Appendix C: How to talk about mental illness

2010 Workers with Mental Illness: a Practical Guide for Managers

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Appendix C: How to talk about mental illness


What words do I use?

First and foremost people with mental illness are people and therefore it is important to use 'people first' language when referring to a person with a mental illness.

Rather than describe the person as being a disease (‘Rhys is schizophrenic’ or ‘Margot is a depressive’), describe the person as experiencing/having mental illness (e.g. ‘Margot has depression’) just as you would someone with any other form of illness/injury (e.g. ‘Doug has cancer’).

A male doctor with a lady smilingWhat works

  • Xavier has a diagnosed mental illness.
  • Margot has depression.
  • Rhys is currently experiencing/being treated for schizophrenia.

There are many inappropriate words used in our society to describe mental illness. Words such as ‘psycho’, ’mental’ or ‘crazy’ are inappropriate and destructive because they often cause shame and humiliation for a person with mental illness. These words can also create fear or stereotyped views, reinforce stigma, influence whether someone will seek treatment or not and whether or not they disclose to their manager or not.

What works

A mental illness can be specifically described as ‘a person experiencing':

  • depression
  • bipolar disorder
  • an anxiety disorder or, more specifically, a person experiencing:
    • a panic disorder
    • obsessive compulsive disorder
    • post-traumatic stress disorder
  • a psychotic disorder or, more specifically:
    • schizophrenia.

There are different terminologies used by people to describe their mental health status. These may include mental health problems, mental disorder, mental health condition and psychiatric disability. These different terms may refer to the extent of their condition and whether it has been formally diagnosed.

If you are unsure about what language to use when talking to a worker about their mental health status, simply ask them what language they use that best describes their condition.

If you need to talk with a worker with mental illness, or to external services and health professionals, it may be difficult if you don’t know what words to use to describe the issues.

Below is a list of some of the words used that describe specific mental health issues and a brief description of what these words mean.

Words Used
What does this mean
Diagnosed/undiagnosed
A mental illness is diagnosed by a mental health professional such as a psychiatrist, general practitioner or psychologist. A person with a diagnosed mental illness may be receiving treatment by a mental health professional, with specific therapy and/or medication.
Unwell
This is a term used when someone with mental illness is experiencing an episode of mental illness.

Just as you would describe someone as having the flu and being unwell, this is the same for a person with mental illness.

‘Martha has anxiety and is currently unwell.’
Episode / episodic or cyclic
This describes the occurrence of a person’s mental illness. The course of a person’s mental illness may be described as being episodic or cyclic, meaning they have periods of wellness and short periods of being unwell. If a person becomes unwell you may describe this, for example:

‘Bruce has diagnosed depression and is currently experiencing an episode.’
Acute or chronic
This describes the extent of the symptoms being experienced by a person with mental illness.

Acute mental illness is characterised by significant and distressing symptoms requiring immediate treatment. This may be the person's first experience of mental illness, a repeat episode or the worsening of symptoms of an often continuing mental illness. The onset is sudden or rapid and the symptoms usually respond to treatment.[37]

Chronic mental illness is characterised as being long-lasting or recurrent.

Just as you would describe someone as having chronic arthritis or a chronic back condition, this is the same for a person with mental illness.

‘Anthea has chronic depression.’

‘James has acute anxiety.’
Treated / untreated
A person with a diagnosed mental illness is being treated if they are receiving some type of treatment such as specific therapy and/or medication by a doctor.

‘Tania has schizophrenia which is currently being treated by her doctor.’

You may be required to talk about a worker who has become unwell in order to obtain information, advice and support from someone qualified in mental health. The most important information to relay to a qualified person is the symptoms and behaviours the worker is displaying, without identifying who they are and/or disclosing personal information that is unrelated to the workplace. It is important to consider privacy laws and disclosure requirements when talking about a worker’s mental illness (refer to Appendix A – Knowing the Law).

You may feel awkward or unsure about how to talk about someone’s symptoms or not know the words to best describe the behaviours. As with responding to other human resources issues, the key focus is to outline your observations. It might help to write down the behaviours that you have observed that concern you. This will help you prepare open questions for discussion with the worker.

Here is a list of words that might best describe the symptoms and actions related to a person’s behaviour:

  • poor motivation
  • disoriented
  • unresponsive or indifferent
  • hyperactive or elevated
  • self absorbed
  • suicidal thoughts
  • deterioration in hygiene
  • poor personal presentation
  • making statements of self-worthlessness
  • excessive fear about certain situations
  • being ‘on edge’ and restless
  • poor concentration
  • increasingly anxious
  • highly emotional, irrational or distracted
  • lack of insight (the person does not recognise their behaviour as inappropriate)
  • dramatic change of personality
  • high risk taking
  • inappropriate and extreme response to constructive criticism
  • become socially isolated
  • unusually lethargic

 

Here is an example of how using the right words can describe a person’s mental health symptoms:

Jo, a manager was concerned about his worker, Alex. He decided to get some advice.

Words that best describe Alex’s symptoms

Alex is a mechanic who’s worked with the business for two years. He’s a good worker and I’ve never had problems with him. He knows what he’s doing with cars and the customers like him a lot. The apprentices don’t get away with anything when Alex is checking up on them.

Last month or so, I noticed Alex wasn’t himself, even his work mates noticed a big change in him.

He started turning up late for work and getting frustrated with everyone.

He began to keep away and isolate himself; he stopped having lunch with the boys and wouldn’t talk much with the customers.

His work also started to slip; he was not concentrating on the job and he would become really forgetful, like putting his tools down in different places and losing them and also forgetting to finish off jobs.

He seemed to be lost in his own world.

When I tried to talk with him he was just so down on himself by saying he was ‘useless’, and that he couldn’t do the job.

How do I talk with a worker about their mental illness?

Making the step to talk with a worker who you think may have mental illness can be difficult. Here is some information that may help you successfully make the step:

  1. Plan a meeting
  2. Initiate the meeting
  3. Observe confidentiality
  4. Consider body language
  5. Prepare for possible responses
  6. Create an outcome

1. Plan a meeting

Think about what you would like to talk about with your worker. What is the purpose of the meeting?

Meeting with a worker who seems to be experiencing difficulties generally happens so you can:

  • talk about any work-related concerns you may have
  • identify what may be the cause of the problems
  • identify what reasonable adjustments the worker may need to enable them to be a productive worker again
  • develop a plan of action with the worker.

It is important to remember that it is reasonable to ask questions and discuss a worker’s possible mental illness with them, just as you would for someone who has a back injury or illness, for the purposes of identifying reasonable adjustments in the workplace.

It is not reasonable, and it may be unlawful, to ask questions of a worker about their illness that are:

  • personal, that may cause humiliation and/or are in no way related to the real task of determining whether the worker can do the job and, if not, what reasonable adjustments could be provided to assist them do the job
  • used as the basis for discriminatory decisions such as unjustified dismissal.[38]

When planning a meeting, you should also consider:

  • the best place to meet: find an informal, non-threatening place, such as a work room that is quiet and private
  • the best person to meet: this may or may not be you, depending on your role and relationship with the worker
  • the best time: choose a time that best suits you and the worker
  • the best strategy: reassure the worker and highlight their skills, abilities and value to the organisation.

It is appropriate to offer your worker the opportunity to bring a support person to any meeting you arrange to discuss their mental illness issues.

2. Initiate the meeting

It is your role as manager to initiate the conversation. Explain why you are meeting with them. Let them know that you are concerned about their workplace performance, and whether this may be due to health issues, and explain why. It is important not to try to diagnose mental illness or to try to be a counsellor.

The main focus should be work-related issues that you have noticed in the workplace, for example:

‘I’m concerned about you. You are a very competent worker but I have noticed lately that you are having trouble coping with customer calls.’

Asking open ended questions can help start the conversation, such as:

‘What do you think are the problems?’ and ‘How can I help?’

3. Observe confidentiality

It is a big decision for a person with mental illness to disclose their disability to a manager. There is the fear of being discriminated against, being seen in a different light and being treated differently, such as being overlooked for promotions and opportunities to do other work related duties.

Tell the worker what the organisation’s policies and practices are regarding privacy and confidentiality to reassure them that any information presented will be kept private (for further information refer to Appendix A – Knowing the Law).

It is important to make clear that the only time that information can be disclosed is if there is a serious or imminent threat to the health and safety of the worker concerned and/or anyone else associated, such as colleagues and other staff.

Outlining privacy and confidentiality policies and practices relating to sensitive information is not only critical for developing and maintaining trust, it is essential when negotiating reasonable adjustments in the workplace.

4. Consider body language

Body language can give many messages. It is important to be aware of this when you are meeting with the worker to discuss sensitive issues.

Example of what not to do include sitting behind a desk, with arms and legs crossed and limited eye contact. This does not help to create a supportive and trusting environment in which to discuss mental health issues.

Consider:

  • sitting opposite the person (taking into account personal space)
  • meeting in a comfortable place (this may be the office, café or quiet work room)
  • having no barriers between you and the worker
  • sitting in a relaxed manner, with legs and arms not crossed, facing in the direction of the worker, bending slightly forward toward the worker
  • show that you are engaged with the worker by giving eye contact (unless this is culturally insensitive).

5. Prepare for possible responses

Be prepared for the meeting to become uncomfortable or for the discussion not to go the way you wanted it to go. Some people can feel very threatened when any attempt is made by a manager to discuss personal issues such as mental health. Reactions can be as extreme as displaying anger and denial. It is important to stay calm, firm, fair, consistent and in control.

6. Create an outcome

There are two outcomes that can occur:

  • denial of any workplace issues by the worker and therefore withdrawal of the offer of reasonable adjustments in the workplace
  • acknowledgement of workplace issues and a subsequent plan of action to identify, implement and evaluate reasonable adjustments in the workplace.

If a worker chooses not to seek assistance from you then it is important to finish the meeting by letting them know that you are available at any time should they require assistance.

If you feel the work performance of the worker is impacting on the business then you have a right to address these issues through formal avenues, such as performance appraisal meetings.

If you feel there is a health and safety risk in continuing to allow the person to work, or to carry out certain work duties, then you have a duty of care to take action to ensure the person is safe in the workplace (refer to Appendix A – Knowing the Law).

Below is a summary about what to do – and what not to do – when communicating and interacting with a worker with a mental illness:

Do

  • Do use appropriate language
  • Do ask the person if they require assistance before providing it
  • Do respect the person, not fear them

Don't

  • Don’t use derogatory terms (e.g. ‘schizo’, ‘crazy’)
  • Don’t speak down to the person
  • Don’t treat the person as an invalid
  • Don’t stay away from them
  • Don’t assume that the problem will go away
  • Don’t tell them that they need to stay busy, get out more and have a good time
  • Don’t make statements that don’t help:
    • ‘Snap out of it’
    • ‘You’re just imagining it’
    • ‘Get your act together'

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[37] Victorian Government Health Information (2008) A Guide to Mental Health Terminology
[38] Section 30 DDA