Running head: DAN’S CASE STUDY
Dan’s Case Study: Psychosocial impact of disability and loss of employment Brenna Coles B00529042 DISM 4050 Dalhousie University June 21, 2012
Author Note This case study has been prepared as a final paper for a university course titled: Psycho-social Issues in Disability Management (DISM 4050) the course is offered through distance education by Dalhousie University in Halifax, Nova Scotia. Please note, that the case study has been adapted from one provided by the professor. I have had the liberty of expanding details relating to the case study which may help identify psychosocial factors that could possibly impact the outcome and assumptions have been made.
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2 Abstract
This case study will examine the psychosocial impact of disability and loss of employment, specifically regarding a 37 year old man named Dan. This case study will identify the psychosocial characteristics and a full analysis will be completed in order to determine the impact of disability and loss of employment directly relating to Dan. By examining and understanding the psychosocial impact on Dan it will help the case management process so it will be client centered and clienttailored to ensure the best outcome.
Keywords: acceptance of disability, addiction, adjustment to loss of function, chronic pain, depression, disability management, disability, grieving process, injury, loss of employment, occupation, psychosocial, return to work, stay at work, stereotypes, stigma, substance abuse, mental health, mental disorder.
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Dan’s case study: Psychosocial impact of disability and loss of employment Dan is a 37 year old man who works afternoon shifts as an industrial electrician at a pulp and paper mill. He is a family man with three children ages eight, ten and 13. He lives with his wife, Pam and their children in a partially finished home. Dan hopes to continue building their house himself over the next 12 months. Pam is currently a full time university student finishing up her bachelor’s degree in education. Dan is responsible to take care of the children in the mornings and afternoon until Pam is home from school and then he goes to work. Currently, Dan is the only source of income for his family however Pam only has a three month practicum remaining. In Dan’s earlier years he played junior level hockey which left him with many injuries and ultimately lead to an addiction to prescription pain medications, luckily Dan has been sober for ten years. He is committed to his sobriety as he attends weekly Narcotic Anonymous meeting offered at his workplace. His best friend and colleague, Sean has been his sponsor for the past four years. In addition to his addiction, Dan has also struggled with depression and anxiety in the past but has never been diagnosed or treated. Unfortunately, Dan was recently involved in a workplace incident. He was pinned between a wall and a truck when his good friend Sean inadvertently backed into him. Dan sustained multiple fractures to his ribs which caused him lots of pain. His work has a private contracted disability management program in place which is available to all of their 250 employees. Dan is entitled to the services and benefits offered by the provincial Workplace Compensation Board (WCB) but had no private insurance benefits and he is non-unionized.
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4 Psychosocial factors
The psychosocial factors relevant to the case include anger, anxiety, guilt, shame, and lack of social contact all of which have a lot to do with Dan’s depression and his grieving process and his adjustment to loss of employment. Other social factors that are relevant to this case are financial and housing. The next section will discuss in detail the impact these psychosocial factors have on the disability management process and overall outcome.
Discussion As described by Blanck & Pransky (1999) a disability “refers to the inability to perform an activity or task, reflecting an alteration in an individual’s capacity to meet personal, social, or, occupational demands because of an impairment” (p. 581). In Dan’s case, since his workplace injury he has been off work for two weeks due to intense pain as he describes it due to his multiple rib fractures and has started abusing prescribed pain medication again. If Dan does not seek help and get his life back under control he may not return to work it could have detrimental psychologically, physically and economically effects. Dan may become reluctant to return to work at all; his attitude will determine the disability management process (DMP). If Dan is a willing motivated client this will positively impact the progress of the intervention plan. If he is not, however, this can stall and even stop the process all together. The identification of red flags will help determine if Dan will be cooperative or not. The red flags that related to this specific case may include the duration of time off work, if there is not job to return to, psychological and social stress, keeping in mind the signs and symptoms of depression, anxiety and substance abuse (all pre-existing medical conditions) and missed appointments.
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In the natural process individuals who experience a traumatic event that results in an impairment or disability they will go through the grieving process and adaptation process.
Potential psychological factors The psychological issue that Dan faces is a relapse of depression and substance abuse. Throughout the stages of grief Dan fell back into a depressed mood. The longer duration of unemployment the less likely Dan will ever return to work. Dan’s depression may escalate from mild depression to severe. If this were to happen Dan will continue to be unemployed and may need more professional treatment such as therapy counselling to help treat the depression. Ultimately this would lead to more financial stress on the family. Another psychological issue may be the major change to the family unit. It could cause tension and stress at first and settling into a new routine may be difficult for this young family. The children may feel tension or may not adjust well to the switch to their daily routine.
Analysis of the stages of grief. Dan has been off work for two weeks so far. At first, he was in denial about his injury and the amount of pain that his injuries caused him. He could not believe that this was happening to him and he has experienced numbness. He self medicated and took prescription pain medication. The second major emotion that he felt was anger. Once he realized the pain was not going away and that he most likely would not be able to return to his highly physically demanding job he was angry. Dan was angry with himself for being careless and letting a workplace injury happen in the first place and breaking his sobriety. Afterwards, Dan was in a depressed mood.
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Currently, Dan is depressed and in despair; He does not know where to start to pick up the pieces. He is anxious and feels financial reasonable to his family and wants to go back to work, but he feels hopeless and overwhelmed. Moreover, Dan is embarrassed of being job-less and the stigma that goes along with it. He is mostly scared of the possibility of failure in his family’s eyes and the community’s. The next section will explore stereotypes and stigma.
Stereotypes and stigma. One of the main contributors to disability is the evaluation of what is considered “normal”. This evaluation is comprised of three elements which were: 1) the characteristic(s) to be judged, 2) the environment in which the characteristics appears and 3) the individual(s) who are making the judgment (Smart, 2008). In Dan’s case he is concerned with returning to work because of his mental health issues (depression and addiction). The lack of information or correct information is what seems to fuel prejudice and stereotypes in the workplace. Employers and other employees are often misinformed and believe myths. This is true for many disabilities, not only the psychological ones. A way to address this issue in order to reduce the stigma would be to implement “training designed to raise their awareness of the myths and the stigma surrounding disability, and specific forms of disability” (Canadian Human Rights Commission, 2006b, section 5.4 Training and education, para. 17). The fact is that due to stigma (a societal perception) not everyone who experiences mental health issues will seek help. If people do not seek help their treatment and recovery will be effected. As discussed in Module 3, “unrecognized and untreated mental illness can become more severe over the long term resulting in an even greater cost to employers and the
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provincial and federal economies” (Dalhousie University, 2012). Unbalanced sense of self can negatively affect the coping process, ultimately the goal is to full adjust and adapt in all aspects. Given that the pulp and paper mill Dan works at has a weekly Narcotics Anonymous meetings and has a private contacted disability management program in place this employer seems to be fairly supportive. Moreover, if the work environment is supportive towards illnesses, injuries or disabilities and promotes stay at work interventions such as accommodations and modifications it will be much easier for employees to stay at work. If these interventions are widely used and known in the company the employees will be more accepting of employees needing accommodation or modification at work, therefore the stigma will be reduced and the atmosphere will be more supportive.
Process of adaptation. Depending on personal characteristics of the individual and the coping skills already developed will impact the severity and level of stress they will encounter. As described by Livneh and Antonak “coping has been viewed as a psychological strategy mobilized to decrease, modify, or diffuse the impact of stress generating life events” (as cited in Livneh & Antonak, 2005, p. 14). Some researchers say it is quite similar to the human adaptation to most other stressful life events where individuals must self-organize during times of stress. They must self-organize in order to overcome these new challenges to regain balance and stability. Livneh and Parker (2005) reported in their article, models related to self-organization. A few of the elements included in these models are:
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There are three components which include: “cognitive appraisals, such as appraisals of loss; emotional experiences, such as experiences of anxiety and sadness; and behavioral responses, such as retreat from social encounters” (Livneh, & Parker, 2005, p.22).
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Chronic illnesses and disabilities are too much for the average persons coping strategies to handle, therefore they experience “overwhelming anxiety and other distressing emotions” (Livneh, & Parker, 2005, p.23). These were described in the grieving process above.
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For individuals’ pre-CID they had stable life experiences (routine/patterns) however postCID they are experiences irregular, unpredictable life experiences (routine/patterns). For Dan he no longer works or participates in social events like he did before, thus disrupting his regular routine.
Potential social factors Financial issues arose the moment Dan lost his job. The family will face financial stress but hopefully they have enough money in their emergency savings fund for them to feel comfortable for at least six months. But if they do not they will be going through some tough times ahead. Dan and Pam made a budget. Since the main source of income has stopped, they decided they would tighten up their finances by reducing their monthly expenditures. They may face the stress of relying on the financial help of other family members in order to keep up with their monthly payments. Anxiety about saving money, not being able to continue to pay for Pam education or continue building their new home may cause extra financial stress.
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If they cannot receive financial support from family or friends they may have to rely on the community recourses such as food banks or their local soup kitchen. This can have a lot of psychological impact on someone’s life, especially if they are not used to using these services. The couple may feel embarrassed that they have gotten to this point; this is partly due to the stigma.
Conclusion Obviously it is in Dan’s best interest for him to be working with a disability manager. As an industrial electrician of a non-unionized pulp and paper mill he has access to a contracted Disability Management Program. He would be able to set and prioritize his personal and career goals and could take advantage of the personal and professional development interventions. He can develop or improve his coping skills to help cope with his mental illnesses, depression and addiction. Providing Dan with relevant medical information as an intervention strategy would be the best option because his injury has resulted in a functional impairment but also has the possibility to become a disability. By keeping Dan up to date as much as possible with the status of his medical condition it may decrease the emotional effects if it were to become a disability. This intervention strategy is said to be “best suited for decreasing initial levels of heightened anxiety and depression, as well as the potentially damaging effects of unremitting denial” (as cited in Livneh & Antonak, 2005, p.17). This strategy may also have prevented an addictions relapse if implemented earlier. Dan ultimately needs to make some positive changes in his life. He needs to make a plan with the help of his disability manager and take action. When he takes advantage of the support services he needs to develop professionally he will experience personal development.
DAN’S CASE STUDY 10 References
Blanck, P., D. & Pransky, G. (1999). Workers with Disabilities: A Conceptual and Demographic Overview. Occupational Medicine. Vol. 14, No. 3, 581-593. Hanley & Belfus, Inc. Philadelphia. Canadian Human Rights Commission (2006b). Research Program: Part V. The management of absenteeism: a continuing strategy. Retrieved from: http://www.chrc-ccdp.ca/. Dalhousie University (2012). DISM4050: Psycho-social Issues in Disability Management. Module 3: The Nature and Effect of Mental Illness on the Workplace. Retrieved from: https://dalhousie.blackboard.com/. Livneh, H., & Antonak, R. F. (2005). Psychosocial Adaptation to Chronic Illness and Disability: A Primer for Counselors. Journal of Counseling and Development. Vol. 83. 12 –20. Livneh, H., & Parker, R. (2005). Psychological adaptation to disability: perspectives from chaos and complexity theory. Rehabilitation Counseling Bulletin, 49(1), 17-28. Smart, J. (2008). Disability, Society and the Individual (2nd ed.). Pro ed.