(Provided by the CCER - Western
Washington University)
Vocational Obstacles Related to Symptoms and
Side Effects
Having active symptoms does not mean that a person is unable to work.
However, the nature of the symptoms being experienced provides
important information to use in identifying appropriate employment
situations for an individual. Many people with long‑term mental
illness experience some combination of the following symptoms, which
may affect their ability to maintain employment.
LEARNING / PERFORMANCE ISSUES
Trouble Initiating Action
Cognitive Problems
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Slowness in initial processing of sensory
information, such as trouble understanding directions
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Difficulty sorting relevant from irrelevant sensory
perceptions
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Short‑term memory problems
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Inability to generalize
Difficulty Concentrating, Distractibility
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May be either a symptom of the illness or a side
effect of the medication taken to treat the illness
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May be due to hallucinations or delusions
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Makes it difficult to attend to the tasks involved on
the job
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Additional structure and/or stronger cues on the job
may be needed for the individual to be successful.
-
Changes in distractibility levels may also be
important feedback for the worker and/or employment specialist to
give the medical consultant regarding levels of medication or
possible decompensation.
Impairment of Insight and Judgment
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Common in all classifications of mental illness
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Poor insight and judgment interferes with problem
solving, insight into cues, setting occupational goals, selecting
appropriate behavior, and many other aspects of employment.
Difficulty in Organization
and Planning
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Though specific task skills are not usually the
challenge for many people with mental illness, the organization of
the work at hand, the reasons for doing it, and the sequencing for
getting it done can be overwhelming
INTERPERSONAL ISSUES
Alienated from Feelings
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May present apathy, slovenliness, and emotional
dullness
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May have difficulty
showing motivation or any other emotion
Social Isolation or Withdrawal
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People may experience a sense of loss, anxiety in the presence of
others, resistance to interpersonal involvement, flight from social
reinforcers.
-
May also cause
problems with task completion: the worker who is focusing on how
uncomfortable it makes him to have to interact with others may appear
distractible and perform poorly.
-
Workers who are
socially isolated miss out on important information regarding the
(usually unwritten) behavioral rules of the workplace.
-
People who have
difficulty establishing or maintaining personal relationships may be
able to meet the task requirements of the job but are nonetheless at
risk due to not meeting the social requirements of the job.
Peculiar or Bizarre Behaviors
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Mainly associated with schizophrenia (for example, responding to
hallucinations or discussing delusional beliefs) or personality
disorders, although persons with mood disorders may also seem strange
at times.
-
Presents obvious
problems with coworkers, employers, and customers; though many people
can learn to inhibit peculiar behavior patterns while in the work
environment.
Dysfunctional Personality Traits
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Many behaviors associated with personality disorders (e.g. emotional
coldness, disturbances in interpersonal relationships, anti‑social
behaviors, lack of control, self destructive urges) are incompatible
with work activity or establishing relationships on the job.
-
In general, these
behaviors are difficult to control or modify and must be worked around
when assessing and modifying jobs
Suspiciousness / Paranoia
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Associated mainly with schizophrenia and personality disorders.
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Besides leading to peculiar conversations or behaviors, paranoia
interferes with the worker's ability to perceive and integrate praise
and/or criticism.
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Interpersonal relationships are difficult to establish with the person
who is always suspicious, so people become more socially isolated.
Decreased Concern for Hygiene
PHYSICAL ISSUES
Physical Restlessness
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Generally associated with bipolar disorder, can also occur as a side
effect of neuroleptic drugs taken for schizophrenia.
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Poses an obstacle to steady consistent performance, especially in jobs
that do not provide outlets for physical activity and demand steady
performance. Adjustment of medication levels or types may control or
lessen physical restlessness.
Sleep Disturbance
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Physiological barrier to good performance (insomnia, or sleeping to
excess).
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A
marked change in sleeping patterns is often an early warning of
decompensation.
-
Care must be taken in considering shift work that will change sleeping
patterns.
Slowed Gait / Awkward Movements
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Due to impaired ability to process environmental cues or side effect
of medication.
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Poor fine motor coordination is also common, as are hand tremors.
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