Employment with a mental illness

Does mental illness make someone a less competent worker? What’s precipitated this question is a comment I received on my previous post. It read:

“…if I had a family member recieving treatment from an OT, PT, any field, even teacher, and had a choice between someone with a history of mental illness and someone without, I would not hesitate to choose the person without. [...] I don’t want the people close to me receiving potentially less the the best. [….] I also think that anyone saying otherwise is not being fully honest with themselves…”

Everyone has different perspectives and it’s fair enough this particular commenter has been honest in sharing her viewpoint. Would I be willing to use the services of a professional who has a mental illness? Given their symptoms did not impact on how they performed the job, then yes I would. I see no reason why a person who has a mental illness can’t do as well as a person without. Especially as mental illness manifests in so many different ways. Whereas in one person it may affect their job to an extent where they cannot work, in another it may make a very insignificant impact on the job that they do. On placement I do everything that the other students do and my mental health issues do not influence the quality of my work. I have friends who are student health practitioners with mental health issues, including nurses, social work, psychology, medicine and I wouldn’t hesitate to use their services.

If someone was quite unwell though and it was impacting their work, that’s a different matter. If a person in the depths of a mental illness could not concentrate enough to provide me treatment, if their self care flew out the window, if their motivation decreased to a point where they weren’t completing their workload or turning up, then no, I wouldn’t use them. And as a health professional, one of the responsibilities that come with it is recognising when an illness, whether it be of a mental or physical nature, puts you and/or your client at risk. 

It comes as a sad reminder though that many people out in the big wide world may not be so understanding. This may include both employers or potential clients. They may say ‘no’ as soon as they hear the term ‘mental illness’. They may sack you after a period of being unwell. Just a couple of weeks ago, my uncle went back to work after one or two months as a patient in a psychiatric ward, only to find out he’s been fired. It’s a real shame that employment, especially as a health professional, is yet another barrier that may be faced by people with mental health issues, because of the prejudices that society hold. 

Us and Them

Taking a mental health unit this semester in my occupational therapy course, I get the sense that there’s an “us and them” way of thinking. We’re the student health practitioners and they’re the people with mental health issues. Especially when talking about someone who is in a psych ward, described as “very, very unwell” by my tutor. I suspect there’s the belief that one of them couldn’t possibly be an OT student among us. Because if you have a mental health issue and have been hospitalised for it, you’re definitely not functional enough to be studying something like OT.

There may be a number of factors contributing to this. A proportion of students have possibly never been exposed to mental illness or people with mental illness before. It may be how the unit is taught. The examples and case studies used have tended to be rather stereotypical. A 48 year old man who appeared “dishevelled,” “rambled incoherently,” and “held a fixed, staring grin which was punctuated by odd facial grimacing,” a 67 year old man who is institutionalised and “has never been employed,” and a 30 year old woman with BPD who’s “participating in vocational rehabilitation as part of her OT program” (I assume this means she was also unemployed). And of course, all the examples involving a patient who’s been hospitalised have a psychotic illness. Because clearly, there are no other mental health issues for which people end up as an inpatient. Obviously there are people with mental health issues who do present in this manner. But there are also people who don’t, and I don’t think that message has been successfully received by those taking this unit.

It’s incredibly frustrating for me. I want an end to the beliefs of “us and them.” I want an end to the misconception that those with mental health issues cannot also be an OT or any other health professional. It almost makes me want to reveal to people my experiences with mental health issues to emphasise that yes, I have mental health issues but I’m not so different from all of them- in fact I blend in well with the rest of my cohort. I’ve had experiences in hospital where the news that I’m an OT student doesn’t receive the most positive reaction from the OTs there. That is what I want not to happen with the OTs of the future.

That feeling from self harm *PT*

One or two bad days I could probably handle. I could use distractions, for example, painting.

And it did, to an extent, work. I’m obviously no artist but it was somewhat calming and therapeutic to express myself on canvas. In this case, it represented the tears I had cried over two days.

When it’s four bad days in a row though, forget it. Conflict with my father on top of a long uni day and stress over the workload and study resulted in an end to my two month streak of being self harm free. Two months would be a lot more impressive if I managed to resist the temptation despite having a rough ride. As it is, those two months went pretty well for me, and it was rare I felt the need to self harm. Unfortunately it only took four days of things not going so well for me to return to using old ways to cope.

Whether it’s a placebo effect or whether it’s the endorphins being released, I feel so much better now.The sharp sting of the blade and the blood dripping down my leg both calmed me and helped release the tension I was feeling, distracting me from my emotions and tears. And now that I’m reminded of how damn good this feels, gosh I just want to do it again.

Recovery?

Recovery. It’s the word of the moment with mental health services. They’ll tell you they operate from a ‘recovery framework’. Recovery as the ultimate goal, it’s what we’re all supposed to be aiming for.

I don’t understand the concept.

When I think of the word ‘recovery,’ I think of someone ceasing to have the symptoms of an illness they previously had and are no longer ill. As in someone recovering from an infection, recovering from a bout of gastroenteritis, recovering from the flu. Or if we’re talking mental health issues, recovering from an eating disorder or recovering from depression. As in, they had that illness but do not have it any more, nor do they have any lingering symptoms.

According to the lecture notes from my neuropsych tutorial though, some of the principles of recovery include;

• Recovery can occur even though symptoms reoccur or remain.
• Recovery can change the frequency and duration of symptoms.

So then I was just confused.

I Google searched ‘mental health recovery’ and came across a government document entitled Principles of recovery oriented mental health practice. Maybe I’m just slow, but I still don’t understand this elusive concept of ‘recovery’.

But perhaps it doesn’t matter, seeing as whatever this word means, it doesn’t feel attainable, achievable or realistic anyway. I may achieve periods of ‘doing better’ but I don’t expect to be completely free of depression and anxiety any time soon, or possibly even ever.

Blamed for being bullied

A segment appeared on TV tonight about children being home schooled due to bullying. It prompted some debate between my father and I. I recounted a story I heard about someone now home schooling  her child due to bullying, which continued to occur despite moving schools multiple times. My father then suggested it was the fault of the child, or else why would they continue to get bullied at all these different schools? I disagreed with this. “Sometimes a child just doesn’t fit in, or they’re quieter, or others just sense that a person is different so they bully them,” I said. He continued to push the point that the child should try to fit in and it may be the child’s fault for being bullied, particularly if the child is, say, rude or standoffish. Of course, I disagreed with him. There is no excuse for bullying and abusing someone and it is not the fault of the person being bullied.

In Year 7 I experienced bullying. Three students who used to be ‘friends’ turned on me. They would bitch about me and make it obvious, they would purposefully ignore me, they’d make remarks to each other about not wanting to sit next to or be near me, one would cough the word ‘Loser’ while she walked past me, they’d make digs and laugh about me to each other; all the sort of subtle yet viscous type of bullying that girls are more likely to engage in. Each day I’d dread coming to school and then go home to cry. I’d pray that they’d leave me alone and if a day went past with no incidents occurring, that would be classed as a ‘good’ day. I’d count down the weeks and days until graduation, with the knowledge that I’d never have to see them again the only thing keeping me going.

My parents’ response to this was to suggest that maybe I did something, maybe it was my attitude and I didn’t act a nice person towards them. My mother gave me an example of when this ex-friend and I were in the car, how a response I gave was rude and short with her. As a then 12 year old, it hurt not to receive sympathy and understanding, instead getting the suggestion that I may be to blame.

I’m glad I have the insight and knowledge now to dispute my father’s views about bullying. Because for goodness sake, it’s awful enough to be on the receiving end of bullying, let alone be blamed for it. I just regret that no one was around to tell 12 year old me that.

High functioning

I know that for a number of people, a decline in functioning is a symptom of their mental health issue. Declining invitations to go out with friends, remaining in bed instead of turning up to work, or failing to hand in school or uni assignments on time. Yet, I find it quite difficult to muster up sympathy and take it into consideration when someone finds themselves unable to do certain things due to their mental health. I feel like I should be more understanding, but I tend to feel rather impatient, irate and at times even resentful of such people even if I’d never outwardly portray it.

I can try reason it out and rationalise it; everybody experiences different symptoms of their mental health issues, there are varying levels of severity, people deal with things in different ways, some people are just able to attain a greater level of functioning than others no matter how severe it gets…but it still doesn’t overrule how I truly feel. I guess a lot of it is probably due to my past experiences as a child and the role it plays in my life now.

As a child I had huge anxiety issues and I would cry in complete terror and dread at the impending situation or task. Despite this, I was never allowed a reprieve. There was no gentle guiding me and holding my hand so I could tackle it in little steps. I was forced by my parents to confront whatever it was, and thrown in head first no matter how terrified I was and how much I didn’t want to do it. I suppose the lessons learnt as a child has done me some good in a way. It’s taught me that I must fulfil my responsibilities and commitments no matter how awful I feel. And for the most part, I do, asides from when I’m in hospital. I’ve never backed out on a friend when we’ve planned to meet up just because I’m feeling anxious or down. When you don’t have that many friends to start off with, you can’t exactly afford to blow off the ones you do have…! I remember overdosing on paracetamol one day and going out with a friend the next, as if nothing happened. In my three years total that I’ve been a uni student, I’ve never ever missed a compulsory class at uni nor a day of work because I felt too miserable to show up. I may have backed out of my volunteer work before, but for the most part I keep my commitments. Last year I even went from the ED after being treated for paracetamol overdose straight to a volunteering event I said I’d attend, despite looking and feeling like shit. I never had the luxury of backing out as a kid, and I don’t afford myself the luxury of doing that now. That is the reason why the feelings I have towards people who do this are somewhat harsh. My thoughts go something along the lines of “Dammit, I suck it up and get on with it…”

Unless I’m practically dying, there aren’t many acceptable excuses. One drawback of this is that it means when I really can’t keep it up and handle it all any more, I go to extremes to avoid having to do my duties. Simply ‘not feeling up to it’ is not a good enough excuse, and so, I make it that I do have a good enough excuse. I make myself fit my definition of ‘practically dying’ by taking an overdose and ending up in hospital. It’s only then I give myself a reprieve and allow myself time to breathe.

Another reason why this issue particularly irked me is because it came up in the consultation I attended today regarding a new youth mental health service being set up for early intervention for BPD or risk of psychosis. One of the criteria that must be met for a young person to access the service is that they must have experienced a marked decline in functioning. I’m already feeling quite disillusioned with mental health services at the moment and that just reminded me of how frustrating it is for people to assume I’m fine and don’t need help because I appear to be doing all the things I’m meant to be doing. “You’re very high functioning,” the doctor said as I was discharged from my last hospital admission, as if that was meant to make me feel better. I can see why having high functioning would be an advantage and an asset, but it does not mean everything’s perfectly fine and dandy. Even up until the very day I end up in hospital, I will still most likely be attending all my commitments. It would be nice if people didn’t assume certain things.