Over the past decade, mental illness in the workplace has become a key issue in the health and business communities, fueled in part by recognition of the high prevalence rates and significant costs for individuals and organizations. Although research in the field is starting to emerge, there are significant gaps in what is known, particularly with respect to the workplace context and its impact on workers. The overall objective of this study was to characterize, from a sociological perspective, the experiences of healthcare workers with mental health issues, and to account for how their experiences were shaped by the social relations of work. A qualitative approach, based on principles of institutional ethnography, guided exploration of the interactional, structural and discursive dimensions of work within a large mental health and addictions treatment facility. Data collection included in-depth interviews with twenty employees regarding their personal experiences with mental health issues, interviews with twelve workplace stakeholders regarding their interactions with workers, and a review of organizational texts related to health, illness and productivity. Analysis of the transcripts and texts was based on an institutional ethnography approach to mapping social processes; examining connections between local sites of experience and the social organization of work. The study findings revealed a critical disjuncture between the public mandate of advocacy, open dialogue, and support regarding mental health issues, and the private experience of workers which was characterized by silence, secrecy and inaction. Practices of silence were adopted by workers and workplace stakeholders across the organization, and were shaped by discursive forces related to stigma, staff-client boundaries, and responsibility to act. The silence had both positive and negative implications for the mental health of workers, as well as for relationships and productivity in the workplace. In accounting for the practices and production of silence, I argue that silence is complex, multi-dimensional, and embedded within the social relations of healthcare work. It serves to maintain institutional order. This conceptualization of silence challenges current beliefs and practices related to stigma, disclosure, early identification, support, and return to work for employees with mental health issues.

Over the past decade, mental illness in the workplace has become a key issue in the health and business communities, fueled in part by recognition of the high prevalence rates and significant costs for individuals and organizations. Although research in the field is starting to emerge, there are significant gaps in what is known, particularly with respect to the workplace context and its impact on workers. The overall objective of this study was to characterize, from a sociological perspective, the experiences of healthcare workers with mental health issues, and to account for how their experiences were shaped by the social relations of work. A qualitative approach, based on principles of institutional ethnography, guided exploration of the interactional, structural and discursive dimensions of work within a large mental health and addictions treatment facility. Data collection included in-depth interviews with twenty employees regarding their personal experiences with mental health issues, interviews with twelve workplace stakeholders regarding their interactions with workers, and a review of organizational texts related to health, illness and productivity. Analysis of the transcripts and texts was based on an institutional ethnography approach to mapping social processes; examining connections between local sites of experience and the social organization of work. The study findings revealed a critical disjuncture between the public mandate of advocacy, open dialogue, and support regarding mental health issues, and the private experience of workers which was characterized by silence, secrecy and inaction. Practices of silence were adopted by workers and workplace stakeholders across the organization, and were shaped by discursive forces related to stigma, staff-client boundaries, and responsibility to act. The silence had both positive and negative implications for the mental health of workers, as well as for relationships and productivity in the workplace. In accounting for the practices and production of silence, I argue that silence is complex, multi-dimensional, and embedded within the social relations of healthcare work. It serves to maintain institutional order. This conceptualization of silence challenges current beliefs and practices related to stigma, disclosure, early identification, support, and return to work for employees with mental health issues.