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David Oddie, BSc, MA, MSW, RSWSocial Determinants of Health (SDH) ServiceAccess and Transitions ProgramCentre for Addiction and Mental Health

Mental illness What is it?

Myths and factsAccommodation

Recovery

Agenda

• Mental Illness• Myths and Facts• Accommodating People’s Needs• Recovery• Centre for Addiction and Mental Health

Mental Illness

Mental Illness

Mental illness encompasses a wide range of illnesses that can affect a person’s:

• mood• thoughts• perceptions • behaviour

Diagnosis

• Based on observation of behaviours• Requires no x-ray, blood test, CAT scan, swab, etc. • Diagnostic and Statistical Manual of Mental

Disorders (DSM)

• can help to identify common patterns and support research with the goal of providing relief

• does not predict a person’s ability to function at work or school

• may imply a greater understanding of the condition than actually exists

Categories

1. Mood disorders

2. Schizophrenic disorders

3. Anxiety disorders

4. Personality disorders

Mood disorders

Depression prolonged feelings of sadness

and despair sense of hopelessness and

helplessness fatigue, lack of energy slowed thinking forgetfulness loss of interest in activities changes in eating and

sleeping patterns agitation affects 10-25% of women and

10-15% of men

Bipolar disorder mania depression mixed state hypomania affects 1-2% of the population

Dysthymia chronic, mild depression affects about 1.5% of the

population

(U.S. National Institute of Mental Health)

Schizophrenic disorders

• Involve a problem with brain chemistry/development

• Affect men and women equally

• Genetic predisposition

• Appear in cycles of remission and relapse

• Treated with medication, therapy, psychosocial rehabilitation

• Affect about 1% of the population

Anxiety disorders

• Involve anxiety that is disproportionate to reality

• Undermine a person’s ability to do everyday activities

• May accompany other psychiatric disorders• Often appear in adolescence or early

adulthood• Affect more than 12% of the population

Examples:• panic disorder• generalized anxiety

disorder

• obsessive compulsive disorder

• phobias• post-traumatic

stress disorder

Personality disorders

• Include many forms; often a secondary diagnosis• Involve patterns of behaviour, thoughts, feelings,

relationships that differ significantly from those of the culture

• Feature inflexibility, difficulty with interpersonal relationships

• Appear during adolescence or early childhood• Affect 4-14% of the population; up to 50% in

prison populationsExamples:

• paranoid personality disorder

• antisocial personality disorder

• borderline personality

disorder• narcissistic personality

disorder

Common associated issues

• Pharmacological side-effectso cognitive delay, lethargy/drowsiness, weight

gain, fatigueo frustration with drugs and side-effects

• Secondary disabilityo loss of vocational trajectoryo loss of family/friend networkso 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

• The impact of mental illness on people’s lives varies

Myths and facts

Myths and facts

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

• Only about 30% seek assistance

Fact: Reasons people don’t access support

• No insight into own mental illness• Don’t know who to tell or how to access support• Try to handle symptoms on their own• Feel ashamed or embarrassed about needing help

Fact: Difficulties with disclosure

• Experiencing stigma• Feeling different/not belonging• Not wanting to be labeled• Fear of rejection, discrimination• Concerns about confidentiality• Fear of not being treated with compassion• Fear that this will become their identity

MythRecovery from mental illness is not possible.

FactMost people with mental illness show genuine improvement over time and go on to lead stable, productive lives.

More myths and facts

MythAll people with mental illness are unpredictable, violent and dangerous.

FactThe vast majority of

people with mental illness are not dangerous or violent.

Myth sensationalized by the media.

Incidence of dangerous or violent behaviour by a person with schizophrenia is the same as for the general population.

People with schizophrenia are 3x more likely than members of the general population to be victims of violence.

More myths and facts

MythEmployees with mental illness are second-rate employees.

FactEmployers report higher-than-average attendance and punctuality among employees with mental illness.Among employees with mental illness, motivation, quality of work and job tenure are reported to be as good as, or better than, that of other employees.

More myths and facts

Points to remember

• Mental illness is treatable, and most people make a good recovery

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

• There is significant variation in symptoms and degree of symptom severity within each mental illness

• How people with mental illness cope and how the illness affects their lives varies significantly

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

Actions to remember

• Don’t assume that you know what a person can or cannot handle

• Don’t attribute every behaviour to mental illness

• Demonstrate understanding and support, but set reasonable expectations

• Don’t assume that everyone with mental illness requires accommodation

• Respect confidentiality – build a trusting relationship

Accommodating people’s needs

Accommodations

• Involve modifications to the school/workplace or its procedures

• Allow a qualified employee/student with a mental or physical disability to perform essential tasks

• Minimize or remove barriers to success for a person with a mental or physical disability

Accommodations

• A request for accommodation requires some degree of disclosure (one of the most difficult aspects of accommodation)

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

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

Accommodations

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

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

• Accommodations last only as long as they are needed

Examples of accommodations

• Flexible working/classroom hours• Part-time attendance in workplace/classroom• Instructions given both orally and in writing• Longer learning period• Buddy or mentor• Assistive devices

Examples of accommodations

• Job modification or restructuring• Training workplace/teaching staff or supervisors

(workplace)• Modifying exam time and/or environment• Modifying physical environment (e.g., using

environments with less distraction/stimulation)

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 and consumer-survivor)

The recovery framework

Recovery means:• 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 people 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 roles• Experiencing success and satisfaction with roles• Reducing/managing symptoms• Increased self-esteem and well-being• Making healthy interpersonal connections• Experiencing improved physical health

Principles of recovery

• Hope• Self-determination• Personal empowerment• Responsibility• Focus on strengths, not deficits • Personal choice• Respect

The social determinants of health

• 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

Mikkonen & Raphael. (2010). The Canadian Facts.

Centre for Addiction and Mental Health

(CAMH)

The Centre for Addiction and Mental Health

• 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

The Social Determinants of Health Service

• The Social Determinants of Health Service (SDH Service) of the Access and Transitions Program (ATP) provides centralized intake and access to CAMH services and consolidates outreach and partnerships under one clinical program.

• SDH Service works with CAMH clinicians by providing ongoing training and consultation in the areas of housing, income, employment, education and related supports, engages in local community development and collaborates with a network of community, agency, academic, family and consumer partners.

CAMH by the numbers

• 3,052 staff• 30,729 unique clients• 482,574 outpatient visits• 4,476 inpatient admissions• 7,422 visits to Emergency • 50.1 average length of stay (days)• Top 3 diagnostic categories: schizophrenia and

other (31.0%), substance-related disorders (29.9%), mood disorders (29.2%)

• Top 4 languages at the time of admission (other than English or French): Spanish, Portuguese, Italian, Chinese

Referral to CAMH

• No referral required for Addictions Assessment Service

• Clients should contact the general intake telephone line at (416) 535-8501 , Option 2.

• A physician referral is required for a mental health assessment. The referral form is available at www.camh.ca

• Emergency Services–250 College St. do not require a referral. Short-term follow-up is provided by the Crisis Clinic

Fore more information

Mental Health and Addictions 101 series

www.camh.ca/en/education