5 Essentials for Writing Mental Health Accommodation Letters Under ADA.

Mental health professionals are increasingly called upon to support clients navigating job-related challenges under the Americans with Disabilities Act of 1990 (ADA), as amended by the ADA Amendments Act of 2008 (ADAAA). In California, these federal protections are further reinforced by state-level laws like the Fair Employment and Housing Act (FEHA), which offers even broader definitions and protections for individuals with mental health conditions.

As a Licensed Clinical Social Worker (LCSW) practicing in California and specializing in workplace-related psychological health and safety, I often write letters to help clients request reasonable accommodations or return-to-work support. Medical doctors frequently refer to mental health providers—especially LCSWs, psychologists, and psychiatrists—to provide the necessary diagnostic and functional assessments related to mental health.

But what makes an accommodation letter effective, ethical, and legally sound?

Below are five evidence-based components that every mental health provider should assess and include when writing workplace documentation.

1. Clear Diagnostic Rationale Using DSM-5-TR Standards

Mental health accommodations must be grounded in clinical diagnoses that meet criteria set forth in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). A diagnosis alone, however, is not sufficient. The provider must also demonstrate how the symptoms substantially limit one or more major life activities, such as concentrating, interacting with others, or regulating mood—aligning with ADA definitions of disability.

Tip: Use language that connects DSM criteria to functional limitations, not just clinical symptoms. For example: “Due to symptoms of Generalized Anxiety Disorder, the client experiences significant difficulty with sustained concentration and working under tight deadlines, which substantially limits their ability to perform essential job functions without modification.”

2. Functional Impact in the Workplace

The ADAAA (2008) clarified that impairments should be evaluated in terms of how they limit major life activities—not how severe they appear medically. In California, the FEHA adopts a broader interpretation of “disability” and allows more generous thresholds for protection.

Assess:

• Cognitive challenges (e.g., focus, decision-making)

• Emotional regulation (e.g., stress response, interpersonal conflict)

• Attendance or stamina issues

Functional impact is key. Without describing how a condition affects workplace performance, the request lacks legal weight.

3. Specific Accommodation Recommendations

General statements like “client needs flexibility” are too vague. Recommendations should be specific, job-relevant, and within the scope of your professional judgment.

Examples of reasonable accommodations:

• A flexible start time or part-time schedule

• Modified deadlines or workload

• Remote work or hybrid arrangements

• Reduced exposure to high-stimulation environments (open office plans, public-facing roles)

Note: Providers are not required to know whether the employer can implement the accommodation—only to document what might help based on clinical need.

4. Time Frame and Reassessment

Indicate whether the accommodation is:

• Temporary (e.g., 3–6 months)

• Ongoing with periodic reassessment

• Related to return-to-work planning

Stating a recommended time frame helps employers understand the scope and signals your intent to monitor progress. Example: “The client is expected to benefit from accommodations for a period of 90 days, at which time a clinical reassessment will be conducted.”

5. HIPAA-Compliant Documentation with Client Consent

All documentation should be written in clear, professional language on official letterhead and provided only with the client’s signed, informed consent.

Letters should:

• State your credentials and licensure

• Include your professional contact information

• Be free of excessive clinical jargon

• Avoid unnecessary detail about personal history or treatment that could create bias or breach privacy

Final Thoughts: Writing effective letters for workplace accommodations is more than a task—it’s an ethical responsibility. The goal is to advocate for your client while ensuring your documentation meets both clinical standards and legal requirements under the ADA, ADAAA, and California FEHA.

In a world where occupational psychological health is finally gaining long-overdue recognition as part of workplace well-being, mental health providers play a crucial role in bridging the gap between diagnosis and accommodation.

Resources:

U.S. Equal Employment Opportunity Commission (EEOC): ADA Title I and Reasonable Accommodation

California Department of Fair Employment and Housing (DFEH): Disability Discrimination

Job Accommodation Network (JAN): Accommodation and Compliance Series

American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.; DSM-5-TR).

Kamenetz, A. (2018). How to Write a Strong Workplace Accommodation Letter for Mental Health. Psychology Today.