2010 Workers with Mental Illness: a Practical Guide for Managers

Appendix B: Types of mental illness

The following information provides a brief overview of mental illness. It is important to have an understanding of what mental illness is and its possible effects on a worker as this helps you to be more effective in handling issues that may arise. However, you do not need to become an expert in mental health nor are you required to assess whether a worker has a mental illness.

If you require further information and/or assistance from a mental health professional, refer to Chapter 5 – Where to Get Assistance.

Mental illness is a general term which refers to a group of cognitive, emotional and behavioural disorders. This section does not cover the full range of disorders; rather it aims to give you some awareness of the main disorders.

Your role is not to diagnose a worker and you should seek professional advice and help as required.

The main disorders that will be dealt with here are:

mood disorders (such as depression and bipolar disorder)
anxiety disorders (such as post-traumatic stress disorder and phobias)
psychotic disorders (such as schizophrenia and some forms of bipolar disorder).

Mood Disorders

Depression

“When I was depressed, I just couldn’t get out of bed. I was completely depleted of energy. I didn’t have the drive to do anything, not even the things that I loved in life. I would wake up and think, 'how am I going to get to work today?'

I couldn’t get my thoughts straight. I was good at my job but all of a sudden I couldn’t even consider more than one task at a time so work seemed so hard.”

Ali, reflecting on how depression impacted on his employment.

Depression is one of the most common of all mental health problems. In any year, four per cent of the Australian population will experience depression.^[26]

The words ‘depressed’, ‘feeling down’ and ‘blue’ are often used to describe the mood a person may be experiencing. This is different from clinical depression. Clinical depression is characterised by having a persistent low mood (over two weeks or more) and a loss of interest in daily life which seriously affects the ability to function.

What are some of the signs or indicators that a worker may have depression?

It can be difficult to determine if a worker has depression. You may attribute depression to a weakness in a worker’s personality, (e.g. ‘they’re just a negative person’ or ‘he just can’t handle the stresses of the job’). You may therefore see a worker with depression as lazy and lacking in motivation rather than recognising these as symptoms of depression.

The main indicator that a worker may have depression is a significant change in their behaviour, such as:

finding it difficult to concentrate on tasks
turning up late to work
feeling tired and fatigued
getting easily angry and frustrated with tasks or people
avoiding being around work colleagues (e.g. sitting by themselves at lunchtime)
finding it difficult to meet reasonable deadlines
finding it hard to accept constructive and well-delivered feedback
finding it difficult to manage multiple tasks or demands
drinking more alcohol to cope with other symptoms of depression
feeling more vulnerable to stress and anxiety
making statements of self worthlessness (e.g. I'm a failure, I’m useless, I can’t do the job)
unusually high absenteeism.^[27]

So what causes depression?

There are a wide range of biological, social and psychological risk factors. Examples of each of these are listed below.

Biological risk factors include:

a genetic predisposition
imbalances in the brain’s neurochemical systems involving serotonin, dopamine and noradrenaline
medical conditions such as chronic pain, low thyroid function or brain injury
changes in the blood supply or structure of the brain
misuse of drugs and alcohol.

Social risk factors include:

problems in personal, social or work relationships
isolation or loneliness
experiencing bullying and/or harassment
feeling overwhelmed with work stresses and issues
working in an ‘unhealthy’ workplace, such as having unreasonable expectations and workload.

Psychological risk factors include:

loss of a job and difficulty finding a new one
having a baby
recent death of someone close
long-term carer role
long-term relationship or family conflict
developing a long-term physical illness.

“I need to be at the office by 6.30am (having woken at 5am after sleeping only 3 hours). There are too many things to do in the office.

Before I go to work, I need to prepare my shopping list, send a couple of emails to friends to organise drinks on Friday night, do a load of washing and log onto my work emails. I really like to have my emails sorted before I go into work so I can get my other jobs done.

I just remembered its Kerrie’s birthday so I will make a cake and take it into work for morning tea.”

Madeleine with bipolar disorder reflecting on how her high mood affected her ability to get to work on time

Bipolar disorder

Approximately two per cent of the Australian population will experience bipolar disorder in any year.^[28] People with bipolar disorder experience extreme mood swings that change between periods of extreme low (depression), extreme high (mania) and normal mood. Some people may also experience psychotic symptoms (see ‘Psychotic disorders’ below for further information).

What are some of the signs or indicators that a worker may have bipolar disorder?

Bipolar disorder can fluctuate more than other mental illnesses. A worker may experience a manic phase where productivity and creativity can be high, but time and energy management may be impaired and the person may over-exert themselves until a depression cycle is reached.

The main indicator that a worker may have bipolar disorder is a significant change in their behaviour.

When a person with bipolar disorder is in a high (mania) mood, they may display:

extraordinary levels of energy, productivity and creativity at work
a dramatic change of personality in the workplace, such as being very loud, talking fast and rushing from one topic to another making little sense
poor concentration and great difficulty holding to any task
high risk taking in areas such as safety, spending, drug and alcohol use and cutting corners in a task
an inability to accept constructive criticism in the job, as they may appear to know everything and deny ever being wrong.

When a person with bipolar disorder is in a low (depression) mood, they may:

find it difficult to concentrate on tasks
turn up late to work
feel tired and fatigued
get angry easily and frustrated with tasks or people
avoid being around work colleagues (e.g. sitting by themselves at lunchtime)
find it difficult to meet reasonable deadlines
find it hard to accept constructive and well-delivered feedback
have difficulty managing multiple tasks or demands
drink more alcohol to cope with other symptoms of depression
become more easily stressed and anxious
make statements of self worthlessness (e.g. I'm a failure, I’m useless, I can’t do the job)
have unusually high absenteeism.^[29]

So what causes bipolar disorder?

Some of the factors that increase the risk of bipolar disorder include:

genetics: people who have a parent affected are up to 40% more likely to develop the disorder^[30]
imbalances in brain neurochemicals such as serotonin, noradrenalin and dopamine
environmental stress or sleep disturbance that may trigger episodes of illness
changes in season may also trigger episodes of illness in some people (there is some evidence that mania occurs more often in spring and depression in winter)
abuse of drugs and alcohol may also increase the risk of developing the illness and worsen symptoms.

“I would be anxious before I even left the house, and it would get worse as I got closer to work. I would feel sick in my stomach – it almost felt like I had the flu. My heart would pound, my palms would get sweaty, I’d get aches and pains and I would get this feeling of being removed from myself and from everybody else.”

Reflections made by a person with anxiety

Anxiety disorders

Approximately one in seven (14%) Australian adults experience an anxiety disorder in any one year.^[31] Anxiety disorders are very different from the general anxiety that we all experience from time to time due to stressful situations, such as public speaking, beginning a new job or dealing with the death of a loved one.

An anxiety disorder is not just feeling stressed but is a serious illness that affects a person’s ability to function. It is more severe, longer lasting and has a significant effect on work and personal relationships.

There are several types of anxiety disorders:

generalised anxiety disorder (GAD) is when a person feels anxious on most days over six months or more
panic disorder (PD) is when a person experiences a sudden feeling of terror or excessive fear about everyday situations which causes severe symptoms that resemble a heart attack
social anxiety disorder is when a person feels extreme anxiety due to social situations such as attending a social event, being in a crowd or doing a job that requires someone to observe their work
obsessive-compulsive disorder (OCD) is when a person has obsessive and repetitive thoughts (obsessions) and/or repetitive behaviours (compulsions) as a way of trying to avoid feelings of anxiety or to prevent a feared event from occurring
acute stress disorder and post-traumatic stress disorder (PTSD) may occur after a distressing or catastrophic event. This event may involve actual or threatened death, or serious injury. Alternatively, it may involve witnessing such an event or learning about such an experience from a family member or close friend. In acute stress disorder the person recovers from the event within a month, whereas in post-traumatic stress disorder the distress lasts longer^[32]
phobia is when a person experiences extreme fear, and as a result avoids certain situations, places or events. This greatly impacts on the person’s ability to manage day-to-day living. For example, a person may have a strong fear of specific places, leaving their home, or travelling on a plane.

What are some of the signs or indicators that a worker may have an anxiety disorder?

It is difficult to determine if a worker has an anxiety disorder. You may mistake anxiety as a personality trait of the person or think that they are just having personal difficulties.

The main indicator that a worker may have an anxiety disorder is a significant change in their behaviour, such as:

being unusually irritable or uneasy with colleagues and management
excessively worrying about work in areas such as the workload, deadlines and quality of work
having difficulty concentrating on work tasks
developing elaborate plans to avoid certain work tasks
having an anxiety attack, with physical symptoms such as heart palpitations, sweating, shortness of breath, hyperventilation, trembling or shaking (do not discount the fact that these symptoms in a person may also relate to a heart condition)
an inability to carry out work tasks that are considered reasonable and achievable
being unusually 'on edge' and restless.

So what causes an anxiety disorder?

Recognised risk factors include:

environmental factors: a change in family or other relationships, change in work role or location or change in workplace supervision
biological factors: an imbalance of chemicals in the brain that affects thoughts, emotions or behaviours
genetic factors: research shows that people with family members who have an anxiety disorder are at a higher risk of developing an anxiety disorder
personality: some people are more prone to anxiety due to their personality type, such as those who are highly emotional, easily upset, ‘perfectionists’ or a ‘worrier’.

Psychotic disorders

‘Psychotic disorders’ is a general term to describe a group of serious but treatable illnesses that affect a person’s ability to maintain contact with reality.

Psychotic disorders are less common than anxiety and mood disorders, affecting up to three per cent of Australian adults in any year.^[33]

An ‘episode’ of psychosis is a period of time when a person is unable to maintain contact with reality. Most episodes of psychosis are short-lived and respond well to medication. Schizophrenia and some forms of bipolar disorder are types of psychotic disorder.

Schizophrenia

Schizophrenia is not about having a ‘split personality’ as is often portrayed in the media. Schizophrenia is an illness characterised by changes in a person’s mental functioning where thoughts and perceptions become distorted.

Schizophrenia tends to occur between adolescence and the mid-twenties and affects less than one per cent of the population.^[34]

How does schizophrenia affect someone?

The development of schizophrenia usually occurs over a period of several months or years. Approximately 20% of people who develop schizophrenia have only one episode and fully recover, another 60% have multiple episodes but are otherwise well, and 20% have a life-long illness.^[35]

“I know everyone in the office is talking about me. My computer tells me what my colleagues are saying about me. I don’t know how to block out the voices that are coming from the computer. I can’t turn off the computer as I need to work.”

Person reflecting on the effects of schizophrenia in the workplace

What are some of the signs or indicators that a worker may have schizophrenia?

The main indicator that a worker may have schizophrenia is a significant change in their behaviour, such as:

being very depressed or anxious
being suspicious of other colleagues
speaking in a flat, monotone voice
showing inappropriate emotional responses in the workplace (e.g. inappropriately laughing aloud during a meeting)
lacking energy and motivation in what were usual work activities
having poor or no eye contact or staring vacantly into space
having odd ideas
talking about things that don’t make sense
having difficulties with concentration or attention to work tasks
having reduced ability to plan and carry out work tasks
jumping erratically from one topic to another when discussing work activities
acting in an odd manner, such as wearing inappropriate clothes
becoming withdrawn and socially isolated
talking to themselves
taking less care with hygiene and self-care.

So what causes schizophrenia?

Recognised risk factors include:

genetic factors: people who have a parent who is affected are at a higher risk of developing schizophrenia
biochemical factors: the changes in the brain caused by schizophrenia are not fully understood, however, the neurochemical called dopamine seems to be involved
stress: the onset of schizophrenia often follows stressful events in a person's life. However, stress is not in itself the cause of schizophrenia; rather it acts as a trigger for an episode in people who are vulnerable to the disorder.

Other factors that may increase the risk of developing this illness include a head injury, prenatal infection, complications around birth and substance abuse (for example, cannabis or methamphetamine).

Substance use disorders

How can mental illness and substance use disorders be associated? ^[36]

Using any type of drug, such as nicotine, alcohol, illegal drugs or prescription drugs, can be a problem if it changes:

the way a person acts (e.g. less motivated, irritable, anxious, aggressive)
the way they live their life (e.g. not getting on with people, not having enough money, finding it hard to keep living in the same house, getting in trouble with the law)
the way they look (e.g. losing or gaining weight, poor self-care, appearing intoxicated).

Does drug use cause mental illness or does mental illness cause drug use?

For some people drug use may trigger symptoms of mental illness. If someone has a predisposition to a psychotic illness, such as schizophrenia, drug use may trigger the first episode of mental illness. Some drugs can also cause a drug-induced psychosis which usually passes after a few days.

For others, having a mental illness may make them more likely to abuse drugs. Drug use may assist the person to alleviate their symptoms, even if it is in the short-term. In the long-term, however, substance use worsens the symptoms, adds new symptoms and can prolong the illness.

A lady talking to a man

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^[26] Australian Bureau of Statistics 4326 National Survey of Mental Health and Wellbeing: Summary of Results 2007
^[27] beyondblue, Workplace Information Sheet 3: Advice for managers and supervisors regarding depression in the workplace
^[28] Australian Bureau of Statistics 4326 National Survey of Mental Health and Wellbeing: Summary of Results 2007
^[29] beyondblue, Workplace Information Sheet 3: Advice for managers and supervisors regarding depression in the workplace
^[30] Black Dog Institute website, Bipolar – Causes
^[31] Australian Bureau of Statistics 4326 National Survey of Mental Health and Wellbeing: Summary of Results 2007
^[32] Kitchener B & Jorm T (2000) Mental Health First Aid in the Workplace – An e-learning course. Mental Health Council of Australia (CD-ROM)
^[33] SANE Australia (2005) Psychosis Fact Sheet
^[34] Medical Journal of Australia Managing Schizophrenia in the Community
^[35] SANE Australia (2003) The SANE Guide to Schizophrenia and other Psychotic Illness
^[36] Adapted from the SANE Australia Fact Sheet: Drugs and Mental illness

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