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* After making an offer of employment, if the employer requires a post-offer, preemployment medical examination, or inquiry. The employer may require a medical examination (including a psychiatric examination) or ask questions related to disability including questions about psychiatric disability if the employer requires all entering employees in the same job category to undergo the same examinations regardless of disability.

* During employment, when a disability-related inquiry or medical examination of an employee is "job-related and consistent with business necessity." This requirement may be met when an employer has a reasonable belief, based on objective evidence, that an employee's ability to perform essential job functions will be impaired by a medical condition or an employee will pose a direct threat due to a medical condition.

Requesting reasonable accommodation under the ADA ³⁷

An employer must provide a reasonable accommodation to the known physical or mental limitations of a qualified individual with a disability unless it can show that the accommodation would impose an undue hardship on the business. Of course, an employee's decision to request reasonable accommodation may be influenced by his or her concerns about the potential negative consequences of disclosing a psychiatric disability at work. Reasonable accommodations for individuals with a psychiatric disability must be determined on a case-by-case basis because workplaces and jobs vary. Accommodations for individuals with psychiatric disabilities may involve some changes to workplace policies, procedures, or practices. Among the most common accommodations listed by experts and people with psychiatric disabilities are those that address symptoms or treatment side effects. These include use of part-time work; job sharing; more frequent breaks (for those who do not have the stamina for full time work); flexible hours (that take into account medication side effects such as early morning drowsiness); time off each week for clinical services; and limited night shift when symptoms or effects of medication interfere.³⁸

Mental health professionals, including psychiatric rehabilitation counselors, are able to make suggestions about particular accommodations and help employers and employees communicate effectively about reasonable accommodations.

Employees and employers have posed numerous questions about what constitutes a request for reasonable accommodation for a psychiatric disability. Since depression is the leading mental illness in the workplace, questions and concerns about reasonable accommodation for employees with depression are those most frequently raised by human resource personnel, employers, and insurance providers.

MENTAL HEALTH PARITY ACT OF 1996

Like the American with Disabilities Act, this is a landmark law which received unprecedented bipartisan support. It begins the process of ending the long-held practice of providing less insurance coverage for mental illnesses than for equally serious physical disorders. The following are key provisions:³⁹

* The law equates aggregate lifetime limits and annual limits for mental health benefits with aggregate lifetime limits and annual limits for medical and surgical benefits. Typical caps for mental illness coverage are

$50,000 for lifetime and $5,000 for annual, compared with a $1 million