Mental and Emotional Conditions

Healthcare employees are not immune to mood disorders such as depression and anxiety. Mood intensity and effect on daily life vary along a continuum and do not always impact rational decision making or interfere with job performance. But they can.  Life stressors and personal/family circumstances do not always preoccupy thoughts or uncharacteristically intrude in ways that impair job related thinking and decision making. But they can. There is typically some tolerance to minor and transient instances of anxiety or depression in the workplace, but tolerance declines dramatically when suboptimal job performance does not recover. Consider the illustrative vignette involving Case Manager Al and his experience living with a diagnosed mental illness.

Case Manager Al is an experienced professional who maintains active licensure both as a certified nursing assistant (CNA) and a master’s prepared medical social worker (MSW). Al is known to be serious type of fellow who generally works hard and in genuinely dedicated to helping others. He has not had any workplace issues or concerns during his seven (7) years of employment and has had absolutely no record of job performance concerns or inappropriate behaviors. Al received a high commendation on his last annual performance evaluation.

Last month co-workers began noticing that Al was more energetic than usual and seemed to be constantly busy “minding everyone else’s business”. He has always been a hard worker, but he started a new project that really started occupying his time and he keeps discussing it with everyone. This project wasn’t assigned to him but Al thought a comprehensive review of all his case records over the last several years would help him uncover any patterns that had been unnoticed. He assured his supervisor that he had the time to spend on this project and so the supervisor agreed to support Al’s efforts. In addition to his own project and his assigned case load, Al also seemed to have the time for conversation with everyone else about what was new and how they were doing. This pattern of communication was new for Al and co-workers weren’t sure whether to enjoy the attention or ask him to mind his own business.

Case Manager Al’s unusually energetic behavior and co-worker comments soon caught the attention of his immediate supervisor. Al’s supervisor took time to observe his behavior and noted that he did not sit or stay in one place for very long – he was always moving. He also was always talking and gesturing with his hands. Sometimes the words were so fast that it was difficult to understand what was being said. When documenting the speech pattern, Al’s supervisor described it as “pressured, rapid, and almost agitated speech”.  The speech pattern and the energetic behaviors were all new for Al. Each behavior by itself was not particularly unsafe or inappropriate, but the new behaviors were different from the previous seven years of employment. Al no longer appeared stable and his hyper-behaviors seemed definitely unusual. The changes also seemed to be escalating. Al’s supervisor contacted Human Resources and met with someone from the behavioral health department. Al had never disclosed any disability, but his current behavior pattern suggested mania.

Al’s supervisor began documenting more details about behavior and communication patterns. The supervisor included specific examples with times, dates, locations, and people involved. The supervisor wanted documentation to support his belief that that there really were job performance changes. Al’s supervisor soon discovered that despite all the energetic activity, job details were not always addressed. Al’s documentation on his patients was sloppy and there were two instances when the words did not make sense. It was time to address these changes with Al.

Al’s supervisor met with him in person late in the shift and asked when it would be convenient to schedule a meeting. Al asked why a meeting was needed and the supervisor only said that Al was a clinical healthcare worker and there are times when all clinical employees need a performance review. Al wanted to schedule the meeting after his shift but the supervisor indicated that this meeting should take place tomorrow, even though Al was not scheduled to work that day. Al agreed.

When Al met with his supervisor, he was confident that he was going to be commended for superior productivity. Al believed he had gone above and beyond usual job expectations and was pleased that he was going to get some recognition. Job expectations were reviewed along with anonymous comments from co-workers and clients. Al soon realized that the unexpected review was not positive.  He immediately began defending his actions and seemed genuinely surprised that his supervisor was less than complementary. The careful and methodical documentation of communication and behavior however was helpful to both Al and the supervisor because there were specific events outlined and reviewed. Al seemed genuinely shocked and admitted he did not even realize that his job performance had declined. Al seemed very concerned and asked if he was being fired.

Al eventually agreed to the job performance expectation contract drawn up by his supervisor. This contract outlined specific job performance criteria that needed improvement. Dates were set giving a timeframe for resolution.  Al also reflected that he had a lot on his mind lately and offered to follow up with a psychologist using his own resources. They agreed to meet again in one week. Documentation of this meeting would be kept in his personnel file, and Al would receive a copy for his own records.

Case Manager Al never shared information about this meeting with his family, or with anyone for that matter. He believed that he would be treated differently or judged more harshly if he disclosed mental illness. He did however follow up with his psychiatrist. Al had been taking medication for bipolar disorder for years and thought he really had this bipolar illness under control. Most likely the latest medication change initiated by the doctor was not as effective as it should be. When Al relayed the job performance concerns along with typed documentation of his recent meeting, the psychiatrist was able to recommend new medication changes that ultimately effected greater stability for Al.

Employees who have a mental illness diagnosis such as bipolar are in a tough situation. Disclosing their illness is not always beneficial to them even when effectively managing their disease. Legal and regulatory guidelines advocate support in the workplace but that is not available unless the individuals choose to disclose. Individuals with diagnoses such as bipolar, major depression, obsessive compulsive disorder, and others too often discover that their opportunities for career advancement are limited. The bipolar diagnosis carries with it a large range of manic and depressive symptoms. By definition, those with the mental illness will generally require ongoing treatment to minimize behavioral inconsistencies. Case Manager Al never disclosed his mental illness to his employer but he was able to comply with the job performance contract. Disclosure is optional for the employee, not mandatory. Because Al worked with his own health provider plus his immediate supervisor, he was able to recover and return to his previous level of job performance stability. Al chose not to disclose personal information about his mental illness and was not aware of his performance changes. Fortunately the immediate supervisor intervened in a way that gave Al the information he needed to seek out his own resources and effect a change. Not all employees have such a favorable outcome because they mistakenly ignore job related cues. Like many health employees with a history of mental illness, potential stigma and workplace discrimination remain strong.