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Breaking Down Employment Barriers for People with Mental Illness Begins from Within

November 8, 2008

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Imagine you’ve broken your leg and are going through physical therapy to get back to work. Your therapist encourages you, saying "you can do it". When you return to work, your employer has provided a foot rest, extra time off for medical appointments and a sympathetic ear.

Now imagine you suffer from anxiety or depression.

Do you get the same level of encouragement or support upon returning to work after an illness?

"Unfortunately, the answer is ‘no’," says Jill SanJule, who represents the consumer voice on Washington State’s Mental Health Transformation Project (MHTP). Along with a small staff of committed change agents, SanJule aims to help change perceptions that exist about people with mental illness, and consequently help improve employment outcomes for this population.

"The unfortunate truth is that due to negative perceptions or “stigma,” individuals with mental illness continue to be viewed as being ‘difficult to serve.’” SanJule goes on to say that individuals involved in the mental health system are more likely to also be dealing with homelessness, domestic violence, untreated histories of sexual and physical abuse and related traumas and drug and alcohol use. She acknowledges these challenges but strongly believes that attitudinal change is the most important first step in helping individuals back to work. “We must offer up the hope and the genuine belief that each person can get better and achieve their goals."

The Division of Vocational Rehabilitation (DVR) for the State of Washington is aware that the cultural bias still exists. "We’re working with our staff to retrain them to shift their thinking to support recovery rather than illness," says Peg Evans-Brown in charge of Special Projects with DVR. "We’re often stuck in the past and know that our own professionals may not believe that people with mental illness can maintain good employment. That’s a false perception. The reality is that the large majority of people with mental illness are bright with significant skills and abilities to perform on a job. We’re trying to retrain professionals to turn their thinking around."

This past year, DVR worked with Seattle-based employer REI for an employer training on how to better serve employees with mental illness.  DVR is currently working on a tool kit to assist employers.  Evans-Brown says employers can do their part to support people with mental illness in ways that are similar to what other employees need to balance work, families, medical needs and other personal issues.  But the “stigma” of mental illness often creates a barrier to supply the following:

  • Flexible work schedules – one that enables the worker to take longer or more frequent breaks, or to start later in the day or to allow some home-based work.
  • Time off to attend therapy – either regularly or to recuperate after an episode of illness.
  • Reduction, rescheduling or restructuring of less important tasks/roles – to reduce pressure, temporarily distract the worker, or make the work environment safer for someone taking medications with side effects.
  • Changes to interpersonal communications – the way that feedback, performance management, conflict resolution, changes in workplace or roles, training and instructions are managed. 
  • Changes to the physical environment to enhance concentration and minimize anxiety.
  • Improve mental disability awareness in the workplace to reduce stigma;  this underpins all other accommodations.

According to the World Health Organization, depression will become the second leading cause of disability by 2020.  U.S. businesses pay about $45 billion of the estimated $150 billion in losses resulting from untreated or mistreated mental illness each year.  SanJule says that data alone should be enough to convince most employers to support proactive mental health policies, including successful return-to work practices after a period of illness or hospitalization. 

"Attitudes begin to change when long-held beliefs are challenged by present-day success stories,” says SanJule.  “Through dozens of trainings and a successful anti-stigma speaker’s bureau, the MHTP and its contractors have been furthering the culture change necessary to achieve the type of outcomes we know are possible.”"

Nearly 200 vocational rehabilitation professionals have participated in trainings over the past two years that look at language, specifically how medical-model language can serve as a major barrier to recovery.  "Having an optimistic outlook is so critical to the recovery process,” says SanJule, adding that “language shapes perceptions and we must be very intentional in the way we use language to facilitate each person’s recovery efforts." 

 “The greatest thing about recovery is that research tells us we cannot predict who will get better.  This means, that we must approach each person who comes to us for support as if they will,” adds SanJule.

The DVR trainings also cover topics including building partnerships with customers, as well as access-to-care requirements and referral processes of different systems. Participants also explore components of supported employment and learn how to work with mental health peer specialists as instructors, facilitators, and long-term supporters. The belief is that once armed with good information and training, those involved in the provision of services will have a variety of tools they can use to help those with mental illness obtain and retain employment.

DVR and MHTG will continue to work on provider and employer trainings to demystify the issues surrounding employment for people with mental illness.  For more information on this topic, please check out the following resources:

 

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