MENTAL ILLNESS

  • A mental   disorder is a syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress in social, occupational, or other important activities.

  • Please refer to RPD ACT if the mental health issue of a student falls under the RPD ACT.

  • A medical condition that disrupt a person's thinking, feeling, mood, ability to relate to others, and daily functioning.

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We suggest numerous accommodation questions related to individuals with mental health impairments studying/working successfully. Although there are various definitions and list of impairments, this document covers those that are received the mostly in CBR projects.

  • Bipolar disorder sometimes referred to as manic depression, "is a medical illness that causes extreme shifts in mood, energy, and functioning. Bipolar disorder is a chronic and generally life-long condition with recurring episodes of mania and depression that can last from days to months that often begin in adolescence or early adulthood, and occasionally even in children."

  • Borderline personality disorder (BPD) is "an often misunderstood, serious mental illness characterized by pervasive instability in moods, interpersonal relationships, self image, and behavior. It is a disorder of emotional dysregulation. This instability often disrupts family and work, long-term planning, and the individual's sense of self-identity."

  • Major depression is "persistent and can significantly interfere with an individual's thoughts, behavior, mood, activity, and physical health.”

  • Obsessive compulsive disorder (OCD) "occurs when an individual experiences obsessions and compulsions for more than an hour each day, in a way that interferes with his or her life."

  • Panic disorder occurs when a person "experiences recurrent panic attacks, at least one of which leads to at least a month of increased anxiety or avoidant behavior. Panic disorder may also be indicated if a person experiences fewer than four panic episodes but has recurrent or constant fears of having another panic attack."

  • Post-traumatic stress disorder (PTSD) is "an anxiety disorder that can occur after someone experiences a traumatic event that caused intense fear, helplessness, or horror. While it is common to experience a brief state of anxiety or depression after such occurrences, people with PTSD continually re-experience the traumatic event; avoid individuals, thoughts, or situations associated with the event; and have symptoms of excessive emotions. People with this disorder have these symptoms for longer than one month and cannot function as well as they did before the traumatic event. PTSD symptoms usually appear within three months of the traumatic experience; however, they sometimes occur months or even years later."

  • Schizophrenia "often interferes with a person's ability to think clearly; to distinguish reality from fantasy; and to manage emotions, make decisions, and relate to others."

 

Accommodating Students with Mental Health Impairments

 

People with mental health impairments may develop some of the limitations discussed below, but seldom develop all of them. Also, the degree of limitation will vary among individuals. Be aware that not all people with mental health impairments will need accommodations to perform. The following is only a sample of the possibilities available. Numerous other accommodation solutions may exist.

Questions to Consider:

1.            What limitations is the student experiencing?

2.            How do these limitations affect the student and the student’s job performance?

3.            What specific job tasks are problematic as a result of these limitations?

4.            What accommodations are available to reduce or eliminate these problems? Are all   

                possible resources being used to determine possible accommodations?

5.            Has the student been consulted regarding possible accommodations?

6.           Once accommodations are in place, would it be useful to meet with the student to

               evaluate the effectiveness of the accommodations and to determine whether additional

               accommodations are needed?

7.           Do supervisory personnel and students need training?

 

 

Key Accommodations:

Managing Panic Attacks: For individuals with mental health impairments, having accommodations to help manage panic attacks can be helpful.

  • Flexible Schedule

  • Modified Break Schedule

  • Rest Area/Private Space

  • Support Animal

  • Support Person

  • Identify and Reduce Triggers

 

Rest Area/Private Space: An individual may need space to rest, take medication, or perform hygiene associated with activities of daily living. An area reserved as a rest area or private space could be a reasonable accommodation. For example, during or after a seizure, people with epilepsy may exhibit behaviors such as crying, drooling, spitting, or urinating. As a result, the person may need time following a seizure to engage in activities of daily living such as grooming and changing clothes. This type of space might also be helpful to those who have sleep disorders, diabetes, or who struggle with panic attacks.

Identify and Reduce Triggers: Some disabilities or medical conditions may have specific triggers that exacerbate symptoms. If triggers are present in the workplace, it can be helpful to identify what they are and explore accommodations to help. A variety of medical conditions may have associated triggers including migraines, seizure disorders, anxiety/panic disorders, PTSD, and fibromyalgia. The process of identifying triggers is individualized. Common examples are noise, light, and stress.

Accommodation Ideas

 

By Limitation

 

By Limitation of: Attentiveness / Concentration

Products
  • Alternative Lighting Applications (apps)

  • Apps for Concentration

  • Cubicle Doors, Shields, and Shades Desk Organizers

  • Desk Pedal Exercisers Electronic Organizers

  • Environmental Sound Machines / Tinnitus Maskers / White Noise Machines

  • Fidget Devices

  • Focus Enhancement

  • Full Spectrum or Natural Lighting Products Noise Abatement

  • Noise Canceling Headsets

  • Simulated Skylights and Windows

  • Sound Absorption and Sound Proof Panels Sun Boxes and Lights

  • Sun Simulating Desk Lamps Timers and Watches

  • Wall Calendars and Planners

Services
  • Disability inclusion coordinators in schools/colleges

Strategies
  • Color Coded System

  • Behavior Modification Techniques Flexible Schedule

  • Job Restructuring Marginal Functions

  • Modified Break Schedule Task Separation

  • Task Flow Chart

  • Telework, Work from Home, Working Remotely Uninterrupted Work Time

  • Verbal Cues

  • Worksite Redesign / Modified Workspace Written Instructions

 

By Limitation of: Control of Anger / Emotions

Products
  • Apps for Miscellaneous Mental Health / Control of Anger & Emotions

  • Environmental Sound Machines / Tinnitus Maskers / White Noise Machines

  • Simulated Skylights and Windows Sun Boxes and Lights

  • Yoga

Services
  • Counseling/Therapy

  • Disability Awareness/Etiquette Training Student Assistance Program

  • YOGA

Strategies
  • Behavior Modification Techniques Communicate Another Way

  • Complying with Behavior and Conduct Rules Flexible Schedule

  • Job Restructuring

  • Modified Break Schedule Positive Feedback

  • Reassignment

  • Supervisory Methods Support Animal

  • Telework, Work from Home, Working Remotely Support Person

 

By Limitation of: Decreased Stamina / Fatigue

Products
  • Anti-fatigue Matting Ergonomic Equipment Stand-lean Stools

  • Wearable Anti-fatigue Matting

Services
  • Ergonomic Assessments

Strategies
  • Flexible Schedule Job Restructuring Marginal Functions

  • Modified Break Schedule Periodic Rest Breaks

  • Task Separation

  • Telework, Work from Home, Working Remotely Worksite Redesign / Modified Workspace

  • Executive functioning deficits

 

By Limitation of: Executive Functioning Deficits (Students with Executive Functioning Deficits)

Products
  • Apps for Concentration

  • Cubicle Doors, Shields, and Shades

  • Environmental Sound Machines / Tinnitus Maskers / White Noise Machines

  • Form Generating Software Noise Canceling Headsets

  • Recorded Directives, Messages, Materials Sound Absorption and Sound Proof Panels Speech Recognition Software

  • Timers and Watches

  • Wall Calendars and Planners

Services
  • Job Coaches

Strategies
  • Checklists

  • Color Coded System Job Restructuring

  • Marginal Functions

  • Modified Break Schedule

  • Recorded Directives, Messages, Materials Written Instructions

 

By Limitation of: Managing time

Products
  • Apps for Organization/ Time Management Electronic Organizers

  • PDAs, Notetakers, and Laptops Smart Watches

  • Timers and Watches

  • Wall Calendars and Planners

Services
  • Job Coaches

Strategies
  • Additional Training Time / Training Refreshers Checklists

  • Color Coded System

  • Color-coded Manuals, Outlines, and Maps Extra Time

  • Recorded Directives, Messages, Materials Reminders

  • Support Person

  • Supervisory Methods Task Flow Chart

  • Task Separation Verbal Cues

  • Written Forms and Prompts Written Instructions

 

By Limitation of: Memory loss

Products
  • Apps for Memory

  • Break Reminder Software Electronic Organizers

  • Form Generating Software

  • Labels/Bulletin Board Medication Reminders Memory Software

  • Notepad or White Board On-Screen "Ruler" / Strip Timers and Watches

  • Wall Calendars and Planners

Strategies
  • Additional Training Time / Training Refreshers Checklists

  • Color Coded System

  • Color-coded Manuals, Outlines, and Maps Extra Time

  • Recorded Directives, Messages, Materials Reminders

  • Supervisory Methods Support Person

  • Task Flow Chart Task Separation

  • Verbal Cues

  • Voice Recorders

  • Written Forms and Prompts or Written Instructions

 

By Limitation of: Organizing / Planning / Prioritizing

Products
  • Apps for Organization/ Time Management Desk Organizers

  • Electronic Organizers Ergonomic Equipment Labels/Bulletin Board

  • Note Collection Software and Technology Notepad or White Board

  • Organization Software Timers and Watches

  • Wall Calendars and Planners

  • Workflow Management Software

Services
  • Job Coaches

  • Professional Organizers

Strategies
  • Additional Training Time / Training Refreshers Checklists

  • Color Coded System

  • Color-coded Manuals, Outlines, and Maps Job Restructuring

  • Marginal Functions On-site Mentoring

  • Organization/Prioritization Skills

  • Recorded Directives, Messages, Materials Reminders

  • Supervisory Methods Task Flow Chart

  • Task Identification Task Separation

  • Written Instructions

 

By Limitation of: Sleeping / Staying Awake

Products
  • Apps for Sleep/ Fatigue Alternative Alarm Clocks Bed Shaker Alarms

  • Dawn Simulators Personal Alarms

  • Rolling Alarm Clocks Sleep Alerting Devices Talking Alarm Clocks

  • Vibrating Watches/Alarms

Services
  • Wake-Up Call Services

Strategies
  • Flexible Schedule

  • Modified Break Schedule Periodic Rest Breaks

  • Rest Area/Private Space

By Limitation of: Stress Intolerance 

Products
 
  • Apps for Anxiety and Stress

  • Environmental Sound Machines / Tinnitus Maskers / White Noise Machines

  • Fitness Trackers

  • Simulated Skylights and Windows Sun Boxes and Lights

  • Sun Simulating Desk Lamps

Services
  • Counseling/Therapy

  • Student Assistance Program

Strategies
  • Behavior Modification Techniques Communicate Another Way

  • Complying with Behavior and Conduct Rules Flexible Schedule

  • Instant Messaging and Texting Solutions for Businesses Job Restructuring

  • Marginal Functions

  • ​Modified Break Schedule On-site Mentoring

  • One-on-One Communication Policy Modification

  • Positive Feedback

  • Supervisory Feedback Supervisory Methods Support Animal

  • Support Person Tele-presence

  • Telework, Work from Home, Working Remotely

By Limitation of: Activity-Related Function

Policies
 
  • Additional Training Time / Training Refreshers Aide/Assistant/Attendant

  • Environmental Sound Machines / Tinnitus Maskers / White Noise Machines

  • Flexible Schedule Marginal Functions

  • Modified Break Schedule Periodic Rest Breaks

  • Physical/Social Distancing Signage Policy Modification

  • Reassignment Service Animal

  • Sleep Alerting Devices Strobe Lights

  • Supervisory Methods Support Animal

  • Telework, Work from Home, Working Remotely Touchless Faucets

Stress
  • Apps for Anxiety and Stress

  • Behavior Modification Techniques Counseling/Therapy

  • Environmental Sound Machines / Tinnitus Maskers / White Noise Machines

  • Flexible Schedule Job Coaches

  • Job Restructuring Marginal Functions

  • Modified Break Schedule Monitor Mirrors

  • Odor Control

  • On-site Mentoring

  • Service Animal

  • Simulated Skylights and Windows Strobe Lights

  • Supervisory Methods Support Animal

  • Support Person

  • Telework, Work from Home, Working Remotely Uninterrupted Work Time

SITUATIONS AND SOLUTIONS:
 

1. A student with borderline personality disorder works as a hairstylist in a beauty salon.

2. At times, she becomes very upset and leaves work abruptly. The supervisor meets with her regarding these occurrences and the student discloses her disability and explains that because of her work schedule, she has been unable to attend therapy and psychiatrist appointments, which has resulted in an exacerbation of her symptoms. The employer suggests providing her a consistent schedule, allowing her to keep the early part of the day open for her therapist and doctor appointments. The employer also agrees to allow the student to take two additional unpaid breaks per shift. The accommodations result in the student getting the treatment she needs, allowing her to continue working successfully in her position.

3. A secretary with PTSD, who had been carjacked several years earlier, experienced significant anxiety during commutes after dark.

4. This caused difficulty concentrating and irritability. She was accommodated with the ability to have a support animal at work and a flexible schedule with work from home during periods of minimal sunlight.

5. A guidance counselor for a large high school experienced severe bouts of irritable bowel syndrome, depression, and fatigue as a result of fibromyalgia.

6. He experienced difficulty in opening the heavy doors to the entrance of the school and had to make frequent trips to the bathroom. The individual's employer complained that he was spending too much of his time away from his office and therefore was not available for students. The employer moved the student's office to a location closer to the faculty restroom, added an automatic entry system to the main doors, and allowed flexible leave time so the student could keep appointments with his therapist.

7. An electrician with severe depression needed to attend periodic licensure trainings.

8. The person had difficulty taking effective notes and paying attention in the meetings. The individual was accommodated with notes from remote Communication Access Realtime Translation (CART) service.

9. A middle school teacher with chronic depression asks for the accommodation of leave one afternoon a week for a sixteen-week period so she can attend an intensive out-patient therapy program recommended by her mental health practitioner.

10. A student voluntarily admitted herself to a hospital inpatient unit due to severe depression. A student returning to work after a stroke was dealing with depression.

11.       As a result, the student’s performance was impaired and the previous supervisory method was no longer effective. The supervisor agreed to meet with the student weekly to discuss performance and conduct issues that were becoming problematic, as well as put accommodations into place. Among the accommodations: a flexible schedule for health care appointments, a diagram to help with the flow of duties, templates to assist in report writing, and a move to an area with more natural lighting.

12.       A county student who is the in the final year of engineering has bouts of depression that are intensified when he is busy, under deadlines, and has frequent interruptions. He then finds it difficult to concentrate and get his work completed. The college rescheduled a peer support allowing the student to go to a specified with peer support.