ADA Audio Conference Series
June 17, 2008

Slide 1:
Accommodating Employees with Psychiatric Disabilities: Working towards Inclusiveness
Dori S. Hutchinson, Sc.D
Director of Services
Center for Psychiatric Rehabilitation

Slide 2:
Mental Illnesses and Psychiatric Disability
Mental Illness is a term that describes a variety of psychiatric and emotional problems that vary in intensity and duration.
Mental Illnesses become a “disability” when they interfere significantly with a person’s ability to work, learn, think, care for oneself and interact with others.
Mental Illnesses are not mental retardation or brain injuries.  In fact, many people with mental illnesses have strong intellectual capacity.

Slide 3:
Examples of Mental Illnesses
Anxiety Disorders
Depressive Disorders: Major Depression, Bi-Polar Disease, Seasonal Affective Disorder
Schizophrenia Disorders: highly complex and few generalizations hold true for all people diagnosed with one of the disorders. Typically characterized by thoughts that seem fragmented and difficulty processing information. Symptoms are either negative (social isolation and withdrawal) or positive (hallucinations, delusions and thought disorders).

Slide 4:
Impact of Mental Illnesses 
They are treatable.
Economic costs are significant-indirect costs of MI due to lost productivity and early morbidity exceed $72 Billion.
NIMH estimates 20% of the population will experience mental illness in their lives

Slide 5:
Characteristics of Mental Illnesses that affect Functioning
Irregular nature of the illness
Stress associated with non-disclosure
Side effects of medications
Interrupted education, training and career path
Co-morbidity issues
Interpersonal difficulties

Slide 6:
Facts of Mental Illness
It is not a moral weakness
People cannot “snap out of it”
People can work and learn successfully with a mental illness with supportive treatment and opportunities
A person’s diagnosis has no correlation or nor can it predict their ability to work

Slide 7:
Recovery from Mental Illnesses
Recovery is the emergent perspective guiding service programs, treatment approaches and our social response to people with mental illnesses (New Freedom Commission on Mental Health, 2003).
Recovery does not mean a “cure”, rather it means developing meaning and purpose in life, despite the reality of living with a disability (Anthony, 1993).
World wide research documents that people do recover from the consequences of a mental illness and live meaningful, purposeful lives in their communities of choice (Harding, 1994;2003).

Slide 8:
The Importance of Work in Recovery 
Last 10 years of research demonstrates that work is one of the most effective ways to assist people with mental illnesses to recover (Drake & Bond, 2008)
Work has demonstrated robust success across age, gender, culture, diagnosis and socioeconomic status as critical to assisting people to fully integrate as rightful citizens in their communities (Drake &Bond, 2008)

Slide 9:
Benefits of Employment for/Of Persons with Mental Illnesses
Decreased poverty
Increased self-esteem
Increased quality of life
Decreased isolation
Decreased cognitive impairments
Improved societal attitudes about mental illness-reduction in stigma
Decreased misunderstandings and fears
Addition of underutilized and underdeveloped workforce

Slide 10:
Americans with Disabilities Act (ADA)
Civil rights legislation to prohibit employment discrimination against a qualified individual because of their disability.
Requires Employers to make reasonable accommodations to the known limitations of the disability of the ‘otherwise qualified individual”.
Accommodations for people with psychiatric disabilities often revolve around schedules, supervision and emotional support.
These accommodations are inexpensive-The Job Accommodation Network states that most cost less than $500 and companies report a return of benefits ($30) for every dollar invested in making an accommodations.  

Slide 11:
Accommodations that Work on the Job for Persons with Psychiatric Disabilities
Adjustment of work schedules ( time off for Dr. appointments, later start time to counteract drowsiness due to medications, more frequent breaks)
Flexible leave (use of sick leave for mental health conditions, extended leave without pay for hospitalizations)
Specialized equipment or assistive devices (use of email to deliver daily instructions) 
Providing special transportation (parking close to the building to help with anxiety)
Providing human assistance (Job coach or mentor)
Changes in supervision (modifying way feedback and instructions are given)
Modifying work sites (install wall partitions around work station to minimize distractions)

Slide 12:
The Reality of Accommodating People with Psychiatric Disabilities
Organization Barriers
Staff attitudes towards accommodations
Preferential treatment vs. Equal treatment?
Supervision vs. Support

Slide 13:
Organizational Barriers.  Some Include:
Challenges in changing the things that define organizational culture (values, expectations for employee behavior, customs and rituals, beliefs, use of language, etc.)  
“New Territory” – some organizations have no experience integrating self-disclosed person in recovery in the workforce
Parallel vs. Integrated workforce 
Executive leadership minimally involved or disengages from efforts too soon
May not take advantage of outside expertise & resources (e.g.- research findings, national TA centers that have an expertise (JAN), local consumer-operated organizations, state Offices of Consumer Affairs, SAMHSA/CMHS, web resources)

Slide 14:  
Strategies to Overcome Organizational Barriers:
Addressing organizational culture: Valuing People who have psychiatric disabilities or people with disabilities in general.
This not Undiscovered Country –reach out to those organizations with successful experiences; some organizations have no experience integrating self-disclosed person in recovery in the workforce
Parallel vs. Integrated workforce – All employees need supervision and support. Many of the issues people with psychiatric disabilities have at work are just magnifications of the issues that all workers have.  Many of the issues are interpersonal.

Slide 15:
Strategies for Organizations
Cornerstone for success: Sustained interest, support, and involvement by Executive leadership – regular meetings with supervisors and peer staff to problem-solve, brainstorm, and assist with inter-departmental issues  
Getting the most from outside expertise & resources – integrate into organization training; link supervisors to Job Accommodations Network, Bring in experts to share and train

Slide 16:
The Stigma of Accommodations
Staff resent staff who receive reasonable accommodations-Over monitoring and tattle-telling often result
Hinders integration and creates divisive work culture-costly for managers and supervisors
Clear performance standards for each role and clear expectations for all employees.
supervision  is critical for ALL employees

Slide 17:
Supervision vs. Support
Supervision helps ALL employees perform their essential functions of their job to the best of their ability
Supports assist the person with the psychiatric disability (who can do the essential functions of their job) to function independently in their work (reasonable accommodations)
In Fact, all Employees may need supports from time to time.

Slide 18:
Our Learned Experience:
Develop clear (but flexible) job descriptions and expectations based on Critical competencies.
Differentiate supervision and support.
Invest in developing skilled supervisors.
Identify and provide useful reasonable accommodations.
Monitor supervisor’s supervisory skills.
Support supervisors in their roles.

Slide 19:
Support Experiences:
Be aware of the personal challenges all workers experience from time-to-time.
Support person to perform his/her role.
Define the types and intensity of support the program is able/unable to provide. 
Consistently provide all that is within the definition of support.
Link employees who need additional support to additional resources.

Slide 20:
Two roads diverged in a wood, and Itook the one less traveled by; 
And that has made all the difference”.
-Robert Frost

Slide 21:
Contact Information
Dori S.Hutchinson, Sc.D.
dorih@bu.edu
www.bu.edu/cpr
617-353-3549