David Oddie, B.Sc., M.A., M.S.W., R.S.W.Employment Support and Development Team

Community Support and Research UnitCentre for Addiction and Mental Health

Mental Illness:What it is

Myths and Facts

Accommodation

Recovery

Agenda

• Mental Illness• Types of Mental Illness• Accessing Support• Myths• Points to Remember• Accommodations• Recovery

~~~~~~~~~• The Social Determinants of Health• Information about CAMH and the CSRU• Assessments and Crisis Support

Mental Illness

• Mental illness encompasses a wide range of illnesses which can affect an individual’s

• mood• thoughts• perceptions • behaviour

Diagnosis

• Based on observation of behaviors

• No x-ray, blood test, cat-scan, swab, etc.

• Uses the Diagnostic Statistical Manual (DSM)

+• can help identify common

patterns and support research that provides relief

-• Does not predict a person’s ability

to function at work or school

• Can often imply a greater understanding of the condition than actually exists

Categories

1. Mood disorders

2. Schizophrenic disorders

3. Anxiety disorders

4. Personality disorders

1. Mood DisordersDepression• Prolonged feelings of sadness

and despair• Hopelessness and

helplessness• Fatigue, lack of energy• Slowed thinking• Forgetfulness • Loss of interest in activities• Change in eating and sleeping

patterns• Agitation• Affects about 10-25% of

women and 10–15% of men.

Bipolar• Mania• Depression• Mixed State• Hypomania• Affects about 1-2% of population

Dysthymia• Chronic, mild depression• Affects about 1.5% of population

(National Institute of Mental Health, U.S.)

2. Schizophrenic Disorders• Problem with brain chemistry/brain development

• Affect men and women equally

• Have a genetic predisposition

• Appear in cycles of remission and relapse

• Treated by medication, therapy, psycho/social rehabilitation

• Affects about 1% of population

3. Anxiety Disorders• Anxiety that is disproportionate to reality• Undermines a person’s ability to do everyday activities• Anxiety also accompanies other psychiatric disorders• Often appears in adolescence or early adulthood• Affects more than 12% of population

• Examples:• Panic Disorder• Generalized Anxiety Disorder• Obsessive Compulsive Disorder• Phobias• Post-Traumatic Stress Disorder

4. Personality Disorders• Many forms; often secondary diagnosis• Patterns of behaviour, thoughts, feelings, relationships that differ

significantly from those of the culture • Inflexibility• Difficulty with interpersonal relationships• Onset during adolescence or in early childhood• A recent survey (U.S./U.K./Norway) showed a range of 4-14% of the

population having one. Up to 50% of prison populations have PD.• Examples:

• Paranoid Personality Disorder• Schizotypical Personality Disorder• Antisocial Personality Disorder• Borderline Personality Disorder• Narcissistic Personality disorder• Avoidant Personality Disorder• Dependent Personality Disorder

Common Associated Issues

• Pharmacological side effects– Cognitive delay, lethargy/drowsiness, weight gain, fatigue– Client frustration with drugs and effects

• Secondary disability– loss of vocational trajectory– loss of family/friend networks– feeling trapped by the system

• Poverty

Summary

• Mental illness is about mood, thoughts, perceptions and behaviour

• Mental illnesses can have few or many symptoms

• Symptoms can have varying degrees of intensity, from negligible to extreme

• Impact on people’s lives is variable

Myths and Facts

Myths and Facts

• 1 in 5 people in Ontario will experience some form of mental illness

• Only about 30% of us seek assistance

Facts Reasons People Don’t Access Support

• No insight themselves into mental illness

• Not knowing who to tell or how to access support

• Trying to handle symptoms on their own

• Feeling ashamed or embarrassed that they need assistance

Real Difficulties With Disclosure

• stigma

• feeling different/not belonging

• don’t want to be labeled

• fear of being rejected, discriminated against

• fear around confidentiality

• fear they will not be treated with compassion

• fear this will become their identity

Myth

Recovery from mental illness is not possible.

Fact

The majority of people with mental illnesses show genuine improvement over time and lead stable, productive lives.

Myth

All mentally ill individuals are unpredictable, violent and dangerous.

Fact

The vast majority of people with mental illness are not dangerous or violent.

This myth is reinforced by sensationalized portrayals in the media.

– The rate of instances of dangerous or violent behaviour by a person with schizophrenia parallel the rate for the normal population

– The rate of being on the receiving end of violence is 3x higher for a person with a schizophrenia diagnosis

Myth

Employees with mental illness are second-rate employees.

Fact

Employers report higher than average attendance and punctuality from employees with mental illness.

Motivation, quality of work and job tenure are reported to be as good as, or better than, other employees.

Points to Remember

• Mental illness is treatable, and the majority of people make a good recovery

• Not everyone with a mental illness takes, or should take, medication

• Within each illness there is tremendous variation of symptoms and degrees of symptoms

• Also variation in how a person copes with an illness and how it impacts their lives

• Each person is the expert on what is problematic for them.

Actions To Remember

• Important not to assume that you know what a person can or cannot handle

• Don’t attribute every behaviour to an illness

• Demonstrate understanding and support, but set reasonable expectations

• Do not assume that all individuals with mental illness require accommodation

• Respect confidentiality – build a trusting relationship

Accommodating people’s needs

Accommodations• Modifications to the school/workplace or its

procedures

• Can allow a qualified employee/student with a mental or physical disability to perform the essential tasks

• Can minimize or remove barriers to success for a person with mental or physical issues

Accommodations

• A request for accommodation requires some degree of disclosure

– This is one of the most difficult aspects of accommodation

• The act of disclosure is always assisted by an explicit discussion of confidentiality

• The accommodation and the process of instituting it must ensure individual dignity and respect

• Costs, if any, are usually quite low (averaging $500 for non-physical barriers)

• People who need them don’t necessarily need them all the time

Examples of Accommodations

• Flexible working/classroom hours

• Part-time attendance in workplace/classroom

• Instructions given verbally and in writing

• Longer learning period

• A buddy or mentor

• Assistive devices

Examples of Accommodations cont.

• Job modification or restructuring

• Providing training to staff/teaching staff or supervisors (in the workplace)

• Modifying exam time and/or environment

• Modifying physical environment (e.g. using environments with less distraction/stimulation)

• All types of accommodation last only as long as they are needed

Recovery

The Recovery Framework“It is important to understand that persons do not

‘get’ rehabilitated the way that a car ‘gets’ tuned up.”

- Pat Deegan (psychiatrist-consumer-survivor)

– Developing a sense of belonging, meaning, and identity apart from one’s diagnosis or disability

– Building or rebuilding a life in the community– Successfully coping with a disability– Redefining treatment as aiming for recovery, not a

“cure”.

What are clients recovering from?

• Loss of self, connection, hope• Loss of roles, opportunities• Multiple recurring traumas• Loss of educational/employment trajectory• Devaluing programs, practices and environments• Social discrimination• Internalized oppression and shame

Recovery Outcomes

• Gaining/regaining valued role• Success and satisfaction with roles• Reducing/managing symptoms• Increased self esteem, feelings of well being• Enriched interpersonal connections• Improved physical health

• Hope• Self- Determination• Personal Empowerment• Responsibility• Focus on Strengths Rather than Deficits • Personal Choice• Respect

Principles of Recovery

The Social Determinants of Health (The Canadian Facts, Mikkonen and Raphael, 2010)

• Income and Income Distribution• Education• Unemployment and Job Security• Employment and Working Conditions• Early Childhood Development• Food Insecurity• Housing• Social Exclusion• Social Safety Network• Health Services• Aboriginal Status• Gender• Race• Disability

The Community Support and Research Unit (CSRU), CAMH

• Income and Income Distribution• Education• Unemployment and Job Security• Employment and Working Conditions• Early Childhood Development• Food Insecurity• Housing• Social Exclusion• Social Safety Network• Health Services• Aboriginal Status• Gender• Race• Disability

• Positive change at the service delivery, CAMH and systems level

• Involved in a wide variety of projects, including international projects

The Centre for Addiction and Mental Health About CAMH• One of the first organizations to bring mental health and addiction services together• Formed in 1998, merging two mental health and two addiction facilities• Brings together specialized care, research, province-wide education, health

promotion and public policy development• Research and clinical practice are intertwined

By the numbers, 2010-11• 2,859 staff• 25,572 unique clients

– 30% of whom access addictions services only• 467,663 outpatient visits• 3,948 inpatient admissions• 5,541 visits to Emergency • 61.6 Average length of stay (days)• Top two substances reported by clients- alcohol and crack/cocaine• Postsecondary Education

– 40% of addictions clients – 27% of mental health clients

• Employed– 44% of addictions clients– 28% of mental health clients

Assessments at CAMH• No referral required for Addictions Assessment

Service.

• Client should contact the general intake telephone line – (416) 535-8501 Ext 6616

• Referral required from physician for mental health assessment – referral form on CAMH website www.camh.net

• Emergency Services – 250 College St (no referral required) – short-term follow-up from Crisis Clinic

More Information

• Mental Health and Addictions 101 series on CAMH website

http://www.camh.ca/en/education