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Effective workplace communication with employees with psychiatric disability


Talking about futures

People with psychiatric disability often lack the orientation to the future that is needed to plan for learning. With the present so hard to deal with, thinking about 'the future' may seem impossible.

The future is an abstract concept and one that people with psychiatric disability will often find quite hard to grasp and deal with. This can have a substantial impact on things like the individual employment planning process.

When a service works with an employee to develop an Employment Plan, it can be hard getting the employee with psychiatric disability to make a meaningful contribution. The goal-setting element of employment planning (What goals would you like to set for yourself for next year?) often becomes a rote-like process with little real contribution from the person supposedly setting the goals.

People with psychiatric disability often lack the orientation to the future that is needed to appreciate:

Depression, fatigue and problems with motivation are common effects of mental illness and are factors that make future planning extremely difficult for the employee.

A mental illness and its ongoing effects frequently result in reduced ability to cope with life's ordinary demands and routines. With the present so hard to deal with, thinking about 'the future' may seem impossible. Lives are often severely disrupted by psychiatric disability: education, work and relationships suffer. Many people with psychiatric disability experience feelings of loss and sadness, and have very little expectation of a better future. Talking about a 'future' you may be unable to appreciate or understand, may be quite beyond you.

One of the most important ways a support worker can help is by encouraging the employee to have a more positive outlook on life. Work gives people with psychiatric disability opportunities for skill development that help empower them and give them some sense of control in their lives.


Martina has decided she cannot go back to university because she finds reading almost impossible. When she tries to read she finds the words on the page become distorted and her eyes become extraordinarily sensitive to light. Sometimes, the print appears excessively large and black. When this happens, she becomes terribly anxious and has to drop the book and curl up with her eyes closed. She wrote Em a note yesterday:

Some days it's as though I can sit back and really see what's happening to me, even though I can't do anything about it. Today's one of those days. I see myself reading over the catalogues they're putting into the mailout. I am looking for a message in them. I have read them five times already. I am going to read them again. I am sure there's a message in them.'

From Em's notebook

I watched Martina today through the window. While I watched she was attempting to get on with her work, putting the catalogues in order. As she sat at her workbench, her face changed shape. She grimaced, she stretched and contorted her mouth. Then her face relaxed for a moment and she looked down. When she looked up again, her face was screwed into another bizarre expression. This went on for about half an hour. It quite upset her workmates.

Martina told me how she often smells sweet smells that remind her of things in her childhood, when she says she was 'really happy'. She also sometimes smells things that remind her of burning flesh; these make her very sad and she starts to cry. She says she can't control the smells and there's nothing she can do to stop them and the memories they bring.

I think about Martina a lot. She's my age and she says she has nothing to look forward to.


  1. Take things slowly. When you have no concept of a 'future', talking about plans for it is likely to be very confusing and agitating. When you are talking about the future, avoid making comparisons to other people's work or activities. Acknowledge the person's feelings.

I know you feel you're not as fast on this job as the others but that does not matter. The main thing is that you are getting better at it each day.

  1. One step at a time. Give step-by-step guides and instructions as to how a goal or task might be achieved. This approach will reduce confusion. It will also give the employee a sense of achievement as single steps are completed.

There are five steps involved to finish this. Let's try to do one each day this week.

  1. Show optimism. Present a low-key but consistent view that there is something they can look forward to.

I know you loved being at university … but there are good things you can do here too.

  1. Provide time for reflection and response. People are less likely to become stressed and respond to you better, if you respond to them in a calm and level manner, and with sincerity and respect. This means treating the person non-judgementally, and not 'prodding' or persuading them to think or act in particular ways. When they feel supported, they are more likely to make further responses and take the conversation further. A key feature of this approach is learning not to ask 'why' too often.

For example, when an employee says I don't want to do that today, it is easy to respond with a series of 'why?' questions – Why don't you? You said you did yesterday. Why have you changed your mind? You may get a better response if you say: You don't want to do that today? That's okay. (Pause). Is there something else you'd like to do?

  1. Provide information. Employees with psychiatric disability need to know they have a role in shaping their futures, and they need to know what this may mean for them. Speak realistically and be future oriented. At the same time, keep things related to what they are doing now. Focus each discussion about the future on one main – and familiar – point.

Let's talk today about what new jobs you might like to learn here at Pikkenpak.

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