Back to Work with Bipolar Disorder

[David Baxter PhD]

Back to Work with Bipolar Disorder: Part I
by Candida Fink MD
September 19, 2008

Many people with bipolar disorder are able to successfully return to work once they’re on an effective treatment regimen, which typically includes one or more medications. In Bipolar Disorder For Dummies, however, we recommend that you avoid stressors and mood triggers – and returning to work, especially a demanding job, can be loaded with stressors and triggers. In this post, we offer some suggestions on how to ease the transition back to work.

Every individual and every situation is different. Some people have no option but to return to work full-time and really have very little support from loved ones. Others may have a tremendous support network, an understanding supervisor, and very accommodating co-workers. Some people may even find that returning to work is less stressful than staying home, and they embrace the opportunity to return to work.

Following are some suggestions that can help ease the transition back to work:

• Meet with your doctor first. You may need a doctor’s release to return to work. In addition, your doctor may offer helpful suggestions concerning how to handle your medications in the workplace.
• Set up a doctor’s appointment for the end of your first work week. By setting up an appointment in advance, you can return to work knowing that if anything goes wrong, you can get in to see your doctor soon.
• Consider any workplace accommodations that can help you function more effectively at work. Under the ADA (Americans with Disabilities Act), you have a right to reasonable accommodations, but you can’t hold your employer accountable unless you disclose the reasons why you need special accommodations. If you are dead set against disclosing that you have bipolar disorder, you can always request accommodations anyway, simply stating that these accommodations will make you happier and more productive, but to gain some legal leverage, disclosure is necessary. Remember, your employer can’t fire you for having bipolar disorder. (In Chapter 13 of Bipolar Disorder For Dummies, we recommend some types of workplace accommodations that you can request.)
• Discuss your return with your supervisor. You’re not required by law to disclose your diagnosis or treatment, but if you feel comfortable disclosing this information, it may make your supervisor a little more understanding and flexible.Tip: You can often predict how your supervisor may react to your diagnosis by thinking back to actions she performed or words she uttered in the past. How accommodating has your supervisor been regarding other illnesses and absences from work? Has she ever made unkind remarks about people who were “nutjobs” or “headcases?” Past behaviors are the best predictors of future behaviors.
• Discuss your return with one or more coworkers you trust. Again, you have no obligation whatsoever to disclose your diagnosis or treatment. In fact, a disclosure may not always be the best idea. But if you have coworkers you trust, a support person on the job can help you watch for early warning signs and avoid potential conflicts.
• Lighten the load at home. If you have a partner or other loved one who can relieve some of your burden at home, ask him or her to take on some additional responsibilities or chores or hire help (if you can afford it). If someone else can chip in by paying the bills, picking up the house, cooking, and making sure the kids (if any) are taken care of, at least temporarily, you may feel less stress at work.

Note: You may need to submit medical forms and other paperwork to receive sick pay or other benefits, but keeping up on all the paperwork can be quite stressful and difficult when you’re feeling depressed or overwhelmed. Get help from a family member or friend, a union representative, or your employer’s human resource department. Union representatives and HR workers are typically very knowledgeable about your rights and dedicated to making sure that your employer follows the proper legal procedures.

From Joe: When my wife, Cecie, was experiencing her worst mood episodes early on, when we really had no understanding of bipolar disorder, her doctor would simply prescribe medications and send Cecie back to work. Looking back, it reminds me of a boxer who’s getting pummeled in the ring being patched up in his corner and then sent back into the ring to get pounded some more.

Cecie wasn’t well enough to return to work. The major breakdown made her weak and confused. When she did return to work, her mind was in such a fog that she couldn’t perform her job duties, which understandably increased the stress she was feeling and ultimately led to another mental breakdown and all the fallout that resulted from it. Now, not only did she feel stress, but she also felt like a failure.

I think a lot of times people have no choice but to get patched up with a few meds and try to return to work before they’re fully healthy. But if you have enough sick time and a support network in place, I would strongly advise that you avoid returning to work prematurely. Wait until you feel healthy and ready. It will help ensure that your return to work is successful.

 

[David Baxter PhD]

Back to Work with Bipolar Disorder: Part II
by Candida Fink MD
September 19, 2008

In Part I of this series, I highlighted the challenge of returning to work with bipolar disorder and provided some practical advice on how to smooth the transition back to work after experiencing a major mood episode. In this second part of the series, I provide some more in-depth information and recommendations on obtaining additional assistance with your back-to-work efforts:

• Bipolar can get worse or better: Don?t add even more stress to your situation by assuming that your condition is progressive and will get worse ? this isn?t universally the case. With the right treatment and some good fortune, situations can and often do improve.
• Brains change: We sometimes have the idea that adult brains have stopped developing and changing ? but that is not true. The brain changes throughout life ? with or without Bipolar Disorder. But this, of course, means that medication needs and symptoms can all change over time as well.
• Stay in touch with your doctor: Returning to work can expose you to additional stressors and triggers, which can lead to more frequent or severe episodes, but medication can make a big difference. During the transition, your doctor may need to monitor the situation more closely and be prepared to make necessary adjustments to your meds. If the doc isn?t willing to consider changes, consider getting another opinion.
• Stay in touch with your therapist: If you have a therapist on your treatment team, he or she will be an important resource for you right now. Digging through the problems that are going on related to work and generating some solutions to those problems ? running the gamut from things you can change to changing work situations and if so to what kind of alternative work ? is an important part of the ongoing management of bipolar disorder.
• Consult a vocational therapist: Even if you already have a general therapist working for you, consult a vocational therapist who specializes in helping people deal with work-related issues and accommodations. Most states have some form of vocational training and rehabilitation services. You may need to be receiving services from your state Department of Mental Health or through Social Security Disability to qualify. Disability income, health care, and other supports should be available to people with mental illness in all states, but it is managed differently in different places. If you prefer private resources, you could consider working with a private vocational counselor. Vocational counselors may be accessible through a local or community college.
  
  Tip: As an added bonus, obtaining vocational therapy can actually make it easier to obtain disability benefits later if you are unable to work. It proves that ?you?ve tried everything,? and may even provide you with an additional advocate (your vocational therapist) who can testify that yes, you have tried everything.​
• Get more help from NAMI: The National Alliance on Mental Illness is an advocacy organization and they may have a local chapter in your area; you can search for local chapters at State/Local NAMI. Connecting with people there may help you to access services in your local area.

Remember to try to tackle this in small pieces ? one task at a time. It won?t all get fixed at once, but as long as you?re talking to people and reaching out you?re still in the game.