livingwithablackdog

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What do you do with the Shockers? 25/11/2011

Yes, I am still here.  Still living, breathing and blogging.  Just fell victim to a couple of very shocking weeks (interspersed with some lovely moments, but very few and far between).

This week I’ve barely been able to tolerate daylight, let alone the computer screen – migraine like I have not had in a long time since my medication includes migraine voodoo concoctions … but … amidst my Barry Crocker of a week the week before and the ensuing weekend I became a bit disoriented and missed a couple of doses of my meds, hence the hole in the firewall (just to mix some more metaphors).  Yesterday I went to the GP to get a medical certificate for work and stopped at the shopping centre on the way home.  Talk about sensory overload!  My world had not yet totally stopped spinning so I had this strange spacey kind of sensation as I was walking, the noises were louder and more jarring, lights and colours still bright, smells still sharp.  I couldn’t get out of there fast enough!

Work has been crazy and exhausting trying to manage the politics and dynamics within the office.  Don’t get me wrong – I like my job.  If only work could just be about going and doing your job and coming home again, what a relief it would be!  But there are systems and other people that one has to navigate to do one’s job.  Equipment that one and space one has to somehow get adequate access to do it.  Preferably in a way that lets you stay well without creating more stress than is necessary – which is where the battle lies at present for me.  At present it seems that I am destined to bang my head against a brick wall and progress nowhere and to endure life in the office that gets claimed by miscellaneous team members to serve as their staff room – while my office buddy and I are trying to work in it!!!

But alas!  These are not healthy things to dwell upon.  The goal is to work out how to attack and push through.  I had thought that we had had a strategy for the work one, but it is back to the drawing board on that one next week as it looks like this is rapidly fading into embers.

At present I am struggling not to dwell on the difficulties of the last few weeks.  I grew frustrated that my usual seasonal dip in mood was dragging on longer than usual, but didn’t really look beyond it for other triggers until much too late.  Sitting down with a friend a couple of weeks ago to go over what had been happening clarified things a lot more for me.  One of the reasons that I am so focussed on work issues over the past couple of weeks has come about because through sitting down and working through my usual triggers and warning signs with my friend revealed that my workplace is simply loaded with triggers.  There is little wonder that I have been struggling to emerge from my usual brief decline and regathering of mood.

It’s so easy to forget to go back to the basics when one gets busy.  I can sort of see why Mary Ellen Copeland, the woman who designed the WRAP suggested that going over triggers and warning signs should be something that someone should do daily to prevent relapse.  I’m not sure that I would ever go to daily, but I do know that I need to be going over my WRAP a lot more frequently than I do.  The whole point of knowing one’s triggers and warning signs is so that you can be alert to them.  It’s one thing to know them – but so easy to miss them unless you’re really watching.

So – What do you do with the shockers?  Do you beat yourself up over them?  There’s no point in that.  To me, it seems you need to do is stand back and detach a little.  Stand in the moment.  Not the future.  Not the past.  Just the moment.  Examine – and for me, it helps if I can find someone to help me stay in perspective … at least to get me going – and learn.  This helps me to see cause and effect relationships; it helps me to learn and relearn trip hazards; it helps me see things specifically rather than looming ghouls and it leaves room to remember that there were a couple of good moments in the last fortnight too.

From there I can start with a plan.  If the plan needs adjusting, then so-be-it, but perhaps – just, perhaps … next week can be a bit better …

Please.

 

Do You Tell Your Boss? 13/11/2011

If you have a mental illness do you tell your boss?

Are you obliged to tell your boss?  Why or why not?

With discrimination rife in society and difficulty getting friends and family to understand what you are going through, what are your greatest fears in the workplace? Or the study environment?  Or wherever it is you spend most of your productive time?

Does your illness affect your ability to do your job at times?  In what ways?

Does your boss know?  Do any of your colleagues? What led to them finding out?

Whether you are studying or working always consider ahead of time whether you are prepared to disclose your illness.  If your current position is non-disclosure, consider carefully any occasions which might arise which might make it more necessary and under what circumstances you may disclose if at all.

Disclosure is always best done in a planned manner.  You should have some idea what you are going to say, how you want to say it and how you are going to explain its relevance to your work.  If you need some adjustments to your work conditions or some time off, it is best for you to come to your boss with some options that you have considered and reasons for your request.  You need your boss to understand that you wish to be healthy and productive as possible and are trusting them so that they are able to best support you to reach a goal that is in both of your best interests.  A large proportion of ‘Western’ countries, including Australia, provide legislation to support your right to this.

When you plan what to disclose think in terms of how you are affected by your mental illness more than your diagnosis.  You may, in fact decide to disclose only the effects of your illness and not your diagnosis, stating that you have “a condition that affects …”.  You may identify symptoms or you may simply describe what it does to you and how that affects your work eg my condition means that I have less energy than I used to have.  This means that I have to be careful how I plan my time and that I have to take holidays at regular intervals throughout the year to maintain stable health.  I need to be careful to use my meal breaks and leave on time so that I don’t become over-tired.  Or my condition means that I need to take medication.  When I change medications, sometimes I am more sleepy than usual and over-sleep or become very drowsy in the afternoons.  Sometimes my speech even gets slurred and I sound a little intoxicated.  So if I’m changing medications I need to take a week off, otherwise I find that I’m coming to work late all week and I sound as though I’m tipsy for half the afternoon and I don’t get much done and am at risk of making faulty decisions or overlooking things because my head is all foggy – especially in the first few days.  After that I will be fine at work again, but might over-sleep a couple of times in the 2-3 weeks afterwards while my body gets used to the new meds.  It doesn’t happen very often.  I’ve only needed to do it 2 or 3 times, but each time I’ve been glad that I did.

You do not need to disclose specify personal or medical information if you tell them about anything at all.

You should also think about when to disclose.  That is – when you are applying for a job, before a job interview, during the interview, after you have been offered the job and before starting, during the time you are employed after you have worked there for a while, if you become unwell and need to or never.  There are pros and cons of disclosing at each point of the way.  Sometimes your circumstances will have presented you with little choice to prevent awkwardness – you may have become unwell at work and have it become obvious that something was wrong or you may have symptoms that you are aware will soon become obvious if arrangements aren’t made to cater for your needs.  Again, despite prejudice and stigma in some places you have legal rights to have your needs and confidentiality met and protected within your workplace in most western countries.  Further, in Australia at least, if you become unwell because the employer failed to attend to your needs having been made aware of them, you are entitled to compensation under work cover.  It is however, worth serious consideration whether or not you are going to disclose because unfortunately discrimination does still happen and there are people who do fail to respect privacy and you never know where they are until you find them.

Some helpful things to consider at each stage of the employment continuum.

Prior to interview

Why you might …

  • You are able to to discuss the organisations policies and support resources when exploring the prospective position
  • You are able to get an idea about your employer’s predisposition to your needs from the word go.
  • If you have restrictions on any key job criteria due to temporary limitations because of recent relapse/graded hours return to work plans.

Examples of Why you might not …

  • Risk of discrimination influencing whether or not you get an interview.
  • No work related needs arising from your mental illness.
  • You don’t believe that they need to know/believe it irrelevant to job.

At the job interview

Why you might …

  • You are able to address people after creating a positive impression of yourself and demonstrating your capability.
  • You can gauge their understanding of your meaning and clarify appropriate questions about your needs.
  • You are able to discuss with the employer positive traits that you bring to the team that you have learned through your journey of recovery.
  • You are able to discuss your needs and what your potential employer would be able to accommodate or explore during the interview process.
  • You can brief them as to whether your referees are aware of your condition and how it affects your work and offer consent to discuss previous workplace arrangements with other employers if they have gone well.

Why you might not …

  • Risk of discrimination in job selection.
  • You don’t feel that you have needs that require accommodating or can manage them without support from your employer.
  • You might worry about where information gathered by panel members will go and whether people are trustworthy to maintain your privacy.
  • Concern that even if you get this job, opportunities for advancement could be limited by poor understanding of your illness.
  • You might be well and consider it unnecessary at this point in time.
  • You might not want to distract the panel from thinking about your abilities by talking about areas of need.

When contacted with an offer of employment

Why you might …

  • You are able to discuss your needs without risk of missing out on the job due to discrimination.
  • You can arrange to enter the work place with a plan in place that accommodates your employment needs and commence as you mean to continue.
  • If required and with your consent, the employer can arrange appropriate mental health sensitivity workshops for managers or staff by organisations such as Beyond Blue or circulate general anti-stigma/population health information among routine organisation circulars, yet not make it obvious that it was for your benefit.
  • Allow development of appropriate support and mentoring systems.

Why you might not …

  • Fear of stigma, gossip and/or discrimination.
  • Currently well and don’t feel that you are affected at work.
  • Work does not need to know.
  • Protection of positive image and opportunity for advancement.

During the course of your employment

Why you might …

  • You decide that your employer is trustworthy.
  • You become unwell.
  • You encounter difficulties or are not performing to standard because of symptoms or medication side effects and need to offer reasonable explanation or require support, alternate work arrangements or time off for medication reviews etc.
  • You are being harassed or bullied.

Why you might not …

  • It might not be necessary.
  • Protection of positive image and opportunities for advancement.
  • It might result in harassment and discrimination.
  • You are able to manage your needs without workplace support.

Never disclosing

Why you might …

  • Protection from gossip and discrimination.
  • Protection of positive image and opportunity
  • Privacy
  • Stable health
  • Lack of necessity

Why you might not …

  • Difficult to prove entitlement to compensation in case of illness, relapse or deterioration due to failure of workplace to meet needs for psychological health if they were not disclosed.
  • Relapse or need for hospitalisation might put your job at risk.
  • Might discover a positive attitude to mental health issues within workplace.
  • Legal obligations under occupational health and safety act where specific work related tasks are affected resulting in serious risk issues.

What did I do about disclosure to my employer with my job?

For me it was simple.  I told mine.  I disclosed at interview.  I felt that this was necessary because I had taken my previous job without learning to manage my mental health well and my references would have reflected that in the answers to some of the standard questions that interviewers ask referees no matter how careful the referees were.  I chose to take control of this situation at the time of my interview because having reached interview I could present myself as a competent individual in person, demonstrate that I was healthy and create a positive impression before and whilst disclosing.  I also needed to disclose because I wanted to work less hours than the position entailed and needed to offer a good explanation.  I told them that I had depression, how it affected me in terms of energy levels, concentration, seasonal patterns, medication changes and how I managed these things to be able to work.  I spoke of arrangements that I had previously made with my former employer that had been helpful and asked if they would be amenable to such strategies.  I also used the opportunity to tell them things that I had learned and accomplished through the experience of working, the determination and dedication that it entailed and the commitment to my job that resulted so that I could achieve personal satisfaction through working.  In my case this had a positive effect and outcome, although it doesn’t always.  I don’t disclose before I have the chance at interview to sit down and talk with the employer so that I can get a gauge on how they are reading what I am telling them and to avoid preconceived assumptions about what I will be like that are difficult to shift.  There are always risks associated with disclosure, but my reasoning is that if they are going to discriminate when I am well, I would rather not have to deal with them if I were to relapse.

When I am in the workplace I lay low for a while and watch what goes on around me.  As long as they are not untrustworthy, I tell someone if they are closely and directly affected by my health so that they are not left in the dark if I have to take leave at short notice.  That’s usually only one or two people.  Often they are among the first to notice that I am off my game,  so it can work in my favour because when someone who I work closely with starts asking if I’m okay and comments that I’m not myself before I notice anything, it gives me a cue to step back and check my early warning signs and triggers.  Over the course of years there have been a couple of people who have learned how to pick my good and bad days at least as well as I do myself and also to support and accommodate me through the bad ones and to lean on me in return when I’m good.  I’m pretty limited in what I disclose to start with, but with proof of worthiness comes more trust.

My current situation in my new workplace is new to me.  I have always had employers who were fiercely protective of my privacy before.  I have little in the way of evidence about my current manager, only the report of one other worker about two specific occasions of breached privacy.  I have, however worked in a place where it has been possible to work with my information kept private and so I am prepared to stand for my rights in both privacy and in workplace accommodation now.  If I expect the respect of others, there may be times that I need to stand up and remind them what it entails.  This is however new to me and the workplace is one with strange dynamics.

I have included in the Fact Sheets menu this week a document called “Choosing Your Path.  Disclosure: It’s a Personal Decision“.  It’s about disclosure of ‘disability’ (or illness) in education and training after High School and employment and the processes of application, entry and engaging in the roles.  The booklet discusses legal issues, reasons why one may or may not disclose at various stages of training or employment, responsibilities and some of the considerations to ponder in making your decision.  Also have a look around the Beyond Blue website as they have a number of resources for work sites and managers as well as fact sheets about telling your employer about your illness and maintaining good mental health for tertiary education students.  Lastly, I have listed a book called “Tackling Depression at Work” in the Books menu.  I’ve not yet read this one, but it was written by reliable people and has been well reviewed so should be worth a read.  I have listed the book at the publisher’s site, you may or may not be able to find it cheaper elsewhere if it interests you greatly.

 

Black Dog, White Knight 03/08/2011

If there is one thing more frustrating than the battle with the black dog, it’s the battle with the white knight.  The overprotective protector.  Oh to be able to call the white knight to heel along with a well-controlled dog!

Take for instance the plan to return to work.  A sensible return to work plan is graded with appropriate supports according to the nature of the illness or injury.  My most recent absence from the work place involved an epic trial to accomplish reentry.  It took five months to the day from the time my psychiatrist of eight years cleared me for graded reentry to the workplace – and almost two months after he cleared me for full hours – for my employer and independent occupational physicians (not psychiatrists) to clear me for a very slow and protective graded reentry programme, more suited to someone with chronic pain or active symptoms.  I, however, have an episodic illness – certainly, with excessive stress and sudden change as triggers – however having been all but symptom free for some time now, the rate of change laid out was a looooooong way from sudden.

The starting plan was laid out as 4 weeks of 3 days of 4 hour days.  This would be followed by 4 further 3 day weeks where hours increased by an hour a day per week.  Finally, a half day would be added on the ninth week to bring me to full hours.  Such a programme would have been appropriate in at the beginning when I was cleared for graded return to work by my doctor.  But five months later?  I had been stable for some time.  Depression is an episodic illness, not a static one.  I would agree that grading is wise for maintenance purposes, but given the amount of time that I’d been stable for it would have been feasible to start with a 3 day week at 4 hrs, progress from there to 6 hrs, then 8, before returning to full hours.  And that would be conservative.

The key factor that will make or break the return to work will be the provision of personal support within the workplace throughout this and over the coming months.  A clear plan for what to do with symptoms in the workplace.  A way of taking control of the situation when things get difficult.  I speak here both as a clinician with experience in work rehabilitation and as person who has treatment resistant depression.

The white knight needs to step back and stop blocking the path.  There are no dragons.  It’s a dog.  A black dog that is currently walking patiently at heel.  Please don’t let it get so bored that I trip on it.  A worthy helper walks beside, notices when the going is hard or easy and helps me to adjust the burden so that I can continue at a pace with just the right level of challenge and focus.  They are about helping me engage with what is around me without losing track of my dog.  The white knight will ultimately drive my dog crazy with all the attention and fuss.  If I don’t trip over the dog, I’ll trip over the knight – although they’ll default all responsibility and blame the dog.  Get rid of the protective sword, the suit of armour and all the pomp and ceremony.  Rather put on your hiking boots, pick up a pack, bring me a spare map and compass for if I lose my way and throw in my dog handling manual in case I lose mine; then come and walk alongside me.

 

 
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