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Tag: anxiety

  • Post #4

    Navigating the Field of Social Work with a Mental Illness

                   Many social workers and other helping professionals begin their career to help people with the life challenges that have afflicted people they know or themselves. It makes sense: people may want to give back or “pay it forward” as a way of expressing their appreciation for the support they have stumbled upon. Helping those who struggle with issues that you may have faced can also be empowering, in that you are not only managing your own mind and body, but you are proving to yourself that you are strong and resilient enough to help others. These are noble intentions. They are also often quite different and simpler than the realities of being a social worker or other helping professional.

                   Having experience with navigating mental illness and working in a position to help others do the same is a double-edged sword. On the one hand, knowing and having had the experience of mental health issues can help us relate to our clients or patients in an invaluable way. For example, consider the pertinent therapeutic task of rapport-building: to build trust with those we serve, it helps if they believe that we “walk the walk” also. However, when the worker has experienced similar realities to the client (or at least have this perception), there is a significant risk for countertransference and burnout, especially if firm, healthy boundaries are not maintained. This is a crucial point to consider, especially for new professionals entering the field.

    Social work is a field with a great variety of settings for employment, from the acuity of an inpatient psychiatric unit, to outpatient therapy, to ensuring the welfare of people across the developmental lifespan, from birth until death, and many more. There can be a high risk for countertransference and burnout in any of these positions. (I have experience though mostly in behavioral health treatment/therapy settings, where workers directly discuss sensitive mental health issues with clients/patients.) Social workers often enter into these complicated and stressful dynamics with upstanding moral intentions. in my experience, those who can endure are highly likely to have healthy boundaries in professional relationships, in that they maintain psychological and emotional distance from those they are serving, even in the context of vulnerable and serious work. I have also noticed that when a worker has rather porous boundaries, in that they may be reluctant to stand up for and protect themselves psychologically, there seems to be a higher risk of deterioration professional and/or personally. This perception/pattern is not usually evident from a small sample size of professional interactions, but rather may take place gradually, as the worker with porous boundaries invests so much of themselves in their work and patients, yet saves little time, energy, and compassion for themselves. You can consult the research and data for the more objective picture of burnout among healthcare professionals, and you will likely find ample evidence of the phenomenon of burnout in recent years.

    As someone who has struggled with symptoms of several mental health disorders, I also want to note that even if you maintain healthy boundaries, you may still be very susceptible to burnout due to mental illness traits. This connection (mental illness contributing to burnout) can look very different depending on the person, their demographic factors, where they have worked, and their particular diagnoses. A worker who has a depressive disorder and is employed in a setting with a high caseload of clients may burn out due to the sheer time and energy required by the job that saps the worker’s internal resources over time. A worker with an anxiety disorder may work diligently and seemingly without great difficulty on site. But outside of work, they worry excessively about their performance or perhaps “take work home with them” and spend too much time ruminating on particular clients (this countertransference can also be detected during work/sessions, and is pertinent to explore, ideally with a clinical supervisor). As a worker with mental illness, you have to be especially strategic and intentional about how to utilize your finite internal resources, for your clients’ sake and for yours. This care might look like having a firm boundary related to yours hours or caseload, or perhaps requesting to work with or not work with certain patient populations. This attention is especially crucial when you notice that your mental health and/or work performance is dipping even a small amount; then it is time to look at the big picture and be honest with yourself about what you can do differently in your personal and professional life to ensure long-term health and growth.

                   By no means am I trying to discourage those mental illness from entering a helping field like social work; we absolutely need this perspective in working with individuals, organizations, and society/policy to work with and on behalf of our clients. My aim with this post was to first validate the intentions of new social workers, and centrally to foster some reflection into what may lie ahead in your work journey, and what you ought to consider and possibly do to promote your professional and even personal sustainability. There is certainly a spectrum with how visible or open a worker is about their personal life and struggles, and it is okay to differ from colleagues on when and how much to disclose. And it can be especially difficult early in one’s career to assess how one’s mental health is being affected by professional life. But prioritizing one’s own health and honest consideration of one’s own trajectory with respect to mental health is a MUST for anyone in this field, in order to sustain yourself, the workforce, and those we serve.

  • Post

    Barriers to Employment for Young Adults with Mental Illness

                Statistics about rates of employment can be misleading. A simple google search would probably yield an “unemployment rate” for young adults in the U.S. to be 9 or 10%; this figure is a good bit higher than the rate for all Americans of around 4%. However, it is important to remember that this figure only include those people who are “actively seeking work”. The “economically inactive” rate, measuring the percentage of people not actively seeking work, for Americans was about 30% in 2024. And this rate for Americans with disabilities? Around 75%. Of course, many of those encompassed in this rate are in the geriatric population, but it is estimated that approximately one quarter of this population is under age 35. Another way to look at this issue is that young adults (ages 16-34) with disabilities are almost 5 times more likely than their peers to be economically inactive. So, clearly there are significant disparities, but what factors and considerations are behind these numbers? In this post, we take a deeper dive into the barriers for young adults with disabilities, particularly due to mental illness, to gain and maintain employment.

                For those who struggle with mood disorders, like depression and anxiety, which are often cyclical in nature and not necessarily chronic, there are ample barriers to maintaining employment. Some hallmark symptoms of depression, like low level of mood or energy, feeling fairly hopeless, helpless, or worthless, and disruptions to physical health (sleep, diet, physical activity), can make it very difficult to consistently meet expectations at work, as well as limit an optimistic outlook that can help one to persist through challenges. Anxiety symptoms, whether cognitive ones (i.e. racing thoughts, ruminating, intrusive thoughts) or more physiological ones (i.e. heart racing, tightness in body parts, GI distress) also can significantly limit productivity and distort our interpretation of our own performance, often for the worse. In addition, those with mood disorders may spend much of their willpower, bandwidth, and internal resources managing their limitations, leaving less to give to professional life. In the short term, these trends may lead to missing deadlines or producing unsatisfactory results. In the long term, burnout and unemployment are prevalent. The logic of this paragraph has pertained to those already employed; for those not economically active, it is possible that many of these trends underlie the more apparent barriers that would be more evident in one’s lifestyle choices (level of activity and connection, maintaining of physical health, etc.).

                For those with more chronic conditions and/or neurodivergent ways of being, like ADHD or OCD, different factors are relevant to difficulty maintaining employment. In addition to difficulty maintaining concentration in ADHD, an important deficit lies in one’s executive functioning skills, which are critical in helping us stay organized, plan, control our emotions/states, and follow-through with tasks. Problems in these areas over time can interfere significantly in sustaining work. Persons with symptoms of OCD experience significant impairment in their functioning, regardless of how apparent their obsessions and compulsions are to others. The energy and time consumed by the irrational distractions characteristic of OCD are also significant impediments to maintaining employment. 

                Examining this trend from a cognitive-behavioral perspective is helpful to illuminate the cause-and-effect of various components of the difficult experience of staying employed. That is, our thoughts, feelings, and behaviors are connected, in response to events or situations. Something happens at work or in our life, and it affects our cognitive and emotional state, which then again can affect our actions. For example, we may receive some explicit feedback (being told that you are not meeting expectations) or implicit feedback (describing standards that others are meeting to a greater extent than you do). This would be likely to somewhat negatively impact our sense of competence; and for those who struggle with anxiety, depression, or other mental illness, we are more likely to distort the objective reality of one piece of feedback to hold greater significance, thinking that, for example, “I am a total failure”. This sort of irrational conclusion may lead to uncomfortable emotions, like sadness, worry, or shame, which could then be a further detriment to our likelihood to put forth a solid effort. In other words, because individuals with mental illness symptoms are more likely to struggle with rational thinking and may tend to distort reality, the deleterious effects of an unfortunate event can be amplified. And when this trend becomes a pattern and happens more regularly, it can exacerbate symptoms and result in an untenable employment status.

                To paint a more concrete picture of how the conglomeration of these factors can make maintaining work profoundly difficult, I will share a few of my challenges/barriers. Initially, I have a variety of symptoms of mental illness, including of depression, anxiety, and OCD. And depending on one’s level of stress, these symptoms can be exacerbated. In the recent past, my son experienced a medical problem, which resulted in a significant sleep deficit, exacerbating my already vulnerable system due to treatment in the past for a brain tumor. Another change occurred around this time, in my medications prescribed by my psychiatrist, which contributed to the storm of worsened symptoms. Outside of my mental health, for a variety of reasons, both external and internal, my employment at this time was becoming less of a source of fulfillment and contribution and more of a labor and stressor. MY performance was suffering, negatively impacting my confidence and self-esteem, as well as struggles with cognition for medical reasons, which likely all negatively impacted my work with clients. This cycle seemed to be a downward spiral, until I was no longer employed. You can see how a combination of biological, psychological, and social/environmental factors contributed to my decline. Millions of other young adults with mental illness struggle to enter or maintain employment due to a combination of predispositions/symptoms and stressors, like or unlike mine.

                So, given these considerations, where can you individually and we as a society, go from here? In my next post, I will explore strategies and solutions to address these barriers. It is also worth acknowledging that not all readers will share the same goal related to employment; for some, now might not be a realistic time to seek employment. But regardless of your situation, I believe it is worth more fully considering factors making it difficult to maintain employment, and then depending on your personal goals, exploring relevant strategies to help you reach your goals.