Area 5 - Educational/Vocational Functioning

 

Myra's most recent employment was in 2008 at a Salvation Army Family Store (thrift shop) in Galveston, Texas. Due to emotional lability, dissociative symptoms, and substance abuse, Myra was unable to get to her job on time, work a full day, and fulfill her job duties adequately. As a result, she was fired after 4 months on the job and has not worked since. Although she has reduced her use of substances, emotional lability and dissociative symptoms still create a significant barrier for Myra, who feels that if she tries to work the additional stress will lead to a relapse or a marked increase in her symptoms.

Nathan got a job unloading trucks last year but walked off the job after 3 weeks. Due to paranoia and delusional thinking, he became convinced that his supervisors were using hidden cameras to videotape him working, and were planning to edit the tape in a way that would make him appear foolish or immoral. Nathan believed that some of his co-workers were actors who had been hired to tempt him and make him look incompetent. Although Nathan reports feeling better on his new medication, he still insists that his prior employers were planning to destroy his reputation with a "doctored" videotape.

Glenn last worked at a Food 4 Less store in 2011. Due to excessive anxiety and trouble concentrating, Glenn had difficulty following directions and kept making mistakes. Glenn reports that he sometimes found himself standing in the warehouse with no idea what he was supposed to be doing. He was let go after his boss caught him outside smoking after he'd been warned to quit taking so many breaks. Glenn is currently unwilling to consider competitive employment, but thinks he might be able to work in a supportive environment where he performed a repetitive, non-stressful set of simple tasks.

Due to symptoms of OCD, Bernard becomes frustrated if things are not done in a particular order or arranged in a certain way. Bernard has difficulty adjusting to things that are "out of order" and becomes preoccupied with fixing them. According to Bernard, "If something's not right, I can't get it out of my mind." In order to get his way, Bernard becomes pushy with co-workers, and on his last job in 2009 he defied his supervisor's orders by coming in early and rearranging a tire display so that the tires were arranged by size rather than brand. Bernard left this job voluntarily but admits it was because he thought he was about to be fired.

Troy has been working on and off since he was 15 years old and says he's had more jobs than he can remember. Although Troy interviews well and is able to get jobs easily, his jobs are usually short-lived due to his mood lability and angry outbursts. Troy reports having trouble getting along with supervisors and co-workers and walks off the job if he feels he's been mistreated. According to Troy, "If people weren't idiots I'd be fine. But nobody knows what they're doing and I'm the guy who's gonna step up and call it like it is. If that offends people...oh well."

Hector has a strong work ethic and an extensive history of working “under the table” in construction and landscaping jobs. He enjoys physical labor and likes getting paid for his work. However, due to grandiosity and a sense that he is superior to others, Hector tries to take over projects, change the rules, and order other workers around. This brings Hector into conflict with the persons who've hired him, and as a result he is not recruited for further work.

Reuben was employed as a carpenter until 2012, when a back injury forced him to stop working. Although Reuben suffered from severe depression prior to the injury, it rarely prevented him from working. After Reuben injured his back, however, he felt completely hopeless and had no motivation to do anything. According to Reuben, "I didn't eat for the longest time, and getting out of bed was like climbing a mountain. Work was the only thing keeping me out of the hospital." Reuben is eating and getting around better now, and is trying to think of ways he can use his carpentry skills without having to engage in physically demanding labor.

Lance has not worked for many years and cannot recall whether his mental illness was a factor in his becoming unemployed. Currently, his disorganized thinking and suspiciousness would make it challenging for him to work cooperatively with others or follow multi-step tasks without prompting. Lance reports that he is not interested in working or going to school, but thinks he would benefit from having something meaningful to do with his time.

Lawrence was able to hold jobs earlier in his life but now receives Social Security retirement income and has no desire to rejoin the workforce. Compared with his peer group (other 64-year-old males), there does not appear to be anything abnormal about Lawrence's decision not to work. No impairment due to mental illness. (This highlights an important aspect of determining impairment: Comparision to one's peer group.)

Due to disorganized thinking and impulsivity, Robin has difficulty carrying out multi-step tasks without continual prompting and redirection. Due to irritability and low tolerance for frustration, she becomes angry at others if they appear to be having trouble understanding her. These qualities limit the types of jobs Robin could successfully perform at this time.

Due to irritability, mood swings, and difficulty regulating emotional responses, Alan was unable to manage the stress of reporting to Labor Ready on a daily basis for temporary work, and eventually quit going. This is a problem because Alan has no source of income, and gets by only because his FSP is providing financial assistance. This is not a permanent solution, and there is no guarantee that Alan's application for SSI benefits will be approved.

Due to paranoia, delusional thinking, and IOR, Tracy has trouble maintaining employment. At her last job, for example, she felt that others were trying to blackmail her and believed there was a conspiracy against her. According to Tracy, "There were references to me in the music they played. They sent out messages that way." Her job performance suffered and she was fired as a result. Other jobs have ended similarly; Tracy reports that she gets fired a lot and has never worked more than 5 months on a job. This is a problem because Tracy is intelligent and enjoys working, and a job would allow her to become financially independent.

Derrick's most recent job was doing telemarketing in 2011. Due to sensitivity to perceived criticism, and difficulty controlling his emotional responses, Derrick was unable to tolerate feedback from his supervisor. When he was asked to quit chatting with customers who had declined to make a purchase, Derrick knocked his monitor off his desk and walked out. According to Derrick, "I don't need some idiot telling me what to do."

Due to auditory hallucinations and disorganized thinking, David has trouble doing homework and studying for tests. He reports that “when it’s quiet and I’m by myself, the voices get louder and I have a hard time tuning them out." This is a problem because these symptoms make it difficult for David to remain focused, study, and complete his assignments.

Thelma has been employed as a telemarketer for the last 3 months. Due to intense anxiety when interacting with the public, and in situations where she feels she's being evaluated or judged, Thelma finds herself struggling to perform her job duties. "When I get really anxious," says Thelma, "my mind just goes blank." Thelma wants to keep her job but is afraid she's going to lose it unless she finds a way to relax and focus.

Due to grandiose delusions and difficulty managing his temper, Henry often becomes enraged if he feels he is not being treated with complete respect or if the value of his work is not immediately acknowledged. If a decision is made that Henry does not support, he complains to everyone around him and sets about trying to prove the decision was wrong rather than making an effort to adjust to it. This is a problem because it interferes with his ability to take direction and work cooperatively with others. According to Henry's last supervisor, "I liked Henry and he did great work, but I felt like I was walking on eggshells all the time and it just wasn't worth it."

Beatrice was able to finish her CNA coursework with the American Red Cross during the prior cycle, at a time she was less symptomatic. Currently, due to grandiose delusions, disorganized thinking, and angry outbursts, Beatrice would have difficulty following directions and working cooperatively with others. Trouble concentrating due to preoccupation with internal stimuli also presents a barrier to passing the State Competency Exam and obtaining employment.

Yolanda's symptoms are now well-controlled and she's expressed interest in getting a job.  Due to the voices she used to hear, however, she hasn't worked in over 12 years.  As a result of being out of the workforce for so long, Yolanda is afraid she will fail and takes no action towards pursuing employement. "I don't know where to start," she says. "I feel like I've lost my way." (Impairments aren't always the direct result of symptoms. In some cases they're the result of skill deficits brought on by years of being highly symptomatic.)

 

All PHI has been de-identified per HIPAA Privacy Rule