Ladies and gentlemen, thank you for your patience and welcome to your Accommodating Employees with Psychiatric Disabilities in the Workplace conference call. At this time all participants are in the listen-only mode. Later we will conduct a question-and-answer session and instructions will follow at that time. I would now like to turn the call over to your host, Ms. Erica Jones. Maam you may begin.
Thank you. Welcome everyone. My name is Erica Jones. I am with the Pacific ADA Center, and I want to welcome everyone to the ADA Audio Conference, which is a monthly audio conference series, a collaboration of the network of ten regional ADA Centers also known as Disability and Business Technical Assistance Centers or DBTAC. You may reach the ADA Center that serves your states by calling 1-800-949-4232, again, 1-800-949-4232. And as always you can get information about upcoming audio sessions by accessing the archives of past sessions and also visiting the Audio Conference webpage at www.ada-audio.org. The audio archive as well as a text transcript of today''s session will be available in 10 to 14 business days following today''s session. The Regional ADA Centers are sponsored by the National Institute on Disability and Rehabilitation Research which is a division of the Department of Education. Today we have an excellent session for you titled, Accommodating Employees with Psychiatric Disabilities in the Workplace. Psychiatric conditions are the leading charge category for complaints filed with the EEOC. Data gathered by the National Institute of Mental Health indicates that more than one in five American adults experience some diagnosable mental disorder in a given year. Employers are often concerned that accommodating individuals with psychiatric disabilities is more difficult and costly than accommodating those with physical disabilities. This session is going to address the realities of accommodating individuals with disabilities in the workplace and offer some practical solutions for employers. We have a really great speaker for you today, Dr. Dori Hutchinson. And she is going to present her slides which you should have gotten by now and they are also on the website. I am going to ask Karen to give a short bio of Dr. Hutchinson.
Hello. Dr. Dori Hutchinson is a Director of Services at the Center for Psychiatric Rehabilitation which is a federally funded rehab and training center in psychiatric rehabilitation. For the last 24 years, Dr. Hutchinson has designed, developed and evaluated innovative mental health services that assist people with serious mental illness to live, learn and work in their community with success and satisfaction. She has a particular experience expertise in functional health for persons with psychiatric disabilities and has conducted services, research, and provided wellness services to help people achieve functional health as a resource for recovery. In addition to helping people choose, get, and keep competitive employment, Dr. Hutchinson has employed, supervised and supported employees with serious mental illness for 20 years. She is also an active member of the United States Psychiatric Rehabilitation Association Research Committee.
After Dr. Hutchinson''s presentation we are going to open up the microphone for participants to ask questions. So without any further ado, Ms. Dori Hutchinson, please.
Thank you. Thank you, Erica. Thank you everyone. I am delighted to be online and sharing my experiences with you and hopefully it will provide you with some opportunities to move forward in your work of employing people who live with psychiatric disability and I am going to look forward to your questions and hopefully I can be helpful to you. What I would like to do just as an orientation is present to you what we know about psychiatric illnesses and the impact on work and then some of my experiences as an employer and my perspective as an employer and things that I have learned, strategies that I have learned over the last 20 years that worked in helping people be successful at work and also helping me as a Director of an agency employ people who live with psychiatric disabilities. I am not sure how many of you are familiar with mental illnesses and psychiatric disabilities, but I thought I will start there as a common place. Mental illness really is a term that describes many, many psychiatric and emotional problems that vary in intensity and duration. And they become a disability when they interfere significantly with someone''s ability to work, to learn, to think, to take care of themselves and to interact with others. What was common in our society, there is so much stigma around mental illness is that many people mix mental illness up with mental retardation. So, mental illness is not mental retardation, nor is it a brain injury. Mental illness is in fact people who live with mental illness, are very often very strong in terms of their intellectual capacity but struggle with their interpersonal and intrapersonal skills. There are many examples of mental illnesses. Anxiety disorders, depressive disorders, people who live with bipolar disease or they live with major depression. Seasonal Affective Disorder, which is when folks become depressed during a certain time of year, usually when there is very little light, they can live with depression. And then schizophrenia disorders, which are probably the most misunderstood psychiatric illnesses that people are diagnosed with. Schizophrenia, there is not one schizophrenia, there are many, many disorders that fall under the category of schizophrenia, and they are very complex, and there are very few generalizations that hold true for all people, but usually people who are diagnosed with schizophrenia will have thoughts that are seem fragmented. They might have difficulty processing information, and symptoms fall into two categories. Folks are either have negative symptoms which means they are very isolated socially and they seem withdrawn even though they might be in a room with many, many people. They are unable to connect with people or they have positive symptoms, which are known as the hallucination, delusion and thought disorders. The important thing to understand about mental illness is they are treatable and there are many, many people and many of you may know people who live quite well with a mental illness. But they are significantly costly in terms of what they cost our society and what they cost people in terms of their impact. We know that the indirect cost of mental illness is due to loss productivity and early morbidity, exceeds $72 billion in our country right now. And as Erica mentioned, the National Institute of Mental Health has done research that estimates that 20% of our population will experience mental illness at one point in their lives. So it is not a disease of others. It is a disease of us. We all have someone in our lives who has been impacted by a psychiatric illness. The other aspect of psychiatric illnesses in terms of the economic cost is that even though they are treatable many of the treatments cost other significant side effects related to people''s health. Diabetes, heart disease, hypertension, those are health consequences of the treatment that people receive. So it is a double whammy in terms of cost and impacting people''s ability to work. Characteristics of mental illness that do affect peoples functioning in their functional health is that any type of mental illness that is a disability, meaning that it lasts for a year or so or longer, is that it is very irregular, it is very episodic. It has ups and it has downs and so people may do very well for a long period of time and then they will have a couple of months where they really struggle. So that is something that stands out about psychiatric illness. Another thing about psychiatric illness that is important to understand is that when people don''t disclose to their employers that they have a psychiatric illness, there is a huge amount of stress associated with that. People talk about walking around with a big secret that is so huge that if they find out they will lose their job, that people won''t treat them the same way, and they have those feelings because in fact that is what happens to folks when people find out that someone has a psychiatric disability or a mental illness. There is enormous amount of stigma. As a society we are afraid or people with mental illness and we mistreat them generally. So not disclosing is often people''s choice because they don''t want it known but it is very stressful to keep it a secret and very difficult. Another characteristic in mental illness that affect functioning and particularly at work as well are the side effects of medication. As I mentioned earlier people take many, many medications that will treat the symptoms of their mental illness, but cause other problem. People get very tired on these medications. They are often dehydrated. They can develop tremors in their hands and in their face and in their legs. All sorts of side effects that can impact people''s functioning. And what happens as a result of this is that many people have interrupted education, training and career path because of the irregular nature of the illness, the side effects of the treatment that they are under, it is very difficult for folks initially, usually in the beginning of their emotional and vocational maturity, to work for long periods of time without a lot of interruption. As I mentioned there are other co-morbid issues that folks are living with many health issues as well. One of the most significant side effects of medication is that people gain enormous amount of weight. It is not unusual or atypical for people to go on certain medication that may cause them to gain 30, 40, 50 pounds in a month. And then that jump starts diabetes and high blood pressure and all sorts of health issues as well. And then the final characteristic that I think is very important to mention is that people with mental illness often have interpersonal difficulty. They have difficulties expressing themselves. They have difficulties maintaining healthy relationships with people and that is a result of the symptoms of their illness. But that is a characteristic that often interferes not only in the workplace but in their living environment. They are having difficult relationships with the people in their lives. Some facts of mental illness, and I put this slide here because I think it is important to address the myth that exists around mental illness that are often in place in the workplace and in educational environment and in living environment. And first and foremost having a mental illness is not a moral weakness. People can''t just snap out of it. You often will hear people talk like that about someone who is depressed or unusually sad, but it is not something that people can just get rid of. But we also know that people can work and learn very, very successfully with a serious mental illness when they have supportive treatment and opportunities to do so. And our Center has done research over the last almost 30 years that has demonstrated that, someone''s diagnoses has no correlation with someone''s ability to work nor will it predict their ability to work. So if someone has a diagnosis of schizophrenia disorder, that isn''t a worse diagnosis in terms of prediction of work than someone who might have a diagnosis of a bipolar disorder. It really comes down to people''s skill and their support when it comes to being successful at work, not their diagnoses. You often hear in the mental health field this term called recovery, and this is really the emergent perspective thats guiding all of the mental health service programs, our psychosocial and our medical treatment approaches and also really the social response to people with mental illnesses. And everywhere you go in the mental health system you hear about recovery, and it has an important relationship to this idea of work because recovery does not mean a cure; rather it means helping people develop meaning and purpose in their life despite the reality of living with a disability. For most people mental illness does not go away. It is an illness and a disability that people learn to live with successfully. And we do know from worldwide research that people do recover from the consequences of a mental illness and they go on to live meaningful and purposeful lives where they want to live. So we know that it happens and we know that it happens despite the fact that their illness may be with them for the rest of their lives. In that way it parallels people with physical disabilities. People who are physically disabled often are physically disabled for the rest of their lives and that is the same as people with psychiatric disabilities. What is important in this whole paradigm of recovery is that we have learned through all of the research that we have done, that the mental health field has done, is that work, going back to work and returning to work is one of the most effective ways to help people recover from the consequences of being diagnosed with a mental illness, and it has demonstrated incredible success across age, gender, culture, diagnosis and socio- economic status in helping people to fully integrate as citizens in their community. So we know that work is really, really critical to folks who live with psychiatric disability. And one of the very important reasons why it is so helpful is for the obvious reasons why work is helpful for anyone else, is that one of the consequences of living with a serious mental illness is poverty. People who are living with these diagnoses are often living very impoverished lives. They are on disability payments which just don''t cut it in terms of living a normal quality of life. But we also know that going back to work when you have a mental illness increases people''s self-esteem and the reason for that is that we so devalue people with mental illness in our society and when you can''t work in our society, that is another stigma that we give to folks. You know you think about going to a cocktail party or going to a restaurant or any kind of event and you get introduced to people, people ask you what do you do, and we tell them what we do for work. So it is a very important role in our society and when you don''t have that role, the impact is very, very negative on many, many factors of life. Peoples quality of life is improved when they return to work, they are less isolated and people''s cognitive impairment that come with a psychiatric disability, they decrease when they are working, when they are given a role that has meaning and purpose, the research has shown that peoples cognitive impairment improves dramatically. And then we also know that people''s attitude about mental illness improve when they know someone with a mental illness and they know that person with a mental illness as a person first, not as a mental illness and then a person. So it reduces stigma. We also know that it decreases people''s misunderstandings and fears when they get to know people as people rather than the mental illness diagnosis. And then here is probably one of the most important things that we are learning in the field right now, is that there are many, many capable and very, very bright people with mental illnesses who have been unable to return to work or who have not have the opportunity to go back to work and they really are an underutilized and underemployed group of folks who have a lot to contribute to the workforce. So there are a lot of benefits of employment for people with mental illness but also for those of us who employ people with mental illness. I am probably preaching to the choir here but I know most people know about the Americans with Disabilities Act, which is a Civil Rights legislation to prohibit employment discrimination against a qualified individual because of their disability and that probably is the most important term there is qualified individual, and this requires us as employers to make reasonable accommodations to the known limitations of the disability of the otherwise qualified individual. So we are starting from the premise that people who come to us for a job or for employment meet the qualification of the job but they have a disability that needs an accommodation. And we know that accommodations for people with psychiatric disabilities often revolve around things like schedule, supervision and emotional support. In contrast to things like barriers and ramps and modified equipment, these types of accommodations are financially inexpensive. The Job Accommodation Network states that most cost less than $500 and company report a return of benefit for every dollar invested somewhere around an average of $30 for making these types of accommodations. So they are not financially taxing on an agency in general when you make accommodations for people with psychiatric disabilities. Some of the accommodations that we know work for people when they return to work and they live with a psychiatric disability are things like adjustment of work schedule, time off for doctors appointment, later start times to counteract drowsiness due to medication, and more frequent breaks. I have several staff who I have made this accommodation of having them come in a bit later because many people with psychiatric disabilities take medications to help them sleep and they really knock them out and then when they awaken they are quite drowsy and they are not moving quickly. So for example, I have people who are coming in at 9:30 instead of 9, and that extra half an hour makes a difference. They give me back that half an hour at the end of the day. I do give people time off for doctors appointments. People need to see often a therapist or go for medication review on a fairly regular basis. What I try to do is encourage people to make those appointments during the lunch hour and then I give them a little bit of extra time during their lunch hour to get to and from those appointments. Another accommodation that we know works for folks with psychiatric disabilities is flexible leave. When people need to take an extended leave, we do that without pay for hospitalization. Every once in a while when as we mentioned earlier, one of the areas that characteristics of psychiatric disability is that illness - I am in the middle of a conference. We do know that extended leave without pay for hospitalization can be very helpful for folks because of the irregular nature of their illness. People will often have a period of time where they need to go in and have their medication re-jiggered, so to speak. Sometimes medications stop working and they need to try a new one and that may require hospitalization. Specialized equipment or assistive devices, in the world of psychiatric illness this might include something like using email to deliver daily instructions. So it involves sometimes thinking creatively around how can we help support someone to do the essential functions of their job so that they can be successful. Another one that is common is providing special transportation. In particular many people have anxiety issues with psychiatric illnesses and public transportation can sometimes trigger that and so if they can provide their own transportation and yet park close to the building and then have the opportunity to do that, that would be an accommodation that would help people get to work. We help people get handicap stickers for this reason, so that they can park very close to the building. Providing human assistance, this is probably the most important one. Many people at work with psychiatric disabilities often need to have someone that they can go to, to ask questions to get support and we find that use of natural support, or having a mentor at the workplace can be very, very effective in helping people do their job well. Some people do have job coaches and those are often provided for by a rehabilitation agency if they come in with a disclosed illness with support from a state DR agency, job coaching will be paid for. So that does not become an employer''s responsibility. But having more natural support such as someone in the office who can be the go-to person and provide that human assistance can be very effective. Another one that I have found personally to be most critical is changing the way we do supervision for folks. And here is something you will hear me say later on is that I learned that supervision is really critical for all of my employees, not just for people with psychiatric disabilities, but it took having staff with psychiatric disability on my staff to help me realize that the way I was delivering supervision for all of my staff was not effective. So giving feedback the way I was giving feedback, changing it so I am much more concrete and detailed and giving very clear and concrete instructions to all of my staff has been very helpful and very helpful for folks with psychiatric disabilities. And then another one that people find commonly doing is modifying worksites, minimizing distractions. There are people with psychiatric disabilities who find that working in a hectic front office environment can be very stressful and so having a quieter work area can minimize those distractions and be effective. So those are things that you would commonly hear people talking about when they provide accommodations for folks with psychiatric disabilities. But then there is the reality of accommodating people with psychiatric disability and what I found is that these are the issues that really seem to rear their ugly head, get in the way, that require collective brainstorming and problem solving, and these are organizational barriers, staff without psychiatric disabilities, their attitudes towards people who receive accommodations, and this whole idea that people with disabilities are getting preferential treatment rather than equal treatment, and then I like to differentiate between supervision and support and found it to be an important differentiation in terms of my experience in accommodating people with psychiatric disabilities. So, organizational barriers. Some of these include the challenges in changing things that define our organizational culture. So our values as an employment agency or as an agency in general, our expectations, our employees, their behavior, our company''s customs and our rituals, our belief, our use of language. If you have someone who is never, if you are an organization that has never hired and employ someone with disability and when you bring a person into that environment, you may find that your culture isn''t that supportive of people with disabilities, and this is true for people with psychiatric disabilities. And where I see this happening most often is around the use of language. Without even realizing it, we use the language of, you know, they are crazy, that is sick, you know, things like that that can be very stigmatizing toward people with psychiatric disabilities and when we brought folks in with psychiatric disabilities to our agency, we were constantly finding aspects of our culture that weren''t inclusive of people with disabilities. And so over time we had to be very clear about what our values are and what our expectations are for employee behavior and changing some of our language so that it is more inclusive rather than divisive. And that is something that each company and each organization will need to figure out on its own, but it does require vigilance. This can be new territory for many organizations because they never had to work at integrating someone who self-disclosing as being a person recovering in the workforce. So it can be very new and that can create discomfort. Then there is also the issue of what often happens what I see happening is that we create a parallel workforce. They have a workforce of people with disabilities and then we have our regular workforce and that can be a barrier. Another barrier that often happens is that we may have leadership that says yes we are going to hire people with disabilities and people with psychiatric disabilities, but then once that has been stated as a vision in the mission for the organization, the executive leadership becomes disengaged from the effort and so it is left to middle management and to the front line coworker to deal with all the issues that come up and it is often not successful as a result. And then there are a lot of resources that are outside of organizations that have the expertise and the willingness to help people do this well. Things like the Job Accommodations Network. Your local consumer operator organization, state Offices of Consumer Affairs where there is a great deal of expertise on helping organizations hire and support people with psychiatric disabilities. So these are some of the barriers that get in the way. So if I can go back to addressing organizational culture, what it really needs to happen in order to overcome this barrier is having the strategy that you are going to put front and center in your organizational values that you value people who have psychiatric disabilities or people with disabilities in general. We call this the principal of personhood, that people with psychiatric disabilities are people. And while that sounds very simplistic, it is not something that really is valued or operationalized as a value in many places. We see them as an illness and we stigmatize. So having that out front and center as a value of an organization could be an important strategy. And then reaching out to people and to organizations who have been successful in doing this can be very, very helpful. The strategy to overcome an organizational barrier of the desire to create this parallel workforce is to step back from that and realize that everyone has a position of support in your organization. All employees have issues and many of the issues that people with psychiatric disabilities that work are just magnification of the issues that all workers have and most of these issues often are interpersonal. We have found over the years historically that people can actually do the essential functions of their job but where we run into problems are around the interpersonal relationships at work. Having sustained interest and support by your executive leadership, regular meetings with your supervisors and your staff to problem solve, brainstorm and assist with all these issues is very, very critical. We are all in this together type of attitude that can be very helpful in coming up with creative ways to be support of people with psychiatric disabilities in the workforce. And then again integrating into organizations training around folks with disabilities and psychiatric disabilities so that people become informed and more aware of the realities of psychiatric disabilities rather than the myths that they operate from. Most people''s images of mental illnesses come from the media and what we see in the movies and television and frankly they are not accurate. So it is very, very important to reeducate people about psychiatric illnesses. The whole Virginia Tech tragedy that happened is a very important one because that is the preeminent image of people with mental illnesses right now and the reality is that the majority, most people, 99.9% of people with psychiatric disabilities are not violent. And so it is that type of strategy of reeducation and educating people around the realities can be very important of reducing those types of barriers and you can use the expertise that is out there to do that. One of the big issues for me in my workplace as an employer and having staff who have psychiatric disabilities and staff who do not is that, I have over the years had to deal with staff who resent my staff who receive reasonable accommodation and what happens is people are over monitoring their co-workers and then tattle-telling to me. And because this is something that is often done in confidence, the development of a reasonable accommodation, it puts the supervisor and the employment in a position of having to really help all workers realize that everyone has their own job to do and everyone has their own issues at work and that everyone gets support to do their job well. But that support is not a one size fits all support. Everyone receives different types of support to do their job well. This is where I see it being costly because I find that this is where I spend time and time is money. When you have staff who become divisive it is costly for managers and supervisors because you are working to integrate and create this inclusive workforce. Because when you have an inclusive workforce that is integrated then people are going to do their jobs well and then your outcomes are going to be positive, whatever your outcomes are. What I have had to do is become very, very clear about performance standards for every single person''s role and have very clear expectations for all employees, not just my employees with psychiatric disability. I have also learned that supervision is critical for all of my employees. I mentioned this earlier that when I first started doing this, I was providing the majority of my regular supervision to people with psychiatric disability and what I realized is that everyone needs supervision to do their job well. If you know Susie is struggling with depression, then I have someone else who has got a personal family issue that is interfering with work and it may not be a psychiatric issue but it is interfering with work, so supervision is important for all employees. So what is the difference between supervision and support? I am going to offer my learned experience. Supervision I believe helps all employees perform the essential functions of their job to the best of their ability. Support assists the person with the psychiatric disability who we know can do the essential functions of their job because we hired them because of those credentials to function independently in their work. So this is where reasonable accommodations come into play. And in fact we know that all employees may need support from time to time. People develop chronic illnesses like cancer and heart disease that may require accommodation. People lose loved ones. They go through divorce. These may require temporary support for people to do their job well but we hire people based on the fact that they all, they have within their credentials the ability to do the essential functions of the job that we have defined. So that is how I see the difference between supervision and support, and I think it is really critical when we think about people with psychiatric disabilities they may need more support at times, but they may also may not need more support given the episodic nature of their illness and their support tend to be related to interpersonal issues at work and scheduling. So what have I learned in doing this in 20 years of hiring and supporting people at work? I have learned that I have to have clear but flexible job descriptions and expectations that are based on people''s critical competency, what their critical skills are, and I do my job description based on job skills as well, not on just the job title with a vague description because then it makes it difficult to supervise and provide support if your job description and expectations are vague. I differentiate between supervision and support and I provide supervision to everyone and everyone is welcome to request reasonable accommodation, and I actually encourage it for people because I think it makes it easier to help people be successful at their job. I invest, this is probably what I have learned, one of the most important learning, I have really invested in developing good supervisors. We often place people in supervisory roles and they are not good at it. I am sure all of you can think of someone in your life maybe even someone who supervises you who is not very good at it and having a good supervisor can make all the difference and to me a good supervisor is someone who can provide critical feedback in a way that is heard and in a way that is used and still maintain an alliance with the employee and this is something that needs to be taught. They are not born to be good supervisors. So that is something I have made a big investment in. I have also identified what I think are useful reasonable accommodations for the work that we do in our organization, and I think that can be a very useful strategy, it is figuring out what are the reasonable accommodations that can be provided by your organization and almost having a toolbox of accommodations that you are ready to tap into should someone request them so that it is not a stressful situation in trying to figure them out. We do a lot of monitoring of supervisors supervisory skills and we do a lot of supporting of them in their role as well because it is not - as I mentioned I think it is not costly so much in terms of finances but it can be costly in terms of people''s emotional energy. It can be difficult to supervise people where they are struggling emotionally, there is no doubt about it, and so supporting people to do that job well is very important. We have learned about, what we have learned about support is that everyone in the workforce experiences personal challenges from time to time. So we have tried to reframe our experiences from this perspective. It is that personal challenges are not just for people with psychiatric disabilities but they are for all workers and I think that help us to be a more supportive workplace. And we support people to perform his or her role. And as I mentioned earlier, for each person that is going to be different. The other thing that we have done and I think this is important for employers is that we have defined the type and the intensity of support that we are able to provide and we have also learned what types and intensity of support that we are unable to provide. So we know when enough is enough. We know when we have reached our own limit, we have defined that limit. And then when we reach that limit, we know who to go to in the large organization and also who to go to outside of the organization for support. And because we have defined that very concretely, we are able to consistently provide that level of support because we have defined it well. And we link employees who need additional support to additional resources. So if we cannot do it, we link them to resources that can provide it for folks. Okay. And then I am going stop there and I have a quote by Robert Frost and the reason this quote is meaningful to me: Two roads diverge in a wood and I, I took the one less traveled by, and that has made all the difference. The reason this really resonates for me as an employer of people with psychiatric illnesses is that I feel I have an enhanced, much more meaningful workforce because I have people who live with psychiatric illnesses as employees, and I feel that I have evolved as a better supervisor, as a better director because of my relationships and my experiences with people with psychiatric disabilities. And when I present this, even to close friends and family who know what I do, you know they still say things like, I don''t know how you do it and how can you do it, and you know that is really the wrong framework because these are people, these are human beings who have a lot to contribute as workers, who come to me with some really incredible skills and it has been a real privilege for me to have the opportunity to work with them as colleagues and they have enhanced my employment as well. So I am going to stop there and let Erica open up questioning.
Thanks so much, Dori, really appreciate your presentation. I also want to remind people that your local DBTAC or ADA Center is also a great resource to hook you up, and you can reach us at 1-800-949-4232. We also all have a website that will lead you to important information. And with that may I have the Operator come back and give folks some instructions on how they can ask questions at this point?
Yes, maam. Ladies and gentlemen, if you have a question at this time, please press the one key on your touch tone telephone. If your question has been answered or you wish to remove yourself from the queue at any time, you may press the pound key. Our first question, your line is open.
That was quick. Good afternoon. I have a couple of questions but I will just start with one. It wasn''t answered in the presentation, if you are dealing with an employee who has psychiatric or mental health disability and you are believing that part of their acting out is because they are not taking the medication, do you have any suggestion on how to deal with that?
That is an excellent question. Yes, I do. It is a great question. The way we deal with that and if that person has disclosed to you and often what happens when people don''t take their medication is you do see their symptoms emerge, and you see them struggling. And what we do as supervisors is we pull them right in and we make an observation and we say, I am observing that you are having trouble meeting your job requirements and I am concerned that maybe your self-care routines, your medications, your treatment, whatever you might be doing to take care of your health issues is off track and how can I be of help to you to get back on track. So I think it is very important to address that right away and to let people know that you have observed that they are not meeting their job expectations or they are having trouble meeting them because of what you are seeing them do and to give them the opportunity to respond to that.
And are you relating that to a specific, like, the supervisor? See, the example that I am looking at right now is the supervisor and the employee just, the supervisor has attempted to work with the employee to have them perform their job duties and tried to outline what those duties are, but the employee won''t even open up the emails that we try to use as a tool when it says job assignment, she is saying no, I am not going to open those up and I am not going to deal with them. Is the supervisor the right person to be dealing with that issue of whether the person take medication to help deal with their issue or should be somebody else that is aware of the persons needs and may have a better communication with that person?
Well, I think there are two issues here. One is that I think if the person has disclosed that they have a mental health issue, then I think it is definitely within the supervisor''s purview to say I am observing, this is what we are asking you to do and you are having trouble doing it. And then the supervisor is not a therapist or a psychiatrist, but it would certainly make sense then to refer that person to their treatment providers or to refer them to an EAP person on site or whoever might have oversight of people''s health issues in an organization. In my organization, people disclose that they have a psychiatric illness and when their symptoms emerge, we say you know this is exactly what you are not doing. You are not answering your email and that is part of your job to answer your e-mails, and I am wondering why you are not answering your emails. It becomes a job performance issue. And if they then you know not taking their medications, we might suggest that they need to take sometime off from work to get their medication or whatever they might be doing in their treatment on track to support their ability to do their job.
Another question, if say the example where the supervisor and the employee where it seemed like the employee just doesn''t have any faith in the supervisor, have you ever used a mediation type of approach to bring a third person in to try to work between the employee and the supervisor to develop some better relationship?
Yes. And that goes back to my comment about investing in supervisors. Yes, we have done that, and you know, often it may be an interpersonal relationship with folks that a lot of people I think with psychiatric disabilities I mean they are often described as being very sensitive, that would be the common language you might hear. So it maybe the style of supervision that isn''t a good match for someone. So it becomes an issue of do you work with your supervisor to help them accommodate that sensitivity to their style or do you assign that person to a new supervisor.
Thank you.
That would be a reasonable accommodation if it is not working and you value that person as an employee.
Thank you
You are welcome.
Our next question, your line is open.
Can you hear me all right?
Yes, I can, perfectly.
This is actually related to the slide on page number 9, the Supervision versus Support.
Uh-huh.
The question I had was, how do you avoid crossing that line between providing reasonable accommodations and simply personal services?
Well, that is another excellent question. That is where you have to be very, very clear with the person what you will provide and what you wont provide. So, when peoples psychiatric issues might tumble into the workplace in some way or another, you know everyone''s personal issues come into the workplace and there is probably some organizational tolerance for some of that that you have defined. So if someones marriage is falling apart, you might chat about a little bit, but you are not going to you know pull that person into your office for three or four hours a day and talk about it. The same thing for people with psychiatric disabilities. They have resources, they should have resources in their lives that address those issues. So it is more stepping back and taking a look at, am I providing more support to this person than is reasonable? Would I provide the same type of support for anyone else who might be going through a hard time or am I doing more? And then is it a reasonable accommodation or not that needs to be in place for this person. You know the supervision is really, are they able to do their job and what kinds of support do they need to do their job and then the other layer is just the human interaction and the human support that we provide at work, when does it become taxing, when are you doing more than you are doing for anyone else. To me that is where the line gets drawn.
Thank you very much.
Okay, does that answer your question?
I think so.
Okay.
Our next question, your line is open.
But the reason I came to this meeting was I am an employee with different neurological disorders and I wanted to know my rights. And in order to hopefully prevent the next time I could go for a job promotion as I once did for KidCare which is almost very anti, it is a very anti-supportive environment, that is being extremely politically correct. Number one, I want to know how do I get a job coach or job assistant? My issues revolve around concentration. I don''t have problems with the scheduling or anything. I work, amen, but my problems revolve around the scheduling. Presently, I have a very supportive boss. I work in a very pleasant environment, but I do have a college degree with some graduate hours and I am your stereotypical underemployed person. And my pay title is Office Associate which I have been with, and I am grateful to have gotten it, but I have been there for the past eight years. Sometime between now and retirement, I am presently 48 years old, I would like a few promotions. Anyway, what I would like to know is, the areas where I have had problems in the past is training, training issues. I am on the appropriate medication, I follow my doctors orders, I go to my counselor, I go to all the prescribed things. I want to know what people with neurological disorders have a hard time doing is making that good first impression, both in personality as well as going through the training. Getting through that first six months, that is what I have the hardest time with, so I want to know when do I disclose as an employee with, or anywhere in fact, that I have these issues because certainly I don''t want to go through you know, going back and forth and different jobs. When do I disclose that? And I have all these good credentials you know but how do I answer in an interview well, you know, for a good part of my adult life and this is before I got into the state in the year 2000, I worked a lot of dead end jobs, low pay, short-term that high school drop outs would have applied for. How do I answer that? I don''t have a whole lot of, I dont have any, hardly any professional experience, I am 48 years old, I am still in that, in that period between where do I get work experience versus you know.
Can we have a question and answer now please?
Okay, so job assistance in the training and when do I ask for, how do I get a job coach and that is basically it.
Thank you.
Okay. Those are all very critical questions and I will share with you when people request you know, accommodations from me and how it has happened in my workplace, which I think seems to be what people have tended to do is that when they come in they are applying for a particular job and so they apply for the job and then when I offer them the job and they come back in, that is once they have been offered the job and accepted it, that is when people will request their accommodations. So they are applying for the job on the basis of the fact that they can do the job and once I hire them, they say to me, I am delighted to be here but I would also like you to know that I am living with this particular condition, and I would like to request these accommodations. This is what I know about myself. And then becomes my responsibility to determine whether or not I can provide them and how I would provide them. And it sounds like to me you are very knowledgeable about what your strengths are as a worker, and you would probably do a great job of saying to someone like you just did on the phone here, this is what I need help with. You know, I can do X, Y and Z but I need help in the first six months of my job and these are things that have worked for me in the past. So that is, the timing of it I think would be once you have been hired to immediately let them know that you would like an accommodation. Then your question of how do you get a job coach or a mentor at work, I think ideally it is nice to have someone within the organization who is willing to be a mentor for someone rather than bringing in an outside job coach. Bringing in an outside job coach often can make people feel exposed and apart from other people. You can get job coaches from voc rehab agencies. If you go to them and you become part of the vocational rehabilitation system in your state and they bring you on as a client and determine you know that you have this need for a job coach, they will provide you with a job coach. But I think ideally it is best to seek someone within the agency that can mentor you particularly during the first six months which is a hard time for everyone but it sounds like that is your particularly rough patch of time. Because if you can get through that rough patch of time, it sounds like there could be opportunity to demonstrate your value and then therefore be promoted.
Thank you.
Our next question comes from, your line is open.
Hi. This is, and I understand that for many persons who have disabilities relating to their mental health, that once they have announced or made it clear that they need some type of an accommodation and we can provide it, that that is fine, and even if their supervisor might see that they are not taking their medications or following their treatment regimen, they might be able to act on it. But one of the problems that we have had more recently is there are persons who we suspect might have a mental illness, but we don''t know for a fact. It is just that their behavior is such that it suggests that perhaps they have a mental illness. And they are unwilling to engage in any type of discussion that would, that would lead to their revealing that. They have been given opportunities and so forth and they simply won''t you know, wont take them. Not only from their supervisor you know, but from other say neutral parties at the agency. So, what kinds of suggestions would you have for that?
Okay. So just that I am clear, you are observing people who appear to have symptoms of a mental illness but they have not disclosed.
Right.
And you have approached them to try to engage them in a discussion about their mental illnesses?
No, just about their behavior. For instance saying you know, we have observed you know, you doing X, Y and Z and we have observed that you are not getting your work done and we have observed that you have been yelling at you know, you yelled at your coworkers or you have been very short with them, or you know with other clients, and you know we have got all these observations of behavior and, so we are wondering you know if you are having some problems or whatever and these people completely block you out. They refuse to acknowledge it. They refuse to discuss. So what do you do in a situation like that?
That is a tough situation, no doubt. And I think, go back to the job description and you make sure it is clearly described what is acceptable and not acceptable and if people are not meeting the job requirements and they are, their behaviors are interfering in the work they are supposed to be doing and interfering the work of others, then you would treat them like any other employee who is not meeting the job requirement. I mean that is really what it comes down to it. I mean people with psychiatric disabilities have a right to be treated like every other employee. So if they are screaming at their coworkers and they are resisting supervision and they not completing their job requirements, then they are not doing their job you know. And if you are trying to reach out to them, sounds like you are making effort to be supportive, and say we have notice that you are really struggling and they are not willing to assume responsibility to take the opportunity for that support, then you go back and you do a performance evaluation and you say look you are not meeting the job requirements, you either have to start meeting them or you are in danger of losing your job. To me that is the bottom line.
I have another question from the same location.
Yes.
Hello?
Hi, I am here. I can hear you.
Okay, thanks. Recently the state of Minnesota came out with data that indicated that the top prescribed medication for state employees were antidepressant by and large. Huge numbers of employees having antidepressant prescription and a colleague said to me is it that a lot of depressed people work for the state or does the working for the state make you depressed? And the expansion of the you know depression diagnosis in some work environments it can be a chicken and an egg situation where an organizational culture is so toxic that it can have a direct impact on the mental health of its employees particularly when it comes to depression and anxiety issues. And I was wondering if you knew of any studies or information about you know the impact of organizational culture on preventing those types of mental illnesses where you have employees, with a lot of those things you have biological predisposition that environmental triggers sent people into acute mental illness diagnosis.
Yeah, absolutely I mean and particularly if you were living in a very difficult time and people are living with a lot of you know issues in their own personal lives you know, people are overworked and underpaid and there is a lot of stress. I mean we are definitely seeing a rise in the general population on these types of medications for anxiety and depression. And that is a huge impact on the workforce, and I think there are programs in the state of Massachusetts, which is where I am from, the Department of Public Health has this Wellness at the Workplace initiative going around trying to help work environment be healthy environment and part of healthy environments are positive relationships with supervisors, reasonable work tasks, you know, there are a lot of workplaces that are downright abusive to people and not very tolerant of the fact that people are human beings. So there are initiatives that are happening from state to state around this whole idea of wellness at the workplace and in an effort to target I think, that very issue you are talking about is that often the environment can be toxic in such a way that it impacts people''s mental health. I mean we know that for sure. And you don''t even have to be genetically predisposed, you know it can happen. It can happen. You can just be, you can have a job that you hate and a supervisor that you don''t like and you are stuck in that job because you have a family at home that you have to feed and that can make people miserable, downright miserable. I mean I know for me because I work in a mental health agency and I have people who have mental illnesses on my staff, I work very hard at making sure we operationalize this idea and value of wellness so when I hear in my staff meeting, so I don''t even have time to eat lunch, that is a red flag for me. That means I am not doing my job as a supervisor to make sure that my staff has time to eat lunch or time you know go out and take a walk at lunch time or go for a run and to me that is what going to keep my employees healthy mentally and physically and therefore I am going to get my outcomes met because my workforce is healthy. So it isn''t just about you know focusing on the individual, but it is, you made a great point of making, taking a more global look at the work culture that you are in and is it a healthy work culture that people are going to thrive in whether or not that they have a disability.
Thanks.
Thank you.
Our next question.
A question about the, just a follow-up when you were talking about would you provide accommodation equally among employees. In that vein, how do you define how to evaluate whether an accommodation becomes an undue hardship for an employer in terms of it is too much in this situation for an employee or an employer, I am sorry.
That is a great question. For me the primary accommodation that I give relates to scheduling and time. So if I am providing an accommodation that will allow people to come in a half hour later and they say well, I really need to come in at 10 or 10:30, but then that interferes with the service that we provide. I have to say I can''t do that because you are here to help me provide this service that starts at 10 a.m. And if you are not here until 10:30 that puts an undue burden on the other staff who are here. So that I think it has to be individualized in terms of your organization and what you can and cannot do. And for me if people request for accommodation interfere with my ability to get my product out, whatever my product might be, then that becomes something that I am unable to do. Or if they ask for an accommodation that I don''t have money for, you know, I can''t do that, I dont have that in my budget. But I never had a request for an accommodation like that. Usually it is around, for example I will share that someone has a substance abuse problem on my staff and they want to go to an AA meetings and then meet with their sponsor, it was taking two and a half hours for them to go through that process on a daily basis. It was interfering with their coworker relationships because it was putting undue burden on the other people who held the same positions, and they were supposed to be doing this together. And I had to say you know what, there are these meetings happen after work and before work, I like you to find them. You need to be at work during your assigned time.
As a follow-up to that, can you talk about the, whether or not the psychiatric disability has the same legal weight as a physical disability?
I would like probably Erica, is probably more of an expert on that, but my understanding is yes, absolutely, they have the same legal weight. I think we are less experienced in responding to complaints about them, which then makes the outcome less predictable but I think according to the Americans with Disabilities Act it has the same weight.
That is correct. This is Erica. It does legally have the same weight, and it is regarded as the same level of disability if it substantially limits a major life activity, and you might be referring to some of the court cases, but they have been all over the map around the country, and it is not just psychiatric disability who have gotten some hits, but other types of physical disabilities have too. But under the law they hold the same weight, yes.
Thank you.
Our next question.
Can we just wait for a second? This is Robin and we have a couple of questions that have come on online that we havent been able to get in yet. Can we possibly take those at this point?
Yeah, I am open to anything.
Okay, why dont we go ahead and do that, Claudia, just because we just want to make sure we got people from different mediums to get a chance to ask their questions today. So, go ahead, Claudia.
Okay, these are people using the streaming audio, listening through their computer speakers. Who had a question about if employees who arrive late or work at specific hours due to medication. Why can''t the employee arrive early or make changes to be able to make it on time instead of having the employee figure out something else to meet their schedule.
Okay, so the question is if someone is on medication and they are arriving late?
Yes. As a result of the medication, why isnt the responsibility on the employee to make changes to make it to work at the same hours as the rest of the employees versus the...
Okay, I got it. So why can''t the person who is on the medication change their schedule so they have enough time. Absolutely, it is a reasonable question I think and then again it is also very individualized. If your organization cant have someone come in later because it will interfere with the product of the organization, then that interferes with their ability to do the essential functions of the job. But many of these medications you know it would need, it might need for people, often people I know with psychiatric disabilities, they are going to bed early already. So you know if they are going to come home from work and they are going to eat dinner, they are going to have a little down time, all of a sudden its nine oclock and then they are going to take medication that are going to knock them out for 10 hours, 11 hours, make them very, very groggy in the morning and for many people it can mean that they need to wait a while so they can operate machinery like drive a car, wake up, that sort of thing, navigate public transportation. I mean these medications that people are taking to manage their physical and psychiatric symptoms of their mental illness are very, very toxic and that I think requires an understanding on part of the employer and the coworkers of what that means to put that kind of toxin in your body so you can come in and do your job. So they do have a huge impact on people''s bodies. There is just no doubt about it, I mean when people first go on these medications, they often keep their eyes open, they are so sedated, and it can take a while for the docs to figure out the right dose. I mean we have even intervened for people on behalf of my employees with their doctors to reduce their medication so they are not so sedated. So I think for me it is an attitude of I can accommodate that. I can have people come in a little bit later if it will help them wake up. It doesn''t interfere with the production of our service. It is not an essential function of someone''s role to be in exactly at 9 in my particular organization. So I can make that accommodation. But each employer needs to decide whether or not that is part of someone''s role you know and is it part of their job description to arrive at 9 and if they didn''t arrive at 9, does it interfere with their job requirement. And then maybe that is another accommodation you can make and you need to let people know that. But if it doesn''t, then that is a reasonable accommodation because of the you know, it is really kind of, it is taking a humanistic approach to being an employer as well is that these people are taking medication just like a diabetic take insulin. We are not going to say to a diabetic, well, you know, I am sorry, you can''t take your insulin at 8, even though you might need it at 8. I want you to take it at 7. But their bodies might need it at 8 a.m. So it is that kind of tolerance of people''s efforts to do positive self care around their illness that we are being asked to accommodate.
Thank you and I have one more question via the online streaming audio, is, what do you suggest when a doctor says an employee is restricted from working with specific supervisors in that situation?
I guess I would, that is a very interesting question. I would, it depends on if the doctor is saying, I don''t want you know Jane working with Kim or is it I don''t want Jane working with a supervisor who has this kind of style. If it is the doctor saying I dont want, I am requesting that this person not work with the supervisor with this kind of style, I would place a huge bet that the reason for that request is that there is a history that that particular supervisor''s style does not work well for this person and has resulted in employment issues. But if it is more individualized like I don''t want Jane working with Kim, I would investigate that more to find out why and to find out what is the supervisory, supervisee relationship that is happening and it may be something that with training and discussion and definition can be modified and fixed.
Great. I would like to bring it back to the Operator to open up for questions.
Thank you, our next question comes from, your line is open.
Thank you, can you hear me?
Yes, I can, very clearly.
Thank you, Dr. Hutchinson. I have really agreed with and appreciated your philosophy and your comments. One of the things I noticed here is we review ADA requests and documentation almost daily, and in the mental health profession we are seeing that a lot of mental health providers don''t understand the nuances of the ADA. In some Circuits in some states things are different. For example here, interacting with others per se is not yet recognized as a major life activity. Nor is concentration per se. Now if they can couple that with something else, then they typically have enough, but I am spending a great deal of time having to communicate to employees who apply for coverage under the ADA to communicate with their mental health providers to let them know look, this just isn''t enough.
Right, right.
And it just seems like there is a general perception across the country that the things apply across the board when in fact they don''t. My specific question for you is, how can I best here in the state of Utah, or wherever we may be, educate the mental health providers who are critical in providing the documentation to establish coverage. What needs to be done to really do an objective job to apply the DSM-IV standards appropriately and really provide us the information we need to either to really do justice to the employees that apply.
Right, right. So they are providing very vague or limited documentation? Is that the issue? And then you are having to go back and figure out what is going on and help them do the documentation more effectively?
Right, both that and they are also assuming things to be major life activities which our jurisdiction hasn''t. And so I would like to be able to find a way to communicate this to the broadest number of professionals as possible so they can really understand this. I just don''t know that there is that much training being provided to mental health providers with respect to ADA.
Well, I think you are absolutely correct in that assumption is that even within the field, you know, you would think in the mental health field that people would be aware of this and would be able to differentiate between reasonable accommodations and support and psychiatric treatment issues, but I find the same thing, that people are very limited in their knowledge and also not only in their knowledge but at what you are talking about the application of that knowledge to the particular person that they are treating. I think this is an opportunity to I don''t know what resources you have available or what you are capable of doing but perhaps for your office to make people aware of the external resources. Certainly we have a website. Erica has a website but one of my last slides, our website actually has a site where frequently asked questions by employers about reasonable accommodations for people with psychiatric disabilities. We have pages on our site that give examples of these, the types of issues that might interfere with folks with psychiatric disabilities that might help them do a better job at documenting that or even if you were to develop a list, a cheat sheet almost, an informative page that you can send providers to see examples of accommodations that fall under the ADA for folks with psychiatric disability to help them do a better job, I think would be very, very useful. And then you would be directing people to that resource. This is what you need to do in order to document that this person needs this.
Thank you.
Thank you.
There are a lot of external resources.
Thank you so much, Dori. Our time is up. The questions have been really enlightening and I am really happy that so many people participated. If you werent able to get your question answered today, please feel free to call your local DBTAC and they will get the answer for you.
And Erica, I am willing, I have my email there if people want to email me with their questions, I am happy to respond.
Okay, that is also on Dori''s last slide. You can contact her directly. Thank you so much, Dori. And I would like to remind everyone that on July 15th the audio conference will be the ADA Update: 18 Years Later with John Wodatch, the Chief of the Disability Rights Section at the Department of Justice, and Jeanne Goldberg, Senior Attorney Advisor at the EEOC, and we really appreciate your participation and this concludes our program for today. You can disconnect and have a great day.