Patti* was working as a hostess in an upscale restaurant in Manhattan when the effects of her erratic mood came to a head. “I was talking and laughing too much, and I couldn’t seem to control it,” she says. “At one point, I helped bus a table and brought a bin of dirty dishes into an area in the dining room that was partly shielded from the customers. I crouched down by the bin, impulsively grabbed a dessert plate that was piled with cake and ice cream, and began shoveling the dessert into my mouth. One of the wait staff came over and looked at me in astonishment. I quickly stood up and walked into an empty back room and started to cry.” 

Patti’s manager found her in tears, and though she was kind and understanding, Patti left the restaurant immediately. “I never set foot in that place again. Not long after, I was diagnosed with bipolar 2, plus a binge-eating disorder. I was relieved to get answers but felt really sorry that I messed up a job I liked.” 

In any given month, about 18% of U.S. workers report having a psychiatric disability, making mental illness one of the most common types of disabilities covered by the Americans with Disabilities Act (ADA), a civil rights law that prohibits discrimination against individuals mental illness and allows for reasonable accommodations in the workplace.  

“One thing to realize is that you’re not so unusual,” says Rebecca Sachs, PhD, ABPP, a clinical psychologist specializing in anxiety, obsessive-compulsive disorder, and autism. “A lot of your coworkers are likely living the same reality. It’s just not something we often talk about at work.”

But the prevalence of mental illness didn’t assuage Patti’s fears that she’d be stigmatized or labeled “crazy.” “Maybe I could have returned to work, but I just couldn’t face [my coworkers],” she says. And her fear isn’t without merit. It wasn’t too long ago that mental illness was considered a character flaw or personal failing. And while more and more people with mental illnesses are sharing their stories publicly, studies have shown that stigma remains a barrier to people receiving mental health care. 

Many workplace environments can also make it difficult to discuss mental illness openly, such as a fast-paced, competitive organization or a small company where everyone knows everyone’s business. “Work culture generally doesn’t allow or accept someone [going] through tough times,” says Liza Mordkovich, a psychotherapist with a private practice in Brooklyn, New York, who focuses on anxiety disorders and postpartum depression in the workplace. 

There are some options, however, for people trying to manage and protect their mental illness at work. Here are six expert-recommended strategies.