1. Performance Issues: Mental Health and Disabilities Presented by Kendra Smith, MSW, LISW-S ViaQuest Psychiatric & Behavioral Solutions

2. Objectives Identification of common mental health disorders Signs and symptoms Separating mental health from developmental or other disabilities Effective supports and resources

3. Common MH Disorders Mood Disorders Anxiety Disorders Substance Abuse Disorders Adjustment Disorders Psychotic Disorders Personality Disorders

4. Mood Disorders Characterized by a disturbance of mood as a predominant feature. Major subcategories include: Major Depressive Disorders Dysthymic Disorder Bipolar I and Bipolar II Disorders Note: Depression is NOT a normal part of living with a disability!

5. Anxiety Disorders Characterized by the presence of excessive fears, frequent somatic complaints, and excessiveness nervousness that can interfere with functioning. Categories include : Panic Attack Agoraphobia Obsessive Compulsive Disorder (OCD) Post Traumatic Stress Disorder (PTSD)

6. Substance Abuse Disorders Characterized by a maladaptive pattern of substance use manifested by recurrent and significant adverse consequences related to the repeated us of substances. Diagnosis is made if the substance abuse related problem occurs repeatedly during the same 12 months period or been persistent.

7. Adjustment Disorders Essential feature of these disorders is the development of clinically significant emotional or behavioral symptoms in response to an identifiable psychosocial stressor(s). It is indicated by marked distress that is beyond what would be expected or by impairment in social or occupational functioning. Symptoms should dissipate around six months. This may occur with onset of disability or new limitations of disability

8. Psychotic Disorders Characterized by any of the following signs and symptoms: delusions, hallucinations, disorganized behavior, impairment in reality testing. Subcategories include: Schizophrenia Schizoaffective Disorder Schizophreniform Disorder

9. Personality Disorders Characterized by enduring patterns of dysfunctional behavior. Symptoms present as personality traits that are inflexible and maladaptive causing significant impairment or subjective distress. 10 Subcategories, including: Borderline Personality Disorder Antisocial Personality Disorder Avoidant Personality Disorder Narcissistic Personality Disorder Obsessive Compulsive Personality Disorder Paranoid Personality Disorder

10. Mental Health Disorders You may see some overlap of symptoms for example: Lack of impulse control Aggressive behaviors Lack of interest in activities Limited cause/effect insight Suicidal Ideation Delusions or hallucinations – may be exhibited in individuals with a dementia, Mood Disorder, or Anxiety Disorder. Could be experiencing delusions or hallucinations as a result of drug/alcohol abuse.

11. Trauma Can be caused by anything that disrupts sense of safety Individuals with disabilities more likely to experience trauma – some studies show up to 90% Mental health clients also have higher prevalence of trauma history Subjective experience Impact of disability on ability to process events Impact of disability on ability to communicate needs Impacts brain development Impacts physical health

12. Trauma on the Brain Healthy BrainTraumatized Brain

13. After Effects of Trauma Opposition to rules/directions/authority Depression or mood swings Motivated by immediate reward Lack of or unrealistic long term goals Unstable relationships Lack of trust in others Difficulty concentrating Lack of self control Educational delays Lack of confidence in self

14. Work Performance Issues Impulse Control Stealing, lying, anger outbursts, aggression, walking out Motivation Lack of motivation to go to work, complete tasks, interact with others Anxiety May be too anxious to go to interview, first day, etc. Overly concerned of being criticized and not doing a good job, may get in the way of employee being successful Personal Life Stressors May struggle to balance and separate work/home stress

15. Performance Issues- Similarities May struggle as supports are reduced Attendance issues Conflict resolution issues with both peers and supervisors

16. Performance Issues - Differences Mental Health Difficulty following through on tasks, concentrating Skills and performance may fluctuate Consistency is good but does not always alleviate issues More likely to cycle, experience ups/downs Disability Difficulty acquiring skill or mastering task Once mastered, skill tends to remain stable Consistency can alleviate many issues

17. Providing Support Provide a consistent and stable environment Establish a trauma-informed approach Provide teaching and coaching Prepare individuals for what to expect, any changes coming Provide environmental accommodations Area to relax/de-escalate Awareness of workspace distractions or triggers Scheduling accommodations to maximize performance Maintain contact if they do need time off

18. Resources Available For those with a mental health or trauma-related issue: Mental health counseling Mental health case management (CPST) Psychiatry/Medication management Services are not time limited, are based on medical necessity Therapists and CPSTs should be included in team meetings to improve care coordination and collaboration

19. When to refer for MH services: Individuals are: Withdrawn Anxious Depressed Feeling hopeless Having mood swing Easily agitated Impulsive Having conflict with peers or supervisors Threatening to harm self or others

20. How to Approach Identify their strengths and why you need them as an employee “What can I do to help you be successful at your job?” Be clear about the issues you see in their performance Genuine collaboration Collaborate to develop realistic goals Follow-up regularly to evaluate progress towards goals Identify what the consequences will be if expectations are not met Approach from a point of care and concern – talk about services available and how they may help to reach the agreed upon goals

21. Contact Information Kendra Smith Kendra.smith@viaquestinc.com 614.339.0865 Central Intake 855-289-1722