Good day ladies and gentlemen and welcome to Understanding Mental Illness: What an Employer Need to Know. At this time all participants are on a listen-only mode, later we will conduct a question-and-answer session and instructions will follow at that time. If anyone should require audio assistance during the call, please press star then zero to reach the Operator. I would now like to turn the call over to Peter Berg.
Alright. Thank you very much Operator and welcome, everyone, to the 2008/2009 ADA Audio Conference Series. The series is brought to you by the National Network of Regional ADA centers also known as DBTACs Disability Business Technical Assistance Centers. You may reach your regional ADA center by dialing 800-949-4232. As a reminder, again, the session today is being recorded and about two weeks'' time the audio archive as well as the text transcript of today''s session will be posted to the ADA Audio Conference website, www.ada-audio.org. And again as a reminder, today we have people joining us via the telephone, individuals joining us through their computers using audio streaming and then other individuals joining us today through their computers using real-time text captioning. We are pleased to have with us today Dawn Zak who is the, operates the company Way of the Willow and today''s session is going to focus on mental illness and what employers need to know when working with employees that have mental illness. Dawn is a clinical substance abuse counselor and she is also a certified employee assistance professional. Dawn has worked with businesses, employers, organizations serving as a consultant with these entities and organizations on understanding issues around mental illness and she has been a presenter on this topic for a number of years, both at the regional level and at the national levels. So, we are very pleased to have Dawn with us today for her presentation and at this point I will turn the session over to Dawn. Thanks for joining us, Dawn.
Thank you, Peter, and I am really happy to be here and to be able to offer this information and really want to say thank you to you and Robin and the ADA center for inviting me to do the talk and I am really pleased to have the opportunity. Also want to, even though I cannot see you lovely people, say thank you to the audience. I am always excited when people are interested in this topic and want to know more so that we can be better at working with ourselves and with other people to keep our employees working and working well within our organizations. Couple of things I want to say just out here at the beginning. I really do this presentation for a couple of different reasons. It is really not about creating employers that can do diagnosing or employers that now have to add the psychologist''s hat to everything else on their plate. It really is an opportunity to give you some information so that that there can be understanding about mental illness, about the common mental illnesses and how those impact people and what that might look like in the workplace. Really the idea is to create some empowerment because the more that we can know, the more we empower ourselves and other people to be able to be less afraid, that helps reduce stigma, it makes us more willing to reach out and make better choices in our lives and in our workplace. We also become agents for helping people increase their performance in the workplace regardless of what the issues are that may be getting in the way of good performance. So again, that kind of bottom line of reducing stigma, increasing our understanding and really obtaining and keeping employees working and working well. So that is, really want to give you an opportunity today to understand, recognize some of the common signs and symptoms of the more common mental illnesses, depression, bipolar, anxiety and schizophrenia. We will identify some of the risk factors and maybe some triggers that can set those cycles in motion and make it difficult for people to sometimes be in a workplace. And then recognize very specifically how some of those can manifest in the workplace and then hopefully leave you with good resources. So let me start. You all should hopefully have enough of a power point in front of you and I follow it pretty closely. I may transpose a few slides here and there but most of them should be included for you to follow along. So, just want you to take a minute as I am giving you some pieces of information here to think about the people that work around you, the people that you work with, the people that may be in the office with you, those of you that, those people that you call your co-workers. I am just going to give you things to think about when we talk about this invisible disability. It is hard to see and often gets overlooked in a workplace as well as other places in our society. So, just want to talk about that a bit. First of all, when I think about the people that work around me, some information that is really important to think about. We forget that mental illness happens on a continuum and maybe we didn''t even know that to begin with. So on one end is mental health and on the end of the other end of the continuum is mental illness and then there is gradations between those two ends where we can have mild mental illness issues, going all the way up to severe mental illness issues and signs and symptoms. So I am going to talk about that continuum a little bit so I wanted to put that out there for you to think about first. And then also the other thing you are going to hear me talking about as we go along is that people can move along the continuum and then each mental illness that I talk about also has a cycle within it where people have better days and people have worse days and so we are going to talk a little bit about that as I am going along as well. So when we talk about mental health and mental illness on this continuum, we really want to talk about mental illness as being real, common and treatable. So want to go back to those coworkers that you are thinking about. Common. Let''s start with common. If you think about the people that work around you, one in five of your coworkers in any given year are going to suffer from a mental illness. So if there are 25 offices, 25 coworkers, 25 stations or cubicles, that means five of them are dealing with mental illness. That is a lot of people when we start to put it into that kind of context. Another piece about common that is important, World Health Organization in the year 2020 is telling us that major depression is going to be the leading cause of workplace disability worldwide. When we think about real, we are much more comfortable thinking about things like heart disease, asthma as illnesses that happen in the body. We don''t think about mental illness as having a biology base, that it really is an illness that occurs in the brain. And so as we talk about this and unfold this today, to remember that we are talking about something that is a real illness like diabetes, like heart disease with that biology-base, it is common, it is happening around us, here is another statistic to think about, 70% of the people with mental illnesses are already in the workforce. We are there, we are working, we are working well and doing a good job. And then the other piece about this is sort of the foundation, this idea about it being treatable. 60 to 80% success rate of people who seek treatment get better. They have some relief, they experience some relief. That is higher than the statistics for heart disease recovery which is about 40 to 50%. The hitch in the giddy-up with this is that two out of three people won''t seek treatment. And I am going to talk a little bit about stigma today because that is part of what keeps people from reaching out, from asking the questions, from seeking the services that they need to stay working and working well. So that continuum I talked about between mental health and mental illness. The truth of the matter is that when we talk about wellness and we talk about wellness in the workplace, if we don''t look at mental health, we are not really touching workplace wellness in the way that we need to because we really want mental health and wellness for all our employees. I just wanted to make a comment about how the things that we want and need and that are important to us are more similar than dissimilar. We really want to, we really have some universal needs and I am just going to name a couple of them and you will hear that these are all things we all want. To believe in ourselves, to be respected, to be loved and to show love, to belong, to be useful and to be productive, to have meaning in our lives. And so, when we think about those, we can start to see where we have this common ground that we all are working from in a workplace. We want to be productive, we want to be useful, we want to be respected, to figure out how we belong and fit in and what is our meaning in the workplace. The other thing that is important is that work matters to us. Work is not therapy but for a lot of us it is therapeutic, it is how we get self-esteem needs met, it is how we have meaning and purpose in our lives. So that is an important piece of the puzzle when we talk about the workplace. And then the other piece about particularly when people are dealing with a lower part of their cycle and the signs and symptoms of their mental illness are higher, that they are not always as able to meet those needs, not always as skilled at getting those needs met and their ability to act upon getting those needs met can decrease and we are going to say a little bit more about that as we go along. So this process of recovery that we talk about, and again, I am making this very broad because as you listen to this definition about what recovery means, you are going to hear that it is something we all want, it is something that we all face, and when we start dealing with people who are dealing with mental illnesses, that achieving balance and reducing symptoms is what recovery is all about. So it is the processing in which we are able to live, work, learn, participate fully in the community. It is that ability of being able to achieve balance between our social, physical, emotional, spiritual, our economic, our mental health, all those aspects of our life and the challenge for all of us is finding and keeping that balance in the midst of cycles, in the midst of up and downs, in the midst of triggers that happen in our life and when we add on top of those challenges this biology base and the mental illness piece that we are talking about, you can begin to see what people are dealing with to be able to function well in a workplace setting. So that ongoing process, that reduction of symptoms and as I said before, we are talking about a mental illness as a cycle so there are times when I am symptom-free, I am not experiencing symptoms in a way that they are getting in the way of my functioning, that they are debilitating in any way and then there are times in my cycle where I may drop to a lower place and the things that I am able to do become challenged and again I am going to say a little bit more about that specifically as we go along. We will talk about some things to consider as we look at the workplace because again I am kind of doing some layering here where we are looking at the things that are common and then the challenges that people who are dealing with mental illnesses face in their day-to-day lives. So as we look at some of those common challenges, that can present some difficulties to our mental well-being, just some things to consider: we are working harder and longer, we take less vacations. As a matter of fact, the Bureau of Labor tells us that the newest statistic is 32% of us don''t take vacations. That is a lot of people who are not doing self-care in terms of their mental well-being. A lot of people who work on their off hours, so even when they are off, they are plugged in by e-mail, they are plugged in by cell phones, the internet, and that is the other piece about we can travel farther, we have home offices, we are more isolated, we are more global, that creates more stressors because it us not as easy for us to unplug. We are doing more with less. And many of us have experienced that as our economy gets tighter and there is more downsizing and layoffs. In terms of working harder and doing more with less, we are working 1,000 more work hours per year than we did 25 years ago and we are stealing that time from other places in our life. So you can see how that starts to impact our balance. Just a couple of comments about the nature of the workplace today is about change. There is a lot of changes going on. A lot of changes in how we do business, differences in job skills and tasks, you know, several years ago, not many years ago, what we were working a lot with were things, tools and physical demands. Now we are finding that we are having to work more and more with people so the demands are about interpersonal demands. And so you can see how that begins to create different challenges in the workplace than we used to have. Those challenges in the workplace, again I am kind of doing some layering here so we can see those challenges in the workplace. We are going to talk about risk factors and triggers and see how those can all kind of come together to make a soup that can be difficult to navigate through, particularly if I am in a part of my cycle where symptoms may be higher. We really don''t know what causes mental illness but we do know some, excuse me, some risk factors that can increase vulnerability. There is a question about who gets it and who doesn''t get it. To be quite honest with you, mental illnesses really don''t discriminate. Anybody can get it but some of these risk factors are important things to note. Biochemistry, we talked about that, brain chemistry, wiring, that kind of goes hand-in-hand with genetics and family history. Mental illnesses run in families. And so if I have someone or I have a family history, the risk factors for me increase just like if I have heart disease, diabetes, alcoholism, any of those things running in the family put me at a higher risk. We know that mental illnesses are about brain chemistry. And there are things that can impact brain chemistry. There are medical conditions, there is a high correlation between medical conditions, heart disease, diabetes, we call that co-morbidity. Co-morbidity between those and mental illnesses. The idea about thinking patterns, people who have more negative thinking patterns, who struggle with coping skills and problem-solving skills, if they are not a lot of those strong judgment and coping skills and problem-solving skills in place, that may mean that I am prone to more low self-esteem, difficulty in thinking patterns and thinking things through which again just creates a risk factor, creates more vulnerability for me and also creates more vulnerability for me as I may be in a low part of a cycle with my mental illness. Environmental factors, what I am talking about there are things like loss, divorce, poverty, access to services, being involved in combat, trauma, those types of environmental factors can increase vulnerability and if I already have genetic predisposition you can see how those things start to pile on top of each other. You will notice when I talk about risk factors and we move to talking about triggers, that there are some overlaps there and I will say a little more about that in a couple minutes. Two other things I want to note about risk factors. We are learning more and more and more in helping primary care physicians understand more and more about postpartum depression so when we are looking at birth of a baby, having a baby doesn''t mean that somebody will automatically develop a mental health issue; however, we know that postpartum depression is a very real issue and learning more and more about how to deal with that and again, helping our primary care doctors to identify so that we can treat people when that happens. SAD, the Seasonal Affective Disorder, most people who deals with Seasonal Affective Disorders are in a lucky part of their cycle at this point in time as our days start to get longer, we have more light, well, I don''t know about that today here, got lots of rain and maybe even some snow but the honest truth is that for most people who deal with Seasonal Affective Disorder, that fall/wintertime can be a high risk factor as they have less and less light available to them, less and less of what their brain chemistry needs to help stave off some of those depression symptoms. I mentioned that I am going to talk about stigma and I just want to identify that as a, I believe a risk factor because it really does impact people''s ability to get the services and the attention that they need to be able to keep functioning and functioning well in a workplace. I told you that you would see some overlap between triggers and the risk factors that I was talking about. The reason that I separated them out is because all of us can experience triggers regardless of where we are at on that mental health/mental illness continuum but as you can see if we start adding risk factors we add workplace challenges, these triggers of loss and trauma, chronic illness, substance abuse, those things can start to create double and triple stressors for people who are dealing with mental illnesses. So I just wanted to touch on those just as part, as we un-package some of this, just wanted to touch on those a little bit as stressors that start to increase our inability to cope and can really impact a reoccurrence of symptoms when people are experiencing successful recovery. I indicated that I really looked at stigma as a really a risk factor for people and I just wanted to say a couple things about stigma. Stigma really makes it in general makes it harder for people to recognize, empathize and want to get involved in situations that they have beliefs about and sometimes what happens with stigma is that we have mistaken beliefs. And those mistaken beliefs end up creating fear and misunderstanding and it really does get in the way of communicating, of knowing what to do, what might be the next best right choice in a situation. So when we think about stigma, it can really have a snowball effect. So it can have this cluster of misunderstanding and negative attitudes and beliefs and then that can lead to avoidance, not in my neighborhood kind of attitude, it also begins to affect our pay system, what we want to pay for, what we don''t want to pay for in a bigger system in a bigger picture. What we think about mental illnesses, making this personal, what I think about mental health and mental illnesses impacts how I treat people. It impacts how I approach the issue, and how I am going to handle it when it shows up in my life. So there are external stigma issues. We often see that, the best place we see that show up is in the media. We talk a lot about you know the stories where we see people who, there is incidents of violence and we talk about their mental health issues or their mental illness. When statistically it is really only 1% of people who have mental illnesses that are violent. And so we have that kind of external sensationalization that can happen that begins to create stigma and an understanding that is not the whole story or can be inaccurate. And then we have that internal stigma, in other words, how I might feel about somebody in my life having a mental illness or about my own struggle with mental illness. I may be embarrassed or ashamed. It is that kind of feeling and those sorts of feelings end up perpetuating a cycle, I can feel symptoms, I might fail to seek help or seek treatment or to talk about what it is that I might need to be successful in a workplace. So just want to translate that into the workplace a little more specifically. So my attitude as an employee about mental health or mental illness issues, I get very concerned about confidentiality and I see this a lot when I do EAP work, when I was doing a lot of EAP work, we would go in and we would talk about the resources and present the amazing resources that were available for people and inevitably I would get the question over and over again about well is my employer going to know about this? Is that service confidential? And so who is going to know and what will happen if they know? So employees are worried about will I still be considered for promotion? Will I still have a spot on the project team? So, the fear about how is this going to impact and affect my job? Will I be seen as credible? Will my input in a situation be valid, be considered as we are forming ideas and creating and developing? A lot of times people get afraid about if somebody else knows, what will be the consequence for my coworkers. Will I be included, will I be laughed at, will I be the recipient of resentment, particularly if there is an accommodation that gets made. The other piece that sometimes plays a role in here is the idea about what are the coverage and benefits a workplace offers. Sometimes people don''t know, dont know what the benefits are, don''t know what the resources are that are available to me and because of this internal stigma in the workplace I am not sure I want to ask, may not even be sure who to ask. So, the challenges we look at when we look the mental illness and the workplace, you can start to hear what some of them are going to be and I want to talk a little more specifically about those. So I know all of you sitting where you are probably have a pen and paper in front of you and I am going to do an exercise with you. I am just going to ask you to follow me through this exercise so you can get a sense of what I am talking about when I start to talk about the challenges that people face when they are dealing with mental illness. So in front of you, you should have a piece of paper and pen or pencil. When I say "Go," I am just going to give you a few seconds to sign your name three times. Okay? Ready. Go! And as you are doing that, I just want you to notice what that is like to sign your name three times. Okay. Now I am going to ask you to switch hands with your pen or pencil. And when I say "Go," I am going to ask you to sign your name again with your opposite hand. Ready? And you are going to do this three times. Go! And as you are doing that, again, I would like you to notice what that is like and how that is different. Now, often times when I do this live what I hear back from people are things like, it takes a lot longer, the product is not so good, I am not exactly proud of how this looks. I am not sure I even want to show it to anybody. I have to concentrate harder and I really wish that Dawn would stop talking so I could focus on what I need to do to get my signature done. Sometimes what happens is people just give up. They just stop partway through the process. And so the reason that I give you that exercise to do is it really gives you a felt experience of what it is like to be dealing with a mental illness, particularly when symptoms are high. Particularly when I am in that low part of my cycle. It is like trying to get through the day signing my name with the opposite hand. So in the workplace, we know that mental health affects people in their prime working years, 18 to 60 years old, and that the age of first onset can be 18 to 24 years old. Now, that is our prime working years that we are talking about here. And if we look at that 18 to 24-year-old onset, that is when people are just beginning to come into the workplace and they bring with them that piece of that opposite hand, signing my name with the opposite hand. I want to make a comment about the chronic nature. This is not one of those things that if I just leave it alone, it will go away. Remember I talked about 60 to 80% of the people who seek treatment get better. They get to have recovery. They get to have that experience of recovery in their lives. But two out of three of them don''t do that because of stigma. And so the chronic nature means that if it doesn''t get treated, it progresses. And then our handwriting exercise also helps us to take a look at the type of impairment that people deal with and what that can mean for the workplace. So it may mean that I have a difficult time learning new things, it takes me longer, I need more time. I may have a hard time when I have to meet new, a new boss or new co-workers. I may have a difficult time finding my way around the plant or work site if I have to go to someplace that is unfamiliar or I haven''t been to before, because, remember, my focus is on I have this signing my name with the opposite hand. That is sort of my backdrop where all this other information is having to get through and get into. I may have difficulty with directions, completing tasks on time which is looking at those pieces and I am going to give you some ideas as we get further into the presentation and the talk here about what might be helpful with some of that. Just give you a couple statistics to think about. I don''t want to get bogged down there but just a couple of pieces that are interesting. Most medical illnesses that get reported to a medical doctor have a strong, like 50 to 80% of them, have a strong mental health component to them and so a lot of times what is happening is people who have untreated mental health issues end up going to the medical doctor using more general health benefits but we don''t get to the core of the issue. So people aren''t getting the services that they need to grab and have that recovery that we are talking about. That recovery that I kind of defined for you. Now, as I am un-packaging these pieces and giving you these signs and symptoms and information to think about I want to say this: I put this information out here not as an excuse for poor performance but to give you the information, like I said before, to reduce stigma, to increase understanding and to give away a context to drop some of the behaviors into that may help us understand better. And make it, may make it more comfortable to start to have some of those what I call those performance-related, courageous conversations. Okay. Let''s look a little bit about what we are talking about on that continuum, mental health/mental illness continuum. What really are we talking about? How do we begin to differentiate somebody having a bad day and I am not trying to trivialize that but to hear that when we are talking about mental illness we are talking about something that is more than a temporary impairment. It is not me having a bad day, not me being anxious and nervous for a few days. It is really something that we tell people that if you are experiencing those kinds of symptoms that I am going to talk to you about for two to three weeks, there is something bigger going on in this picture. So I want you to think about, just for a minute, think about the worst day you had. A day that was really sad, a day when you were really anxious. Then multiply that experience times five. And multiply that times several weeks. That is what we are talking about, then, more than temporary impairment. It is more than a temporary alteration in our mood. It is in general terms sometimes what we see as a change in thinking, people may become confused, they may have behavior that doesn''t make sense, they have difficulty thinking and trouble concentrating. They may not be able to follow through with activities. So what we are really looking at is something that begins to profoundly affect or disrupt a person''s thinking, their feelings, their ability to relate to others, their ability to cope with those demands of daily life in the workplace. I said this before, this is not something that somebody just snaps out of or pulls it together, they really need to have some support and some services and we will talk a little bit about those treatment supports and services to be a partner in their recovery. And to understand that recovery is possible and available and what does that mean for them. So that they can begin to create a life that is about managing those mental health symptoms. Kind of some rule of thumb questions that I like to give people, they are kind of internal questions to ask yourself as you look at what is happening in the workplace. You know, just to take a look at. What is going on with this person? We are looking for what is different, what has changed. Is there a pattern that is different? When did that pattern start to change? And then to be able to ask myself: What is the severity? Is somebody having some difficulty concentrating at a work station or are they having a difficult time being at the work station at all? And how long has it been going on? So what is the duration? How many symptoms are they having? What are the behaviors that I am noticing and how really is that impacting their work? How is that affecting their performance? Now, I am aware on the power point slides that you have it talks about getting a professional diagnosis, I will ask you to put a line right on through that because we are talking about not needing to diagnose, we are just talking about understanding and bringing the information and the knowledge about mental health and mental illness to the table as we look at what is happening to people in the workplace. So I want to look at some of the signs and symptoms, more specific signs and symptoms, of the more common mental illnesses and I am just going to go through those signs and symptoms and then I am going to bring it more specific into the workplace. So we are going to look at depression, bipolar disorder, anxiety disorders, and I am going to do anxiety disorders as a bunch but underneath anxiety disorders we often see generalized anxiety, panic disorder, phobias, post traumatic stress disorder and OCD which is obsessive-compulsive disorder and then we are going to talk a bit about schizophrenia. So again, remembering that as I am talking about these signs and symptoms and I touch on those few signs and symptoms, that we are looking at a cycle so that these signs and symptoms also cycle as a high and a low so there are times when people are, you will see very few symptoms going on and then may have times where the symptoms are much more obvious. So often times what we look for when we are looking for somebody dealing with depression, how many symptoms do they have? So, we are looking for four to five symptoms that have been going on for two weeks or more. And so in the workplace, again, I am looking for patterns, I am looking for changes in behavior and how is that impacting their ability to do the work that they are being asked to do. So here is some things that you may see or that you might expect to see if somebody is dealing with depression. They may be dealing with profound sadness, an irritability, particularly with men we see, men and young adults and adolescents that depression can show up as anger. They may be a loss of interest in things that typically interested them in the workplace. A loss of hope in being able to control the circumstances and what is happening for them, so more and more getting more and more demoralized as the depression deepens. Now, we may not notice in the workplace if somebody''s appetite or sleep has changed but what we are going to see instead are maybe some changes in their thinking, in their concentration, in their judgment, in their ability to make decisions so they may have some difficulty following or remembering directions. They may have difficulty getting going on a task or getting started at a work station. They may have some confused reasoning so as you are talking things out, what they are saying back or as you are trying to problem-solve something, it may be confusing or not make sense in terms of what it is that you are trying to problem-solving. And again, as I am going through these, a lot of these are difficult to tell just by looking. Some of these are just not going to show up until I start to do some interacting with my employee. Recognizing bipolar, what does that look like, walk like and talk like? Bipolar disorder usually alternates between depression and mania and there are really different kinds of bipolar so again I am talking in general about what you are going to see in the typical bipolar that alternates between the depression and mania. The depression is going to look like just what I described when we were looking at recognizing depression, the mania is going to be just the opposite and that is a little bit tricky because, again, not everybody has all these symptoms, the symptoms are very personal but people who are working in recovery, part of the work is they understand their symptoms and how to manage those. So when somebody is dealing with bipolar disorder and they are in the manic phase what you are going to see is some restlessness, hyperactivity, they may be a lot more talkative, have a lot of excessive energy, sometimes people may be unusually irritable, very, very angry without a lot of provocation, there may be some paranoia, the anger may feel like it comes out of nowhere. Lots of racing thoughts, so people can''t stop thinking and talking, there may be changing of topics or subjects abruptly so in the workplace there just may be missed information. And you may not notice anything going on, you may be very excited about the fact that this person has extra energy when what you may notice is as they crash on the other side and the depression shows up. This, the manic side of this phase of this, can carry with it impulsive behavior, thinking in grandiose ways which means that I don''t always have good judgment so I may make impulsive choices or poor choices. And then there is recognizing anxiety. And what does anxiety look like and how may that look in a workplace? Just think about this idea of how we all can get nervous, sometimes meeting new people, every time I am getting ready to do a presentation I can feel my heart start to beat, I get a little bit sweaty, a little bit nervous, the difference between that experience and people who are dealing with anxiety when we are talking about mental illness is that I return to baseline after a while, my heart slows down, my sweating stops, I come back to this kind of calmer baseline. People who are dealing with ongoing anxiety, they don''t return to baseline at all. Or if they do, it takes a lot longer for them to get back to that baseline. So they can have these worrisome thoughts and tension that go on through the day. Anticipating the worst, unreasonable fears that can interfere with, and this is the important part, it really interferes with activities that people want to do. I want to go out and interact with my co-workers but I am so anxious that I am not able to leave my work station without having my heartbeat and having a panic episode show up. So it really interferes with people doing things that are important to them that they really like to be able to do. There are a lot of physical symptoms that come with anxiety because the body is often in that tense state that kind of fight-or-flight state that remains activated. There can be a lot of jaw-clenching and teeth grinding, headaches, people have difficulty sleeping. All of those can contribute to being exhausted, fatigue, tired at the workplace, I may be edgy, I am not as patience as I would be, I may be more impulsive, I might not be able to focus on the present task or directions that somebody is giving me. I often am experiencing something called chemical flooding. You know if you are in this constant state of anxiety your body is being flooded with adrenaline and other chemicals because I am in that fight-or-flight worrisome state. That increases my vulnerability to triggers that can show up, losses, trauma, those type of triggers that can happen in all our lives, I am more vulnerable because I am already on chemical overload. And then a couple things I want to say about schizophrenia. Again, being aware that the signs are personal and can be different for everybody, and a comment that I will make about schizophrenia is that it is one of the mental illnesses that can respond very well to medication. And so often times what happened for people when they are not on medication is they can hear most often they hear voices and, you know, I did an amazing workshop a while back where they actually tried to do a simulation of what it would be like to have to do tasks and move through a day while you were hearing these voices and how difficult that was. It was an amazing simulation and how that really does interrupt concentration, interrupts my ability to motivate, to stay focused on task because those voices and noises inside my head are constantly distracting. There may be some paranoia, someone is out to get me, someone is trying to hurt me, there may be some religious, extreme religious preoccupation with religious ideas, a lot of times I will see this in people''s writing and their artwork, just in the way they speak about things and the view, their view of the world. Their thoughts can jump between related topics or may not track with the conversation that is going on, it may be about a completely different answer versus the question that was asked. The other thing that sometimes happens and can be hard for people to understand, when people are dealing with schizophrenia, there can be a blunting of their affect and it is not that they don''t care about people, it is just that the emotion that they have really doesn''t register or show on their face. And that there can be sort of a lack of awareness of cues or emotion in a particular situation or an appropriate emotion in a particular situation. There may be a sense of indifference to something that looks like it should have a different kind of impact. So if we go back and kind of remember that handwriting exercise, busy, concentrating on how to sign my name with the opposite hand, and those are some of the symptoms and experiences that are going on for me depending on whichever mental illness we are talking about, you can see that workers with mental health issues can be more susceptible to stressors and those triggers that we were talking about, they can have more difficulty with workplace and social demands, particularly if I am in a lower part of my cycle where my symptoms are high. I can have problems with information and the more stressed I get, the harder it is for me to process information, to recall information and to receive both full directions. There can be side effects to my medication and that can impact my attention. There are some medication that can make people drowsy, that impact memory, energy and activity level, I talked about that cycle already so workers with mental health issues are often can be faced with reoccurrence, you know, those cycles I was talking about which can interrupt attendance, can interrupt performance, can interrupt my functioning in the workplace. And then we already talked about stigma and self-disclosure so I am not going to say a whole lot more about that. Specifically in the workplace, we have this really great list in your set of handouts that talks about things like decreased productivity, lack of cooperation. Because I am busy focusing on how to get a task done, I don''t have as much patience, I don''t have as much energy, I don''t have as much attention available to give to interpersonal relationships and cooperating. I may have fatigue, I may have aches and pains that I am talking about or that show up that are not related to a medical issue, I may have difficulty completing projects, difficulty managing time and having enough time to complete projects. I may lose my place, you know, they call that absent-mindedness, I may lose my place or lose track of where I am in a project. Tardiness, sometimes what I call presenteeism, there is absenteeism where I need to miss work but there is also presenteeism where I am on the job but I am really not focused or paying attention as well as I need to. This is sort of like listening to this presentation and making my grocery list, I am there but I am not there; that is an example that I often use that kind of brings it home for all of us. You may also notice that there is an impact on deadlines. If I am having difficulty managing time, I might need additional time to complete a project. And I can do it and I can do it really well if I have some additional time and you know a lot of people that I work with who are dealing with mental illnesses have learned very well how to deal with those, live their life, managed, experience recovery and so they know what it is that they need when their symptoms show up. They know if they need additional time to complete a task, they know because they have practiced over time signing their name with the opposite hand. So they know what it is that can help them get through that point in time. I may show, notice that critical thinking skills, particularly in new situations and new settings, become compromised and I don''t know about you but my frustration with myself when I am trying to learn something and not able to get it, so my frustration and irritability can be impacted that way. So you can see how these start to sort of snowball and layer and feed on themselves. Again, I want to make the comment here that we are not talking about if we start looking at what do I do in these situations, we are not talking about having to diagnose what is going on, just want to be able to have this on the table and in the context of considering what is happening for me as a supervisor or employer, why might I be waiting to have those performance conversations, again, what I call those courageous conversations about what I am seeing in somebody''s performance and does it have to do with the fact that I have some ideas or some thoughts about what this person may be dealing with in terms of mental illness and I am not sure what to do with that. So I don''t have to be a psychologist, I don''t have to be a counselor, I do have to be a good supervisor and employer and be able to have those conversations about performance because we are talking about mental illnesses, they are not an excuse for poor performance. So that brings us kind of to these places, this place about what to do, what are some things that I think are important for people to have at their fingertips. First of all, to know my resources. And when I say external resources, external to my company, to my employment, to my organization. What are those resources out there that I have available to me? And we are going to touch on a couple of those way at the end here. My internal resources. Who is it inside my organization? Inside my company? Who is it that works with me inside my company that can be helpful in this process to me as I am looking at having courageous performance conversations, how to do that in a way that is respectful and how to include the right people in that process. Knowing myself, knowing what it is about you that are your strengths, what are your limits, what are your biases? When you are looking at having these performance conversations with people, what is your motivation? Because the motivation is, as a good supervisor and employer, is to have employees to keep working and working well. That makes them successful, me successful and the organization as a whole successful. So what is it I am telling myself about this person, this situation that may be helping or hurting the intervention that I want to make? And then just knowing and understanding and part of what you are doing today is just increasing the knowledge and information about what is mental illnesses, how do they work and how do they impact people? Specifically some things that I just want to touch on here, remembering to focus on performance and what it is that I need to do to help somebody increase their performance, to address those areas where I see that changing and shifting. To be specific about needs, needs as a supervisor, needs as a company, to slow down because if I am dealing with anxiety, depression, schizophrenia, remember, I am working at signing my name with the opposite hand so if you can give me directions and if you can write those directions down, that will be helpful for me. Looking at structure and routine. Structure and routine gives me something that I can count on as symptoms increase. It gives me something that I can know and that is comfortable that I don''t have to adjust or readjust to. So if there is a structure or a routine I can put in place. Are there places where I can reduce stimulation and distraction? Can I give somebody a headset to put on, headphones to put on? It worked in a cubicle for very long time at one of the organizations I worked with when I was doing a lot of presentations, it was great because I wasn''t in the office a lot but when I was there, headphones were really helpful for me to be able to take out those distractions. So imagine somebody who was dealing with anxiety in a work station where there is a lot of traffic. So can I give, can I do something as simple as that? Seeing the employee who may be suffering with mental illness as a valuable resource. As I said often times we know what it is that we need and to be able to talk about that in terms of how can we help you improve and increase those areas in performance where there are some struggles going on. As a member of a team who works with this person besides you? Who can you talk with, who supports you? Who is your supervisor? Who is your manager? Do you have a human resources person in place? In bigger organizations there are sometimes employee assistance professionals that are available or an employee assistance program that is available that can help guide you through some of these steps. What is the next step that may be needed? What is the next step that I may need to take and really that is a whole another, bigger conversation when we start breaking down performance-related kinds of conversations, so just giving you pieces to think about. I cannot do any presentation that I do without talking about self-care. It just doesn''t feel right to me to do that so I really want to just take a minute to talk about self-care, say a few words about treatment and then resources for you. As a supervisor, employer and a manager, you are a resource as a person, as a human being, and if you are not doing self-care you put at risk your own mental health. So being aware of your stress, where do you carry stress in your body, what stresses you, how do you know what stresses you? For those of you who can do this, I am just going to ask you to put your hand out in front of you and make a really tight fist and just to hang on to that fist for a little while, while I am talking. Make it as tight as you can and don''t let go. So being aware of your own stress, where it happens, where you carry it in the body and then what to do about that because being in constant stress begins to activate the fight or flight response in our bodies. And as you notice as you are holding that fist if you are really doing this and holding it tight, you will notice that it starts to move up your arm and it will creep up your neck and into your lower back and pretty soon your body is going to be aching. And then what I notice happens a lot of times with people as they start to get frustrated and annoyed and pretty soon they just let go. By the way, you can let go of that fist now at this point. Because that is what happens with stress in the body and how it begins to impact us emotionally as well. So I need to take a look at where in my life do I take appropriate breaks? Where in my life am I taking care of the basics, how I eat, do I exercise? Who is my circle of support both inside and outside of work? Where do I vent? Where do I blow off steam? Who are those people that are my feedback loop that can be my mirrors and give me feedbacks about my blind-spots? Who do I ask for help? So that I can get input, ideas, resources. Often times I liken it to carrying a couch up the steps by myself. I can do it, going to take me a lot longer, I am going to be really sore when it is done or I can ask somebody to help pick up the other end of the couch and so who do I ask for help in my life, both inside the workplace and outside? (Phone interference all of a sudden)
Excuse me, I think we just lost Dawn there for a moment so we will give her a second to phone back in. While we are waiting for Dawn to reconnect with us, just a quick reminder about a couple upcoming sessions that begin in May. We have a two-part audio conference session on state and local governments and the first of those will take place on May 19th and the focus will be on Public Rights of Ways: What are the Rules? And we are fortunate that we will be joined by Lois Thibault from the U.S. Access Board in May for that session and then to wrap up that two-part session, in June we will have a session on emergency preparedness. And you can get additional information about those upcoming sessions and any CEUs that may be available for those sessions by visiting the ADA audio website, www.ada-audio.org or you can always call the ADA audio conference toll-free number which is 1-877-232-1990. And let me check with the Operator. Did we get Dawn reconnected?
She has not dialed back in yet. I will let you know when she has.
Okay. (Pause) While we are waiting for Dawn to rejoin us, I take the unscheduled opportunity to talk about some other long-distance learning sessions that we will be providing. In addition to the audio conference series that we offer, we also offer a couple of webinar series and the fourth legal webinar series for this fiscal year is scheduled for April 28th. And this is going to focus on litigation under Title III of the ADA, all the prior webinar sessions up to this point have been employment in focus but there is enough interest in the area of Title III litigation that this session will focus on that. There is not a whole lot of case law out there but that will be discussed in the next legal webinar series. The legal webinar series along with our accessible information technology webinar series are done through an on-line fully accessible web-based conferencing system and requires a high-speed internet access in order to participate in those sessions. Our third accessible technology webinar session is scheduled for May 11th, and that is going to look at the, looking at the update of the Section 508 standards which have recently been undergoing an update from the U.S. Access Board. So for additional information about the webinars in addition to the audio conference, audio conference sessions that are upcoming in the next couple of months. You can find all that information visiting www.ada-audio.org or again calling the toll-free number. And I am just going to check with the Operator again. Do we have?
She has not called back in.
She has not called back. Do you have a call-back number for her?
Yes, 866-262-34.
No, did she, did you get a call back, her call back number?
No.
Okay. (Pause) I again apologize for the difficulties that we are having here. I don''t know if Dawn is unaware that she is no longer connected to the session but we are working on the issue on our end to identify what is going on with her. While I have the moment, again, my name is Peter Berg and I am the Technical Assistance, Project Coordinator of Technical Assistance and Employer Outreach at the DBTAC - Great Lakes ADA Center. And just some of the things that Dawn had been talking about and talking then from an ADA perspective, because as Dawn mentioned, you as an employer you don''t want to be out there you know making diagnosis, attempting to diagnose your employees. From an ADA perspective and the obligation to provide reasonable accommodations, the focus of approaching an employee that may be having issues with their job should always be approached and addressed from a performance issue and addressing that, looking at that, what are the issues that the individual is having difficulty in performing their job and, you know, at that point making it known and give the employee the opportunity to disclose or make a request for a reasonable accommodation. And why is this even more important for many of you out there, you know that the ADA Amendments Act was signed into law back on September 25th of last year, and went into effect on January 1st of this year and while the Equal Employment Opportunity Commission has yet to issue regulations on the new definition of disability.
Hi, Peter! I understand you lost me along the way here.
You blew up at some point, and I just pictured you in your office talking away while I was sweating to death here.
I am so sorry, I am just like talking away, having a good time, Peter, I am so sorry!
No, no, that is all right. Well, let''s get right back to where.
Yes, where did you lose me at? What was I talking about?
We were at the point of -- you were talking about people recognizing and being aware of the resources that are available to them.
Oh, good.
And how to access those resources and you had just done the exercise with the closed fist when you went away.
When I went away. Have you all been holding your closed fists that whole time? That''s horrible!
Fortunately, you had told people to let go before you went away.
Thank heavens because your stress level and frustration and anger would be through the ceiling. Oh my goodness.
Yes, so it is about 2:06 now so if you want to go for a few more minutes and just leave us some time for folks to ask questions.
Absolutely, absolutely.
Alright, thanks Dawn.
So, we were talking about that kind of taking care of yourself. I did a little bit on treatment and I think I lost you about that time. So what I will say very quickly about treatment is that treatment really depends on the severity of the symptoms that somebody is dealing with and their personal preference and that can include anything and everything from a primary care doctor to mental health specialist like a psychiatrist or a counselor or a psychologist, it may include community mental health centers and resources where people can be involved in consumer groups. It may include a workplace employee assistance program, it may also include what I like to call our complementary care, like relaxation, massage, eating, sleeping, exercising, being out in nature, meditation, those things create incredible resources for people that can complement medications, talk therapy and self-help strategies. The other thing that I will say and I have said this before, I will say this once more, that workplace, even though it is not therapy can be incredibly therapeutic, it matters to us, it matters that we do a good job and it is an amazing place for creating intervention in a way where I might be able to make changes and look at what I may need to manage in my life. Resources, knowing your potential local resources. There are a few listed in your packet that you got. Your local state mental health boards and departments. Here in Milwaukee, Wisconsin, we have call-in lines, like a warm line as well as an emergency line, being able to know what those are so that you can educate your employees about those services. Knowing your centers, your walk-in clinics, where are your insurance billable centers, where are your places that take slide fees in case somebody does not want to use insurance or cannot use insurance. Your state NAMI - National Alliance on Mental Illness, every state has a chapter, find out where yours is located, there is a website there, they are an amazing resource. They have advocacy resources, information for families and friends of people dealing with mental illnesses, research information, they are an incredible resource. There is also a National Alliance and there is a phone number and a website for that in your packet as well. The National Mental Health America is another excellent resource with information handouts, tools, pamphlets that can be at low cost or no cost, things that you can easily reproduce and use in your workplace. Our local, a lot of states have local Mental Health America chapters, ours here Mental Health America Wisconsin provides presentation and anonymous screenings that employees can do where that information doesn''t go anywhere except to the employee. So there is lots of things that those local state chapters can do for you as well as the national chapters. Center for Psychiatric Rehabilitation, the Partnership for Workplace Mental Health, those are also places where you can get research information, resources, tools, ask questions, the place that I have been so lucky to be in contact with, you know, Robin Jones and Peter at the ADA centers, amazing, amazing tools both online as well as in person to be able to, like I said, ask questions and get resources and direction when you are looking at how and where and what to do next. Then the last piece is just my contact information should you have questions, pieces you may want to talk about at a further, at a later time, there is my number as well as my e-mail address that you can contact me through. So as I said although none of you heard me because my headset was off, that pretty much wraps up the pieces that I have to give to you today and I would like to open things up to questions and then turn this back over to Peter and the Operator to help me with that.
Excellent, thanks Dawn. Operator, if you can come and let folks know how they can ask questions.
Ladies and gentlemen, if you have a question at this time, please press the 1 key on your touch tone telephone. If your question has been answered or you wish to remove yourself from the queue, please press the pound key. Again, if you have a question, please press the 1 key now.
Dawn, while we are waiting for folks to get in the queue for that, one question that was submitted online through the, someone participating through the audio streaming, and their question goes, some individuals have the mindset that whether in the public or private sector, that seeking mental health assistance is a career-ender and the individual wants to know what your thoughts are on getting past that and people getting, seeking the help that they may need.
You know, as you heard in the presentation, I talked a lot about how powerful stigma can be and a lot of people do see that as a career ender. One of the pieces that I will say about that and it certainly isn''t the only answer or the be-all and the end-all answer, is that sometimes what we can do in a workplace is provide information in a more general way so that people can seek those services and resources outside of the workplace without having to involve the employer. And so then the employer is not even in that picture, they are seeking services, the resources, the supports, the interventions that they need, taking that responsibility and managing that outside the workplace. And so as a workplace, as an employer, I can create handouts, I can create things that I hang up in employer break places that talk about resources, that talk about mental illnesses and if you have these signs and symptoms here may be a place you can get more information, just those kind of general, more or kind of less threatening ways of putting information out there.
Excellent, thanks. Operator, do we have our first question?
Our first question.
Hi.
I am from the Chapel Hill area here in North Carolina. I have something unusual, I am new at being disability and age 65 but I am getting there, I am telling you, I live in a senior citizen living complex with multi-age group and multi-income levels, we have a mentally challenged person here who has caused quite a bit of harm to the facility room she was part of on several occasions, yet allowed to return. I addressed management with the issue, management feels that their hands are tied and nothing for them to do so I wrote a letter, so if they could be informed in writing this was added to the personal file but I want some action taken because I am very much afraid of the possibility we don''t need the place to burn down or for other persons to be harmed before someone can take appropriate action to help the mentally challenged person living at this complex. So what options do I have available for -- to tell management to do something!
And thanks for your question and I will jump in here real quick, Dawn. I would recommend that you contact the ADA center in your area which is the Southeast ADA Center by calling the 800-949-4232 number and they will be able to provide you with information on your question so thank you for your question. Operator, can we have our next one, please.
Our next question.
Hi.
Your line is open. Please check your mute button.
If you would pick up the handset if you are using a -
I am sorry, can you hear me now?
Yes, there we go.
Great. I am an employer and I have a person who has self-identified with post traumatic stress disorder and has requested full accommodations, some of which are reasonable, some of which we feel are not and we are working through that. But the latest is that part of her essential functions of the job are causing this post traumatic stress disorder to cause a personal crisis for her and now wants accommodation being able to leave the workplace and that might happen. I am not so sure that is reasonable and I am not sure how to get any kind of advice on that.
Excellent question. Peter, I think I am going to give that one to you, too.
Right, right, again, I would recommend that you follow up with your regional ADA Center but you need to remember and I was, Dawn while you were off I was beginning to talk about the ADA Amendments Act which went into effect on January 1. When you look at the definition of disability, the three prongs have basically stayed the same but in addition to that in an employment context, you talk about someone being qualified to perform the job so able to perform the essential functions of the job with or without a reasonable accommodation and an employer is never obligated to remove an essential function as a form of reasonable accommodation, an employer certainly can choose to do so but is not required to do so as a reasonable accommodation. So you as an employer need to look at, you know, what this individual has requested, are you able to provide that particular accommodation without it having a dramatic impact on your business operations as an employer and posing that undue hardship on you that you would not be able to operate, that with an individual leaving unexpectedly, you know, that there would not be other employees that would be able to cover those tasks or would have the skill level or the experience or the knowledge to perform the tasks that this individual does on a daily basis and you need to also consider when looking at if it does pose an undue hardship, is this something that may happen once a month, once every six weeks, once every eight weeks where truly it may not be undue hardship and you could get by. Is it something that is happening more frequently? And those are the things you need to look at and continue to dialogue with the employee as you consider the accommodation request. But again I would encourage you to again follow up with your regional ADA Center on the question. They can then put you in contact with resources from the EEOC, Cornell, JAN, a lot of resources out there.
Peter, I will just echo that because whenever one of the things that I really like when I am doing presentations is I like to bring Robin, Peter, somebody from the ADA with me because often times when I am doing the presentation, those are the questions that come up, how do I do this? What can I do? What is reasonable and what is not reasonable? And they are the experts. They have the information and the support.
Alright, Operator, can we go to our next question, please.
The next question.
Hello. This has been very, very, very informative, I appreciate this. I have worked with individuals who have hearing loss, a lot of deaf and during the hiring process, I was just wondering, you know, if someone does have a mental illness, are we expected to bring that up in any way at all during, I mean, regarding accommodations. Is that only if to answer something like that if they are offered the job or do you have any thoughts on that?
Sure, sure, Dawn, let''s approach this in two ways. I will answer the ADA part of it and then if you could talk about, some of the issues that people consider whether they should or should not disclose a mental illness, maybe something that they are controlling through treatment or medication and how that, how an individual feels about revealing that to an employer. From an ADA perspective, prior to any job offer being made on the application or during the interview, an employer should not be, is prohibited from asking any disability-related questions or any questions that would require someone to disclose a disability and the individual applicant is under no obligation to disclose a disability unless they are requesting a reasonable accommodation. If the individual requires a reasonable accommodation, you know, in order to access the application, let''s say that someone is deaf and needs an interpreter, well, if they also have a mental illness they don''t have to disclose the mental illness. They are only seeking the accommodation for the need for an interpreter in order to have equal access to that application process. But Dawn, if you want to touch on the issue that, we get this question often regarding hidden disability, should or should I not disclose?
Right, and you know what makes that difficult and we talked about this as part of the presentation, those fears about what will happen if I do disclose and you know a lot of times people are already, like I said, managing their mental health and mental illness issue outside of the workplace, they may have medications, they may be involved in treatment, they may be involved in support groups and there is no reason for them to disclose that. Particularly in the hiring process before they even have a job, before they even have been offered the position. So even though we are doing this outreach and we are working to decrease stigma, it is still there. And it is very hard, I find it very difficult to help people, I don''t want to say convince but for want of a better word, to really convince people that there may be time where it is in their best interest to disclose that information. Most of the time people are afraid about it and we heard it from one of the other questions that will be a career-ender and don''t even up even talking about it until their symptoms get to a place where it is really impacting their job performance again.
Right, and have you ever dealt with the question or issue where someone feels that while they may not need an accommodation at this particular time, that how do they deal with it in the future, the fear that they will think they deceived the employer by not revealing this earlier on, even though they didn''t need any type of accommodation earlier on.
Are you saying Peter that they are feeling like maybe they lied to the employer or the employer is feeling lied to?
Yes, that the employee may feel like they are deceiving the employer by not revealing.
Right, right, so they may have the fear that if I don''t talk about this, I am not being forthright, forthcoming, honest with my employer.
Right, right.
And your question is?
Well, how do you respond to someone that feels that they need to disclose even though they don''t need an accommodation at that particular time.
So, how I would respond to a person if they were kind of working that through with me, or we were talking about it, what I would end up doing is probably something like a cost benefit pros and cons with them. So let''s talk about the pros, lets talk about the cons, lets talk about how it is helpful for you, lets talk about why you don''t need to do this at this point in time and some of that is about is it going to feel for you on the inside. I mean, are you going to be able to do this and not have that create, because you know we are talking about stressors, increasing anxiety, are you going to have a stressor and an increased anxiety? Do you feel like it is your responsibility to talk about this up front?
Right. Okay.
I mean, I wouldn''t go into an employer and talk to an employer about something going on for me, that wasn''t going to impact my workplace.
Right. Operator, did we drop another, the questioner''s line? Cause we are getting some feedback there. I have another question.
Yes, I am hearing that, too.
I think it is gone now too. Dawn, I have another question that submitted online by someone. And they wanted to know if there is a greater incident of mental health or mental illness among individuals with physical disabilities, severe physical disabilities and also the questioner wants to know are there any exercises that can be done that would help relief, easy exercises that can be done in the workplace that might help relieve some stress during the work day?
Okay, so first question and then remind me of the second part if I forget it Peter. So, the first question is I don''t know and I think it is a really interesting question and I would like to know. What I do know is that there has been research out there done by the Journal of Occupation and Environmental Health that looks at people who go to their medical doctors for medical issues, that 50 to 80% of them also have a mental health component or an emotional component to them. What I don''t know is it when we are talking about physical disabilities, if you think about co-morbidity in terms of heart disease and diabetes, if I am dealing with a physical disability that includes chronic pain that is absolutely going to have an impact on my emotional well-being and my mental health. I don''t have any really good hard statistics about that, I would like to have them, so if this online person has some of those or is interest in e-mailing me, we may be able to find some of that together because that would be a curious question I would like an answer to as well. And then the second question about are there some simple things that you can do in the workplace to relief stress? Absolutely. The easiest one that I like to teach people I call it balloon breathing. People call it all kinds of different things. If I was there live I would demonstrate it so I will just give you quick direction. Hand on your belly, you want to inhale like you are blowing up a balloon in your stomach, and so you are taking a really deep full inhale, I can''t do it and talk at the same time, into your belly. And you can do this anywhere, you can do this in your car, you can do this in your workplace and then after you do that really deep inhale, you are going to exhale like you are blowing out birthday candles. And you can kind of do it without the noise so people don''t wonder what you are doing in the next cubicle or office or in your car. But if you do that three or four times, what they have shown in the research is that that actually starts to reverse the stress response in the body. And it is a really easy thing that you can do sitting in your workplace. Getting up, standing up and doing some simple stretches if you can do that, if you are not able to do that, the balloon breathing is a really easy, simple thing to do. That is the quick ones off the top of my head.
Excellent. Operator, do we have one more question we might be able to slip in before the bottom of the hour.
The next question.
Hi, yes, we had a question about the chemical flooding. We got cut off when you were explaining that. Could you explain that again?
Sure, all I was talking about with chemical flooding, we were talking about anxiety disorders and what happens with anxiety is that the body is kind of stuck in that fight or flight response, which means the bodies getting flooded with those fight or flight chemicals like adrenaline. And so this chemical flooding then happens if my body is sort of stuck in the fight or flight response, I am in that constant state of chemical flooding which makes me more vulnerable for stressors, you know lots of trauma and workplace challenges because I am already kind of in that heightened state. So that was what I was talking about with that chemical flooding.
Alright, excellent. We have gotten down to the bottom of the hour. We have run out of time, and I apologize to everyone for our technical difficulties.
Definitely.
And apologize that you had to listen to me more than Dawn because she had a whole host of great information today. As Dawn mentioned, the last slide of her power point presentation contains her contact information. And she has invited anyone to follow up with her if you have additional questions. Anyone that was in the queue, and didn''t get a chance to ask your question, again I please invite you to contact your regional ADA Center by calling 800-949-4232 to have your questions addressed. And as I mentioned at the top of the session, we have been recording this session and in about two weeks'' time an audio archive as well as a text transcript will be posted to the ADA Audio website, www.ada-audio.org and once again, coming up on May 19th we will have a session that kicks off our two-part state and local government series on public rights-of-way with Lois Thibault from the U.S. Access Board. And you can always get additional information on upcoming audio sessions as well as webinars by calling the toll-free line 877-232-1990. So I want to thank all of you for participating today and want to thank Dawn for giving us her time this afternoon and providing her knowledge and expertise with us. I will look forward.
I appreciate the opportunity, Peter. Thank you.
You are very welcome. And we look forward to all of you joining us in the future. Thank you and have a good afternoon
Ladies and gentlemen, that does conclude the conference for today. Again, thank you for your participation. You may all disconnect. Have a good day.