Supporting Clients with

Mental Health Problems:

The Career Practitioner’s RoleNeasa Martin & Kathy McKee

Cannexus Conference,

January 24th 2012, Ottawa, ON

Project’s Roots

Project context

MH work-related costs

Fastest growing occupational disability

Cost to Canadian economy $14.4 B lost productivity $18.6 B substance abuse

Focus is on workplace mental health

Understanding stigma & discrimination:

What is stigma & why does it exist?

1. Labeling: Characteristics

signal important difference.

2. Stereotyping: Differences

linked to undesirable

characteristics.

3. Separating: Distinction

between ‘normal’ & labeled

group creating ‘them & us’.

4. Status loss: Devaluing,

rejecting, discriminating &

excluding.

Stigma Attribution Model

Decade of the ‘Broken Brain’

Self-stigma is common

What works to reduce stigma?

Contact is most effective…Contact is common - disclosure is not - creates a distorted image Relationship of equal status Context of cooperation Opportunity for discussion Credible presenters - disabuse common myths

Social inclusion is the journey towards greater participation and citizenship…

Survey Findings:

Project Approach

May 2011 Sept. 2011 May 2012

Survey tool

Who participated?

266 survey participants in total (81.5% completion)

176 Career practitioners 46% report having mental health problems/illness (65)

90 Clients 62% report having mental health problems/illness (56)

100 stakeholders participated in 5 regional meetings

Meeting of 25 Career Resource Centre Managers

Contact is common - 1 in 5

Contact is common

Career Practitioner contact with MHP/MI % Yes

Co-worker 86%

Close family/friends member 78%

Personal experience 46%

Client contact with MHP/MI % Yes

Co-worker 78%

Close friend 77%

Close family member 71%

“Only those close to the person would ever know they are experiencing a mental health problem” Client

Disclosure is not…

Disclosure People disclose when they feel safe

LIKELY to DISCLOSE LIKELY to be ACCEPTING

Spouse 92% 90%

Family 90% 80%

Friend 88% 82%

Guidance/Career 80% 68%

Teachers 50% 46%

Work-mates 31% 24%

Employers 28% 22%

Neighbours 21% 18%

over 90% agree

Impact of stigma on work (99%)

About mental illness (99%)

Mental health resources (98%)

About peer support (97%)

Skills in motivating clients (96%)

Work-related coaching (95%)

How to support employers (94%)

About recovery practices (89%)

About treatment for MI (79%)

To help clients Career Practitioners need to know…

Clients rating vs Career Practitioners

Knowledge of mental health Making right referrals Recommend peer support Comfort working with clients Discussing +/- disclosure Understanding & explaining rights

Across all categories Career Practitioners rate themselves higher than Clients

Client rating cont…Strongly/Agrees

Career Practitioners: Share tools for coping with work 50% Good support & access work/training 35% Have knowledge to help me re: work 33% LESS likely to refer clients for training 28%

Satisfaction working with clients“Same as with all clients”

Seeing progress… Supporting change… Gaining trust… Helping clients get / maintain job… Support people to reach their goals… Improving self-esteem… Supporting greater social inclusion

Frustrations working with clients

“When I was first diagnosed with schizophrenia in my early 20's, I went to what was then called the Manpower Office and asked for training. The counselor told me there were no training opportunities for me because I was chronically ill with schizophrenia.”

“Sometimes (stigma and discrimination) is very apparent and other times it is hidden but lurking below the surface. I was once told at a workplace that I would advance no further in my career because of my mental illness.”

Barriers to employment

Self-confidence 98%

Finances 96%

Employment 91%

Community involvement 91% Family relationship 81% Friendships 78%

Client rating

Impact of mental health problems?

Have you seen workplace discrimination?Clients: 90% - Yes “Happens all the time…”

Career Practitioners: 48% - Yes “Quit being paranoid”

Clients agree…

Agree discrimination is common (96% vs 76%)

Few feel fairly treated by employers (< 7%)

Agree work improves mental health (89% vs 80%)

Agree recovery is possible (87% vs 76%)

Have hope they will work (79%)

Don’t need to be symptom free to work (76% vs 86%)

Agree mental health problems make work stressful (52%)

Career Practitioners disagree less reliable employees (86%)

90%CLIENTSagree

Given choices (91%)

Believes my capacity to recover (91%)

Can trust my counselor (91%)

Feel respected (94%)

Treated fairly (94%)

My privacy is respected (93%)

• Listen without judgment (91%)

Inspires hope (91%)

Feel care & compassion (84%)

In client / counselor relationship very/important…

“Treat People Like People… Not a Disorder”

“Include us as partners in planning”

Strong agreement on how to help

Where would clients prefer to receive career planning service?

43%

23%

18%

16%

Career Practitioner Training Needs

Take away messages…

“Have your people not be therapists...but be knowledgeable about the

clients they are trying to help integrate back into society. We want to be

part of the workforce but may only dip our toes in and then back away,

come back and test the water again...several times before we are really

ready.

HAVE PATIENCE....we will jump in when we are ready, just offer the

tools and services so that we can make an informed decision. Do not

force us. We have enough struggles already, this has to be something

that we do for ourselves...and we will...trust me! :0)”

Last Words…

http://Chartingthecourse.nscda.ca

http://chartingthecourse.nscda.ca/index.php/workplace

Stigma & Discrimination Related readings

Bio-medical framing Angermeyer M, Matschinger H. Causal beliefs and attitudes to people with schizophrenia: trend analysis based on data from two

population surveys in Germany. Br J Psychiatry 2005;186:331–334.

B. Schulze. (2007) Stigma And Mental Health Professionals: A Review Of The Evidence On An Intricate Relationship; International Review Of Psychiatry; 19 2 ;137-155

Arthur Crisp, Liz Cowan and Deborah Hart. (2004) The College's Anti-Stigma Campaign, 1998-2003: A shortened version of the concluding report; Psychiatric Bulletin; 28 4 ;133-136

Read, J. & Harre, N. (2001). The role of biological and genetic causal beliefs in the stigmatization of ‘mental patients’. Journal of Mental Health, 10, 223-235.

Stigma – Related Attitudes and Beliefs in the United States 1950 - 2006" Presented by Bruce G. Link, Stigma in Mental Health and Addiction, delivered in Calgary, June 3, 2008.

Schnittker, J. (2008) An uncertain revolution: Why the rise of a genetic model of mental illness has not increased tolerance. Social Science & Medicine, 67(9), 1370-1381.

http://www.camhcrosscurrents.net/thelastword/2010/03/psychiatrists-fighting-stigma.html  

Read J, Haslam N, Sayce L, Davies E. (2006) Prejudice and schizophrenia: a review of the ‘mental illness is an illness like any other’ approach. Acta Psychiatr Scand: 114: 303–318

Phelan, J., Cruz-Rojas, R. and Reiff, M. (2002) Genes and stigma: the connection between perceived genetic etiology and attitudes and beliefs about mental illness, Psychiatric Rehabilitation Skills, 6(2): 159–85.

Ross M. G. Norman, Richard M. Sorrentino, Deborah Windell, Rahul Manchanda. (2008) The role of perceived norms in the stigmatization of mental illness. Social Psychiatry and Psychiatric Epidemiology Online publication date: 23-Jul-2008.

Walker I. And Read J. (2002) The differential effectiveness of psychosocial and biogenetic causal explanations in reducing negative attitudes toward "mental illness"; Psychiatry-Interpersonal And Biological Processes; 65 4 ;313-325

Bernice Pescosolido, Stigma in Global Context: Fourth International Conference on Stigma (Jan. 2009) London, England

Corrigan PW. How clinical diagnosis might exacerbate the stigma of mental illness. Soc Work. 2007 Jan;52(1):31-9.

LAM Danny C. K., SALKOVSKIS Paul M.; An experimental investigation of the impact of biological and psychological causal explanations on anxious and depressed patients’ perception of a person with panic disorder, Behaviour Research and Therapy Volume 45, Issue 2,

February 2007, Pages 405-411

Education & changing attitudes Spagnolo, A. B. Murphy A. A. and Librera L. A.. (2008) Reducing stigma by meeting and learning from people

with mental illness; Psychiatr.Rehabil.J.; 31 3 ;186-193

Nagel, T, Thompson, C, (2007) AIMHI NT ‘Mental Health Story Teller Mob’: Developing stories in mental health, Australian e-Journal for the Advancement of Mental Health, vol 6, issue 2

Chang, C, Increasing Mental Health Literacy via Narrative Advertising, (2008) Journal of Health Communication, 13:37-55

Angermeyer, M. C., & Schulze, B. (2001). Reducing the stigma of schizophrenia: Understanding the process and options for interventions. Epidemiologia e Psichiatria Sociale, 10(1), 1-7.

T. M. Lincoln, E. Arens, C. Berger and W. Rief. (2008) Can anti-stigma campaigns be improved? A test of the impact of biogenetic vs psychosocial causal explanations on implicit and explicit attitudes to schizophrenia; Schizophr.Bull.; 34 5 ;984-994

Self-stigma Lauber, C. Anthony, M. Ajdacic-Gross, V., Rössler, W. (2004) What about psychiatrists' attitude to mentally ill

people? European Psychiatry. Volume 19, Issue 7, November, Pages 423-427

Link, B. Mirotznik, J & Cullen, F. (1991). The effectiveness of stigma coping orientations: Can negative consequences of mental illness labelling be avoided. Journal of Health and Social Behavior. 32(3), p. 302 – 320.

Hyman, I. (2008) Self-Disclosure and Its Impact on Individuals Who Receive Mental Health Services. Substance Abuse and Mental Health Services Administration.

Otto F. Wahl, Ph.D. Mental Health Consumers' Experience of Stigma Schizophrenia Bulletin 1999 25(3):467-478;

Fighting Shadows: Self-Stigma And Mental Illness: Whawhai Atu te Whakamâ Hihira. 2008 http://www.likeminds.org.nz/assets/docs/FS%20Brochure_FINAL_SCREEN.pdf

Corrigan, P. (2001). Don’t call me nuts: Coping with stigma and mental illness. Tinley Park, Ill: Recovery Press.

Corrigan, P.W., Larson, J.E., Nicolas Rusch, N. (2009) Self-stigma and the “why try” effect: impact on life goals and evidence-based practices. (World Psychiatry 2009;8:75-81)