In your last letter you drive home the point that employers need to develop a workplace "that is tolerant of individual differences," something they wouldn't naturally do unless forced to by civil-rights legislation, namely, the ADA. But I'm less concerned that a regressive darkness will descend upon the workplace without a "reasonable accommodation" mandate. As I said earlier, valued workers, mentally impaired or not, will likely be accommodated because businessmen want to keep good workers. Family and medical leave policies and Employee Assistance Programs (EAPs), for example, were voluntarily implemented by businesses years before the ADA.
Now, to your suggestion that we focus on "what we know best: the mentally ill, who they are and how they work." Fine, but our field of psychiatry isn't particularly good at distinguishing between someone who is just being "difficult" and someone who has a personality or mood disorder. Nor is it obvious to us when a person, say, can't tolerate "stress" because of an actual illness (such as bipolar disease) or because it's "just the way they are." These are thorny matters, true, but the EEOC doesn't seem to care a whit that almost anything goes as an accommodatable condition. I would argue that (1) employers hold people with mental illness to the same standards as other workers; (2) if the job applicant has a history of mental illness, that record cannot be used against him; (3) if workers suffer symptoms on the job it's their own responsibility to get the help they need to perform; and (4) employers are welcome--but not required by government--to accommodate impaired employees as they see fit.
Surely, some employers could use a little enlightening. So how about the National Institute of Mental Health or the Center for Mental Health Services (both federal agencies) and/or the National Alliance for the Mentally Ill and National Mental Health Association (both private advocacy groups) undertaking high-profile educational campaigns? Such public service announcements could describe the warning symptoms of mental illness, list local area public and private clinics, and illustrate types of accommodations that other employers have found beneficial.
Why do you call this "tough love," Peter? My approach is neither tough, nor is it love. It is simply straightforward, sensible, and unsentimental. Like you, I'd rather see someone with a mental illness out working--perhaps the best therapy, we already agreed--rather than sitting home, isolated, collecting disability payments. But "out working" doesn't have to mean employed in a competitive setting. For the mentally ill person who falls in the gray area--not so ill that he can't work, but too fragile to handle the social or cognitive demands of a formal workplace--there are other options.
Humanitarian agencies like the Easter Seals Society, Goodwill Industries, and the Salvation Army (not to mention local churches, non-profit agencies, and even, lately, the Veterans Affairs Administration) have been running sheltered workshops for years. Corporations such as Marriott and McDonald's offer so-called supported employment opportunities which may provide job coaches and other special services. Such noncompetitive and supported employment situations can be a stepping stone to a more formal job. This is accommodation at the level of the labor market, not the specific work site. People who can't handle the rigors of the workplace can find a slot in the parallel universe of noncompetitive jobs. But it's no favor to our patients to be "accommodated" in a job they can't handle--or don't want to--out of misguided compassion or government mandate.