Promoting Acceptance and Social Inclusion for People with Mental Health Problems in the Workplace
January 27, 2009

Coordinator: Hello and welcome to the training teleconference Promoting Acceptance and Social Inclusion for People with Mental Health Problems in the Workplace. Your moderator for the afternoon is Michelle Hicks, Director for the SAMHSA ADS Center. Thank you ma'am. You may begin.

Michelle Hicks: Thank you. Hello everyone. This virtual training session is sponsored by the SAMHSA Resource Center to Promote Acceptance, Dignity and Social Inclusion Associated with Mental Health also known as the SAMHSA ADS Center.

If you would like to reach us you will find our contact information listed on slide number 2.

Today's teleconference is titled Promoting Acceptance and Inclusion for People with Mental Health Problems in the Workplace. The presentation portion of our training will take place during the first hour and will be followed by a 30-minute question-and-answer session.

At the end of the speaker presentation, you may submit a question by pressing star 1 on your telephone keypad. You will enter a queue and be allowed to ask your question in the order in which it is received.

On hearing this conference operator announce your name please proceed with your question. After you have asked your question your line will be muted. The presenters will have an opportunity to respond to you at that time.

For your reference, these instructions may be found on slide number 4. We ask that you keep your questions concise with minimal background information.

If we do not get to your question, please feel free to email them to the ADS Center and we will follow up with you.

Within 24 hours of this teleconference, you will receive an email request to participate in a short, anonymous online survey about today's training material.

Survey results will be used to determine what resources and topic areas need to be addressed by future training events. The survey will take approximately 5 minutes to complete.

Before we begin, please let me say that the views expressed in this training event do not necessarily represent the views, policies, and positions of the Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, or the U.S. Department of Health and Human Services.

Presenters for today are Dr. Beth Loy, Ms. Clare Miller, and Ms. Nicole Clevenger.

Dr. Loy is a Principal Consultant with the Job Accommodation Network, JAN. In this capacity she leads JAN's external evaluation process and internal continuous improvement process, providing leadership to JAN's teams of service delivery and information services.

Our second presenter for the day is Ms. Clare Miller, who serves as the Director of the Partnership for Workplace Mental Health, a program for the American Psychiatric Foundation which advances effective employer approaches to mental health by combining the knowledge and experience of the American Psychiatric Association and its employer partners.

Our third presenter for the day is Ms. Nicole Clevenger, who is a Consultant and Trainer for the Ohio Supported Employment Coordinating Center of Excellence. Currently, she assists mental health centers in evidence-based supported employment implementation through onsite training, consultation, and fidelity reviews.

And now please look at slide number 9 as we begin today's events.

Dr. Loy?

Dr. Beth Loy: Hi. Yes. I am Beth. Usually the only people who call me Dr. Loy are really my mom and dad. I'm the one with the West Virginia accent, so you should be able to tell me apart from the other presenters today.

I'm a Principal Consultant with the Job Accommodation Network otherwise known as JAN.

And just to let you know, I have to say who pays the bills, we are still a free service provided by the Office of Disability Employment Policy through the U.S. Department of Labor.

And I always like to ask how many people have heard of JAN or use JAN. In this type of environment it's a little bit harder to do. But hopefully some of you have had some experience related to using our service.

So what happens with JAN? What do we do here? What are we funded to do? And how can we help you, your coworkers, your families, your constituents?

Well, our specialty area is accommodation, accommodation and ADA consultation. And of course ADA consultation has taken a little bit of a turn with the new amendments act over the last couple months.

What else do we do? Well we provide many technical assistance documents and several related to mental health impairments, or mental health management, mental health accommodations. Really we base most of these documents on what our constituents are asking for.

What else do we provide? Well we provide information on accommodation process, accommodation guidance, policy implementation. We also provide information related to benefit/cost research and policy development.

You say, well what do you know about policy development? Well, what we do is we work on the ground. We take about 38,000 accommodation-related calls a year. And these run the gamut of all types of limitations, work environments, work situations.

And we gather information from individuals, from consumers. And we synthesize that information, pass the aggregate information back to the Office of Disability Employment Policy. And hopefully we're able to make some changes, at least congressional changes or legislative changes. So we like to consider us a part of that big picture.

So just a little bit about this presentation. I'm not going to hit everything on the slides today but I wanted to provide the slides just to give you some guidance if you weren't familiar with what JAN does, talk a little bit about accommodations, a little bit about employment situations. And then I'll be happy to stick around for some questions at the end.

So what do we hear? The first thing that I want to highlight is that I can only tell you about JAN's experience and what we hear. There's lots of different situations out there where we don't have all the answers for that type of situation.

But what do we hear from people who contact us when it comes to a situation involving an individual with mental health impairment?

Well an individual will call and that individual will say, you know what, I'm really afraid of the stigma attached with disclosing. And that's really the part of my job or part of the workplace that I fear the most.

Typically these individuals feel isolated or rejected, fearful, sometimes afraid of dismissive attitudes from supervisors, discouragement from coworkers, and even discrimination from management.

So hopefully if you contact JAN we can get involved in one of these situations before it really gets outside of the office and enters the legal forum. And maybe we can help you solve that.

So stigma and social exclusion—well, the situations that JAN hears about, stigmas that really keep people from self-identifying on the job because they're afraid of how they might be treated or perceived. So what happens?

Well, oftentimes a person will disclose after there's a crisis in the workplace. And really, we like to get involved in that situation before this happens.

So what we go out and train about—we travel all over the country and try to do as much training as we can, really having open communication and informed attitudes.

And those in that bullet where I say open communication, that has nothing to do with psychiatric disability, a mental health impairment, or any other type of disability or limitation. It's really more about good management. And that's what I like to go out and train on is good management techniques regardless of the environment and regardless of the limitation.

So accommodation ideas and supporting that social inclusion. Just to give you a few of the myths that JAN tries to dispel: People with mental health problems may have difficulty coping with the demands of life.

This can be true. It might be true in some situations. It might not be true in others.

Persons of any age, religion, or race, or any level of income or education can experience mental health limitations.

Mental health conditions are quite common. They affect almost 58 million Americans, and there are probably even more individuals that aren't counted in that.

So some of the limitations that we hear about on the phone. Well, individuals may be distracted at the workplace; it may be difficult concentrate. Memory may be impacted.

Sometimes an individual might need time off. There might be fatigue-related issues, they may have difficulty managing social interactions like parties or other office-related get-togethers.

The individual may be angry or emotional. And sometimes organizational skills may be a challenge. And honestly, in many situations there may be no limitations related to the call. It just may be a situation where the person may want to disclose and ask for something very simple in the workplace.

So accommodations. Well for improving concentration—and I'm just going to pick out a couple of these to highlight—let's see, so improving concentration. Well what about planning for uninterrupted work time? Does that sound like it's something special for someone with a mental health impairment? Does that sound like something unusual or something expensive or something that would be strange in the workplace?

Planning for uninterrupted work time really is just a good management technique. If someone does have limitations related to concentration, this and the other items listed on this slide can be helpful.

Improving memory. So one of the bullets is, let's see, providing written minutes. How many people out there have meetings where maybe right after the meeting they think that they missed something or maybe they'd like to go back and have notes from that meeting?

Providing written minutes is not something, again, that is unusual or some type of accommodation that might be expensive. It's really a good management technique along with the other accommodations listed on the slide.

So for limitations related to productivity, performance, and absenteeism—well, what about implementing job restructuring, reallocating or eliminating those marginal job functions?

We all have what we call essential job functions. And, for a day like today in the middle of West Virginia where we have about a fourth of our staff in the office and we need to really be productive but yet we're very limited, it's a time where we need to implement some job restructuring and really reallocate those marginal functions and prioritize our essential job functions.

So again, not something that's some type of special or expensive accommodation, but really something that's a really good management technique.

Organization and meeting deadlines. And probably many of us need this especially when we have several deadlines we need to meet.

Well we're not talking about things that are really overly expensive or really high on the technology meter, using to-do lists or calendars and organizers, even providing reminders.

I use my email for some of the individuals that I supervise. And I'll set the email so that it goes out immediately and a copy goes out maybe 2 weeks from now as a reminder.

So what about even using color files? This week I have, let's see, six presentations I will do in one week. And I have every presentation as a different color file folder so that I know when I'm sitting here on the phone I'm supposed to know exactly what I'm talking about.

Even implementing what we call mini-assignments can be an excellent accommodation for someone who needs to meet deadlines.

And these are situations where you don't give someone a really large project to complete over a long time period, but you have several little projects and you build up to that large project.

So for fatigue, stamina, and even anxiety. And, because we are having a rather large snowstorm today, there is some anxiety in the JAN office, so ...

What are some things that we can do? What are some accommodations or otherwise good management techniques? Well what about flexible schedules? What about providing positive reinforcement?

And I've had questions on this as an accommodation idea before. Well, what do you mean as a supervisor, I have to give positive reinforcement?

And I say, you know what? That's not really an accommodation. That's a management technique. Why not say good job, glad to see you got the project done, nice colors that you used on that design, nice layout that you used? What does that cost you to stop and say hey you did a good job?

Communicating in alternative ways. I do this as some employees who like email, some of you like face-to-face, some of you enjoy meetings, and others who do not want to talk in meetings and would rather do that after the fact.

Even setting clear expectations for those small projects, when's it due, how long are you going to need in order to complete this? What resources do you need?

And even reviewing the disciplinary policy. And you say, well why would you put that on here? Anxiety. If someone carries a great deal of anxiety and is worried about how he or she is performing, reviewing the job expectations or disciplinary policies, the accommodation policies, even your evacuation policy.

Reviewing those policies can be really excellent management techniques and help really resolve any forthcoming issue related to accommodations.

Allowing telework and implementing ergonomics. You say, well, why would you want to do that? Well telework can really sometimes be really very beneficial for someone who has fatigue or stamina issues. Maybe a person needs to work at home 1 day a week or even 2 days a week.

And implementing ergonomics. There are a lot of things that we can do to a workstation to really help someone be comfortable throughout the day and maybe cut down on those fatigue or stamina issues.

And attendance. Well how can we increase attendance? Well one of the bullets that is probably my favorite is allowing employees to make up time. Like today we had several employees who were late because of the snow. And they offered to work through lunch or even stay later or come in early tomorrow. Trying to have some of that flexibility in the workplace really tends to be quite helpful.

Handling stress and emotions. And again, this is something that applies to many people in the workplace when you're under tight deadlines. It's not necessarily just individuals with a mental health limitation. It can be anyone in the workplace.

Again, providing that positive praise and reinforcement as a supervisor can be helpful. Offering some outside counseling or even a EAP tends to be something that employers find effective.

Allowing contacts to support persons from the workplace, allowing the presence of a support animal. Support animals can sometimes be controversial. And we could probably do a week's training on support and service animals. But it could be an effective accommodation.

Providing break time. Maybe instead of having an hour lunch a person takes 15 minutes here or 15 minutes there. And training on stress management techniques which again I think can be very helpful for everyone in the workplace.

So some other tips I'd like to mention. I think it's just always important that employees understand that change can be stressful. With the economy right now we have seen an increase in our calls related to individuals who are fearful of being laid off or have been laid off or . . . just because of the economy. So I think just training your employees that change is stressful can be helpful.

Maintaining open communication, having those weekly or even monthly meetings regardless of how painful you think they might be.

And reviewing expectations with all employees.

Working with coworkers. I think it's important to educate all employees in their rights to accommodation. Some other tips that I think are beneficial are listed on this slide.

The very last bullet is providing a mentor. I think whenever you hire new employees, giving that employee someone who is a mentor or a coach or someone to help guide them, that can really help with any changes or things that a person goes through when he or she first starts a job.

Some proactive procedures that all you managers out there might want to consider implementing. Again, offering that praise and reinforcement, something I've learned as I get a little bit more age on me, how effective that can be.

Monitoring accommodations for effectiveness, going back to an employee and saying you know, how are you doing? How's everything going?

Putting those work agreements in writing, especially if it's a job performance agreement.

Having those long- and short-term goals, clear expectations and consequences. And trying to have as open door—as much of an open-door policy as you can have.

So just to wrap up my 15 minutes or so of fame here, you can contact JAN at any time. You can visit us on our Web site. Again, we try to be as open as we can be from 9 to 6 unless of course it's a day like today.

We are available to anyone related to any question that has to do with accommodations or the Americans with Disabilities Act.

And that is all I have.

Michelle Hicks: Great. Thank you so much Beth. And now Clare, we'd like for you to proceed.

Clare Miller: Sure. Thank you so much. That was a beautiful overview of JAN in particular. And I just want to reinforce what a wonderful service JAN is to employers.

We very often refer employers to JAN as just a fabulous resource.

So I'm Clare Miller. I'm the Director of a program called the Partnership for Workplace Mental Health. And we're here at the American Psychiatric Association and the American Psychiatric Foundation.

And the purpose of the program is really, it's, we're an educational program. And we collaborate with employers and APA.

So the idea is to help bridge communication between these, the mental health community and America's employers.

And our mission quite simply is to advance effective employer approaches to mental health.

And, you know, one of the things that we stress when we talk with employers is that while part of our concern is certainly encouraging employers to hire people with mental illnesses, part of this is just looking at their existing population and recognizing that because mental health and mental illnesses are so prevalent that they already employ people with mental illnesses.

And so part of their concern is retaining those employees and making sure that those employees are able to succeed and be productive on the job.

And so we talk a lot about kind of the business case for mental health and the importance of matching an investment in employee mental health with dollars and resources and things that don't cost any money at all, some of which are the accommodations that we just heard a lot about.

So, you know, these are just a few snippets of part of what is really a growing body of evidence supporting the business case for mental health.

We know that 80 percent of those treated for mental illnesses have reported high levels of efficacy and satisfaction. And there's really a growing body of work that supports the fact that when people get good care that they are more productive and, you know, a greater—play a greater role in the workplace.

Another company, Abbott Labs, achieved a 1.7:1 return on investment simply by conducting a depression screening program.

So this stat really reinforces the need for employers to do screening to make sure that mental illnesses are detected and that people get into good care.

We also know that when obstacles are removed which prohibit access to mental health treatment that the employer can actually see a reduction in disability claims or just productivity losses in general due to, you know, lessening these obstacles.

And then, you know, the bottom line really is that when people get treatment that they are able to be more productive employees, it's a cost-effective proposition for a company. And those are just a couple of other statistics that support that.

In terms of who we work with, we have a growing list of partners. And these are employers, employer organizations, and other interested stakeholders that we really check in with and connect with on a regular basis to make sure that the work that we do reflects their interest, their needs, and their priorities.

I'm just going to go quickly through some of the specific resources that the Partnership for Workplace Mental Health offers, the first of which is a free quarterly newsletter called Mental HealthWorks.

And what it does is it features what corporations are actually doing related to mental health.

So the idea with this publication is to, you know, identify positive examples of what companies are already doing, and tell the story from that corporate perspective in the hopes that other employers, other corporations, will share those best practices and introduce them at their own workplace.

The other thing that Mental HealthWorks does is we try to bring the latest research to employers, just, make it visible to them. And so we also frequently provide summaries of research that's related to workplace mental health.

We actually have a more recent issue of Mental HealthWorks which is accessible through our Web site. All of our materials are accessible through our Web site. So I would invite you to visit our site and download those materials as well as get signed up to start receiving all of our materials on a regular basis.

Other information that we offer to employers as I said before of information related to the business case for quality mental health, we have toolkits to help employers focus specifically on depression and anxiety because in particular those two illnesses are so prevalent in the workplace.

We also promote tools that help employers choose which health plans to actually contract with, with an eye towards looking at quality and not just cost.

And then finally we provide access to depression and costs, and alcohol cost calculators. These are free Web-based educational tools that allow an employer to determine how much either depression or alcohol is affecting their bottom line.

So it's a place for an employer, if you're trying to make the case with a specific company that they too should pay attention to mental health, these are excellent tools for doing so.

The employer can go online or you can go online for them, put in some specifics related to their demographics—their industry type, number of employees, location, et cetera.

And then it gives a little detailed report that says based on their specific population, here's what they're paying right now associated with depression, untreated depression.

And then it explains that if those folks suffering from depression received access to good care what the return on that investment would be. So again, it's part of this whole making the business case.

One of the most—one of the things that employers tell us is the most useful things that we do is providing examples of what companies are actually doing related to mental health.

So we've developed a Web database of these employer approaches to mental health. And we call this tool Employer Innovations Online.

And basically what it does is provide quick case examples of what companies are doing. And we allow anyone to access it. And you can actually search it based on a specific area that the employer might be interested in.

So, you know, there's a special focus for instance on what employee assistance programs are doing. Or maybe it's a specific mental health benefit design piece.

So the idea here is to serve employers with specific ideas for what to do, how to do it, and to hear those stories from other corporations.

I'm just going to take a look at one such example. This is a company named Highsmith which many of you have probably heard of. They've received a lot of great attention for the wonderful work that they've done.

Highsmith, if you're not familiar with them, they are rather small company in Wisconsin. They have about 300 employees. And they are a distributor of library furniture and supplies.

And one of the reasons—this story is not just about mental health. This story is actually about health in general.

And one of the reasons that they were motivated to do something in this space is that, this is actually in I think 1989, they experienced a really huge increase in their healthcare costs—a 53 percent increase in health insurance premiums, which is obviously a significant, significant amount.

So they really wanted to take a look at this health space because they were forced to.

And then the second thing that's actually not on this slide but another reason that they wanted to take a look in this area is that they recognized that as a relatively small employer in a rural area that it was really important for them to be able to attract and retain creative, productive, stellar employers—employees.

And so one of the things that they wanted to do was, you know, what could we be doing to focus on keeping the good employees that we have and becoming an employer that people want to work with?

So what they did is they really took a look at their entire culture, and they instituted a number of new programs. These programs make mental health implicit and explicit in the programs. So it's really infused throughout all of what they do.

And then what I think is perhaps the most important message is that they didn't let their size limit possibilities.

Sometimes you go to conferences and you hear about all the expensive investments that an employer has been able to make with not just mental health but physical health where they'll install a gym. They'll, you know, have stress management programs and lots of sophisticated stuff.

One of the points that the President of Highmark makes is—or, excuse me, Highsmith makes is that, you know, we did this in a way that suited our culture in a way that suited our size. So they didn't have money to build a gym.

So what they did was they developed some walking paths around the campus. They, you know, moved tables and chairs out of the way and did, you know, exercise programs in conference rooms.

So that's I think a really important message, that this isn't just about what big companies are doing, this is what all kinds of companies can do.

So I'm just going to talk a little bit here about some of the specific interventions that they looked at, one of which is really a comprehensive menu of health promotion and disease prevention activities and programs that included mental health screenings, domestic abuse outreach and education, and stress reduction and time management.

They had a wealth of other health promotion activities. I've just selected out the specifics that were related to, at least most directly, to mental health.

They also really took a look at learning and development and developed classes that really span job and career development, personal well-being, self-care, physical well-being, and work-life enrichment.

They also have an EAP that really spends a lot of extra attention looking at mental health issues with this very clear recognition that mental health is a part of all health and is also quite clearly connected to productivity.

And one of the things that this, I think is a really significant piece, in their orientation sessions for new employees they include a first aid kit for the mind. And so it includes a session about the signs of mental illnesses, stress, substance abuse, and tips for maintaining healthy fitness.

And what I like so much about this is that this is the message that the employees are getting, the new employees are getting very early into the job. So there's a culture that is really created by this from day one that, you know, that mental health is important and that physical health is important and that this is something that at Highsmith we talk about and we value.

So in some ways it's, part of it's the content of what they do in that first aid kit. But part of it is just that they do it and that they do it so early.

Other interventions from Highsmith include annual health screenings that include a meeting with an EAP counselor to talk about personal well-being and to learn more about the tools and the resources available to balance work and life.

And they also have an Internet section that links employees to quality health information on really a variety of topics including depression, anxiety, relationships, and domestic abuse.

In addition, they also have another section that's called Leader's Edge, which provides information specifically for managers.

And, you know, just to kind of overview quickly here some of their results. Despite really increased—increases in the health insurance premium trend that we've seen across the Nation, they have actually had quite moderate increases. And I know the slides says something from 2003, we've had some increased or some more recent numbers that look at basically an average of 5 percent, which is really quite reasonable given what the trends are overall.

They also have increased productivity, and, perhaps more valuable to them, they have extremely low turnover. This was one of their concerns back in ‘89 and ‘90 when they started this program was not just the high healthcare costs but also wanting to make sure that they were an employer of choice.

So their turnover rates are extremely low and in particular given their region.

And then lastly employee loyalty. We've heard that they had a real test. And we can certainly all appreciate this in today's economy, where they had to do a workforce reduction in 2002.

This is usually, you know, a demoralizing experience and certainly not a positive thing for a company to have to go through.

And about a month after, the EAP conducted a resiliency survey, which found that “faith and trust in management” remained solid even after that significant of a reduction. So that is really I think a telling, telling statement. And their average length of service is about 13 years.

So this is just one specific company that we have included in Employer Innovations Online just to give you a bit of a snapshot about the kind of story that we try to feature there.

So I look forward to being a part of the Q&A and a session and thanks for joining us today.

Michelle Hicks:Great. Thank you so much Clare.

Nicole, would you please proceed with your portion of the presentation?

Nicole Clevenger: Oh, thank you so much. Those were two hard acts to follow I have to say. I was just feverishly scribbling some things down myself for resources for some of the folks that I work with.

So I just want to thank the previous presenters for such excellent information. And I'm honored to be an—to have this opportunity to be a part of this.

I am a Consultant Trainer for the Ohio Supported Employment Coordinating Center of Excellence. We help agencies implement that model.

But I'm also a person who went back to work because of the evidence-based supported employment model. In fact, I am currently still receiving follow-along support from an employment specialist.

The—this job is a job that I obtained through participating in supported employment services.

So it's—this is a topic that is, you know, really close to my heart, because it has transformed not only my life but I've seen over and over again just so many examples of people whose lives were transformed by getting back to work but also accomplishing some of what the previous presenters were talking about, related to, you know, effective advocacies on one's own behalf for what accommodations you need to be successful and comfortable in a job but also effectively communicating with your employer, and really how to look at employers so that we can make informed choices and feel like we're in control and select companies that are going to be a good fit for us and maximize our potential for success.

So I just thought I'd start out with a—I would like to talk maybe just briefly about some of what my own experience was in that and then some themes that I see in other success stories.

And then I thought as I was approaching this, one thing that would have been helpful to me along the way was some strategies that I could've used to look at employers when I was looking for a job so that I could determine their position on mental health, if they were aware of it, if they—if it was something that they valued, and then just some strategies for interviews and once someone is working, whether they're doing that on their own or whether they're participating in service in the way that I did, I think, I was trying to think of the things that were important to anyone regardless of whether they were seeking employment independently or with the support of another person.

There we go. And so, you know, one of the things that sticks out to me in my story about getting back to work is that there was a time in my life before I received, you know, the diagnosis of bipolar, that people, my friends, my family, teachers, people I worked with, they would view me in a positive light.

And they sort of would talk about me, you know, and recognize the things that were unique about me. But it was never viewed negatively.

For instance, they would never say that I was overemotional. They would say things like, you're just sensitive or, you know, if I had a whole lot of ideas going on at one time people would say oh, you know, you're just creative.

And so it was never really viewed from an illness perspective. You know, I kind of grew up with this—well, this is just the way that you are. You're a sensitive person, you know, and that was just a part of my identity.

And then when I was a senior in college, having been depressed most of my life I had a manic phase for the first time in my life. And since I had been depressed for so long it initially felt like I was getting better.

And so it took things getting pretty out of control. I got pretty sick before I realized that there was a problem. And that's when I finally received the correct diagnosis of bipolar disorder. I also struggle with some OCD and other anxiety issues.

But, you know, that was a sort of a beginning of a shift in my life, where I started to, over time, begin to view myself and the way that I approached life and relationships and everything that I did really from this illness paradigm, where I attributed a lot of things to the illness.

I was focused a lot on, what does bipolar mean for me, how do I cope with it, what medication should I be taking, you know, making sure that I attended all of my various appointments with all the different service providers that I was working with, once I was trying to get sort of back on track.

And I really socialized into this role of the bipolar patient. And it started to become my identity.

And when I initially took this job it became really apparent to me that this was something that had become part of my identity because I would introduce myself even and say I'm bipolar.

And it's a very subtle thing but people were pointing it out to me as a CCOE that I was actually Nicole and I had bipolar disorder.

And it was the beginning of starting to view myself in a different light and really reconciling the person that I had become after my manic episode with the person that I started out to be, you know, when I went to college and had dreams for better things for myself.

There was a point in time where I had tried working part-time jobs, not selecting jobs that were a good fit for me and just kept repeating that over and over. And I got so discouraged that I decided to give up working.

And it wasn't until somebody sort of loaned me their hope that I could have something better for myself and my life that I was able to begin to think about recovery. That was a whole new concept for me.

And so I just started to develop goals because I started to just have the faith that I could do that.

And I used to believe that whenever would happen to me would determine the outcome in my life. And what I've learned through working and through my treatment, you know, and just everything, is that it's actually not the events that determine the outcome. It's the events plus the response that determines the outcome.

And for me truly employment has been the final piece of the puzzle.

Case management services and medication management and counseling are still very important and were very important in the beginning.

But getting back to work was really the thing that I feel has taken me the farthest in my recovery efforts especially as of late.

You know, people talk about recovery as if you're getting something back, like you've recovered something. But I can tell you from my personal experience that I've been able to achieve I think a level of resiliency and stability through employment that I'd never experienced before. So I think that sort of exceeds the definition of recovery.

So I'm really passionate about, you know, helping people get back to work. And I think sharing success stories is one of the most powerful things that we can do to begin to change not only our own attitudes about working because I think sometimes we stigmatize ourselves as much as other stigmatize us.

But we can begin to just change the larger societal culture about the role that people with mental illness play in society. And it—is recovery possible.

So I thought I would just highlight a couple of success stories real quickly of some individuals that I know of who kind of—their story illustrates some of the common themes that I hear about often when people share their success with me.

And David's story is one that I thought we would start out with because one thing that I always hear is that an important part for folks to be successful at work and in recovery in general is just that they have the hope and the faith that they can do it.

You know, just believing in one's self, believing in a higher power, believing in the support people they have around them, it's a different thing for every person. But there's some element of belief and a positive, sort of, suspension of disbelief if you will, in just kind of pushing forward.

And David's story is I just think is so illustrative of that because he is a person who had so many barriers. When I first met him, he was homeless. He was in the middle of a very nasty custody battle with his ex-wife over their son.

And he had a lot of goals. He wanted to go back to school to become a paralegal. And, you know, he wanted custody of his son.

And so he had a lot going on. And the thing that I thought just impressed me the most about David's story was that he had to do things like take the bus 1 hour each way just to get to the library so that he could go to class. And he didn't have anyone to watch his son, because when he had his son he would have to take him with him to study.

And he would take him on the bus, and he would do all of these things. And he just had this belief that he could rise above anything. And you could just see that he was willing to put aside his fears and just believe in the greater good and that, you know, if he pursued what he thought was right that it would work out. And it did.

I mean he—not only did he succeed at school and is a paralegal now, but, you know, he got custody of his son. And he's not only working but he's a single dad.

And I think—you know, for him it really started out with just that initial belief that, you know what, I can do this. And I think that's common in everyone's stories.

Another thing that I hear often when I talk to people who've been successful and I say, you know, what do you think about that, one thing that sticks out is that they say informed choices make a big difference.

People obtained good factual information. They wrote their questions down. They, if they had benefits, you know, food stamp benefits or Social Security benefits—whatever –medical benefits—any kind of benefits like that they got a professional consultation around that so that they could make informed choices about what they were doing.

And Harvey's story I think is one that sort of illustrates that because, you know, he was able to go back to work. And his initial fear that he admits was keeping him from trying to go back to work was that he was afraid he'd lose his Social Security benefits.

And he, you know, met with a professional benefits consultant and basically just sat down and did the math. And he realized that he would lose a little bit of money in his Social Security check but that at the bottom line he was actually earning more than he was losing. And so it relieved his anxiety and he was able to get back to work.

And he made even, you know, informed choices about what he wanted to do when it was time for him to get a promotion because then he did the same thing again and got good information and was able to sort of negotiate how much more he was able to accept in his pay raise so that he wouldn't compromise the parts of his benefits that he was trying to maintain.

And of course—all of these stories by the way, are in a booklet that I will mention later on in here as a resource. If you'd like to review them they're on our Web site.

But . . . another thing that sticks out among most of the folks that I talked to is that they have that support network. Healthy relationships are key to, you know, success at work I think for folks, especially dealing with a mental health issue at the same time.

I know for me that's been the saving grace is the employment specialists that I work with and really having a supportive supervisor and a mentor at my current position like we heard mentioned in the previous presentations that those are things that I absolutely believe in.

Because one of the folks that I work with I think put it the best when he said, the difference between mental illness and mental wellness is to change the “I” to a “we.” And I thought that was kind of neat.

And I—Judy's story was one that I thought I might share with you just real quickly because it's unique story in that Judy is a person who was very, very sick. She was hospitalized every year for 8 years and had never really lived alone when I met her.

And her sister, Joyce, is a team leader for a supportive employment program in town. And so she, you know, had her sister's support right off the bat because her sister really believed in the value of work for folks in recovery.

And, you know, the cool thing for them though is that as a family member Joyce was getting a little bit burned out from trying to help Judy all the time. And even though she really believed that she—that her sister could work she was ambivalent about it at the same time because she knew that she would require extra support.

And so they went ahead and she decided to enroll in supportive employment services at the agency. And that's what made the difference for them because then the focus was off of Joyce. And then Judy had more folks to include in her safety net of supports that were there for her on a job. They were there for her in crisis if she needed it.

And so Joyce was able to just really relax and enjoy her sister's transformation that sort of came over her after she started working.

She—they're now working out together on a regular basis. I just talked to her the other day. You know, and Judy is now living on her in her own apartment for the first time in her life. And they're planning a vacation together.

And it's just really exciting, you know, to see that, because there was a time in their life when Judy was so overmedicated that she sort of was paralyzed if you will, didn't have a lot of energy, just kind of sat around, couldn't even interact well with her sister.

And, you know, now they sort of feel like they're sisters again and they have each other back and they can enjoy each other.

And that's just one of my favorite stories. But I think it definitely illustrates how the support network, you know, even outside of your immediate natural supports can be very helpful.

And other healthy relationships on the job, I know that Judy's boss is also extremely supportive and does a lot of just real minor things to support Judy that again, like we heard earlier, are not anything that they would do differently for anyone else, don't cost a lot of money, but that relationship she has with her boss and the willingness that her boss has to do that for her is so important.

And then positive attitude of course is critical. People sort of—that's—I hesitate sometimes to talk about that because it seems almost like you're saying to somebody who's depressed, cheer up. Or if you just, you know, if you think you can, you can do it.

And it's really not that simple. It's more when I say positive attitude I'm really referring more to the idea that somebody makes a conscious decision to think positively when faced with adversity.

Folks that I meet, especially Mike, made this decision at one point that he couldn't make his illness go away—the symptoms weren't going to completely disappear—but that he could kind of work around them.

And, you know, he consistently looked to past experiences of times when he was able to do something difficult and overcome something that was challenging. And just, he just kept really reinforcing that for himself that, you know, he was going to choose to use his mind to reframe the way he was thinking about something.

And one of his favorite quotes was one of the quotes from, I think it's Albert Einstein, that says, you know, we can't solve a problem with the same thinking that created it. And that was Mike's philosophy too.

And, you know, so he just—it was a deliberate sort of act to remain positive whenever he would come up against a barrier. And that's something that I hear quite often.

And then of course closely linked to positive attitude is just that persistence to keep going.

One of the stories that a lot of our staff members like to use is a story about a gentleman named Anthony, who had so much anxiety that he couldn't get off of the bus when he was trying to get to work in the morning.

And so every time he would get a job he would just ride the bus. And then when it was his stop he wouldn't be able to get off.

So he would just keep riding the bus until it got back to his home or wherever he knew to get off. And he would just get off the bus.

And so then they decided well we're going to have to—he was working with an employment specialist at the time. And they decided, well, why don't we maybe look for jobs where you can walk there since the bus is really so anxiety provoking?

And so they looked for jobs then that were in walking distance. And they found one. And then that job had a situation where the supervisor was apparently a very attractive female to Tony. And it was so distracting to him that he was unable to work.

And they tried a couple of things to do some accommodations to see if they could work around it. But it was a really small company and there weren't a lot of other folks that could supervise him.

And so they made the decision to look for a job that was within walking distance and didn't have a supervisor that was going to be like standing over top of him all the time so that that wouldn't become an issue.

And so they kept looking. And they went through probably six or seven jobs until they found the one that really fit for Anthony.

And he—since the last time I've checked—has been working there for 4 years now. But I think that would have been really easy not only for Tony to give up and kind of just say you know what, this is too hard.

I think when we have a negative experience, you know, especially if there's more than one it's so easy to just say this isn't working out. You know, apparently I can't do it. That's what I did.

But he kind of kept going. And I think part of what kept him going was that the service providers didn't give up on him either.

You know, one of the things that I heard from family members was, well you're not serious about keeping a job, because I had some challenges with keeping jobs.

And, you know, it's not that folks aren't serious about it, it's that they need the support. And sometimes it's also that they need to really, really find that job that's a match for them.

And so I thought that story's just a great illustration of how not only Tony but the team that was supporting him were persistent in helping him achieve his goals.

And so some of the things that I was—that I wished I would've known to look for in some of the jobs that I chose as far as assessing employers to see what their perspective is on mental wellness, and I thought I'd bullet out just some of the things that you can look at regardless of what your position is on disclosure.

So these are things that you can kind of look at to evaluate the employer whether or not you are ready to talk about accommodations or any kind of level of disclosure. This is something that can be done regardless.

So one of the areas of course that you would want to look at is the insurance. And if there's a way to tell—and most of this stuff is online—just looking to see if mental and physical wellness are equal.

One way you can kind of gauge that is to look at the number of yearly outpatient mental health visits. If they give you three per year, you know, you kind of know that that's not something that's highly valued because they didn't include that in their plan selection.

And also just looking at the percentages that are covered.

And then the prescription coverage and the available plans is important too for lots of folks.

Another thing to look at is other wellness programs. You know, if the company has substance abuse screening and available treatment programs for employees or smoking cessation supports, those kinds of wellness programs suggest that the employer values wellness in general.

And I think that's key to being able to make the case for mental wellness to be included in that if you, you know, need to discuss any sort of issues or accommodations with your employer.

And then even other employee supports like if there's child care onsite or other employee assistance program programs I think it can be important to look at.

If a company has none of these things, you know, I would be concerned. It's not that I would say that a company would need to have all of these things, but these are just some of the things that you could look at as potential indicators for potential success in that environment.

And then before the interview, you know, one thing that I'm a real big advocate of is the informational interview. I like that because you can kind of look around. You're not on the spot if you will.

And you can, you know, see the employees that are in the area. Is there diversity among the employees that you see there? You can assess the environment for any potential accommodations.

You know, sometimes when I've done an informational interview I have noticed that a job is like one of three things. A, it's not a good fit and I just know that and so I don't pursue it any further. B, I noticed something that I would need a potential accommodation for.

One thing that I struggle with is the whole concentration issue. I get easily distracted. And so I currently work part time from home to manage that. But in other environments I would use some headphones and some other things to try to block out noises in a cubicle sort of setup.

And so, you—in an informational interview you could sort of see where you might need an accommodation and you could decide whether or not that was something that you would want to discuss with your employer.

Or the third thing that sometimes would happen is I would see the environment, look around, talk with the folks there, and just really feel like there wasn't any need for any special accommodations, that the job as it was, the duties, the facility, you know, was conducive to what I needed.

And so then disclosure was sort of a non-issue because I didn't need any specific accommodations.

Michelle Hicks: Excuse me Nicole. We have about 3 minutes to wrap up your portion.

Nicole Clevenger: Sure. Thank you very much. And so one of the ways that you could do this is through calling the HR Department and ask if the benefits consultant there includes mental health benefits. Flexible scheduling policies again really helpful, visiting the Web site, reading existing literature.

And then if you're working with employment specialist I think before the interview it's a good idea to discuss disclosure, who's going to do it, why specifically, and what's going to be said.

So during the interview I think it's just important for people to remember that they have equal power and to ask questions.

I often felt very grateful to have an opportunity. And so I would just go into an interview sort of feeling like well I should be grateful for any job and forgot that I need to also ask questions of the employer to see if they're a good match for me just as much as they're trying to find out if I'm a good match for them.

Just ask outright what their needs and hiring challenges are and really then you can tailor your responses to what you need to address based on what their needs are. And be prepared to answer tough questions.

Now this won't apply for everyone. But for some folks if they bring up the accommodation or they make mention of anything, somebody may say something like, what's wrong with you or something like that.

And so if you can practice a way to handle those kinds of questions that respects your privacy and, you know, your dignity so that, you—but you also can sort of satisfy what they're saying and sidestep that question a little bit because it's sort of inappropriate.

And also knowing which questions are kind of illegal and what some potential responses are.

I know as a single mother, not even as a person with mental illness but just as a single mother, one of the things that comes up a lot in interviews is sort of this idea of are you married, is, you know, do you have a husband?

And I get the feeling that people are trying to determine whether or not I'm a single parent. And that is irrelevant for most things.

And so one of the ways that I've dealt with that is just to say, you know, my family is very supportive of my work. And—or, the other thing is that you can just say, you know, if you can explain to me exactly how that's relevant to the job duties, I'd be happy to answer that. And that will often take care of it. It's kind of an interview killer, but it's a way to gracefully sort of get around some of those illegal questions.

You know, establishing common ground with the employer I think is just basic good practice for any person. Accenting the value of the employer of hiring you versus somebody else and reducing their perception of the risk of hiring you.

You know, so just really selling yourself as far as, other than your skills, what other things are you bringing to the table, your enthusiasm, your commitment to the job, you know, your work ethic—those kinds of things.

And being able to explain gaps in your work history I think is really important. One of the things that I've heard over and over again from employers is just that they would like to know what was going on.

And one of the things that you can say if you weren't doing any side jobs or odd jobs or anything during that time is just to say that you had to take some time off to take care of an illness in the family if your gaps in work history are related to your mental illness. And that satisfies most people.

And then I just have a couple of slides here about what you can sort of do to be successful at the job. And so some of the stuff I think that was covered previously so I guess I don't need to go into detail.

But I just wanted to really reinforce the idea of, even if the employer's not giving you that extra feedback, be assertive about asking for it. And it's your right to, you know, ask questions until you understand things.

One of the things I really love is WRAP planning for work and just having that plan in place for what you're going to do if things start to slip.

Most employers will go really far in helping a good employee keep their job and just keeping your perspective. You know, it's not all mental illness. There are other things that will impact your work, you know, family issues, physical issues.

And some anxiety and depression is normal based on whatever circumstances are happening in your life. And so just trying to remember that, you know, everything that you face isn't related to your mental illness I think will help others around you do the same.

And so, you know, finally, just don't be afraid to transition from a job that's not a good fit into one that is. And I have a couple resources here for more information.

And then if you go to our Web site, those success stories that I was telling you about earlier are in that work recovery booklet that's located in the center.

And then this, off to the left this audio CD resource if you're interested, it contains a little bit more information about my personal back-to-work story. So and there's some more stuff on there as well. We have e-news and stuff like that. So . . .

Michelle Hicks: Great. Thank you so much Nicole.

Nicole Clevenger: Thank you.

Michelle Hicks: That concludes the presentation portion of our session. And I want to thank each of the presenters again for sharing your knowledge, expertise, and personal experiences with us today.

If you're interested in following up with the presenters in the future, please see slide number 8 or contact the ADS Center for their contact information.

We will now open the call for questions from the participants. As a reminder of the instructions you may refer to slide number 4. And please dial star 1 on your telephone keypad to be placed in the queue.

And we have a number of questions that have been submitted online. And I know that we have a number of questions in the queue. So we'll try to get to everyone and we'll try to get as many questions answered as possible.

If we're not able to answer your question today on the call, we will send questions to the presenters. And we will also provide information through the ADS Center.

So operator, we'll take our first online call.

Coordinator: Absolutely. Our first questions going to come from Dr. (Gina).1 Your line is open.

Dr. (Gina): Hello. I have a question for Clare. That was a very excellent presentation. I enjoyed all the presentations.

My question is, how much have you seen coaching, wellness coaching play a role in employee—in your employer satisfaction?

Clare Miller: That's a great question. I think that, you know, every employer handles that piece differently.

And, you know, I think the most common that at least my perspective, my experience would share, is that sometimes this is handled through the health plan.

And in those cases I see health coaches, wellness coaches, those people can also play a very crucial role in terms of helping to navigate our fragmented healthcare system.

And it's an excellent tool in particular for bridging the unfortunate disconnect that often exists in mental and physical health care.

So I think coaching is a key role. It's another important thing that an employer can make sure to invest in.

I think that we could see—it's an area where we could definitely use some growth in terms of more employers and more employees and their families having access to that kind of a role because it does seem to have very good results when it is used.

Michelle Hicks: Great. Thank you. I have a question that's come in over the email. It's—there's an apology first for the long question. I'm going to try to shorten it a little bit.

I'm interested in taking the accommodation conversation to perhaps the next level. Research tells us that the number one reason individuals with psychiatric disabilities lose their jobs is due to issues related with interpersonal difficulties.

These situations oftentimes involve a behavior that the individual learned in order to survive the circumstances of their life.

And while these individuals may bring many talents to the workplace, there is the probability that during a difficult situation these behaviors may come out.

If we are really going to help folks stay employed, don't we need to talk about allowing individuals the opportunities and chances to learn new ways? Do you see this in the category of reasonable accommodations? And if not, where does it fit into the conversation?

Dr. Beth Loy: This is Beth. I could probably at least try to address that question. Then if my co-presenters wanted to add in anything that would be great too.

I think in these types of situations you have behaviors on the workplace that are appropriate behaviors and then you have a list of behaviors that are inappropriate.

And I think maybe if you know there's certain behaviors that are going to come out in a work situation, either a stressful situation or a meeting situation, maybe just having a—a coach or your supervisor who you can talk with beforehand and say, you know, this might happen in this meeting.

Maybe I could just take a break and leave or walk around the building or maybe not attend or attend via speaker phone or attend in a different way.

So maybe, I guess, I've seen so many different situations with behaviors in the workplace that it's kind of hard answer this question without having a specific example.

Maybe if you know those behaviors that you're dealing with and that have been your coping behaviors, if you could talk with your supervisor about those and maybe come up with strategies on how not to get in those types of situations. Sometimes that's the best avenue—not always but sometimes.

But there's still going to be those certain set of behaviors on the job where those are inappropriate behaviors. And I think training all employees on those really is what we found to be the most effective way to resolve those.

I don't know if my co-presenters have any advice on that one.

Clare Miller: I guess—this is Clare—I guess the thing that occurs to me is that this is so not—it doesn't only relate to people with mental illnesses when we think about, you know, problems at work, this is a common in issue of interpersonal conflicts, et cetera. That's often why people leave jobs or often why there is difficulty with productivity on the job.

So I think that, you know, I would take a step back and say, you know, this is an issue that relates to all employees regardless of whether or not they have a mental illness or not and that a lot of it does come back to communication.

I'm thinking about a—and just even having a conversation about what some of the problems are, having conversations about what the expectations of the job from the employee and the supervisor are, making sure that deadlines are clear. Just having that communication can actually alleviate some of these problems before they get worse.

I was thinking about a very large company that I know of that does training for managers of call centers. And there was a major problem of, you know, people have these calls from very angry customers.

And it's a very difficult job where you're basically having the keep your cool with, in the face of incredible pressure to have high productivity, to be nice to the caller no matter what they say to you, et cetera.

And so in this training with supervisors, the EAP was used to help explain to supervisors what this means for an individual, not an individual with a mental illness per se, but just a human.

And one of the very basic solutions that was identified is when someone has a really difficult call that they be allowed to step away from their desk for 5 minutes and take a—breathe, take a breath, get a cup of coffee, and then come back.

And at first there was incredible push back, well we can't do that because our numbers won't be met, et cetera.

But through communication and helping the manager understand what this experience is really like for his employees, they were able to come up with a solution.

So those are my kind of initial gut reactions, thoughts.

Michelle Hicks: Great. Thank you. Operator we'll take a call, question that's on the phone.

Coordinator: Absolutely. Our next question will come from (Amy). Your line is open.

Michelle Hicks: (Amy)?

Coordinator: (Amy) is your mute key on?

Michelle Hicks: Okay if we could move to the next one please?

Coordinator: Absolutely. Our next question will come from (Joanne). Your line is open.

(Joanne): Hello. My question is, you talked a lot about the employee, what the supervisor could do for the employee. What can the employee do for the supervisor that has that problem? How could the employee offer to be any kind of support?

Dr. Beth Loy: Well, this is Beth. And I can address this from the advice that I give to employees. And I think it is, you know, most of the time we get the call where the employee is in a situation where either the employee doesn't want to disclose or the employee is in a heightened anxiety type situation.

And what we do is try to talk to the employee about being honest with the supervisor and in those types of situations really letting the supervisor know, hey, I'm a good employee. Here are the good things that I can do. Here's how I can be a productive member of this workforce.

But this is the type of situation where I need some type of change or I need to interact in a different way. So focusing on the things that the employee can bring to the workplace a lot of times helps support that supervisor in making decisions and in having confidence in that employee.

I don't know if my co-presenters want to add anything to that.

Clare Miller: I think that's great. I don't have anything to add.

Nicole Clevenger: Yes.

Michelle Hicks: Great. Thank you. Operator, next question please?

Coordinator: Your next question will come from (Rhonda). Your line is open.

(Rhonda): Yes hi. This is for the JAN presenter, the first presenter. You mentioned that one of the strategies you mentioned was changing employees' break schedules.

I was wondering if there is any FLSA implications to changing around break schedules especially for people who are nonexempt?

Dr. Beth Loy: But it doesn't have to be additional paid break leave time. That's really about the extent of what we get into related to FLSA. And then usually we take that question and refer it on to DOL.

As far as the break time it doesn't have to be additional paid leave.

Michelle Hicks: Great. Thank you. We have a question that came in over the Internet. And it's for Nicole.

Nicole, the question is, what do you think of encouraging the use of 12-step programs as a support particularly Al-Anon as an affordable and effective way of dealing with life issues surrounding illness?

Nicole Clevenger: Well, you know what, I am just a big advocate of, you know, especially if substance use is an issue that impacts either you or someone that you're close to, involving as many supports as you can, around your work efforts in particular, I think is going to benefit you in the long run.

Because work seems to be the things that's the common denominator for everybody. And everybody talks about working.

And so that could be an excellent, excellent place to identify other folks who are dealing with issues that are—that could potentially impact them on the job and are struggling with similar issues like you are and have found, you know, coping skills and strategies that work for them.

So, you know, I just even for myself, I try to diversify the support network that I have. And if you have connections with someone at an Al-Anon or 12-step program already, absolutely pull them in if they're willing to be part of your support team for work. I would encourage that.

Michelle Hicks: Great, thank you. Operator, we'll take a question from the phone.

Coordinator: Your next question will come from (Frieda). Your line is open.

(Frieda): Hi. This is inspired by the last speaker. My familiarity with State vocational rehab programs is that once you find a job you're somewhat on your own especially if it's a job you found yourself. And I was intrigued that there is support for job-keeping.

In terms of how things are across the country, how many States actively help people once they've found employment, maybe employment they've found on their own, to help them stay in the job versus those that might close a case because the person now has a job? And how do people get help to keep a job?

Nicole Clevenger: Well, typically in Ohio the way it works is through our vocational rehabilitation system, people can receive follow-along services for up to 90 days once they're employed.

But the folks that are receiving employment services through an evidence-based practice supported employment site, they are—they have access to what we call continuous or time-unlimited follow-along services.

I personally get follow-along support. It's been 3 years now since I entered the program. And that is typically funded through mental health board dollars, Ticket to Work moneys, and some other—some private grants and stuff sometimes.

But, so that's what I know of in Ohio. And in other States I know of course that have evidence-based supported employment programs that the continuous follow-on is just a piece of the model. And so that would be automatically offered to anybody that was participating in those services.

And to the best of my knowledge we have two, four, six, eight, we have 10 States that are currently implementing evidence-based practice supported employment across the country unless anyone knows otherwise. I think it's Connecticut; Washington, DC; Illinois; Kansas; Maryland; Minnesota; Ohio; Oregon; South Carolina; and Vermont.

Michelle Hicks: Great. Thank you very much. There is a question from the Internet. And it's directed to Clare. And other presenters can answer as well.

Screening employees for mental illnesses coupled with encouraging employers to assess the costs of untreated mental illnesses in their employees who have screened positive for specific illnesses seems to invite rather than prevent discrimination by falsely leading employers to see their staff as liabilities if those staff do not seek and receive conventional mental health services usually construed as medication compliance.

The resulting atmosphere of privacy loss, change, fear, and coercion is a recipe for discrimination.

Client survival organizations and allies have criticized this type of policy for these reasons. Of course, self-care and wellness are vitally important to all employees' success. And employees should consider costs of various employee issues.

But depression and anxiety are not one-size-fits-all experiences. And no cookie-cutter formula can accurately predict an individual's performance potential.

JAN's recommendations for reasonable accommodations and an open-door policy are much more likely to reduce workplace discrimination.

What other practices might be better to equip employers to support employees with mental health issues as individuals rather than statistical liabilities?

Clare Miller: Thank you so much. Okay first I would like to just thank the person who posed the question.

I do a lot of presentations and I typically do them with businesses. And my point is always, people with mental illnesses—I myself have a mental illness—we are not different than anyone else.

We all, you know, have our good sides and our bad sides and make the point with businesses that right now, today, whether they realize it or not—and they generally speaking do—they do have people on staff and on under their health insurance who do suffer from mental illnesses.

And so the point that we are trying to make is that it helps the business just as it helps the employee to be able to access services and in particular access services within the medical system.

And the reason that we take it from that standpoint is that unfortunately because of the way our health care is financed in the United States, many people do rely upon their employers for access to mental health insurance.

So let me just clarify that when I say screening, what I mean is not at all for an HR person, for instance, to be doing the screening of someone, of an employee to determine whether or not they have a mental illness. It is not that at all.

This is with all of the appropriate safeguards in place so that this is done through the healthcare system.

One of the things that we try to get employers to work with their health plans to make sure happens is that when employee goes to their family practice doctor because of asthma that they get screened there for depression and anxiety. We know that these are illnesses that very frequently co-occur.

And so the point is not to provide screening as a way to stigmatize people. It's quite to the contrary. It's all within the protected healthcare system in terms of confidentiality and about making sure that employees, when they do ask for help through the traditional healthcare system, are able to get that care covered through health insurance.

So I hope that that is clear, that that is the standpoint from which we're speaking.

Michelle Hicks: Great. Thank you. Operator, we'll take another question please.

Coordinator: Our next question will come from (Helen). Your line is open.

(Helen): Thank you. I just wanted to add my experience with undetected vision problems. And there, you know, there are this convergence insufficiency. It might be as many as 8 percent of the population that‘s going around with undetected untreated vision problems.

And our optometrists are generally not able to detect it because they don't have the training, there are developmental optometrists available if you know about them.

I went for decades without knowing about vision therapy or that my optometrists were wrong. And when they said there was nothing wrong with my vision, it causes enormous stress on the job, and it can lead to real difficult depression problems.

And it's a problem in most all States. There's only about three States now that are requiring better screening for children.

And so we're letting loose oh maybe 30 percent of the population or 20 percent of the population who have vision problems which could be corrected if they were detected if they found the right therapy. So I just wanted to add that to the mix. I think it's huge.

Michelle Hicks: Thank you. And operator I believe we have time for one more question. And I apologize for those of you who are still in the queue both on the phone and online.

I encourage you if your question has not been answered, you may send those questions to us here at the ADS Center or you may look at slide number 8 for the contact information for the presenters. And they are willing to respond to you as well.

Thank you. Last question operator?

Coordinator: Our last question will come from (Margie). Your line is open.

(Margie)Hello and thank you. My question is, what strategies can you recommend for individuals who have experienced long-term hospitalization in State hospitals and have a very limited or no work history? How can we help get those folks to work?

Michelle Hicks: Would one of the presenters like to tackle that?

Clare Miller: This is Clare. This is really not my area. But I'm thinking that supported employment would be ...

Nicole Clevenger: Yes.

Clare Miller: ... probably the first avenue to think about. I don't know. Do other presenters have thoughts on this?

Nicole Clevenger: That was my—hello, this is Nicole. That was my initial thought. Oftentimes in supported employment services folks are there for that very are reason because they don't have a lot of work history.

And, you know, employment specialists are highly trained at helping folks identify skills that they have anyway, you know, through other things that they've done through—in their lives so that they can begin to identify what they—an area that might fit with them as far as selecting a job.

And, you know, there are strategies that the employment specialist can use to sort of help you get your foot in the door.

Because employers sometimes feel a little bit extra security having the employment specialist there because they feel like somebody that's working with an employment specialist has that extra support network. The job coach is available if needed onsite and at the initial training period.

So, you know, all I can say is that the research shows that the only predictor for employment success is the desire to have a job. And prior work history doesn't seem to have an impact on outcomes.

So, you know, it seems from the research that that particular approach to employment services helps people regardless of whether they have experience or not.

Michelle Hicks: Great. Thank you so much. And again, thank you to all the presenters and all the participants for today. This does conclude our training.

If you missed all or part of today's call, please access our Web site at for the playback instructions and downloadable materials.2

Thank you for your interest and participation. And again, I encourage you to participate in the anonymous survey when you do receive it. Goodbye.

1At and after this point in the transcription, parentheses are used around the names of people who asked questions because the spellings may not be correct (they are audible in the teleconference recording, but how the person spells his or her name isn't known).

2Please note that you no longer need playback instructions, as audio is now available at the ADS Center Web site.