Employment Support for People with Mental Illness

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Employment Support for People with Mental Illness

• Providing Support Through Job Restructuring and
  Accommodation
• Laurie Ford
• Center for Continuing Education in Rehabilitation

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Long-Term Mental Illness

• Caused by the biochemistry of the brain.
• Too many neurotransmitters, or they
  aren't reabsorbed quickly enough,
  or the nerves are too sensitive.
•  
• Effect depends on the area of the brain and the
  specific neurotransmitters involved.

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Schizophrenia

• Difficulty filtering, processing, and acting on
  information
• One out of every three hundred people
• Most common mental illness seen in supported
  employment programs.

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Mood (Affective) Disorders

• Depression, bipolar or manic-depressive illness
• The effects of these illnesses are often
  cyclical, with periods of stability.

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Anxiety Disorders

• PTSD, Obsessive-Compulsive disorder, excessive
  fears
• Often co-occur with depression

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Causes

• Mood, thought, and anxiety disorders are probably
  caused by a combination of genetics and stress
• Most develop in the late teens or early adulthood
• Impact ranges from moderate to severe

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Personality Disorders

• Long-term problems in adjustment
• Emotionally needy
• Seeking attention inappropriately
• Nonassertive
• Always getting in trouble
• Volatile, unstable

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Impact of Mental Illness

• Poverty, stigma, and discrimination
• Unpredictable onset
• Cycle of illness and effects of symptoms
• Side effects of medication
• Possible need for hospitalization.

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Impact of Unemployment

• Loss of time structure
• Loss of social participation and support
• Loss of identity and self esteem

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Learning/Performance Issues

• Trouble Initiating Action
•  
• Cognitive Problems
•  
• Difficulty Concentrating, Distractibility
•  
• Impairment of Insight and Judgment
•  
• Difficulty in Organization and Planning

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Interpersonal Issues

• Alienated from Feelings
• Social Isolation or Withdrawal
•  
• Peculiar or Bizarre Behaviors
• Dysfunctional Personality Traits
• Suspiciousness/Paranoia
• Decreased Concern for Hygiene

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Physical Issues

• Physical restlessness
• Sleep disturbance
• Slowed gait or awkward movements

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Relating to People with MI

• Ask about their experiences
•  
• Train yourself to be an expert observer
•  
• Employ active listening techniques
•  
• Dont be afraid to ask questions.

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Relating to People with MI

• Display your empathy
•  
• Help people name their feelings
•  
• Stay focused on here-and-now situations.
•  
• Build trust by going at the client's pace

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A Study on Accommodations

• 194 employees in 26 SE programs in 3 states.
• 322 reasonable accommodations were provided by
  209 employers.

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Awareness

• Most workers were unaware of the ADA, their
  rights to accommodation, or the types of
  accommodation that might benefit them
• Employers were familiar with the ADA, but weren't
  aware that they had arranged accommodations

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Common Accommodations

• Flexible scheduling
• Part time work or job sharing
• Frequent or flexible breaks
• Changes in start/finish times
• Time off for appointments
• Flexible policies for paid or unpaid leave

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Common Accommodations

• Supervision and Job Structuring
• Extra supervision
• Providing written assignments or instructions
• Breaking down assignments into smaller tasks
• Use of checklists
• Job coaching
• Providing frequent feedback

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Common Accommodations

• Modified work environment
• Allowing employees to eat or drink as needed
• Allowing phone calls at work for information or
  support
• Work at home to minimize stimuli
• Workspace with walls or sound barriers
• Opportunities for movement
• Give choices regarding work area

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Common Accommodations

• Assistive Technology
• Typewriter or PC to compensate for tremors
• Magnifying devices, large print
• Earphones, radio, white noise
• Non-glare work or flooring surfaces
• Watch, computer, beeper with prompts
• Noise modulation
• Simple ergonomic modifications

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Being Reasonable

• Its a very simple philosophy empty whats
  full fill whats empty and scratch where it
  itches.
• Everyone uses some sort of reasonable
  accommodation to reduce barriers and
  inconveniences in their everyday lives. Turning
  on a desk lamp is as much a reasonable
  accommodation as is a ramp for a person who uses
  a wheelchair.
• Mary Lee Stocks, 1996

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Helping with Symptom Management

• Symptoms which indicate a relapse
• Changes in behavior, feelings, thoughts
• Take them seriously, increase support, encourage
  person to get medical help

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Helping with Symptom Management

• Symptoms which stand out, cause embarrassment,
  frighten others
• Bizarre, socially unusual behaviors delusions,
  talking to self, loose associations
• Changing meds or dosage may help
• Direct feedback or skill training

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Helping with Symptom Management

• Symptoms which increase isolation
• Apathy, social withdrawal, poverty of thought,
  blunting of emotions
• Have friends, activities, places to belong
  educate others in the workplace

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Helping with Symptom Management

• Symptoms of another disorder or illness
• Poor health care is common
• These may not be recognized or treated, but can
  complicate the employment situation

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Helping with Symptom Management

• Medication Side Effects
• Blurred vision, drowsiness, slowed movement,
  stiffness, restlessness, mental fogginess
• Might be improved through changes in meds,
  dosages, schedule

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The final word on support

•  
• Use careful job matching
• Know the warning signs and patterns AND the
  things that help improve the workers outlook and
  performance.

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final word, continued.

•  
• Be skilled in job analysis, systematic
  instruction, adult learning principles, learning
  styles, and accommodation strategies
• Use a village approach everyone needs a
  variety of supports