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Bipolar disorder – a workplace challenge

Celéste Olivier

Working in the EAP environment for the past 10 odd years I have noticed a significant increase in the number of employees accessing the EAP for support around bipolar disorder. It appears that the number of individuals diagnosed with this often debilitating illness is on the rise especially in South African workplaces. According to The South African Depression and Anxiety Group, bipolar disorder affects up to 1% of the population in South Africa.

It is estimated that bipolar disorder typically begins in adolescence or early adulthood and continues throughout life. As a result putting those struggling with this disorder right in the working stages of their lives.

Because the general public does not understand the impact of bipolar disorder, people suffering from this illness are often expected to get ‘over it’ and move on. While we all have our ups and downs, people struggling with bipolar disorder experience these peaks and valleys more intense. The symptoms of bipolar disorder can negatively impact on an individual’s job, damage relationships and disrupt their lives in general. To manage the impact of bipolar disorder in the workplace, it is important for HR teams and line managers to understand the basics of this illness and to accommodate employees suffering from bipolar disorder as far as possible.

What is bipolar disorder?
Previously known as Manic Depression, bipolar disorder is a physical illness characterised by extreme changes in mood, energy, thinking and behaviour. These extreme changes could run from the highs of mania on one extreme end of the spectrum, to the lows of depression on the other. These cycles of bipolar disorder can last for days, weeks or months. Unlike ordinary mood swings, the mood changes of bipolar disorder are so intense that they interfere with a person’s ability to function.

Signs and symptoms of bipolar disorder
Bipolar disorder does not look the same in everyone diagnosed with the disorder. Symptoms can vary in pattern, severity and frequency. Generally there are four types of mood episodes in bipolar disorder: Mania, Hypomania, Depression and Mixed Episodes. Each of these has their own set of symptoms:

Mania and Hypomania
In this phase feelings of heightened energy, creativity and euphoria are common. People in a manic phase often talk extremely fast, sleep very little and are hyperactive. They may feel like there are powerful, invincible or destined for greatness. In this phase people often behave recklessly. They may also become irritable or aggressive.

Hypomania on the other hand is a less severe form of mania. People in a hypomanic state feel euphoric, energetic and productive, but they are able to carry on with their day-to-day lives and they never lose touch with reality.

Common signs and symptoms of mania include:

  • Feelings unusually ‘high’ or optimistic or extremely irritable
  • Unrealistic beliefs in one’s abilities or power
  • Sleeping very little but feeling extremely energetic
  • Taking so rapidly that others can’t keep up
  • Racing thoughts; jumping from one idea to the next
  • Highly distractible
  • Impaired judgement and impulsiveness
  • Acting recklessly
  • Delusions and hallucinations in severe cases

Research proved that regular depression and bipolar depression are significantly different. Most people with bipolar depression are not helped by antidepressants. Certain symptoms are also more common in bipolar depression, these include:

  • Feeling hopeless, sad or empty
  • Irritability
  • Inability to experience pleasure
  • Fatigue or loss of energy
  • Physical and mental sluggishness
  • Appetite or weight changes
  • Sleep problems
  • Concentration and memory problems
  • Feelings of worthlessness and guilt
  • Thoughts of death and suicide

Mixed Episode
A mixed episode features symptoms of both mania, hypomania and depression. Common signs include depression combined with agitation, irritability, anxiety, insomnia, distractibility and racing thoughts. This combination of high energy and low mood makes for a particularly high risk of suicide.

Treatment Options
A bipolar diagnosis requires long term treatment. A psychiatrist is the best professional to prescribe medication and monitor the impact of the medication. Along with medication other treatment strategies include therapy, lifestyle changes and social support.

A Guide for Employers
Taking into account the practical challenges employees face when diagnosed with bipolar disorder specifically around the extreme changes in mood, energy, thinking and behaviour it might to important for HR managers, line managers and/or team leaders to consider reasonably accommodate the employee as to create a positive work environment where they can flourish.

It is important to recognise that some people with bipolar disorder may develop some limitations. According to the Job Accommodations website, it is important to consider some key questions before applying accommodations. These key questions include:

  1. What limitations is the employee with bipolar disorder experiencing
  2. How do these limitations affect the employee and his or her job performance
  3. What specific job task are problematic as a result of these limitations
  4. What accommodations are available to reduce or eliminate these problems
  5. Has the employee been consulted regarding possible accommodations

Based on the answers obtained from these questions the follow suggestions are made in terms of accommodation ideas. These ideas are merely a guideline and it should be noted that the type of accommodation would be dependent on the work-environment as well as the job requirements of the employee in question.

Maintaining stamina during the workday

  • Allow flexible scheduling
  • Allow longer or more frequent breaks
  • Provide additional time to learn new responsibilities
  • Provide self-paced work load
  • Provide backup coverage for when the employee needs to take a break
  • Allow for time off for counselling
  • Allow work from home during part of the day or week
  • Allow part-time work schedules

Maintaining concentration

  • Reduce distractions in the work area
  • Provide space enclosures or private office
  • Allow for use of white noise or environmental sound machines
  • Increase natural lighting or provide full spectrum lighting
  • Divide large assignments into smaller tasks and goals
  • Restructure job to include only essential functions

Working effectively with supervisors

  • Provide praise and reinforcement
  • Provide written job instructions
  • Develop written work agreements – including agreed upon accommodations, clear expectations and consequences of not meeting performance standards
  • Develop strategies to deal with problems as they arise

Handling stress and emotions

  • Refer to counselling and EAPs
  • Allow telephone calls during work hours to doctors and others for needed support
  • Provide sensitivity training to co-workers and supervisors

Attendance issues

  • Provide flexible leave for health problems
  • Provide a self-paced work load and flexible hours
  • Allow work from home
  • Allow the employee to make up time missed

Celéste Olivier is the EAP manager at Kaelo Consulting. She has a BA in social work from the Rand Afrikaans University (now the University of Johannesburg) and an MA in occupational social work from the University of the Witwatersrand.