Employment Supports for Individuals with Psychiatric Disabilities and
Employment Supports for Individuals with Psychiatric Disabilities and Substance Abuse Disorders Brianne Lott, MRC, CRC Jackie Tijerina, M. Ed. Center on Community Living and Careers Indiana Institute on Disability and Community Indiana University #National. APSE 2015
Lott & Tijerina APSE 2015 #National. APSE 2015
Lott & Tijerina APSE 2015 #National. APSE 2015
Lott & Tijerina APSE 2015 #National. APSE 2015
Lott & Tijerina APSE 2015 #National. APSE 2015
Lott & Tijerina APSE 2015
Lott & Tijerina APSE 2015 Why Does it Matter? • Average of 80% of individuals with mental illness are unemployed • Estimated 9. 6 million adults in the U. S. (4. 1% of the population) have a serious mental illness • Twice as likely to have a co-occurring substance abuse disorder #National. APSE 2015
Lott & Tijerina APSE 2015 Bipolar Disorders • • • Depression Elevated or irritable mood Impulsive Easily distracted Pressured speech Flight of ideas #National. APSE 2015
Lott & Tijerina APSE 2015 Schizophrenia & Related Disorders • • Unable to think clearly Difficulty relating to others Impaired reality testing Odd sensory experiences Severe mood disturbances False beliefs Positive symptoms ▫ Hallucinations, delusions, and disorganized speech • Negative symptoms ▫ Flat affect, lack of motivation, ambivalence #National. APSE 2015
Lott & Tijerina APSE 2015 Anxiety Disorders • Panic Disorder ▫ Sudden sense of doom ▫ Increased heart rate, difficulty breathing, dizziness, and terror • Generalized Anxiety Disorder ▫ Constant worry • Obsessive-compulsive Disorder ▫ Intrusive thought and impulses with ritualistic and illogical behavior • Post-traumatic Stress Disorder ▫ Extreme emotional reaction including nightmares and flashbacks ▫ Estrangement from others and poor concentration #National. APSE 2015
Lott & Tijerina APSE 2015 Personality Disorders • Antisocial Personality Disorder ▫ Violates the rights of others without remorse • Borderline Personality Disorder ▫ Instability of interpersonal relationships • Narcissistic Personality Disorder ▫ Exaggerated sense of self-importance • Histrionic Personality Disorder ▫ Very emotional and attention seeking • Avoidant Personality Disorder ▫ Extreme social discomfort #National. APSE 2015
Lott & Tijerina APSE 2015 One Woman’s Story • http: //www. independentmail. com/news/anders on-woman-with-bipolar-disorder-struggled-tofind-a-job_73473290 #National. APSE 2015
Lott & Tijerina APSE 2015 Methamphetamine • After quitting psychotic symptoms can last months, even years (typically precipitated by stress) • Changes activity in the dopamine system of the brain which can lead to impairments in verbal learning & reduced motor speed • Emotional & cognitive problems/deficits #National. APSE 2015
Lott & Tijerina APSE 2015 Prescription Opioids • Depressed respiration (hypoxia) can cause brain damage • Deterioration of white brain matter may lead to difficulty making decision, regulating behavior & responding to stressful situations • Link to using heroin (cheaper & easier to obtain) #National. APSE 2015
Heroin • Deterioration of white brain matter may lead to difficulty making decision, regulating behavior & responding to stressful situations • Heart lining & valves can become infected, abscesses, gastrointestinal cramping, and liver or kidney disease • Pulmonary complications including pneumonia #National. APSE 2015 Lott & Tijerina APSE 2015
Lott & Tijerina APSE 2015 Injection Drug Use and HIV & HCV Infection • Injecting drugs = high risk of HIV and HCV infections • HIV treatment side effects ▫ Dizziness, pain & nerve problems, fatigue, decrease in bone density (increase risk of injury) • Hepatitis considerations ▫ Fatigue, confusion, drowsiness, and slurred speech #National. APSE 2015
Lott & Tijerina APSE 2015 Austin, IN: A case study https: //www. youtube. com/watch? v=lmsv. OO 0 ZX Uc • Population ~ 4, 000 • 171 HIV positive as of 6/10/2015 ▫ 15 times national estimates • IV drug use, sharing needles #National. APSE 2015
Lott & Tijerina APSE 2015 Rehabilitation & Employment Ideas #National. APSE 2015
Lott & Tijerina APSE 2015 General Considerations • Employment goal • Culture ▫ Ideas ▫ Beliefs ▫ Values • Benefits currently receiving ▫ ▫ SSDI/SSI Medicare, Medicaid, other health insurance Housing subsidies Food stamps/TANF • Natural supports #National. APSE 2015
Lott & Tijerina APSE 2015 Medications and side effects • Traditional antipsychotics can cause tardive dyskinesia (involuntary movements of the mouth and face), listlessness, and blurred vision • Atypical antipsychotics can cause weight gain leading to associated risk factors (diabetes, hypertension, etc) • Mood stabilizers have side effects including sedation and irregularity of the cardiovascular system #National. APSE 2015
Lott & Tijerina APSE 2015 Strategies for Support • On-site Accommodations ▫ Job coaching/extra training to reach full productivity �Electronic organizers �To do lists �Weekly meetings �Clear goals and consequences in writing ▫ Assistance modifying schedule to improve attendance #National. APSE 2015
Lott & Tijerina APSE 2015 Strategies for Support • On-site Accommodations ▫ Assistance concentrating on work tasks �Reduce distractions �Private work area �Frequent Breaks ▫ Addressing work safety issues (common employer concern) #National. APSE 2015
Lott & Tijerina APSE 2015 Strategies for Support • Off-site Accommodations ▫ Assistance with transportation (increase attendance rates) ▫ Interpersonal skills & stress tolerance counseling �Praise and positive reinforcement �Employee assistance programs ▫ Educating on rights �Contact Job Accommodation Network (JAN) �Know provisions and limitations of ADA �When and how to contact the EEOC #National. APSE 2015
Lott & Tijerina APSE 2015 References • http: //www. drugabuse. gov/publications/drugfacts/hero in • http: //www. drugabuse. gov/publications/researchreports/methamphetamine/what-are-long-term-effectsmethamphetamine-abuse • http: //www. drugabuse. gov/publications/drugfacts/pres cription-over-counter-medications • https: //www. aids. gov/hiv-aids-basics/just-diagnosedwith-hiv-aids/treatment-options/side-effects/ • http: //www. mayoclinic. org/diseasesconditions/hepatitis-c/basics/symptoms/con-20030618 #National. APSE 2015
Lott & Tijerina APSE 2015 References • http: //www. nih. gov/news/health/jan 2014/nida 03. htm • http: //www 2. nami. org/Template. cfm? Section= press_room&template=/Content. Management/C ontent. Display. cfm&Content. ID=169616 • http: //www. nimh. nih. gov/health/statistics/prev alence/index. shtml #National. APSE 2015
Lott & Tijerina APSE 2015 References • Walls, R. T. , Batiste, L. C. , Moore, L. C. , Loy, B. (2009). Vocational Rehabilitation and Job Accommodations for Individuals with Substance Abuse Disorders. Journal of Rehabilitation, (75)4, 35 -44. • Beimers, D. , Beigel, D. E. , Guo, S. , Stevenson, L. D. (2010). Employment Entry through Supported Employment: Influential Factors for Consumers with Co-Occurring Mental and Substance Abuse Disorders. Best Practices in Mental Health, (6)2, 85102. #National. APSE 2015
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