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Effective workplace communication with employees with psychiatric disability

Chapters

Talking about safety

Employees need to follow health and safety rules in the workplace and know what to do if there is a health or safety problem.

One of the keys to getting employees to work safely is communicating the abstract notion 'safety', in concrete terms. An effective way to do this is by linking the actual things that are done in the name of 'safety' – walking in designated walkways, wearing PPE, and so on – with the concrete experience of 'being hurt'. In other words, we do all these 'safe' things to stop ourselves getting hurt. In this way, safety 'rules' (which are themselves an abstract concept), can become personalised and linked to the individual. Therefore it is made concrete – we follow the 'rules' so we won't get hurt (or hurt other people).

Disabilities and how individuals are affected by them are like fingerprints, unique to each person. It is very important that you communicate with employees with psychiatric disability to find out what they need to be safe and feel safe in their work environment. It is vital that employees feel comfortable talking with you about their needs, and seeking assistance from you.

Some forms of psychiatric disability may lead to specific workplace safety issues. Two examples are given below.

1 Anger and aggression

Sometimes anger can be a direct product of a mental illness. When anger is directed outward and has the potential to harm others, it becomes aggression. Aggressive behaviour in people with mental illness can stem from an altered mental state, or from frustration or fears the person may be unable to deal with. When dealing with aggression, there are some important things to remember.

Note: Despite the impression sometimes given in the media, violence is uncommon in people with mental illness. Violence is more likely to be associated with the use of drugs or alcohol.

2 Delusions and hallucinations accompanying psychotic episodes

When people are having a psychotic episode, they may experience delusions. Delusions are fixed, but false, beliefs that no amount of reasoning can change. People may also hear voices or see or smell things that are not actually there. If you or other workers feel frightened around a person who is experiencing delusions or hallucinations, try to remember that they are probably more frightened than you.

If you are dealing with someone experiencing delusions try to:

If the employee is having hallucinations, let them know that you are aware they are not well and suggest they contact their case worker or doctor. Offer support to do this if they need or want it.

I can see you're frightened because you're hearing snakes. It might help to talk to your case worker about this. Would you like me to help you phone him?

Liam

Liam is 26 years old. He was diagnosed with schizophrenia when he was 17 and he has had several relapses over the years. Since coming to work at Frame Up he has been well and very happy with his life.

Just lately though, Liam seems to have lost interest in things. He is frequently late and has been absent quite a few days. He is obviously not looking after himself either because he's unshaven and his clothes are often dirty. He shares a flat with Jasper who has complained that Liam stays up all night playing the X-Box.


From Paul's notebook

Today's the first day Liam has been in this week. He seemed calm enough when he came in, though he was over an hour late. At morning tea time, however, it all started. He came up to me and told me he had to clean out his locker and leave as one of the directors had rung to say he wasn't welcome at Merrinvale any more. He started shouting, 'I've been sacked. I have caused big trouble, so I'm sacked'. I made the mistake of saying that wasn't true and he started shouting about how 'everyone knew he'd been in trouble and there was an article in the paper today about it' (there is no article!). Then he threw out his arm and swept all the stuff off the table, and got up and started pacing up and down as if he couldn't stop. It was quite hard to stay calm myself. I've never seen Liam so stressed – I've never seen anyone so stressed!

He calmed down though. Came up to me, and said he was sorry but he thought he'd better go home now. I said, 'That's fine'. I asked him if he wanted me to contact anyone for him. He was quite OK by then. Said he'd try to get an appointment with his case worker. As he was leaving he went in to tell Bob that he was only going home because he was sick: he was not resigning from his job.

Strategies

  1. Gather information. Assess the functional safety skills of the employee with psychiatric disability on a regular basis.
  1. Plan for emergencies. All support staff should be aware and up-to-date regarding any specific safety issues for employees with psychiatric disability and have a contingency plan for those employees in any emergency.

If Kaye's medication is changed or she stops taking it, she may become disoriented and confused. At times, she has bumped into machines and forgotten how to use her equipment.

  1. Assess employee awareness of safety issues. A mental illness might prevent the person perceiving there is a safety problem. Try to find out how much insight the person has into safety issues affecting them, and their responsibilities for working safely. Questioning and observation are probably the most effective strategies.
  2. Clarify safety responsibilities. Mental illness can prevent a person taking on a sense of responsibility for safety in the workplace. Be clear about the safety rules.

I will work beside you but if you take off your safety goggles I will stop the press immediately.

  1. Be alert to any medication side effects. Medications commonly used for mental illness can produce side effects which could themselves cause a safety problem for an employee. For example, tremors or drowsiness can affect fine motor control making it difficult to perform certain functions or operate equipment safely.

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