Paragraph seven reads: "In Ms Holt’s case, her condition was not diagnosed until she had reached “a psychotic state”, triggered by an anti-depressant that, she says, turned out to be like “jet fuel”. When police found her outside her home, “half-dressed and holding a butcher’s knife” she was finally committed under the mental health act. It led to a diagnosis of bipolar type two, in which there is a dominance of depressed moods with a few periods of hypermania."

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The wrong kind of illness

By Emma Jacobs

Published: May 16 2011 22:16 | Last updated: May 16 2011 22:16

Mary Holt used to have a reputation at work, she says, for “being unusual, creative and connecting with people”. It served her well in her career as an account manager for an advertising company. She was productive, well liked by colleagues and senior managers.

Yet her peers had no idea of her private anguish. “I had peaks and valleys in my moods,” she says, asking that her real name not be used. “I could be walking down the street on my way to meet my friend feeling happy and then two blocks down I could be overwhelmed by a feeling that I should kill myself.” During the euphoria, she felt she was “touching the hand of God”, feeling capable of curing cancer one minute, before hatching plans to launch a Hollywood career. Self-medication was her way of managing these manic phases – Valium in particular. During the lows she would get through the day by making a series of pacts with herself: “If I just made it through to the end of the meeting, I could kill myself then.”

The World Health Organisation suggests that “one in four people in the world will be affected by mental or neurological disorders at some point in their lives”. Last year, it produced a report on mental health that found “the vast majority of people with mental health conditions would like to be employed but stigma, discrimination, and lack of professional experience prevent them from doing so”.

Rates of discrimination against people with schizophrenia seeking employment are high and consistent across countries of varying income levels. According to WHO, in a cross-sectional survey of 732 people diagnosed with schizophrenia across 27 countries, 70 per cent were unemployed, and almost half experienced discrimination in finding or keeping work.

A number of studies have indicated the reluctance of employers to hire people with mental health conditions. This week Mind, a mental health charity, released figures that showed one in five people who had disclosed a mental health problem to their bosses had been sacked or forced out of their jobs.

The decision to disclose a mental illness, such as schizophrenia, bipolar or recurring depression, to an employer is difficult. Vicki Nash, head of policy and campaigns at Mind, says: “In order to get help under DDA [the Disability Discrimination Act] you need to disclose your illness to an employer. But people fear disclosure – worrying it might prevent them from even being interviewed. Many people find that if they disclose their illness they will get bullied and forced out of the role.”

In Ms Holt’s case, her condition was not diagnosed until she had reached “a psychotic state”, triggered by an anti-depressant that, she says, turned out to be like “jet fuel”. When police found her outside her home, “half-dressed and holding a butcher’s knife” she was finally committed under the mental health act. It led to a diagnosis of bipolar type two, in which there is a dominance of depressed moods with a few periods of hypermania.

After receiving medication and learning how to handle her illness, she resumed her career. Her moods were stable, so she felt no need to tell her employer. In fact, she felt disclosing it would stigmatise her. She was, she says, an excellent employee.

Eventually, after two years in which she worked very long days for a big client, she began to feel stressed and at a work event told her boss how she was struggling under the workload and felt unsupported. The next day she was called in for a meeting. Her boss had discovered her mental illness. “He said I was a risk to clients and colleagues. [My choice was to] leave or be fired,” she says.

Tips on how to offer a sympathetic ear

Mind’s guidance for employers:

Encourage open and supportive work environments where employees can discuss mental health without fear of discrimination.

Ensure protecting mental health is embedded in change management, in order to manage extra pressure on staff.

Treat mental health problems with the same importance as physical health problems.

Ask staff how they are. Schedule regular catch-ups to discuss how staff are managing and progressing.

After consulting lawyers, the 41-year-old agreed a financial settlement to leave the company. She is nonetheless angry at the way she was treated. “If I had breast cancer, it would have not ended like this,” she says. “Schizophrenia and bipolar are very misunderstood – people fear you might pull a ‘postal’. In fact, you’re more likely to hurt yourself. Did I do a good job for the client? Absolutely. What was the point of firing me? Would you fire someone with cancer?”

Suzanne Hudson, chief executive of MDF The Bipolar Organisation, points out that employers have misconceptions about mental health, particularly that such individuals will be off sick more frequently. In fact, she says, the opposite might be true: employees are more concerned about proving they can do the job as well as people without a mental illness. Also, the employer “might feel they are treading on eggshells” when talking about bipolar or schizophrenia.

Jonathan Naess, a former City financier and founder of Stand to Reason, a mental health charity, says because mental health issues are so prevalent, employers cannot afford to ignore the issue.

“Life events within our working lives – bereavement, sick children – may prove triggers for more serious issues. We can’t deny mental illness has an impact on the workplace – just as having children or a having an accident will do,” says Mr Naess. But work can be an important part of recovery from depression, for example “it gives you a social life and a purpose in life”.

The stigmatisation of mental health is one of the reasons Mr Naess, who has a bipolar condition, set up his charity, which aims to open the topic for discussion. He cites Deloitte, the professional services firm, as having an innovative approach. It runs a mental health champions scheme, an initiative established by a partner who has suffered from depression. It encourages staff to discuss mental health problems with senior executives who have experienced it themselves. Such discussions are outside career appraisals.

As Ms Nash points out, seeing senior staff being open “provides reassurance that mental illness does not signal the end of their careers”.

Lord Stevenson, former chairman of Pearson, owner of the Financial Times, and a number of big City businesses, who has spoken openly about his bouts of depression as “hell on earth”, believes that companies must foster a culture of humanity in which emotions are allowed to be discussed.

Chloe Williams, a 28-year-old who experienced depression after a car accident, says it was an informal career discussion with her boss at a charity that enabled her to deal with the illness. “My boss was brilliant – she instigated weekly meetings where we discussed my progress [at dealing with the illness at work] and allowed me to work flexibly in order that I could attend counselling sessions.”

This does not mean employers must become counsellors but they need to be able to monitor staff, insists Ms Nash. “Even if you have brilliant policies in place, you need to ensure the culture is open,” she says. “Employers need to be able to spot symptoms early. It’s very difficult if you are junior and struggling to own up to these feelings, particularly in an era when there is a threat of redundancy.”