The relationship between mental illness and work can be looked at in a number of different ways, including:
• the stresses and strains today's workplace places on us;
• the incredible pressure placed upon people to continue to perform at work when an illness strikes, and the extra strain this places on their families and friends;
• the difficult barriers those persons diagnosed with a mental illness face in the working world;
• the strain encountered by people who work while they care for someone with a mental illness at home;
• the therapeutic role the act of work plays in helping to reduce stress and improve mental health; and,
• the benefits work can bring in guiding people diagnosed with a mental illness toward recovery, rebuilding their self esteem and hopefully returning to the jobs they left when the illness struck.
What is mental illness?
The first step toward discussing mental illness and helping eliminate myths, misconceptions and stereotypes is to understand what a psychiatric illness is.
In general it refers to significant clinical patterns of behaviour or emotions associated with some level of distress, suffering (pain, death), or impairment in one or more areas of functioning (school, work, social and family interactions). At the root of this impairment are symptoms of biological, psychological or behavioural dysfunction, or a combination of these.
Depression is a good example of a mental illness. It has been cited as the most common psychiatric illness that doctors are called upon to diagnose and treat. Depression and manic-depression alone pose an enormous economic burden on society. The annual cost of these two illnesses to Canadians is estimated at over 5 billion dollars.
This amount accounts for doctors' services, patient care and pharmaceutical costs, losses caused by people missing days of work or lower worker productivity, and total earnings lost as a result of suicides. This total does not include the lost productivity caused by substance abuse (that could possibly be eliminated if all depression cases were successfully treated), the financial costs to persons paying for care, and the time lost away from work by family members or friends who care for others.
In Canada, one individual out of five will suffer from a mental illness at some time in his or her life. The financial burden of mental illness on society is far too great to ignore and is just one reason why education, understanding and creative solutions to dealing with mental illness in the workplace are necessary.
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Mental Illness In The Workplace
Of all persons with disabilities, those with a mental illness face the highest degree of stigmatization in the workplace and the greatest barriers to employment opportunities. Persons diagnosed with a mental illness are more likely to experience long term unemployment, under-employment and dependency on social assistance.
Many employers and employees have unwarranted fears and see persons with psychiatric disabilities as unskilled, unproductive, unreliable, violent or unable to handle workplace pressures. This stigma creates a climate in which someone who has a problem and needs help may not seek it for fear of being labelled.
Undiagnosed mental illness also has a high cost on the workplace. If left undetected, overall work quality and productivity can be affected by an ill employee's misunderstood behaviour.
Mental illnesses and the fact that they can be successfully treated must be understood by employers. Only then can they begin to recognize and accept the symptoms of a true condition and know how to establish an internal management program to accommodate their employees.
Flexibility and understanding
Mental illness should be perceived and accommodated in the workplace like any other illness or disability. One of the most important employment barriers faced by persons with a psychiatric disability is lack of flexibility at work.
Flexibility is built on the positive arrangements that organizations need to put in place to promote equality in employment. Preparations should include:
• Creating an environment where arrangements are accepted by addressing the individual needs of each employee,
• Respecting the employee's desire for confidentiality and specifically identifying the form and the degree of confidentiality;
• Being willing to engage in joint problem solving;
• Making all arrangements voluntary for the employee, and being prepared to review plans periodically to meet changing needs;
• Being flexible in enforcing traditional policies; and,
• Being concrete and specific when identifying accommodations made. Puffing them in writing is a good idea.
A partnership approach between persons with disabilities and management personnel is essential if organizations are to deal successfully with the obstacles to employment faced by persons with a mental illness or by those caring for a family member or friend with a mental illness.
Working caregivers
Over one-third of all family members or friends who take care of a person diagnosed with a mental illness also work outside the home. This figure represents over one million Canadians.
There is great physical and emotional stress that comes with providing care. One-third of caregivers who work report that it interferes with their paying jobs. Many caregivers have chronic health problems, experience depression, and suffer excess stress when the burden of work or caregiving increases.
Employers need to be aware of the difficulties some of their employees experience, and who those employees are. Employers must acknowledge the situations which caregivers in the workplace face, and strive to support their employees with more creative organizational policies such as flexible hours.
The caregiver must strive to take care of herself or himself as well. One should adopt lifestyle practices that help manage the stress, and seek services available to caregivers to help achieve a healthier and more balanced life.
Stresses and strains of today's workplace
With the stresses and strains placed on everyone in today's working world, workplaces should look at how they can help promote the best possible mental health amongst their employees.
A wide range of biological, personal, social and environmental factors related to a person's employment may contribute to mental health problems and reduced productivity. Attention must be paid to encouraging healthy practices through education and training programs, as well as to the development and maintenance of working conditions that support or contribute to the well-being of staff and to the prevention of illness.
Elements such as air quality, proper ventilation, adequate lighting and comfortable and proper office equipment are physical elements the employer can control. The employer can also help with emotional elements such as more personal control over work-related decisions, clear job performance objectives and adequate rest and vacation periods.
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The Role Of Work In Recovery
Work plays an important role for a person recovering from a mental illness. The workplace provides a social support system and the opportunity for people to regain their sense of self-esteem, control and self-worth.
Although in some more severe instances a return to work is not possible, once on the path to recovery, many individuals can benefit tremendously from working again. A supportive workplace can offer a sense of stability that is otherwise hard to find.
The reintegration of an employee into the workplace after recovery again requires the employer's flexibility. Often the process has to be gradual. The workload may have to change temporarily and hours and days worked may have to be altered. Job sharing and people working with an emergency fill-in person are considerations depending on the individual's and employer's needs.
The benefits of understanding
The benefits to the employer of accommodating the return of an employee are many. They avoid the added costs of hiring a new employee, and training and raising him or her to d level of productivity comparable to that of an experienced worker. Overall morale will rise as employees see the care placed on the individual, and coworkers share in the challenges faced by the returning staff member.
Employers and employees alike will always benefit from breaking down the stigma attached to mental illness in the workplace. Removing the barriers to education, open discussion, flexibility and acceptance will ultimately allow those needing medical attention and social support to seek help and receive it.
Everyone knows when to go to the hospital in a physical emergency, but what are the warning signs of emotional emergencies? When and how do we get help for these urgent conditions? Most of us fear and/or dread mental illness, so it's hardly surprising that emotional emergency is a widely taboo topic. This accounts for why many of us lack the insight and resources to deal with urgent emotional situations in our own lives, or in the lives of our friends and families.
It benefits all of us, however, to understand how we can respond to these events, which can be just as life-threatening as severe accidents or physical illnesses. According to Roderic Gorney, M.D., a Los Angeles, Calif. psychiatrist, psychoanalyst, and professor of psychiatry at UCLA Medical School, "Not only are friends and family members very capable of handling these crises that come along, but every once in a while, you run into someone who has a great understanding of human nature." Although most people may not be experienced with mental illness, says Dr. Gorney, "They have had decades of experience trying to figure out people's minds. Never undersell your own intuition and never ignore your own experience," he advises.
Before you can help the situation, it helps to have a diagnosis. "In mental health," Dr. Gorney says, "the average person doesn't realize that there are very specific diagnoses for feeling terrible emotionally." What you do about your condition, or someone else's, depends on the diagnosis. "A generalized anxiety state could have a medical basis, a stress basis, or could be a result of a conflict that the individual is placed in by someone else," Dr. Gorney explains.
While traumatic life changes, such as loss of a spouse, parent, job or health often trigger emotional emergencies, physical illnesses may also precipitate them, says Dr. Gorney. "Certain sudden anxiety experiences may be due to physical causes, such as the rare adrenal tumor," he says. In the case of sudden manic psychosis, such as when someone with a very high fever is deluded and is physically combative, they may need acute medical care to save them from a fatality. Dr. Gorney advises restraining the individual and calling 911 for paramedics in these cases. Individuals who become suicidal or show signs of acute onset depressive psychosis must also be restrained while someone calls 911 for help.
In less dramatic emotional emergencies, such as when people experience modest depression or anxiety and/or start exhibiting changes in diet, weight, sleep, job attendance, mood and behavior, individuals can seek a psychiatric referral from a primary care provider. "If you're not getting referred," Dr. Gorney says, "you have to push on it. Speak with your care manager in the HMO or insurance person who can authorize that kind of a consultation."
Many health insurance plans fail to cover psychiatric referrals and some people lack insurance altogether, but low-cost resources can be located via your local or state psychiatric society. Your local hospital and county medical association are other possible sources for information on low-cost mental health clinics.