1. Accommodating Depression and Anxiety Melanie Whetzel, M. A., CBIS
Lead Consultant, Cognitive/Neurological Team
Sarah Small, M.S., CRC
Consultant, Cognitive/Neurological Team

2. Agenda Definitions and Info on Depression and Anxiety
Job Difficulties/Limitations
Differentiating Stress and Anxiety
Assessing Stress on the Job
Issues and Accommodations through the Employment Cycle
Application and Interview Process
On the Job
Leave
Return to Work

3. www.nami.org 6.9% or 16 million
The National Alliance on Mental Illness (NAMI) (n.d.a) defines depression as:
more than just feeling sad or going through a rough patch. It’s a serious mental health condition that requires understanding, treatment and a good recovery plan.
*used as source for definitions and statistics in this presentation
6.9% or 16 million

4. www.nami.org 18.1% or 42 million
The National Alliance on Mental Illness (NAMI) (n.d.a) defines anxiety as:
feelings of intense fear and distress that are overwhelming and prevent us from doing everyday things
*used as source for definitions and statistics in this presentation
18.1% or 42 million

5. Limitations Sleep Disturbances Attendance Panic Concentration
Fatigue
Memory
Organization
Stress/Emotions
Time Management
Sleep Disturbances
Panic
Coworker Interaction
Working Effectively

6. Stress:
The American Institute of Stress currently uses the definition “the non-specific response of the body to any demand for change.”
Anxiety:
The National Alliance on Mental Illness (NAMI) talks about anxiety as “persistent, excessive fear or worry in situations that are not threatening.”

7. How do employers reduce stress in the workplace
How do employers reduce stress in the workplace? Determine the cause of it!

8. Assessing stress and determining accommodations:
individualized
case-by-case basis

9. Employment Cycle: Application process Interview On the Job Leave
Return to Work

10. Disclosure

11. Disclosure:
Estelle needs to disclose her disability and ask for an accommodation of a flexible schedule while she adjusts to new medication. She is having sleep difficulties and was late three days in a row. She is wary of disclosing her medical condition, but doesn’t want to get into disciplinary action.

12. Disclosure:
Ronisha, who has severe depression, is written up after several verbal warnings for inappropriate conduct. She is placed on a thirty-day plan of improvement and warned that if the behavior doesn’t stop, she will be let go. She decides to disclose and ask for accommodations.

13. Application and Interview Process

14. Application:
Jude, an applicant with a depression and anxiety, is applying for a customer service position that requires a pre-employment test.

15. Application:
Phillipe travels to the HR department in person to pick up an application for employment to take home and complete.

16. Interview:
Lexie is a nurse with PTSD. She has applied for a nursing position and has been called for an interview.

17. Interview:
Jack is a school psychologist who is in the midst of interviewing with several school districts for a position of staff psychologist.

18. Performance and Conduct

19. On the Job

20. Example
A veteran with PTSD and returning to civilian work was assigned to a cubicle in an office setting. The employee had no choice but to have his back to the opening, which caused him to have flashbacks that disrupted his ability to concentrate.

21. Accommodation Issues: Concentration
Reduce distractions in the work area
Increase natural lighting or provide
full-spectrum lighting
Divide large assignments into small
tasks and goals
Use auditory or written cues as
appropriate
Restructure job to include only
essential functions
Provide memory aids

22. Accommodation
A mirror was attached to his computer so that he could see when co-workers enter his workspace.

23. Example
A real estate agent had difficulty keeping materials organized for various clients. He tried to organize the paperwork in different colored notebooks, one for each client, but was unable to keep track of them all.

24. Accommodation Issues: Organization
Use daily, weekly, and monthly task lists
Use calendar with automated reminders to highlight meetings and deadlines
Divide large assignments into small tasks Use a color-coding scheme to prioritize tasks
Use electronic organizers or mobile devices / apps

25. Accommodation
As an accommodation, the agent’s existing system was streamlined by using one large binder with colored tabs. This helped him separate and keep track of each client’s specific paperwork, yet enabled him to keep it all in one easily accessible location. A key in the front of the binder listed clients by color.

26. Example
A counselor was having difficulty with organization and time management after moving to a new position in a more fast-paced environment. He was having difficulty keeping track of meetings and getting paperwork completed in order to meet his deadlines.

27. Accommodation Issues: Time Management
Make daily TO-DO lists and check items off as they are completed
Provide organizational tools
Divide large assignments into smaller tasks
Schedule weekly meetings with supervisor, manager, or mentor to determine if goals are being met
Remind employee of important deadlines
Assign a mentor to assist with determining goals, providing daily guidelines, reminding of important deadlines

28. Accommodation
The employer helped the employee set up alerts in his digital calendar to remind him of upcoming meetings and deadlines. They also set up a color- coded filing system to keep track of specific documents and their due dates. The employee was able to prioritize what needed to be completed and work more efficiently.

29. Example
An elementary teacher experienced temporary but extreme fatigue that was expected to persist for several months due to both a change in medication and the onset of winter.

30. Accommodation Issues: Fatigue
Allow flexible work environment
Provide a goal-oriented workload
Reduce or eliminate physical exertion and workplace stress
Implement ergonomic workstation design
Regulate temperature and lighting

31. Accommodation
The teacher was accommodated with the removal of two extra duty requirements. Job restructuring, which consisted of temporarily removing his early and late bus duties, caused no hardship to the employer and greatly reduced his expenditure of depleted energy.

32. Example
An employee at a manufacturing site had been steadily working second shift successfully. He experienced fatigue and difficulty with concentration due to disruption of his sleep patterns and couldn’t work the early shift a new manager assigned him to.

33. Accommodation Issues: Sleep Disturbances
Allow for a flexible start time
Combine scheduled short breaks into one longer break
Provide a place for the employee to rest during break
Allow the employee to work one consistent schedule
Provide work areas with natural lighting

34. Accommodation
The worker was accommodated with the ability to remain on his current shift. The employer found many employees willing to switch and work the day shift.

35. Example
A paralegal who had been carjacked several years earlier experienced significant anxiety concerning commutes after dark. This caused difficulty concentrating, irritability, and inappropriate interactions with coworkers.

36. Accommodation Issues: Working Effectively
Develop clear expectations of responsibilities and consequences of not meeting performing
Schedule consistent meetings with employee to set goals and review progress
Allow for open communication
Establish written long-term and short-term goals

37. Accommodation
He was accommodated with the ability to have a support animal at work and a flexible schedule with work from home during periods of minimal sunlight.

38. Example
A help desk employee’s main job functions were troubleshooting the problems of other staff members. He was highly competent in solving problems, but became impatient, rude, and disrespectful to coworkers who contacted him for assistance.

39. Accommodation Issues: Coworker Interaction
Encourage the employee to walk away from frustrating situations and confrontations
Allow the employee to work from home part time
Provide partitions or closed doors
Provide disability awareness training to coworkers and supervisors

40. Accommodation
A new policy was instituted which allowed the employee to take requests for help by instead of in person or by phone, reducing the employee’s stress caused by interactions with coworkers. This enabled him to keep his emotions and behavior in check.

41. Example
A new employee had a service animal for PTSD. She had been attacked from behind, and the dog emitted a low growl to alert her that someone was coming up behind her. A coworker reported that the dog was too aggressive.

42. Accommodation Issues: Stress / Emotions
Refer to counseling and EAP
Allow telephone calls during work hours to doctors and others for needed support
Allow the presence of a support animal
Allow flexible work environment:
Flexible scheduling
Modified break schedule
Leave for counseling
Work from home/Flexi-place
Modify environmental triggers

43. Accommodation
The employer accommodated the employee further by inviting the trainer to join them in a meeting to discuss the dog’s training and demonstrate the behavior in question.

44. Example A woodworker/carpenter with a panic disorder experienced
recurrent panic attacks
when traveling during peak
traffic times. He was required
to pick up and order supplies
when necessary.

45. Accommodation Issues: Panic Attacks
Allow the employee to take a break/go to a place where s/he feels comfortable to use relaxation techniques or contact a support person
Identify and remove environmental triggers such as particular smells or noises
Allow the presence of a support animal

46. Accommodation
He was accommodated with a schedule that gave him the opportunity to drop off and pick up materials when coming to work in the morning.

47. Example
A telecommunications technician needed to attend periodic updates and trainings where he had difficulty taking effective notes and remembering information from the trainings.

48. Accommodation Issues: Memory
Allow use of job coach / provide mentor
Use auditory or written cues
Allow additional training time
Provide written checklists
Use a color-coding scheme
to prioritize tasks
Use notebooks, planners, sticky notes, apps to record information
Provide labels/bulletin board to assist in locating items
Provide minutes of meetings and trainings

49. Accommodation
The technician was accommodated with an iPad and apps/software that would record the trainings. He was trained in how to use both the device and the apps.

50. Example
A human resource manager had difficulty attending impromptu meetings where he was expected to address specific issues raised in the meetings. His absences were mounting as he left work to avoid the meetings.

51. Accommodation Issues: Attendance
Allow flexible work environment:
Flexible scheduling
Modified break schedule
Leave for counseling
Work from home/Flexi-place
Modify environmental triggers

52. Accommodation
The manager was accommodated with scheduled meetings and an advanced organizer / agenda for each meeting so he could be aware of issues likely to surface and be better prepared to address them.

53. Leave

54. Example
An employee who works in a corrections facility was having difficulty waking up due to new medications she has been prescribed. She has had increasing symptoms of PTSD with the approaching ten-year anniversary of the traumatic event.

55. Accommodation
Because of her inability to get to work on time and attend work at all on some days, her employer provided her with an accommodation of leave to help her manage the temporary side effects of the medications.

56. Example
An employee voluntarily admitted herself to a hospital inpatient unit due to severe depression. Her mother called the employer to let them know what had happened and to tell them her return date was uncertain at that time.

57. Accommodation
The employer provided leave under the ADA for the employee and requested her mother to keep them informed about the employee’s progress and possible return-to-work date.

58. Return To Work

59. Example
An office employee returning back to work from a four-week leave has asked for a flexible schedule as she adjusts to new medications and schedules follow-up medical appointments.

60. Accommodation
The employer meets with the employee to determine what “flexible” really means in terms of reporting to work in the mornings and also asks about the frequency of the medical appointments.

61. Example
A long-term employee returned to work after an extended leave for in-patient mental health treatment. In her absence, her supervisor had been promoted and she had been reassigned to a new position.

62. Accommodation
As an accommodation to help the employee transition back into working, her supervisor agreed to meet with her weekly to discuss performance expectations and determine if accommodations/strategies needed to be implemented in order to help her fully perform her new tasks.

63. Additional Accommodation Examples

64. Example
An architect in a large, busy, open office space requested a private workspace to help her handle stress and emotions brought on by the open, crowded, and often noisy environment.

65. Accommodation
The employer agreed, but also provided telework as an option as well as flexible scheduling for when the employee was particularly stressed while under firm deadlines.

66. Example
A teacher with agoraphobia had been off on leave for a school year. With her psychiatrist’s help, she determined that she could return to work if the school was within a five-mile radius of her home. She asked to be placed in one of those schools when a position became available.

67. Accommodation
The teacher was given the choice of two schools right off as the district knew those particular jobs were going to be open for the next year. She accepted the offer on the elementary position, since she felt most comfortable with that age group.

68. Example
A pre-school aide with depression finds it impossible to get to work before 10:00, so she asked for a delayed start time to her work day.

69. Accommodation
Because the critical time period when the teacher needs assistance is between 8:30 and 10:30, the delayed start time was denied. However, the employer had a part-time position to cover lunches that would work better with the aide’s requested accommodation. The teacher’s aide was reassigned to the lunch schedule position.

70. Example
An employee with a major depressive disorder has difficulty attending large meetings.

71. Accommodation
The employee was permitted to attend meetings by phone conferencing so that he was provided the same benefit of the information gained from the meetings that everyone else experiences.

72. Example
An employee who has been traveling as part of her job for years abruptly tells her employer that she can no longer do it. Travel is too stressful.

73. Accommodation
After much discussion during the interactive process, her employer finds that the cause of the stress is driving a rental car in strange cities. The employer looks to provide transportation in alternate ways.

74. Example
A nurse in ICU, diagnosed with both attention deficit disorder and obsessive compulsive disorder, had great difficulty getting to work on time. She had asked for a flexible schedule. When she was unable to get to work by the time of the shift change, she requested a nurse from the night shift stay over until she arrived.

75. Accommodation
The accommodation was denied. The nurse determined that making lists of what needed to be done at night (getting her clothing, lunch, work items, etc. ready), using a watch with multiple settings to help her pace herself in the mornings, and devising a checklist system so that she did not do multiple checks of locked doors, the oven, the iron, etc., would help her succeed.  

76. Example
A county employee who works in the property records room has bouts of depression that are intensified when he is busy, under deadlines, and has frequent interruptions. He finds it difficult to concentrate and get his work completed.

77. Accommodation
The employer rescheduled a part-time worker to help during the busy times, allowing the employee to go to a specified desk behind a partition where he could concentrate more fully on the records he was responsible for.

78. Questions

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