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When Work Really Works… for Everybody

By Elizabeth Lines
Network, Spring-Summer 2007

By 1994, Anne Neill had been working as a server at the Fishbowl Restaurant in Timmins for 12 years. Then she became ill.

As Louise Cantin, owner of the Fishbowl Restaurant and Anne’s employer, recalls, ‘At the time, Anne was a wonderful young woman in her 30s going through the usual life changes of marriage and children. And while she was always outgoing, with hindsight I can see there were changes happening. For example, at one point she became obsessed with the health benefits of carrots and ate so many carrots her hands turned orange. Or she might exercise for three hours, serve a dinner shift and then do three more hours of exercise.’

Adds Anne, who was later diagnosed with bipolar disorder, ‘When I was becoming ill, I don’t think my employers knew what was happening and could only recognize the symptoms after the fact. And then they were shocked to realize the seriousness of the situation.’

To Charlotte MacFarlane, a trainer with the Canadian Mental Health Association’s Mental Health Works program, this story is not unfamiliar. ‘When an employee is in fact becoming ill, employers and managers may feel that perhaps what they’re seeing is someone who’s being lazy or unreliable, or someone who’s no longer a team player. Or maybe a star performer has mysteriously developed a bad attitude. Often the response on the part of the manager tends to be one of avoidance &3150; they either avoid the person themselves, or they avoid the issue. And it is usually due to fear of becoming over-involved or crossing personal boundaries.’

The Mental Health Works program was developed in recognition of the fact that there are people who live with mental illness and are trying to remain productive members in the workplace, explains Charlotte. The program is designed to help managers identify if someone in their place of business is struggling with a mental illness, how to communicate effectively with them, and how to develop solutions that will work for both the employer and the employee.

‘Even when the signs of mental illness are known,’ continues Charlotte, ‘people will tend not to talk about it because they still have little understanding of it. Consequently, those who are unwell at work may become increasingly unwell because they’re not getting the support they could. And if they become ill enough, then they need time off and are often off at home alone. The longer a person is off, the less likely it is that they’ll ever be able to return to their previous level of productivity.’

But in Anne’s case, Louise and her sister Lise were two of her biggest supporters. As Louise puts it, ‘Once Anne was diagnosed, she started on her road to recovery. And we knew that part of the recovery would include work. I believe work can allow you to focus on an activity and allow you to still see yourself as the person you know you are and want to be. And for Anne, that’s exactly what happened. We were able to use the restaurant as a vehicle towards her recovery.’

‘Anne had lost a lot of weight and was very shaky. And of course, she was dealing with having been identified with a serious illness that she’d have to live with the rest of her life. So it was a very difficult time. But we allowed her to come back to work at that point, even though she was quite ill.’

‘On her first day back, Anne started as a dishwasher in the kitchen. There it didn’t matter how she looked or if she was shaking. With the support of all her colleagues, she would just do what she could do. But it didn’t take long for her to get back to serving her customers.’

Anne was fortunate to be in a workplace that could offer such flexibility and to have the support of employers like Louise and Lise. Not every workplace so readily accommodates those with mental illness, and the tasks of finding and maintaining meaningful employment remain a challenge for many.

Dr. Heather Stuart is a Queen’s University professor who studies stigma and discrimination in the workplace for those with mental illness. According to Dr. Stuart, ‘When you do surveys of people with mental health problems, one of the biggest problems they face is not being able to take on a working role. It’s a huge problem for self-esteem, for inclusion, for their economic independence and well-being. They need to be able to work. But if employers don’t hire them, or keep them, that is a major barrier to inclusion.’

The stigma that remains a barrier to inclusion in many workplaces needs to be attacked on multiple focused fronts. ‘To me, attitudes and programs are opposite sides of the same issue,’ Dr. Stuart continues. ‘If you’re trying to target peoples’ negative attitudes and negative attributions toward people with mental illness, you’re trying to fight stigma. If you’re trying to promote their inclusion through providing supportive programs, you’re basically doing the same thing but from the opposite perspective. I think we need to do both of those things.’

‘Stigma is not just a hard fact that people think they know. There are negative emotions attached to it. And there’s a lot of good research to show that when people operate with these negatively charged belief systems, they’re deep-seated and they’re hard to change. So if you want people to change the way they think and feel and act towards somebody else, you’re going to have to attack the issue with very focused programs. You’re going to have to understand very specifically what is bothering them and what kinds of behaviours you want to change.’

‘So if you’re working with business owners, you’re going to have a very different message than you would for school teachers. You need to tailor your message, segment your audience and focus your efforts. When anti-stigma programs do that, they have a much better chance for success.’

‘In fact, those that aren’t very successful are those that take broad-blanket, shotgun approaches, that assume that if people gain knowledge about something that that will change the way they think about people or behave toward them. I don’t think that’s a very effective way to attack deep-seated fears and concerns and stigma about any social group, particularly those with mental illness.’

‘All people have rights that are protected in law,’ Dr. Stuart explains. ‘Disability legislation tells employers that they must make reasonable accommodations but doesn’t tell them what those actually are. So when we move to the policy and program level, we must be able to determine and let employers know what a reasonable accommodation is in a given instance. Various mental health issues may require individual approaches. But we must be able to operationalize accommodations at this level and employers must recognize this as an obligation on their part. And so this is where you have to get at the attitudes as well.’

According to Charlotte, the Mental Health Works program recognizes that ‘solutions are as diverse as the individuals who may require them. Every situation requires a unique response. For example, there was an employee who was subject to anxiety attacks, and she had come to recognize the warning signs. So we helped negotiate an arrangement where she could access the manager’s office at these times, which provided a quiet space with a door to close herself off from the rest of the office and find a place of calm when necessary.’

Like Mental Health Works, the Global Business and Economic Roundtable on Addiction and Mental Health is working with employers to improve the mental health of the working population, notes Dr. Stuart. ‘One of the things they’re working with is stigma, in the sense that employers don’t always ‘get’ why they have to make changes. I don’t think they would describe it as an anti-stigma program, but stigma is one of the underlying barriers that they’re trying to break down. They’re going at it in a number of ways and it shows a lot of promise.’

‘In the end, it will be important for all promising strategies across education, policy and programs to be evaluated so we know which approaches really work. That’s the only way we can learn and do things better.’

After a short time, Anne resumed her preferred work as a service person at the restaurant, where she works to this day. ‘Being able to work is mandatory to my well-being,’ she states firmly. ‘I wouldn’t want to do it any other way. I’m taking university courses by correspondence too at the moment. But when I graduate, I can’t see myself doing office work 9 to 5. It’s just my back-up plan. Because I like doing what I’m doing more than anything.’

As for dealing with her illness in the workplace, ‘I don’t talk about my illness at work, but I don’t hide it either,’ she says. ‘Sometimes some of the newcomers will ask about my books. I’ve self-published a book on manic depression.’

‘One of my best friends is a nurse and she thinks of my illness like the common cold: it comes and goes, it’s not a big deal. In that sense, in my personal life, where it counts, I don’t encounter stigma. But I think one of the reasons is I don’t carry a stigma with it. I don’t think I’m different than anyone else. And one of the reasons I wrote my book was to tell others like me to not be afraid to be who they are.’

Clearly, Anne knows all about the value of inclusion – and the value of including herself.

See for more information about the Mental Health Works program.

Elizabeth Lines is a researcher/writer in areas of health and social issues.

» Return to Network, Spring-Summer 2007 – Contents