Performance Issues: Mental Health and Disabilities Presented by Kendra Smith, MSW, LISW-S ViaQuest Psychiatric & Behavioral Solutions.

Performance Issues: Mental Health and

Disabilities

Presented by Kendra Smith, MSW, LISW-S

ViaQuest Psychiatric & Behavioral Solutions

Objectives

• Identification of common mental health disorders • Signs and symptoms• Separating mental health from developmental or

other disabilities• Effective supports and resources

Common MH Disorders

• Mood Disorders• Anxiety Disorders • Substance Abuse Disorders• Adjustment Disorders• Psychotic Disorders• Personality Disorders

Mood Disorders

• Characterized by a disturbance of mood as a predominant feature. Major subcategories include:• Major Depressive Disorders• Dysthymic Disorder• Bipolar I and Bipolar II Disorders

Note: Depression is NOT a normal part of living with a disability!

Anxiety Disorders

• Characterized by the presence of excessive fears, frequent somatic complaints, and excessiveness nervousness that can interfere with functioning. Categories include:

• Panic Attack• Agoraphobia• Obsessive Compulsive Disorder (OCD)• Post Traumatic Stress Disorder (PTSD)

Substance Abuse Disorders

• Characterized by a maladaptive pattern of substance use manifested by recurrent and significant adverse consequences related to the repeated us of substances. Diagnosis is made if the substance abuse related problem occurs repeatedly during the same 12 months period or been persistent.

Adjustment Disorders

• Essential feature of these disorders is the development of clinically significant emotional or behavioral symptoms in response to an identifiable psychosocial stressor(s). It is indicated by marked distress that is beyond what would be expected or by impairment in social or occupational functioning. Symptoms should dissipate around six months.• This may occur with onset of disability or new

limitations of disability

Psychotic Disorders

• Characterized by any of the following signs and symptoms: delusions, hallucinations, disorganized behavior, impairment in reality testing. Subcategories include:• Schizophrenia• Schizoaffective Disorder• Schizophreniform Disorder

Personality Disorders

• Characterized by enduring patterns of dysfunctional behavior. Symptoms present as personality traits that are inflexible and maladaptive causing significant impairment or subjective distress. 10 Subcategories, including:• Borderline Personality Disorder• Antisocial Personality Disorder• Avoidant Personality Disorder• Narcissistic Personality Disorder• Obsessive Compulsive Personality Disorder• Paranoid Personality Disorder

Mental Health Disorders

You may see some overlap of symptoms for example:• Lack of impulse control• Aggressive behaviors• Lack of interest in activities• Limited cause/effect insight• Suicidal Ideation• Delusions or hallucinations – may be exhibited in

individuals with a dementia, Mood Disorder, or Anxiety Disorder. Could be experiencing delusions or hallucinations as a result of drug/alcohol abuse.

Trauma

• Can be caused by anything that disrupts sense of safety• Individuals with disabilities more likely to experience

trauma – some studies show up to 90%• Mental health clients also have higher prevalence of

trauma history• Subjective experience • Impact of disability on ability to process events• Impact of disability on ability to communicate needs

• Impacts brain development• Impacts physical health

Trauma on the BrainHealthy Brain Traumatized Brain

After Effects of Trauma

• Opposition to rules/directions/authority• Depression or mood swings• Motivated by immediate reward • Lack of or unrealistic long term goals• Unstable relationships• Lack of trust in others• Difficulty concentrating • Lack of self control• Educational delays• Lack of confidence in self

Work Performance Issues• Impulse Control• Stealing, lying, anger outbursts, aggression, walking out

• Motivation• Lack of motivation to go to work, complete tasks, interact

with others• Anxiety• May be too anxious to go to interview, first day, etc. • Overly concerned of being criticized and not doing a good

job, may get in the way of employee being successful • Personal Life Stressors• May struggle to balance and separate work/home stress

Performance Issues- Similarities

• May struggle as supports are reduced• Attendance issues• Conflict resolution issues with both peers and

supervisors

Performance Issues - Differences

Mental Health• Difficulty following through

on tasks, concentrating• Skills and performance may

fluctuate• Consistency is good but does

not always alleviate issues• More likely to cycle,

experience ups/downs

Disability• Difficulty acquiring skill or

mastering task• Once mastered, skill tends

to remain stable• Consistency can alleviate

many issues

Providing Support

• Provide a consistent and stable environment• Establish a trauma-informed approach• Provide teaching and coaching• Prepare individuals for what to expect, any changes

coming• Provide environmental accommodations• Area to relax/de-escalate• Awareness of workspace distractions or triggers• Scheduling accommodations to maximize

performance• Maintain contact if they do need time off

Resources Available

• For those with a mental health or trauma-related issue:• Mental health counseling• Mental health case management (CPST)• Psychiatry/Medication management

• Services are not time limited, are based on medical necessity• Therapists and CPSTs should be included in team

meetings to improve care coordination and collaboration

When to refer for MH services:

• Individuals are: • Withdrawn• Anxious• Depressed• Feeling hopeless• Having mood swing• Easily agitated• Impulsive• Having conflict with peers or supervisors• Threatening to harm self or others

How to Approach

• Identify their strengths and why you need them as an employee• “What can I do to help you be successful at your job?”• Be clear about the issues you see in their performance• Genuine collaboration• Collaborate to develop realistic goals• Follow-up regularly to evaluate progress towards goals• Identify what the consequences will be if expectations are

not met• Approach from a point of care and concern – talk about

services available and how they may help to reach the agreed upon goals

Contact Information• Kendra Smith• [email protected]• 614.339.0865

• Central Intake• 855-289-1722