health concerns and employment. For example, one of the key functions of the EEOC is to provide enforcement guidance for the ADA. As the situational analysis illustrates, the impact for the employer and employee of EEOC rulings on mental health claims for depressive disorders has been significant. The National Institute of Mental Health (NIMH) programs have helped sensitise the nation to the serious public health implications of unrecognised and untreated depression. One of the most successful initiatives sponsored by NIMH has been D/ART (Depression Awareness, Recognition and Treatment Program)

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D/ART has been successful in de-stigmatising and creating general public awareness regarding etiology, intervention, and treatment of depressive disorders. D/ART also spurred increased receptiveness of employers to recognising the impact of depression on costs and performance. D/ART was reconfigured as the National Worksite Program, which works almost exclusively with employers and organisations handling employment issues.

In terms of workers' organisations, literature from unions, such as the broad-based AFL-CIO, illustrates their involvement in advocating for workers with disabilities. Although most union advocacy has been associated with physical disabilities, there has been a growing recognition of mental health issues, particularly the impact of workplace violence on the mental health of employees.

Although there are numerous employers' organisations, two stand out in terms of their work on employment and mental health issues as well as their partnerships with government agencies. They are the Washington Business Group on Health and the National Business and Disability Council.

Non-governmental organisations are vital in raising awareness of mental health issues and advocating for people with psychiatric disabilities. The situational analysis points out that there are perhaps thousands of consumer and professional groups representing the interests of individuals with psychiatric disabilities. The report highlights several national organisations which have been vital in raising awareness of mental health issues, eliminating stigma and discrimination, and advocating for appropriate legislation and the availability of jobs.

The US has numerous academic institutions that conduct research, organise conferences, and disseminate information on mental health, as well as provide mental health services. These institutions often work closely with a government agency or agencies, perhaps funding a particular research study or conference.

Managing mental heath in the workplace examines work-family issues and their impact on productivity; employee education for mental health promotion, and mental illness prevention and provides illustrations of corporate experiences and innovations.

An overriding theme throughout this situational analysis is that employers of all sizes are beginning to recognise that depressive disorders often constitute their single highest mental health (medical) and disability cost. A large percentage of employers understand the relationship between health and productivity and are improving their management strategies by developing and implementing programs supportive of work/family/life issues, such as flextime, part-time schedules, child care benefits, personal leave, wellness-health programs, and family counselling. Innovative employers have developed practices in conjunction with their health and human resource systems for managing both the direct and indirect costs and con-