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Effective workplace communication with employees with psychiatric disability

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Psychiatric disability

An introduction to psychiatric disability

Let's talk about terms

Two important terms are used this resource.

  1. Mental illness: When we say someone has a mental illness we mean they have a disorder of the mind that results in disruption of the person's thinking, feeling, moods, and ability to relate to others.

Just as a physical illness affects our bodily functioning in some way, a mental illness affects the functioning of the mind. A medical doctor looks for bodily symptoms in a patient suffering something physical. (Does he have fever? A rash? Pain when swallowing?). In diagnosing a mental illness a psychiatrist will consider how the patient's mental functioning relates to the norm. (Is she alert to what is happening around her? Does she see things that are not in fact there? Is her conversation 'on track'?) Just as there are relatively clear criteria for defining a healthy body, enough is known about how the mind works to determine if it is functioning properly.

Both physical and mental illnesses are classified by the category of disorder into which they fall(cardio-vascular disorders, mood disorders), and each of these major categories is then broken down into further categories (for example, arrhythmia, aortic aneurysm, depression, bipolar disorder), each getting more and more definitive regarding the specific symptoms related to a particular disorder or condition.

  1. Psychiatric disability: We say someone has a psychiatric disability when the effects of a mental illness cause disruption or difficulty in their ordinary daily functioning. Mental illness can impair someone's ability to carry out daily activities such as working, learning and caring for themselves during periods of the illness. For example, a person experiencing an episode of psychosis may have severe problems concentrating on tasks.

A psychiatric disability is a problem or problems that people experience because they have, or have had, some sort of mental illness or disorder.

The information in this section is very general. It aims to give you a basic understanding of the nature of mental illness, the way it can impact on people and some of the issues that can arise for you in your work.

Mental illness

The term 'mental illness' describes a very broad range of mental and emotional conditions. Accurately determining the cause and predicting the outcomes of mental illness is almost impossible.

Mental illness affects many people in the community. At any one time around 15 per cent to 20 per cent of the population demonstrates symptoms of mental illness warranting further investigation. Another 15 per cent to 20 per cent of people are unhappy or psychologically distressed in some way. Many of these people can work through these problems; others will require support.

For some, psychiatric disorders will lead to serious impairment of their functioning – their ability to interact with others, learn efficiently, work, transact business, negotiate their way through everyday tasks and activities. They are therefore experiencing psychiatric disability.

What is mental illness?

Treatments for mental illness

Written records of the search for cures and the practice of treating people with mental illness go back at least 3,000 years.

In the middle ages, mental disturbance was considered evidence of possession by evil spirits.

In later ages, people who were mentally ill were generally cared for in institutions. Mental illness was viewed as shameful, a stigma that was best hidden. By the 19th century most large cities around the world, including Australian state capitals, had at least one institution, often called something like a 'lunatic asylum', built in an isolated part of the city to house people with mental illness well away from the rest of the population.

Institutionalised care often produced adverse effects in addition to those caused by the disorder. Patients, separated from family and mainstream society, often regressed to levels where they required almost total care.

In the 1960s and 70s the development of a group of drugs (phenothiazines or 'anti-psychotics'), led to profound changes in the treatment of mental illness, enabling people to spend much shorter periods of time in hospital. The concept of psychosocial rehabilitation grew to include the development of planned support systems and an integrated community approach to mental health care.

Today, people with mental illness can be assisted through one or a combination of three forms of assistance or 'treatment'. Mental illness can be episodic and the different forms of assistance or 'treatment' reflect this changing nature of an individual's illness.

1 Drug therapy (psychoactive medication)

Many employment service employees with psychiatric disability will be taking some form of medication, which may have side effects associated with it. Four categories of medication are commonly used in the treatment of mental illness:

2 Psychotherapy (counselling)

There are hundreds of types of psychotherapies. Cognitive behavioural therapy, for example, is a relatively short-term and focused way of treating types of emotional, behavioural and mental health problems. It helps people identify unhelpful thoughts and behaviours and to learn (or relearn) healthier ones.

3 Psychosocial approaches

This approach involves assembling a 'package' of support services to assist people with mental illness live as normally as possible in their communities. Employment services play a vital role in this support.

Community support systems have a key role in the alleviation of isolation, vulnerability and feelings of rejection in people with a mental illness, and in their learning and relearning of crucial social and interpersonal skills.

The major mental disorders

Medicine has identified more than 200 forms of mental illness. The most common forms of mental illness fall into three categories: anxiety disorders, mood disorders, and schizophrenia and psychotic disorders.

1 Anxiety disorders

This is the most common group of mental illnesses. Anxiety disorders are characterised by severe fear or anxiety associated with particular objects and situations. Anxiety is marked by negative feelings and tension because a person feels apprehensive about something that might happen in the future.

Everyone gets anxious and nobody likes the feeling much but it is a normal part of experience, and helpful in keeping us alert. However, too much anxiety can be extremely harmful and, in some people, becomes a controlling feature in their lives. Severe anxiety usually doesn't go away and people can go for long periods not accepting that there may really be nothing to fear.

Anxiety disorders can include the following.

2 Mood disorders

Most people, most of the time, can regulate their moods and make them 'fit' with the circumstances. People who suffer mood disorders have great difficulty monitoring and regulating the moods they experience and their moods may often seem unrelated and out of touch with the context in which they occur. Two types of mood experience – depression and mania – contribute to a mood disorder.

Depression is when the clinically-depressed person perceives a world in which everything is hopeless and negative, and beyond any control on their part.

Mania is a period of abnormally marked elation, joy or euphoria. When in a manic state, a person will derive immense pleasure from everything and have enormous energy, requiring little sleep. Sometimes the mania can lead people into behaviours and activities that are completely alien to their usual patterns of life, such as wild extravagance (often based on unfounded optimism) or sexual promiscuity.

It is important to appreciate that some people experience depression or mania singly, some have both at different times (bipolar mood disorder – previously called manic depression), while a few even have both at the same time (elation and energy, but depression or anxiety as well). Each person is likely to have different patterns in terms of the timing of episodes, what (if anything) seems to bring them on, whether they actually recover fully between episodes and how much their normal, day-to-day functioning is affected.

3 Schizophrenia and psychotic disorders

A psychosis is a severe mental disorder characterised by disorganisation of the thought processes, disturbances in emotions, disorientation to time, space and person, and, in some cases, hallucinations and delusions. Schizophrenia is one of the disorders that involves psychotic behaviours and is by far the most common. Every year an estimated three to four thousand people enter public hospitals in Australia with a diagnosis of schizophrenia. Around one in a hundred people will experience schizophrenia, usually starting in early adulthood.

Schizophrenia is an extremely complex disorder. The symptoms can include:

Effects of mental illness

As with any condition, the effects of a mental illness differ from person to person, even those diagnosed with the same condition.

The issues for employment services

Any service that aims to assist people with psychiatric disability build their work skills is involved in assisting them to learn, and some people with psychiatric disability may face significant communication and learning problems.

Individual functioning in employment is also likely to be affected by some specific characteristics of psychiatric disability, which include:

Key points

When working with people with psychiatric disability it is useful to remember the following.

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