce
hiring and training costs

employee growth, and development and health and
safety, have also shown significant opportunities for
employers to address MH issues in the workplace.
A return on investment showed that for every dollar
spent on EAP programs, a return of between $5.17
and $6.47 was found for employees with various
psychiatric conditions who participated in individ-
ual counseling through their EAP program (Hargrave
et al., 2008).
3. Organizational culture and impact on
employee mental health
Organizational culture is identified by the morals
and social concepts shared by members of an
organization and are displayed through an organiza-
tions’, “corporate objectives, strategies, management
philosophies, and in the justifications given for these”
(Dextras-Gauthier, Marchand, & Haines, 2012, p.
83; Schein, 2004). Organizational culture has been
shown to impact employee MH (Bronkhorst, Tum-
mers, Steijn, & Vijverberg, 2014; Kelloway & Day,
2005), especially anxiety and depression (Arnetz,
Lucas, & Arnetz, 2011; Martin, Karanika-Murray,
Biron, & Sanderson, 2014). For example, organi-
zations that promote autonomy and independence
in employee decision-making have been associated
with better MH outcomes (Dextras-Gauthier et al.,
2012). In contrast, higher MH distress has been
associated with work environments having fewer sup-
ports and less encouragement of employees (Eriksen.
Tambs, & Knardahl, 2006), and lack of autonomy
over work (Michie & Williams, 2003). Additionally,
MH conditions can be attributed to work injuries,
unsafe conduct, and unsafe working environments
(Nahrgang, Morgeson, & Hoffman, 2011), which can
also cause and/or aggravate MH conditions (Martin
et al., 2014).
Hurrell (2005; as cited in Dextras-Gauthier et al.,
2012) conveys that organizational investment in alle-
viating work-related MH issues has not resulted in
the outcomes anticipated. Dextras-Gauthier and oth-
ers (2012) state that increased attention needs to be
paid to organizational culture and its impact on MH,
and many interventions do not pay attention to incor-
porating both individual and organizational facets.
Although organizational attitudes towards mental ill-
ness are changing, workplaces continue to face issues
related to employee MH, revealing that industry must
continue to reform DM programs and to improve
workplace organizational cultures.
4. APA 5 Elements of psychologically healthy
workplaces
The concept of health and an employers’ role in
supporting healthy work environments has evolved
 W.A. Coduti et al. / Healthy workplaces, DM and employee mental health
over past decades. Sauter, Lim, and Murphy (1996)
define a healthy workplace as, “any organization that
maximizes the integration of worker goals for well-
being and company objectives for profitability and
productivity” (p. 250). The duality of this defini-
tion is important in that it recognizes the needs of
the employee as well as the needs of the organi-
zation (Grawitch, Gotschalk, & Munz, 2006). The
dual focus reflected in contemporary definitions of
a healthy workplace denotes a paradigm shift in
the conceptualization of health within organizations
(Grawitch et al., 2006).
This paradigm shift is also evident in concep-
tualizations of health promotion by including both
physical and MH. Health promotion, as considered
in the organizational and industrial context, was
originally conceptualized as a strategy for prevent-
ing and mitigating physical injuries incurred in the
workplace. As employers developed awareness of
the broader implications of disability prevention and
management programs, increasingly comprehensive
methods for retaining quality employees with phys-
ical disabilities emerged. As such, health promotion
and DM efforts have gained widespread acceptance
as employers and insurers recognize the importance
and cost savings involved with promoting employee
health as well as retaining quality employees with
disabilities.
While businesses and DM rehabilitation profes-
sionals, including vocational rehabilitation, have
become proficient in addressing physical health
issues, awareness of the need to promote and sup-
port employee psychological or MH is becoming
recognized as an important emergent area. Orga-
nizations now realize psychological health is an
important issue with 85% of individuals claiming
long-term disability (LTD), identifying MH con-
ditions as their primary disability (Carls et al.,
2012). Additionally, when reviewing LTD per claim
expense, MH disorder claims tend to be more
costly given the longer recovery timeframes and
increased difficulty returning work (Salkever, Gold-
man, Purushothaman, & Shinogle, 2000). Hodgson
(1996) defines MH promotion as “the enhance-
ment of the capacity of individuals, families, groups
or communities to strengthen or support positive
emotional, cognitive and related experiences” (p.
1). Interestingly, the workplace has remained an
underutilized setting for mental illness prevention
and MH promotion in the United States (Barkway,
2006).
331
4.1. Five elements of a psychologically healthy
workplace
The APA has identified five categories of
workplace practices that positively promote the psy-
chological health of employees in the workplace.
Specifically, employee involvement, work-life bal-
ance, employee growth and development, health
and safety, and employee recognition are acknowl-
edged as having merit in promoting the psychological
health of employees (APA, 2014). The reported orga-
nizational benefits of adopting the five elements
of a psychologically healthy workplace include (a)
improved quality, performance and productivity, (b)
reduced absenteeism, presenteeism and turnover, (c)
fewer accidents and injuries, (d) improved abil-
ity to attract and retain top-quality employees, (e)
improved customer service and satisfaction, and (f)
lower healthcare costs (APA, 2014).
4.1.1. Employee involvement
Employee involvement efforts empower work-
ers, increase autonomy, and involve employees in
decision making on behalf of the organization. Graw-
itch, Ledford, Ballard, and Barber (2009) suggest
that employee involvement efforts can be identified
and measured for efficacy along a continuum. Low
involvement strategies are primary management-
driven initiatives that include open door policies,
suggestion forums, and employee surveys. Moder-
ate involvement strategies require more participation
by management and involve joint committee work,
employee-driven committees and tasks forces, and
continuous improvement teams. High involvement
strategies are construed of high involvement systems,
self-managed work teams, and employee ownership.
High involvement strategies have been found to be
predictive of employee quality of work life and per-
formance, morale and organizational effectiveness,
and overall organizational performance (Cohen, Led-
ford, & Spreitzer, 1996; Gibson, Porath, Benson, &
Lawler, 2007; Vandenberg, Richardson, & Eastman,
1999). The issue is global in context, and consis-
tent with the World Health Organization’s (WHO)
guidance on MH promotion (WHO, 2002, 2007,
2010). The European Network for Workplace Health
Promotion (2009) recommends that mental or psy-
chologically healthy interventions should promote
empowerment and control over one’s work, and
include employees in decision making. Interestingly,
localized rather than organization-wide employee
332 W.A. Coduti et al. / Healthy workplaces, DM and employee mental health
empowerment strategies may be more appropri-
ate, feasible, and effective (Foster-Fishman & Keys,
1997).
4.1.2. Work-life balance
Work and other life responsibilities can conflict,
resulting in a reduced quality of work and home life
for employees. Subsequently, this can impact organi-
zational outcomes such as productivity, absenteeism,
and turnover (APA, 2014). The APA recommends
policies and programs that enhance work-life balance
including flexible work arrangements, childcare and
eldercare assistance, and family and partner benefits.
Efforts to help employees improve work-life balance
can improve morale, increase job satisfaction and
strengthen employees’ commitment to the organiza-
tion in addition to increasing employee productivity
and reducing absenteeism and turnover. While orga-
nizations may be willing to implement the latest
“work-life balance” programs, it is important to note
that achieving a healthy workplace requires consid-
eration of the interplay among the employee, the
organization, and the specific practice itself when
adopting healthy workplace strategies (Grawitch,
et al., 2009).
4.1.3. Employee growth and development
Increased motivation and job satisfaction are
outcomes of workplace learning and development
activities. Opportunities that offer employees ways
to increase their knowledge, skills, and abilities can
also have the side benefit of stress management
(APA, 2014). Overall workplaces that have a well-
formulated learning philosophy continually improve
existing talent and are attractive to new talent as well.
The APA identifies the following opportunities for
employee growth:
• Continuing education courses
• Tuition reimbursement
• Career development or counseling services
• Skills training provided in-house or through out-
side training centers
• Opportunities for promotion and internal career
advancement
• Coaching, mentoring, and leadership develop-
ment programs
4.1.4. Health and safety
When deconstructing the link between workforce
safety and profitability, evidence seems to support
that building cultures of health and safety provides
a competitive advantage in the marketplace. There
is an association between companies that focus on
health and safety and companies that manage other
aspects of their business equally well. Organizations
that form a culture of health by focusing on the well-
being and safety of their staff yield greater worth
for their stakeholders (Fabius et al., 2013). Addi-
tionally, in their State of the American Workplace
report, Gallup (2013) found that the best-managed
teams versus the worst managed teams have approx-
imately 50% fewer accidents and 41% fewer quality
defects.
In addition to shareholder value, organizations that
invest in the health and safety of their workforce see
yields in increased productivity, reduction in health-
care costs, absenteeism, and injury rates (APA, 2014).
The APA provides the following examples of ways to
address health and safety for employees (a) training
that addresses workplace security issues; (b) initia-
tives that help workers develop a healthy lifestyle (for
example: stress management, smoking cessation and
weight loss programs); (c) health insurance benefits
that include coverage for mental health; (d) access to
fitness facilities and screenings; and (e) support via
Employee Assistance Programs (EAP’s) that address
worker life issues such as grief counseling, sub-
stance abuse programs, and referrals for mental health
services.
4.1.5. Employee recognition
Recognition efforts provide employees with
rewards for their contributions to the workplace.
These efforts can take various forms and need not
be outrageously expensive; however they must be
targeted to the employee and/or team and tied to a
specific organizational outcome, strategic initiative or
quantifiable effort. When employees are recognized
publicly, morale and self-esteem are enhanced as well
as productivity and engagement. The APA (2014)
offers these examples of employee recognition: fair
compensation, competitive benefits, awards (from
a simple thank you or publicly displayed plaque),
performance-based bonus or pay increase, and cer-
emony that recognize employee contributions.
4.2. Communication
Communication is critical in the success of policies
and programs designed to achieve the psychologi-
cal health of organizations. The APA (2014) posits
a variety of ways to communicate employee needs
and management support. For example bottom-up
 W.A. Coduti et al. / Healthy workplaces, DM and employee mental health
communication (employee to management) can facil-
itate knowledge about worker opinions and values
so that programs can be targeted. Top-down com-
munication (management to worker) can increase
awareness and utilization of programs. Using mul-
tiple channels of communication such as print,
electronic, and face-to-face meetings will aid in get-
ting the message out regarding the benefits and
importance of a psychologically healthy workplace.
5. Disability management and impact
on employee mental health
Disability management is defined as “a workplace
prevention and remediation strategy that seeks to pre-
vent disability from occurring or, lacking that, to
intervene early following the onset of disability, using
coordinated, cost-conscious, quality rehabilitation
service that reflects an organizational commitment
to continued employment of those experiencing
functional work limitations. Disability management
means using services, people, and materials to (a)
minimize the impact and cost of disability to employ-
ers and employees; and (b) encourage return to work
for employees with disabilities” (Akabas, Gates, &
Galvin, 1992, p. 2). A valuable DM program uti-
lizes a company’s financial and human resources
in the most efficient manner and helps employ-
ees with disabilities and illnesses perform at their
greatest potential and satisfaction. Disability man-
agement, therefore, complements corporate values in
both human resources and fiscal performance. Simply
put, a DM program encourages a healthy workforce
while ensuring the company’s long-term profitability
(Akabas et al., 1992).
Tweed (1994) stated that the culture of a company
and whether management demonstrates it cares about
employees are key factors influencing the potential
for injury and lost time. Bronkhorst and colleagues
(2014) confirm that employers’ positive views of
DM in the workplace reduce job stress and result
in improved MH. Thus, the culture of the organiza-
tion impacts the success of DM programs. In fact,
Amick et al. (2000) state that people-oriented cul-
ture facilitates strong safety environments and DM
programs and these policies and practices remain
“consistent with a management perspective that
views investments in people through safety, health,
and accommodation, as an equally important strat-
egy to achieving the productivity and financial goals
of the organization” (p. 35).
333
Successful DM programs exist in organizations
that value employees and enhance a support-
ive workplace culture. Attributes of effective DM
programs mirror those found in the American
Psychological Associations (APA) elements of psy-
chologically healthy workplaces (Table 1). As MH
issues in the workplace continue to remain a global
phenomenon impacting both individuals and orga-
nizations, employers will need to find ways to
expand organizational initiatives (DM programs)
while building psychologically healthy workplace
cultures.
6. Elements of successful disability
management programs
6.1. Successful disability management program
components
Harder, Hawley and Stewart’s (2011) review of
the literature identified evidenced based components
of successful DM programs. Not only did the fac-
tors below prove to be successful in DM programs
but were also “consistent with the principles and
practices of successful employment and intervention
strategies for mental health disability in general” (p.
430). These components included:
• A supportive workplace culture, including man-
agement and labor commitment with supportive
policies.
• Early intervention and ongoing monitoring of
disability.
• A collaborative and coordinated team approach.
• Psychoeducational opportunities for managers
and workers.
• Systematic case management procedures.
• An organized return-to-work program with sup-
portive policies, modified work options, and
workplace accommodations.
• Use of incentives in benefit design, cost account-
ing, and performance evaluation to encourage
participation.
• An integrated management system to monitor
and evaluate outcomes (p. 429).
While the list above is not exhaustive, it does
identify DM program elements that include multiple
stakeholders (e.g. organization, agencies, employees,
etc.). Stakeholder involvement at all levels of DM
programs is imperative, as is stakeholder accountabil-
ity (Dyck, 2000). Successful DM programs provide
334 W.A. Coduti et al. / Healthy workplaces, DM and employee mental health
multiple benefits for both employee and employer,
which are consistent with psychologically healthy
workplaces.
6.2. Disability management program benefits
The APA’s five categories of workplace prac-
tices that promote psychological health in employees
have a similar conceptual basis as successful
DM programs, and many corresponding bene-
fits, as shown in Table 1. Employers and DM
service providers have moved beyond initial inter-
ventions of reactive protocols (i.e. return-to-work
after a work injury) to more proactive strategies
which included safety/prevention, health/wellness
programs, ergonomics, ecological assessments, and
specialized case management strategies (Hursh,
1997; Rosenthal, Hursh, Lui, Zimmerman, & Pruett,
2005).
The proactive nature of DM programs is criti-
cal as the most successful timeframe for bringing
employees back to work from an absence is 30
days (Dyck, 2000). Poor relations between manage-
ment and employees can discourage employees from
following safety practices at work, and even from
returning to work after an injury (Tweed, 1994). Com-
panies with low claim rates (for workplace injuries)
include safety and prevention interventions, proce-
dures to prevent and manage disability, and an open
managerial style and human resource orientation
(Amick et al., 2000).
7. Summary and conclusion
Understanding workplace cultures and supports
for individuals with MH conditions involves under-
standing employer disability policies, programs and
interventions. Over the 35-year time span of DM,
successful programs have expanded beyond a focus
solely on physical impairments to include MH
and have expanded beyond reactionary measures
to include preventative and proactive interventions,
such as absence management. The evolution of DM
into absence management is a necessary response to
the increases in costs related to absenteeism, to the
inefficiencies of a fragmented benefit system, and to
an aging and more diverse workforce (Hursh & Shrey,
1994) as well as the increased prevalence of MH.
Absence management aims to reduce the incidents
of unscheduled employee absences, due to illness,
injury, personal or family problems, or other causes.
Presenteeism goes a step further, seeking to improve
the productivity of those who are still on the job (Lui,
2002). Vocational rehabilitation professionals work-
ing in the areas of DM must understand not only the
evolution of DM but also how DM can support MH
through programs designed to decrease absenteeism
and presenteeism, such as psychologically healthy
workplaces.
Efforts to keep workers on the job and perform-
ing at their best will require an integrated approach,
one that can span traditional disability and workers’
compensation programs, group-health, and short- and
long-term disability benefits. Expertise in each of
these programs and benefits areas, along with an
understanding of union and labor practices, federal
laws (such as Americans with Disabilities Act or
Family Medical Leave Act) and state regulations for
workers’ compensation, is a requisite for VR profes-
sionals today. The benefits of integrated DM include
simplifying of an all-too-often confusing administra-
tive function, utilizing a single point of contact to
access services, eliminating the “claims-denial” men-
tality, and sustaining an overall commitment to health
and productivity (Calkins, Lui, & Wood, 2000).
Employers that understand how their culture sup-
ports and protects people with disabilities, especially
those with MH conditions, will have a competitive
advantage over employers that don’t. The same can be
said for VR professionals. Understanding the impact
of workplace cultures, and the benefits of DM pro-
grams on MH conditions will open up opportunities
to work with employers in designing such programs
to protect the MH of its’ current workforce.
Workplace cultures that value employees create
psychologically healthy workplaces and DM pro-
grams that include employees with MH conditions.
Vocational rehabilitation professionals need to rec-
ognize the importance of workplace culture and the
positive or negative impact on individuals with MH
conditions. Research needs to be conducted to evalu-
ate the financial impact of adopting these principles,
behaviors, and programs. Research examining both
the direct and indirect costs of MH in these envi-
ronments can prove a catalyst for other employers to
adopt, as well as provide evidenced based best prac-
tices. Additional research needs to include role and
function studies of those working in the field of DM,
such as vocational rehabilitation professionals, and
with employers identified as being APA psycholog-
ically healthy workplaces. Identifying the financial
impact workplace environments have on MH costs
can go a long way in making work environments
 W.A. Coduti et al. / Healthy workplaces, DM and employee mental health
more psychologically healthy and supportive for
all.
Conflict of interest
The authors have no conflict of interest to report.
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