Workplace Solutions for Mental Health · Workplace Solutions for Mental Health ... for more than half of all disability claims in the next five ... difficulties anchor one end of

Workplace Solutions for Mental Health

Manager Training

Course Transcript

© 2014 Homewood Health™. This workbook accompanies the e-course Workplace Solutions for Mental Health - Manager Training and is for the exclusive use of clients and customers of Manulife Financial and Homewood Health™. Disclaimer. Please be advised that the content of this course is for informational and educational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

Workplace Solutions for Mental Health Training

© 2014 Homewood Health™2

Index

Introduction

I. About Mental Illness

II. Factors Contributing to Mental Illness

III. Mental Illness and Performance Concerns

IV. Accommodations

V. Talking to Co-workers and Reducing Stigma

VI. Preparing for an Employee’s Return to Work

VII. Managing a Crisis


© 2014 Homewood Health™ 3

IntroductionIt is highly likely that as a manager, leader, supervisor, or employer, you will encounter an employee with a mental illness at some point in your career — whether you know it or not. While you do not need to become an expert in mental health, having a better understanding of what mental illness is, including its possible effects on a worker, enables you to be more effective in handling issues that may arise.

Workplace Solutions for Mental Health — Manager Training is intended to assist you in meeting your obligations towards employees with mental illness and your workplace. By completing the course, you will learn:

• the signs and symptoms of the most common mental illnesses;• the challenges of addressing mental illness in the workplace;• how to discuss mental illness as a performance issue;• the rights and responsibilities of employers in cases of mental illness;• the most likely accommodations that are necessary for return-to-work planning; and• how to manage a mental illness crisis.

About the WorkbookThe Workplace Solutions for Mental Health — Manager Training workbook is a comprehensive workbook designed to improve confidence in recognizing, responding to, and supporting employees with mental illness in the workplace. These goals are achieved through a variety of paper-and-pencil activities, real-world activities, checklists, and action planning.

The online component to the course is designed to increase your understanding of key issues in managing mental illness-related issues as they may arise in your workplace, and the best ways to support employees who may be struggling with these issues. Throughout the online component there are references to the “Learning Activities Workbook” (a PDF that can be printed from the Course Materials section of the course and landing page). The Learning Activities workbook contains questions and activities that can help you apply the information from the course to your particular work situation. The workbook is completed offline.

As a manager, supervisor, or key person you have a unique opportunity to help create a work environment where employees (including yourself) feel welcome, safe, and productive.



I. About Mental IllnessThe National Standard of Canada for Psychological Health and Safety in the WorkplaceIn 2013, the Mental Health Commission of Canada and its partners released the National Standard of Canada for Psychological Health and Safety in the Workplace (the Standard). The voluntary Canadian Standards Association (CSA) standard provides employers with a systematic process and tools to create psychologically healthy and safe workplaces. It involves you because your response to mental illness in the workplace is key to both mental illness prevention and mental health promotion.

Why Learn About Mental Illness?As a manager, there are a number of compelling reasons why you should recognize signs of mental illness and have the skills to support employees with a mental illness. The sooner you recognize the signs of mental illness, the earlier you can respond with appropriate support (e.g. by offering the Employee and Family Assistance Program (EFAP)). The earlier mental illness is recognized and treated, the better the outcome will be for the employee and the organization.

• You are key to ensuring you have a psychologically healthy workplace.

• You may encounter an employee experiencing a crisis related to mental illness.

• You can help prevent inappropriate, hurtful and/or unproductive co-worker responses to mental illness (i.e. stigma).

As an employer, there are similarly compelling reasons to support good management of mental illness in the workplace.

• The average company loses up to 12percent of its payroll to employee disability through loss of productivity and sick leave, and mental illness is expected to account for more than half of all disability claims in the next five years.

• Many mental illnesses are considered disabilities if they affect an employee’s ability to work productively and accommodations may be required.

Key Facts About Mental Illness• Mental illness is a health issue that can significantly affect how a person feels, thinks, behaves and interacts with other

people.

• Mental illness is real and is treatable.

• No one is immune to mental illness. In fact, one in five Canadians has, or will develop, a mental illness at some point in their lifetime.

• Symptoms vary over time. The symptoms of mental illness can be mild, moderate or severe and may appear at different times in a person’s life.

• Awareness and understanding is key to properly supporting mental illness. To properly and effectively support an employee with a mental illness, it is important to recognize that the symptoms are often beyond their control and they cannot just ‘snap out of it.’

The Spectrum of Psychological Health and Mental IllnessPsychological health and mental illness are not distinct experiences.

They exist as two extreme ends of one continuous spectrum of well-being.

None or mild psychological difficulties anchor one end of the spectrum, and several or more severe psychological disorders and difficulties anchor the other.



How is Mental Illness Diagnosed?The signs, symptoms, and diagnostic categories of mental illnesses stem from two classification systems: the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Statistical Classification of Diseases and Related Health Problems (ICD).

According to these classification systems, mental illness is considered a “disorder” when the following conditions are met:

• The signs (e.g. behaviours) and symptoms (e.g. feelings, thoughts) match one of the defined lists.

• The illness causes a lot of distress or impairment to the person in one or more areas of their lives that are important to them.

• You can’t explain the signs and symptoms by common stressors and losses (e.g. losing a loved one), or the person has a lot of trouble changing his or her behaviour.

Common Signs and Symptoms of Mental Illness

Signs (observable behaviours) and symptoms (inferred from experiences described by the individual) vary depending on the type of mental illness but any of the following may be cause for concern:

• Major changes in eating or sleeping habits

• Having strong feelings of anger

• Having strange beliefs not based in reality (delusions)

• Hearing or seeing things that are not there (hallucinations)

• A growing inability to cope with daily problems and activities

• Thinking about harming or killing oneself

• Not admitting to obvious problems

• Having many physical ailments that have no clear cause

• Substance abuse

• Confused thinking

• Poor judgment

• Feeling sad or irritable for more than two weeks

• Extremely low mood

• Extreme anxiety

• Spending more time alone or avoiding others

• Grandiose thoughts, unusually high energy

How to Recognize Mental Illness in an EmployeeMental illness includes a broad range of signs and symptoms. For this reason, it is not easy to determine whether someone is suffering from a mental illness, nor is that diagnosis your responsibility. However, there are several observable indicators that can alert you to a potential mental health issue in an employee.

Signs of mental illness include:

• consistently arriving late to work or being absent;

• creating excuses for missing deadlines and commitments;



• being late for or missing meetings;

• increased errors in work performance;

• displaying a lack of interest in work responsibilities;

• a significant change in personality;

• taking frequent breaks;

• complaining of tiredness and fatigue;

• difficulty concentrating, poor memory;

• irritability with co-workers and/or customers;

• change in personal hygiene and/or appearance; and

• avoidance of co-workers and/or withdrawal from group activities.

The Main Categories Of Mental IllnessThe following are some common signs and symptoms characteristic of most mental illnesses but not specific to any one.

1. Mood Disorders (e.g. Depression)Mood disorders are a group of psychiatric diagnoses whereby a person’s mood is disturbed and causes severe impairment to daily living. The most common of the mood disorders is depression. Ten to 25 percent of women experience major depression at some time in their lives. Men also experience depression, but when they are feeling depressed they may deal with it differently than women (e.g. using alcohol or other substances).

Depression

Major depressive disorder, or major depression, refers to the experience of severe and persistent symptoms of low mood, apathy, poor sleep, lack of appetite or overeating, an inability to enjoy what once were pleasurable activities, and more. People experiencing depression often describe it as the most emotionally painful experience of their lives.

Prevalence

• The prevalence of depression among Canadian adults is approximately eight percent.

• That is the equivalent of every person of all ages in Toronto (approximately three million).

Signs and symptoms

People with depressive illnesses do not all experience the same symptoms. The severity, frequency, and duration of symptoms vary depending on the individual and his or her particular illness. Signs and symptoms include:

• persistent sad, anxious, or “empty” feelings;

• feelings of hopelessness or pessimism;

• feelings of guilt, worthlessness, or helplessness;

• irritability and/or restlessness;

• loss of interest in once pleasurable activities or hobbies, including sex;

• fatigue and decreased energy;

• difficulty concentrating, remembering details, and making decisions;

• insomnia, early-morning wakefulness, or excessive sleeping;

• overeating or appetite loss; and

• thoughts of suicide and\or suicide attempts.



Causes

Depression is most likely caused by a combination of genetic, biological, environmental, and psychological factors.

• Brain structure and chemistry. For some adults with a history of depression, the structures and chemicals (neurotransmitters) of the brain involved in mood, thinking, sleep, appetite, and behaviour appear different. But brain studies cannot reveal why the depression has occurred and they cannot be used to diagnose depression.

• Genetics. Some types of depression tend to run in families. Scientists are studying certain genes that may make some people more prone to depression.

• Environment. Some life experiences, such as long-term abuse, trauma, loss of a loved one, or any significantly stressful and persistent situation, can trigger and/or contribute to the experience of depression.

• Personal factors. Depression may be caused or maintained by certain thoughts and interpretations of experiences (e.g. exaggerating failures, thinking that one is helpless to change a situation).

Treatment

Once diagnosed, a person with depression can be treated in several ways, any of which can be effective on their own or in combination.

• Medication. Antidepressants (e.g. Prozac, Zoloft, Paxil) work on brain chemicals called neurotransmitters. Scientists have found that these particular chemicals are involved in regulating mood, but they are unsure of the exact ways that they work.

• Cognitive Behavioural Therapy (CBT). CBT can help people with depression restructure negative thought patterns and interpret their environment and interactions with others in a positive and realistic way. It can also help a person recognize things that may be contributing to depression and change behaviours that make the depression worse.

• Interpersonal Therapy (IPT). IPT helps people understand and work through troubled relationships that may cause their depression or make it worse.

Bipolar disorder

Bipolar disorder, also known as manic-depressive illness, causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks. People with bipolar disorder experience unusually intense emotional states that occur in distinct periods called “mood episodes.”

Symptoms of bipolar disorder are severe. They are different from the normal ups and downs that everyone goes through from time to time. Bipolar disorder symptoms can result in damaged relationships, poor job or school performance, and even suicide.

But bipolar disorder can be treated, and people with this illness can lead full and productive lives.

Prevalence

• The prevalence of bipolar disorder among Canadian adults is approximately 1percent.

• That is the equivalent of every person of all ages in Halifax (approximately 350 thousand people).

Signs and symptoms

Note: An overly joyful or overexcited state is called a manic episode, and an extremely sad or hopeless state is called a depressive episode.

Symptoms of a manic episode:

• Periods of feeling ”high” or overly happy, irritable, agitated, and “wired”

• Racing thoughts, easily distracted, unrealistic beliefs about one’s ability (grandiose thinking)

• Little sleep



Symptoms of a depressive episode:

• Feeling tired, slowed down

• Low mood

• Feeling irritable

• Problems concentrating

• Contemplating suicide

Causes

Most scientists agree that there is no single cause. Rather, many factors likely act together to produce the illness or increase risk.

• Brain structure and functioning. Brain imaging of people with bipolar disorder shows that they sometimes differ in the development of certain brain structures and this may begin in adolescence.

• Genetics. Bipolar disorder tends to run in families. Children with a parent or sibling who has bipolar disorder are much more likely to develop the illness, compared with children who do not have a family history of bipolar disorder. However, most children with a family history of bipolar disorder will not develop the illness.

• Environment and personal factors. As with depression, life experiences and personal factors may play a role in the development of bipolar disorder, but the severe mood swings may imply that these play less of a causal or developmental role, relatively speaking.

Treating bipolar disorder

To date, there is no cure for bipolar disorder. But proper treatment helps most people with bipolar disorder gain better control of their mood swings and related symptoms. This is also true for people with the most severe forms of the illness.

Because bipolar disorder is a lifelong and recurrent illness, people with the disorder need long-term treatment to maintain control of bipolar symptoms. An effective maintenance treatment plan includes medication (e.g. mood-stabilizing medications, anti-depressant medications), and psychotherapy (e.g. individual psychotherapy, family therapy, and education).

2. Anxiety Disorders (e.g. Panic Disorder)Anxiety is a normal reaction to stress and can actually be beneficial in some situations. For some people, however, anxiety can become excessive.

While the person suffering may realize their anxiety is too much, they have difficulty controlling it, to the point that it significantly interferes with the performance of daily activities and responsibilities.

There are a wide variety of anxiety disorders, including generalized anxiety disorder, panic disorder, post-traumatic stress disorder, and obsessive-compulsive disorder.

Prevalence

• The prevalence of anxiety among Canadian adults is approximately five percent.

• That is the equivalent of every person of all ages in both Calgary and Montreal combined, (approximately two million people).

Signs and symptoms

Each anxiety disorder has different symptoms, but all the symptoms cluster around excessive, irrational fear and dread.



Generalized Anxiety Disorder is characterized by worrying and concern about everyday activities and an inability to relax or gain control of these fears. This fear can persist throughout all situations, all day.

Panic Disorder is characterized by unexpected and sudden attacks of intense panic (a sense of impending doom, heart palpitations, rapid breathing, sweating).

Obsessive Compulsive Disorder (OCD) is characterized by recurring, unwanted thoughts or rituals that the individual cannot control (e.g. touching objects and becoming contaminated by germs). OCD is also accompanied by compulsive behaviours (e.g. repetitive handwashing).

Post-Traumatic Stress Disorder is characterized by intrusive and anxiety-inducing recollections, memories, and flashbacks of life-threatening experiences (e.g. surviving a car accident).

Causes

Anxiety disorders are complex and probably result from a combination of genetic, environmental, psychological, and developmental factors. Additionally, several parts of the brain are key actors in the production of fear and anxiety.

• Brain structure and chemistry. Using brain imaging technology and neurochemical techniques, scientists have discovered that the amygdala and the hippocampus play significant roles in most anxiety disorders.

• Genetics. Anxiety often runs in families. Certain genes may make some people more prone to developing anxiety.

• Environment. Some people may develop anxiety after having been exposed to another family member (e.g. parent) who experiences anxiety. Or certain events (e.g. a severe car accident) can trigger anxiety (e.g. Post-Traumatic Stress Disorder).

• Personal factors. Anxiety may be caused or maintained by certain patterns of thinking (e.g. exaggerating the potential for danger, excessive worrying).

Treatment

In general, anxiety disorders are treated with medication, specific types of psychotherapy, or both. Additional co-existing problems (e.g. depression, alcoholism) will influence the decision of treatment type and its focus.

• Medication. Medication will not cure anxiety disorders, but it can keep them under control while the person receives psychotherapy. The principal medications used for anxiety disorders are antidepressants, anti-anxiety drugs, and beta-blockers to control some of the physical symptoms. With proper treatment, many people with anxiety disorders can lead normal, fulfilling lives.

• Cognitive Behavioural Therapy (CBT). Cognitive behavioral therapy is very useful in treating anxiety disorders. The cognitive part helps people change the thinking patterns that support their fears, and the behavioural part helps people change the way they react to anxiety-provoking situations.

• Medication can be combined with psychotherapy for specific anxiety disorders, and this is the best treatment approach for many people.

3. Thought Disorders (Psychoses)Thought disorders (psychoses) are the group of mental illnesses characterized by hearing or seeing things (i.e. hallucinations) or holding unusual beliefs that other people do not share (i.e. delusions).

Schizophrenia

Schizophrenia is the most common example of a thought disorder. It is a chronic, severe, and disabling brain disorder that often leaves a person unable to care for themselves, struggling to hold a job, and severely limited in their ability to form lasting social relationships. Despite this, with proper treatment, many individuals with schizophrenia can lead productive, fulfilling lives.



Prevalence

• The prevalence of schizophrenia among Canadian adults is approximately one percent.

• That is the equivalent of every person of all ages in Halifax (approximately 350 thousand people).

Signs and symptoms

The symptoms of schizophrenia fall into three broad categories: positive symptoms, negative symptoms, and cognitive symptoms.

• Positive symptoms: seeing, hearing, or smelling things no one else can, scattered thoughts, garbled talk, and agitated body movements or not moving at all for long periods of time.

• Negative symptoms: dulled, flat emotions, speaking little, lack of ability to gain pleasure from activities.

• Cognitive symptoms: poor ability to understand information and make decisions, trouble focusing attention, bizarre and untrue beliefs.

Causes

Experts think schizophrenia is caused by several factors.

• Brain structure and chemistry. Scientists have identified brain structures and neurochemicals that occur in many individuals who experience schizophrenia.

• Genetics. Scientists have long known that schizophrenia runs in families. The illness occurs in one percent of the general population, but it occurs in 10 percent of people who have a first-degree relative with the disorder, such as a parent, brother, or sister.

• Environment. Interactions between genes, brain structures, and the environment are probably necessary for schizophrenia to develop. Many environmental factors may be involved, such as exposure to viruses or malnutrition before birth, problems during birth, and other not yet known psychosocial factors.

• Personal factors. Personal factors are less likely to play a role in schizophrenia than many mental illnesses, but social isolation and withdrawal, as an example, can allow unchecked development of false beliefs, untested interpretations, etc.

Treatment

Because the causes of schizophrenia are still unknown, treatments focus on eliminating the symptoms of the disease. Treatments include antipsychotic medications and various psychosocial treatments.

• Antipsychotic medications (e.g. Chlorpromazine, Haloperidol). Common side effects of these medications include: drowsiness, dizziness, blurred vision, tremors, and/or restlessness.

• Psychosocial and cognitive behavioural treatments. For people already stabilized on medication, these treatments focus on learning coping mechanisms to help deal with the everyday challenges of the illness, testing the reality of perceptions, and/or learning how to not listen to voices.

• Integrated treatment for co-occurring substance abuse. Substance abuse is the most common co-occurring disorder in people with schizophrenia. But ordinary substance abuse treatment programs usually do not address this population’s special needs. When schizophrenia treatment programs and drug treatment programs are used together, better results are achieved.

• Rehabilitation. Rehabilitation emphasizes social and vocational training (e.g. job counselling).

• Family education. With the help of a therapist, family members can learn coping strategies and problem-solving skills.



II. Factors Contributing to Mental IllnessWhat Causes Mental Illness?Anybody can experience mental distress and this can evolve into mental illness.

There are many contributing factors to the occurrence of mental illness. For example, things like genetics, environment, stressors, or a person’s coping mechanisms and personality.

And so each individual is unique in both the cause of mental illness and the experience of mental illness.

Genetics

Genetics are thought to account for 40 percent of a person’s susceptibility to mental illness while psychological and environmental factors account for the other 60 percent.

Research demonstrates that many mental illnesses are polygenic: meaning there are multiple defective genes and not a single gene that is responsible for a disorder.

Even if a person inherits these abnormal genes it does not prove that the person will develop the illness.

Environment

The term “environment” is loosely defined when it comes to mental illness.

Events that evoke feelings of loss or damage are most likely to cause a mental disorder to develop in an individual.

Stressors

There is good evidence of the importance of stressors and coping mechanisms, and how these influence mental illness in general although there is less information known about the specific risk and protective mechanisms.

Coping Mechanisms

Healthy coping mechanisms are essential to good mental well-being. When these skills are lacking, or unhealthy (e.g. drinking too much alcohol), the challenges of daily work and family life can quickly become overwhelming.

Mental Hazards and Behaviour Change: A Model of InteractionMental hazards are often not easy to identify and the impact of psychological hazards can have a cumulative effect, with changes in behaviour or work performance occurring slowly over time.

Stress

We can all think of someone who has been rude or short-tempered at work. This behaviour may be attributed to their personality or ‘just who they are.’ But behaviour is often influenced by factors in the environment such as stress.

If there has been an absence from work, the employee may be apprehensive and experience increased anxiety as a result.

Psychological hazards

Since social interaction with co-workers may be reduced and social support withdrawn, the employee might be perceived as anti-social by their co-workers, or aloof, and their failure to manage their workload may foster feelings of resentment.

These factors contribute to the psychological hazards for this individual and may further negatively influence their ability to cope.



Social activity

Changes in behaviour may also have a negative impact on social relationships at work. A common example is an employee who, at one time, had positive relationships at work and met expectations in their role but, over time, their behaviour may have changed so that deadlines were missed and trust was lost between co-workers. Eventually, social interaction between co-workers is reduced so that the employee becomes somewhat isolated at work and is no longer supported by the social network in the workplace. Later, they might be perceived as anti-social by their co-workers, or aloof, and their failure to manage their workload or the necessity of others to help with their workload may foster feelings of resentment. These factors contribute to the psychological hazards for this individual and may further negatively influence their ability to cope.

Changes in behaviour such as these may indicate a need for professional help to assess mental illness and provide appropriate treatment. If there is an ensuing absence from work, the employee will again be faced with these stressful situations and fractured relationships upon returning to work. These factors will likely increase anxiety or apprehension about returning to work and will need to be addressed in order to ensure a successful and sustained return to work program.

Behaviour change

If behaviour is a change from a previous behaviour pattern it may be a sign of burnout or difficulty coping in a stressful environment.

Breaking the cycle

Creating and maintaining a work environment which fosters psychological safety can help to break this cycle. This can be accomplished by recognizing and acknowledging changes in behaviour, maintaining open communication about stress, burnout, and mental illness, and working with employees to reduce psychological hazards.

The Development of Mental Illness: Industry-specific ScenariosPeople will often exhibit mental illness symptoms differently because performance expectations, job control, and physical demands vary by industry.

Having a clear knowledge of the complexity of how mental illness may develop and manifest in different industries is an important learning to have.

Corporate scenario - Accountant

Janet is a 47 year old accountant working for a large cable installation company.

Linda is Janet’s manager and has been manager of the department for six months. She has seven years of management experience.

Janet feels pressure from all areas of her life and her work is yet another stressor. She knows that her performance is lagging, that it is unusual for her, and that she is making a terrible impression. She’s also worried that things are worsening and she might be better off not coming to work at all.

Linda knows that Janet has been a good performer in the past. But she recognizes that since they have begun working together, Janet’s performance has declined and is getting worse. Linda is worried that this situation may be something to do with her own management style or personality.

Adding more pressure, Linda’s own manager is pressuring her to pick up the productivity of the business unit overall. So Linda knows that Janet, and possibly she, herself, are affecting productivity.



The response

Janet is afraid to tell Linda that she is struggling with a mental health issue because she is not sure she can trust her yet. And she has concerns that disclosing a mental illness may work against her when it comes to performance appraisals and the distribution of challenging and/or sensitive work.

Because of this concern, Janet is purposefully avoiding Linda and making excuses for her absences and performance problems.

Things have gotten so bad that Janet has turned to her family doctor for help. He has advised her to seek counselling, starting with an inquiry to the company’s EFAP. However, he suggests that she take some time away from work and recommends six to eight weeks of absence.

Linda is struggling with whether or not she has something to do with Janet’s performance. But she has some reassurance that this is not the case because Janet is the only nonproductive team member and Janet’s previous managers had a few struggles with her performance as well.

Later in the course, learn what happens to Janet and Linda and the return to work plan that is made after Janet takes a leave of absence for medical reasons.

Manufacturing Scenario – Machine Operator

Greg is part of the road repair crew of a city government. He has been employed by the city for approximately eight years.

Greg’s manager, Bob, has supervised the road repair team for nearly 20 years, during which time he has come to know Greg quite well, in a work context.

Greg has been feeling increasingly sluggish and his mood has been low for several months. Each day things seem to get a bit worse. He hates that he feels this way but feels hopeless that there is anything he can do about it. He has be waking every morning at about 3:00 a.m. and has been unable to return to sleep. Worse, he feels like a failure because he’s falling behind on his daily workload and he has to leave the work area several times a day for a break and to re-energize before returning to work.

Greg feels that things are so out of hand he needs to talk to someone. He doesn’t think he can talk about this with any of the road crew, and certainly not to Bob because he fears he is going to be made fun of.

Bob is worried about prying into things that may not be his business. But he can’t ignore Greg’s performance lags, and he’s starting to hear complaints about Greg’s behaviour from his co-workers who have to make up for his production shortfall.

Bob is thinking that he should approach Greg about his performance but he is not comfortable doing so. Bob is also concerned that Greg’s change in behaviour is getting worse and that Greg is in serious distress.

Later, learn what happens and the return to work plan that is made after Greg takes a leave of absence at the advice of his family physician.

Retail scenario – Sales Clerk

Sarah is a sales clerk at a large department store in a major city.

Sarah’s manager, Brian, has been managing this department, and Sarah, for just over a year now. He, himself, is fairly new to this position.

Sarah is finding it too difficult to manage multiple tasks simultaneously and has to take occasional absences. She also finds she needs frequent breaks throughout the day because she often feels anxiety and sometimes panic, without any provocation. As a result of the anxiety, Sarah is distracted and ‘on edge.’ She isn’t completing her work on time and she is starting to avoid approaching customers unless they come directly to her. She is afraid that customers are noticing these changes, that co-workers are talking about her behind her back, and that she will be fired.

Brian has been satisfied with Sarah’s sales numbers in the past and he has seen her charm the store’s customers and represents the



company well. But Brian has noticed that Sarah hasn’t been circulating on the floor very much lately, she’s rarely there when he drops by, and her sales numbers are falling. This has been going on for about two months, getting worse each week.

Brian wants to help Sarah but has no idea what to do. He has thought about talking to HR or the company’s EFAP about options that might help but in the meantime, he still needs someone on the floor selling or he will be held accountable for the sales results of his department.

Later, learn what happens to Sarah and the plan that is made to assist Sarah to stay at work while learning to cope with her anxiety.

III: Mental Illness and Performance ConcernsWords to use

As a manager, you may grapple with how to talk about performance concerns relating to a suspected mental illness. These suggestions might help.

Use ‘people first’ language when referring to a person with a mental illness. Do not describe the person as being the disease (e.g. “Julia is a depressive”) describe the person as having a mental illness, just as you would someone with any other form of illness/injury (e.g. “Julia has depression”).

These are some appropriate words that can be used when describing what you observe.

• Poor motivation

• Disoriented

• Hyperactive or elevated mood

• Self-absorbed

• Making statements of worthlessness; suicidal thoughts

• Deterioration in hygiene; poor personal presentation

• Excessive fear about certain situations

• Being ‘on edge’ and restless

• Poor concentration

• Highly emotional, irrational or distracted

• Lack of insight

Follow A Nine-step Process To Talk About Performance Concerns

Step1: Be prepared

• Write down the behaviours that you have observed that concern you. This will help you prepare open questions for discussion with the employee.

• Obtain advice and assistance from external support services (without disclosing personal information).

• Talk with allied professionals, such as GPs and other treating practitioners (with the approval of the employee). Review policies and procedures with respect to accommodation.

• Bring to the meeting EFAP brochures and other helpful information.

• Practice what you will be saying before meeting.

• Be positive and supportive.



Step 2: Focus on observed behaviour changes and impact on performance

The discussion you have with your employee should focus on the concerning behaviours you have observed and the impact they’re having on the employee’s performance and/or the performance of co-workers. Stick to the facts and avoid prying into the employee’s personal business. Don’t try to diagnose or counsel.

Step 3: Lead by example

You can support an employee’s return to work, and encourage higher morale and better reintegration into the workplace, by demonstrating that you aware of mental illness and its impact, and that you value and respect the employee.

Step 4: Ask the employee what they need

The employee knows what they are capable of and what they need to succeed in the workplace. To help them remain at work, or make their return from an absence successful, ask what they need. Also consider any recommendations from the employee’s healthcare provider.

Step 5: Schedule a time to meet again and review progress

Once you have set a plan and realistic goals, determine an appropriate schedule to review progress. This may mean weekly or biweekly touch points.

Step 6: Document all details of the meeting and any plans discussed

Advise the employee that you will be documenting the details of the meeting and the agreed-upon actions and goals.

Step 7: Anticipate objections

Sometimes when you meet an employee to discuss your concerns, your offer of help may be refused.

The following are examples of some of the objections you may encounter, and examples of a suggested response on your part.

Employee: “I have no time”

Manager: “You can meet someone from the EFAP during and after work hours or talk by phone. The counsellors are very flexible in terms of time, place, and ways to make a connection with them. Even connecting online is possible.”

Employee: “It’s none of your business.”

Manager: “That’s true but I’m worried about you and your work performance. And the impact your attitude and behaviours are having on the team.”

Employee: “You can’t force me to”

Manager: “You’re right but why not give it a try? It might help.”

Employee: “Will anyone find out?”

Manager: “Absolutely not. The counsellors are all professionals and bound by a code of ethics that protects your privacy. If there are any exceptions to that rule, they’ll tell you the first time you meet.”

Employee: “I’ve got a handle on this.”

Manager: “I’m sure you can handle it. But a little extra help can’t hurt and it might make things a lot easier.”



Step 8: Do any of the actions in the following list.

• Focus on performance issues.

• Focus on outcomes and objectives.

• Stick to facts.

• Create an atmosphere of support.

• Meet privately.

• Provide access to the EFAP.

• Reassure confidentiality.

• Document.

• Consult Human Resources.

• Educate yourself about your policies and legal requirements.

Step 9: Do not do any of the following actions:

• Probe.

• Ask questions for the sake of curiosity without a real need to know the answer.

• Offer a pep talk.

• Reassure with words like “Don’t sweat it... you‘ll get over it soon.”

• Be accusatory.

• Make assumptions.

• Ask what is the medical reason for the absence.

• Ask if the employee is taking medication or seeing a psychologist/counsellor/specialist.

• Make remarks that suggest you question the validity of the absence.

• Offer advice based on “past experience” with family/friends.

IV: AccommodationsAccommodations should be assessed on an individual basis. They should meet the employee’s needs as they relate to their medical condition and be based on the resources available to you.

The Duty to AccommodateMental illnesses are considered disabilities if they affect an employee’s ability to work productively.

According to the Canadian Human Rights Code, accommodation is required when an employee’s disability results in functional limitations preventing them from performing an essential duty of their job. Accommodations are considered reasonable if they do not impose undue hardships on the employer.

Apart from these requirements, accommodating employees with mental illness can help them to remain successfully at work. This is key to their recovery. For most employees, work is a positive experience, provides a sense of accomplishment and self-esteem, and helps create social connections.

A successful return to work requires (1) lack of risk (e.g. from harassment by other employees; not posing a risk to others), and (2) consultation with the individual to incorporate their own recommendations for accommodations.

Note: Always consult your Human Resources department for guidance before taking any action.



Roles and Responsibilities: You, the Organization, and the EmployeeA “one-size-fits-all” approach does not apply to accommodations.

Each situation should be assessed accordingly, with the assistance of a case manager, rehabilitation specialist, or Human Resources.

Remember that as a manager you have an obligation to help provide appropriate workplace accommodations and to know your workplace accommodation policies and procedures.

The Role of ManagersYour role as a manager includes the following:

• Don’t assume you know the cause of changes in work performance.

• Don’t assume problems will be resolved without action from you.

• Don’t assume responsibility for the employee’s well-being but do offer information and support.

• Inform the employee of your observations about his or her behaviour and mood.

• Convey empathy and express your genuine concern.

• Clearly articulate your performance expectations.

• Understand your workplace accommodations and procedures.

• Reassure the employee that your conversation is confidential and that they do not have to reveal the reasons for work performance changes.

Example:

“John, it’s come to my attention that you’ve been absent for four of the past 14 workdays and that you’ve been arriving late on the days you are here. I’m worried about you and I am concerned because you need to perform your duties consistently. Others in your team depend on you.

I hope to discuss the situation with you and talk about what we can do to prevent the situation from getting any worse, as well as ways to make it better.”

• Sometimes the employee must disclose some aspects of their illness or you will not be able to provide reasonable accommodations that may be helpful to them. You should still offer the assistance of the EFAP and discuss the situation with your Human Resources department.

• If you feel the work performance of the employee is impacting the business, then you have a right to address these issues through formal avenues, such as performance appraisal meetings. Additionally, denial of any problems by the employee may mean withdrawal of any accommodations that you may have been ready to make.

• If you feel the employee’s safety, or the safety of others, is at risk, you will have to take appropriate steps to report the situation, respecting confidentiality to the degree that is appropriate.

The Role of the Organization• Ensure policies and processes are available to managers.

• Train managers to take appropriate action in cases of mental illness.

• Create a psychologically healthy work environment that fosters well-being and productivity.



The Role of the EmployeeAn employee may choose not to disclose their mental illness to you, even when it is evident that they are not coping in the workplace. Despite this the employee is responsible for:

• their work performance and taking steps to address obstacles that prevent them from meeting those expectations;

• providing medically supported limitations if accommodations are being requested; and

• following the treatment program prescribed by their health care provider.

Accommodations That May Be Made for an Employee With A Mental IllnessThere are many accommodations that may help an employee with a mental illness stay at work or have better success when returning from an absence. Some of these include the following:

• Flexible scheduling – at the start or end of a shift, part-time or frequency of breaks.

• Changes in manner of supervision – in the way instructions are given, for example.

• Changes in training – permitting different kinds or extended training opportunities.

• Use of technology – recording supervisor’s instructions, for example.

• Modifying duties, workspace or location – freeing an employee from distractions.

Accommodations for Cognitive DifficultiesAccommodating for a physical illness or injury often involves modifying job duties to meet the employees’s functional abilities. Mental illness on the other hand, will often require accommodating for cognitive difficulties.

Having an understanding of the cognitive requirements of the employee’s job and comparing these to the employee’s cognitive abilities is key to a successful accommodation.

Learning and memory challenges

• Put instructions in writing

• Highlight specific information or tasks to prioritize

• Provide an electronic or written organizer to diarize work tasks

• Allow for additional training time

Concentration challenges

• Allow extra time to complete tasks

• Allow short breaks

• Modify the work space to minimize distractions

• Explain complex ideas clearly and simply

• Ask for ideas to be repeated back to you to ensure they were understood

Planning and organizing challenges

• Develop written plans of action

• Identify achievable tasks with explicit deadlines

• Develop checklists for tasks

• Allow extra time to complete tasks



Social interaction challenges

• Do not make social interaction mandatory or reintroduce it gradually if it is a required job function

• Allow the employee to work from home

• Relocate employee to quieter area

Emotional and stress management challenges

• Minimize stress that may be a trigger for the feelings

• Adjust work schedule to allow medications to take effect. For example, allow the employee to start later if mornings are difficult

• Provide positive feedback when possible

Scenarios

Recall the corporate scenario:

Janet is a 47 year old accountant working for a large cable installation company. Janet feels pressure from all areas of her life and her work is yet another stressor. She knows that her performance is lagging, that it is unusual for her, and that she is making a terrible impression. She’s also worried that things are worsening and she might be better off not coming to work at all.

Linda is Janet’s manager and has been manager of the department for six months. She has seven years of management experience. Linda knows that Janet has been a good performer in the past, but she also recognizes that since they have begun working together, Janet’s performance has declined and is getting worse. Linda is worried that this situation may be something to do with her own management style or personality.

Janet feels pressure from all areas of her life and her work is yet another stressor. She knows that her performance is lagging, that she took an extended absence for medical reasons and is now planning her return to work.

Linda’s role in the return to work process:

• Set up a meeting on the first day back to work.

• Welcome Janet back and try to make this a positive experience.

• Review the return to work plan, including accommodations, and ensure understanding that the plan is flexible.

• Make expectations clear and leave the door open for ongoing discussion about any concerns or difficulties.

• Plan what will be said to co-workers in relation to accommodations that may be planned.

• Address any actions that suggest that Janet may be at risk for being stigmatized.

• Update the employee on any changes in the workplace during their absence.

• Discuss a process to evaluate the return-to-work plan regularly.

• Respect Janet’s right to privacy.

Janet’s role in the return to work process

• Understand the expectations and responsibilities of the return to work plan.

• Ask about changes at work during the absence.

• Know who to turn to if there are questions, concerns or setbacks.

• Maintain outside supports including medical and/or psychological.



Recall the manufacturing scenario:

Greg is part of the road repair crew of a city government. He has been employed by the city for approximately eight years.

Greg’s manager, Bob, has supervised the road repair team for nearly 20 years during which time he has come to know Greg quite well, in a work context.

Greg has been feeling increasingly sluggish and his mood has been low for several months. Each day things seem to worsen. He hates that he feels this way but feels hopeless that there is anything he can do about it. Worse, he feels like a failure because he’s falling behind on his daily workload and he has to leave the work area several times a day because he cannot focus and feel he cannot be around the work crew. He left work at the advice of his doctor. He has been away from work for almost three months and is now planning his return to work.

Bob’s role in the return to work process:

• Prepare for the meeting by ensuring that restrictions and limitations are reviewed and any accommodations or transitional work duties are identified.

• Speak with the disability carrier managing the absence to discuss return to work needs.


• Welcome Greg back and try to make this a positive experience.

• Review the return-to-work plan, including accommodations, and ensure Greg understands that the plan is flexible.



• Address any actions that suggest Greg may be at risk for being stigmatized.

• Update the employee on any changes in the workplace.

• Discuss a process to evaluate the return to work plan regularly.

• Respect Greg’s privacy rights.

Greg’s role in the return to work process




• Maintain outside supports including medical and/or psychological.

• Problem solve, with Bob’s assistance, what he should say to his co-workers about his absence and/or the accommodations if they ask.

Recall the retail scenario:

Sarah is finding it is too difficult to manage multiple tasks simultaneously and has to take occasional absences. Because of the sudden onset of panic she sometimes feels, she takes frequent breaks from her work to calm herself. She took an extended absence for medical reasons and is now planning her return to work.

Brian’s role in the return to work process

In preparation for the return to work, Brian reviewed the previous accommodations that included time off to attend medical appointments to ensure this was still available, and determined whether additional modifications could be made. Brian also spoke with the disability carrier to obtain additional information on Sarah’s return-to-work needs.



• Provide modified duties that placed Sarah in a non-customer facing role for the first two weeks of her return to work

• Provide non time sensitive work projects during the early phase of the transitional return to work program so Sarah will feel productive.


• Welcome Sarah back and try to make this a positive experience.

• Review the return-to-work plan, including accommodations, and ensure Sarah understands that the plan is flexible.



• Address any actions that suggest Sarah may be at risk for being stigmatized.

• Update the employee on any changes in the workplace during their absence.

• Discuss a process to evaluate the return to work plan regularly.

• Respect Sarah’s right to privacy.

Brian provided modified duties that placed Sarah in a non-customer facing role for the first two weeks of her return to work. Brian provided non time sensitive work projects during the early phase of the transitional return-to-work program so Sarah would feel productive. Brian thought that he could shadow Sarah during the latter part of the return to work when she had to do customer facing work on any changes in the workplace during their absence.

Sarah’s role in the return to work process



• Follow through with all scheduled meetings.

• Inform Brian if co-workers are not being supportive.


V: Talking to Co-Workers and Reducing StigmaAbout Disclosing Information Concerning an Employee’s Mental IllnessMental illness is a medical problem and you are not free to discuss the situation with co-workers of the employee. However, co-workers will sometimes question the accommodations that are being extended towards an employee. These questions, and any perceived unfair treatment, are usually eliminated when the accommodation policy is known and when your attitude toward the accommodations is positive.

Co-workers do need to know if another employee’s accommodations will affect them, and it is not a breach of confidentiality to discuss the accommodations themselves. However, it is a breach of confidentiality to discuss the specific reasons for these accommodations.

About StigmaStigma is a form of negative stereotyping that sets a person apart. Negative attitudes and misinformation create prejudice that leads to negative actions and discrimination.

Stigma is an unfortunate reality for people who live with a mental illness and one of their biggest barriers to a complete and satisfying life. Stigma is a mark of disgrace that sets a person apart. When a person is labelled by their illness they are seen as part



of a stereotyped group. Negative attitudes create prejudice which leads to negative actions and discrimination.

Both powerful and pervasive, stigma prevents employees from acknowledging their own mental health problems, much less disclosing them to others. Stigma affects these individuals when they are ill, while they are seeking treatment, and while they are attempting to reintegrate into the workplace.

How is stigma shown?

Stigma is manifested by the following:

• Bias

• Distrust

• Stereotyping

• Fear

• Embarrassment

• Anger

• Avoidance

• Being treated as less competent

What are the effects of stigma?

Everyone has the right to fully participate in the workplace but individuals struggling to overcome a mental illness can find themselves facing a constant series of rejections and exclusions.

If you became physically ill, you may visit a doctor. Once you’re better you expect to get on with life as usual. Life, however, does not always fit back into place for people diagnosed with a mental illness.

How do we stop stigma?

We can stop stigma with facts, awareness, and being exposed to people who have a mental illness and who are healthy and productive despite the mental illness.

The first section of this course gave you some basic facts about mental illness. Even though it’s not your job to diagnose mental illness, it is important to understand as much as you can. Most importantly, you need to know that mental illness is a medical condition. And just like physical illnesses, mental illness can be treated.

VI: Preparing for an Employee’s Return to WorkAn employee’s return to work is the most critical phase of recovery. How you and the employee handle this return is key to success.

How Do I Handle the Employee’s First Day Back?

Be prepared

• Contact your Human Resources representative if you have any questions.

• Promote a supportive and welcoming workplace.

• If required, arrange for access cards to the building/office.

• Arrange for computer/workstation access, including access to any programs, folders and systems required for the employee to perform their job.



• Set up workstation. Verify that the employee has access to all materials required.

Make it positive

• Make this a positive experience for the employee.

• Welcome the employee back and remember that they may need a period of adjustment.

Explain what has been discussed with others

• During the meeting, if previously agreed upon with your employee, discuss how you have educated co-workers for the return to work (including any impact on workloads/job duties).

Explain privacy rights

• Help to ensure the employee understands their privacy rights. Specifically, employees have a right to self-disclose a mental illness or not, and to control their own care (i.e. whether or not they choose to seek care and the type of care selected). If you have any questions about the employee’s privacy rights or what information you can ask for and/or share with others, see your Human Resources department for guidance. These rights may be governed by legal parameters.

Review the plan

• Review the return to work plan.

• Outline your expectations regarding workload, job duties and performance.

Provide updates

• Update the employee on any changes in the workplace during their absence, any key events/activities that are taking place and how you will assist them in getting up to speed (e.g. training, time to review materials, shadowing).

Discuss follow-up

• Discuss an agreed upon process to evaluate the return to work plan regularly with the employee. For example, have brief scheduled check-in periods every day for the first two weeks with a formal review weekly until no longer necessary.

• Agree upon a plan for addressing issues proactively as they may arise.

Anticipate challenges

Not all return-to-work plans go as expected.

• You may need to adjust the work schedule or duties to help ensure the employee is successful.

• Agree upon a plan for addressing issues proactively as they may arise.

VII. Managing a CrisisCrises do happen unexpectedly and can be very upsetting to witness and manage. Knowing how to respond before an actual crisis occurs is the best way to prepare for these unpredictable situations.

Being informed about your organization’s EFAP and encouraging employees to use it is one of the best ways to prepare for a potential crisis situation. Have EFAP materials with contact information visible and available in the workplace at all times.



When an Employee is At Risk of Harming ThemselvesAs a manager you need to know how to respond to employees who may be at risk of harming themselves.

• Remind yourself to stay as calm and level headed as possible.

• Do not leave the employee alone.

• Talk to them in a quiet and calm voice.

• Be direct and tell them what you have learned.

• Let the employee know you care and value them.

• Offer hope that solutions can be found.

• Seek their agreement to get help.

• Ask “will you agree to talk to an EFAP counsellor?” and, if they do, call the EFAP immediately.

• If the situation seems more imminent or the employee is not communicating and/or agreeing to get help, call your EFAP crisis line, security, or 911.

When an Employee is At Risk of Harming Others*• Contact your EFAP crisis line.

• Contact your security department or the police if you feel it is necessary.

• Contact the employee’s treating health professional, if known.

• Avoid being drawn into arguments.

• Remind the employee of basic rules of behaviour in the workplace.

• Stay calm and talk in a calm, slow but firm manner.

• Keep at a reasonable distance.

• Suggest that the employee sit down to help them feel more at ease.

• Take any threats or warnings seriously.

• If you are in a contained/closed space, such as an office, make sure you have clear access to an exit.

* Violence accompanying mental illness is not common and is usually associated with untreated illness. It is actually more common for a person with

mental illness to be the target of aggressive and violent behaviour.

ConclusionIf you have worked through all of the online material, and completed the Learning Activities Workbook for each section of the course, you will have learned the following:

• How to recognize the signs of mental illness in your workplace.

• The types of mental illness and their most common expression.

• The complexity of how mental illness develops and how anyone can develop a mental illness at any point in their lives.

• A step-by-step process to manage mental illness issues as performance concerns.

• The role that you, the employee and the organization play in making accommodations for an employee with mental illness considerations.

• The types of accommodations that are reasonable and possible, including accommodations for employees who may be experiencing cognitive challenges.

• The experience of stigma by employees.



• How to best prepare employees, co-workers, and the workplace to support the successful return to productive work when an employee is ready and able.

• What to do if an unexpected mental health crisis occurs whether the employee presents no risk, a risk to themselves, or a risk to others.

Remember that mental health in the workplace affects us all—and as a manager, supervisor, or leader, you are in a unique position (1) to support employees who may have a mental illness, (2) to assist in the accommodation of employees with a mental illness so that they may continue working or return to work successfully after an absence, and (3) to contribute to the overall psychological health of your workplace.

More Questions?Visit the Resources section of the course through the link on the course landing page. Here you’ll find links to many valuable sources of mental health information, among other topics.

And if you’re still in doubt? Contact your Human Resources department representative for answer to questions about your workplace responsibilities in managing and supporting mental illness. Or contact your EFAP for any questions and concerns you have about mental illness in general, the mental well-being of your staff, or yourself.

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