Psychiatric Disabilities in the Workplace

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Psychiatric Disabilities in the Workplace
CRP-RCEP Upcoming Events

• David R. Strauser
• University of Illinois

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Overview

• Changing Nature of Work- Why is this important?
• Key Terminology- How do we talk about the
  implications of psychiatric disabilities
• Diagnostic Criteria- Why is this important.
• Introduce the dimensional model
• Impairment and treatment options

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Overview Continued

• Mood Disorders
• Depression
• Bipolar
• Dysthymia

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Changing Nature of Work

• Global Economy
• Impact on Individuals with Mental Illness
• Career and Vocational Development Issues
• Benefits of Work for People with Mental Illness

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Diagnostic Criteria

• Conceptualizing Psychiatric Disabilities
• Multi-axis Diagnostic Scheme
• Axis 1- Clinical Disorders
• Axis 2- Personality and Mental Retardation
• Axis 3- General Medical
• Axis 4- Psychosocial-Environmental
• Axis 5- Global Assessment of Functioning

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Categorical Model

• Categorical
• Implications for Treatment
• Dimensional Model
• Implications for Treatment

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Conceptualizing Impairment

• Implications for Vocational Functioning
• Understanding and Memory (Making Occupational
  Adjustments)
• Making Performance Adjustments
• Making Personal and Social Adjustments
• Work Adjustment

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Understanding and Memory

• Follow work rules
• Relate to co-workers
• Deal with the public
• Use Judgment
• Interact with supervisors
• Deal with work stresses
• Function independently
• Maintain attention and concentration

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Making Performance Adjustments

• Complex job instructions
• Detailed job instructions
• Simple job instructions

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Making Personal and Social Adjustments

• Maintain personal appearance
• Behave in emotionally stable manner
• Relate predictably in social situations
• Demonstrate reliability

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Work Adjustment

• 8 hours per day
• 5 days per week
• Work without excessive breaks
• Maintain regular attendance

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Characteristics of Disorders

• Temporal requirement (time)
• Symptom cluster (necessary amount of symptoms)
• Symptom intensity (sufficient intensity)
• Not explained by another condition

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Depression

• Criteria
• Five or more of the following symptoms have been
  present during the same 2-week period and
  represent a change from previous functioning.
• At least on of the symptoms is either
• Depressed mood
• Loss of interest and pleasure

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Criteria for Depression

• Five or more of the following
• Depressed mood
• Diminished interest or pleasure
• Significant weight loss
• Insomnia or hyper-insomnia
• Psychomotor agitation
• Fatigue
• Feeling of worthlessness
• Diminished ability to concentrate
• Recurrent thoughts of death

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Criteria Depression

• Symptoms do not meet criteria for Mixed Episode
• Cause clinically significant distress or
  impairment in social or occupational function
• Not related to substance abuse or other medical
  condition
• Not related to bereavement.

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Vocational Implications of Depression

• Work Performance
• Occupational Adjustments
• Performance Adjustments
• Personal and Social Adjustment
• Work Adjustment

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Making Occupational Adjustments
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Making Performance Adjustments
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Making Performance Adjustments
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Work Adjustment

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Implications for Career Development

• Cognitive Issues
• Affective Issues
• Behavioral Issues

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Dysfunctional Career Thoughts

• Dysfunctional career thoughts lead to
• Avoidance of career and other life decisions
• Decreased life satisfaction
• Depression and anxiety
• Decreased job satisfaction
• Increased job stress
• Interpersonal relationship problems
• Expressed through
• Behavior-poor performance
• Verbal-negative statements and expressions
• Emotions-depression and anxiety

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Pyramid of Information Processing Domains
Executive Processing Domain
Meta-cognitions
Decision-Making Skills Domain
CASVE Cycle
Knowledge Domains
SelfKnowledge
OccupationalKnowledge
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CASVE Cycle
Communication
Analysis
Execution
Synthesis
Valuing
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Thoughts and Decision Making

• Occupational vs. Employment Decisions
• Career choice
• Executing a job search
• Thoughts That Influence Decision Making
• Self-Talk
• Positive vs. Negative
• Self-Awareness
• Thoughts, Emotions and Behaviors
• Reactions of self to significant others
• Monitoring and Control
• Where they are in the process
• Purposeful engagement

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Two Dimensions of Career Choice

• Capability
• Cognitive and affective ability to engage in
  effective career problem solving and decision
  making
• Career Thoughts Inventory (CTI) Subscales
• Decision Making Confusion (DMC)
• Commitment Anxiety (CA)
• Complexity
• Contextual factors, originating in the family,
  society, economy, or employing organizations that
  make it (more or less) difficult to solve career
  problems or make decisions
• CTI Subscale
• External Conflict (EC)

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Two Dimensional Model of Readiness
Complexity (High)
Complexity (Low)
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Questions