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Employment Counselling for People With Mental Health and Physio-neural Disorders

Employment for people with disabilities can take many forms. The specific disability will influence the strategies you and your client must consider. But to find the right type of work, focusing on the client’s abilities is at least as important.

Before you begin, you may want to learn more about disabilities that fall into these two categories:

Employment strategies for clients with mental health disorders

In the past, clients with well-managed mental health disorders may have been encouraged to “keep their secret.” With so much stigma against mental illness, the thinking has gone, why share information that might trigger employers’ and coworkers’ prejudices?

The problem with keeping secrets is that they tend to reinforce society’s and clients’ beliefs that something about them—something vital to who they are—is shameful and must be kept hidden. An attitude like this can’t promote anyone’s mental health.

Job search

Job search, in particular, can provoke anyone’s anxiety. For those with mental health disorders, which often include issues with low self-esteem, it can be even worse.

As a counsellor, part of your role is often to remind your clients of the many strengths they have to offer a workplace. Clients with mental health disorders may just need these reminders a little—or a lot—more often.

A key facet of managing most mental health disorders is establishing and sustaining healthy daily routines. Adequate sleep, good nutrition, and regular exercise are some of the most important keys to mental health.

Unfortunately, a characteristic most people with mental health disorders share is a tendency to let routines go. An important way of supporting clients through this stressful time is to remind them that those daily routines are key to keeping them on a level keel and managing their mental health optimally.


During a job search, even the best-managed mental health disorders can become apparent in the form of gaps in the client’s employment record. These may have occurred:

  • Before they were diagnosed, when they may have had difficulty finding and keeping employment
  • Around the time of diagnosis, while the client’s mental health was becoming stabilized
  • After diagnosis, when they may have needed to try several different medications, alone or in combination, for several months each before finding the right fit for their needs and body chemistry
  • After they’ve become settled, when a personal or job-related event triggered a relapse

It’s best for clients to acknowledge and explain employment gaps. Providing fact-based information is a better way to dispel concerns about mental health issues than offering no information at all, for several reasons:

  • Hoping employers won’t notice gaps puts clients at a disadvantage. How should they respond if, or more likely when, the employer does notice the gaps?
  • Planning to disclose gives clients the opportunity to consider their answers to the most likely questions. With those answers in place, they may become more confident in responding even to unexpected queries. Most employers respond favourably to job seekers who show they have nothing to hide.
  • Saying something like, “Before my illness was diagnosed and treated, I sometimes had difficulty with employment,” frames the mental health disorder as it should be framed—an illness that required diagnosis and treatment. This approach normalizes the client’s specific disability while also indicating that their situation has improved.


Honest disclosure can set the stage for the client to specify, at their discretion, any job accommodations that might optimize their performance. For example:

  • A client with an anxiety disorder may state that regular, brief check-ins about their job performance, at least during the early months, may help them settle in. Even if this means 5 minutes a week of the supervisor’s time, easing the client’s anxiety may help them learn the job more quickly than if they have to wait for the end of their probationary period to learn how their employer feels they’re doing.
  • A client with major depressive disorder may state that a potential life crisis, such as the health of an aging parent, has potential to trigger a relapse of their depression unless it is properly managed. Having said this, the client may feel more comfortable notifying the employer when a problem arises. The employer may then know to check in more often with the client at work, offer a more flexible work schedule, or prepare for the client to take leave to deal with the crisis as well as with their own mental health needs.
  • A client with any mental health disorder may need a short leave to adjust to a change in medication. All psychiatric medications can have profound effects on appetite, sleep, and mood. An employer who understands their employee’s situation will be better equipped to understand the need for a brief absence and accommodate it.

Employment strategies for clients with physical and neurological disabilities

Physical and neurological disabilities may not be readily apparent. Employers tend to be more familiar with disabilities to people's hearing, sight, and mobility and the types of accommodations these may require, including:

  • Making workplace facilities, such as washrooms, more accessible
  • Increasing illumination
  • Adding ramps in appropriate areas
  • Modifying work schedules (for example, splitting positions or allowing rest periods and time off for medical appointments)
  • Acquiring or modifying equipment or devices, such as a braille writer, sound and print amplification aids, and reaching aids
  • Providing qualified support services, such as interpreters, readers, and travel assistants
  • Considering work alternatives, such as telecommuting

But less visible physical and neurological disabilities can also include Crohn’s or other inflammatory bowel disorders, arthritis (of which there are more than 100 types), or early-stage Parkinson or Alzheimer diseases. They can also include chronic pain and fatigue from a poorly understood organic condition such as fibromyalgia or a traumatic injury, such as mild traumatic brain injury (MTBI, better known as concussion).

Exploring work alternatives

Clients who have experienced injury or onset of illness as adults can transfer skills, interests, and values from a previous career or goal to one that matches their current abilities. For example, an athlete with a spinal cord injury may compete in adapted sports and pursue a career as a coach, manager, agent, scout, or sports journalist.

On the other hand, clients may be encouraged to view their disease or injury as a door into a world they hadn’t considered. That same athlete might advocate for others with spinal cord injuries, as Rick Hansen does, or people with mental health issues, like Clara Hughes, or those who’ve suffered concussion, like Chris Nowinski.

Most people have more than one interest but as we get older, we narrow our explorations down to specific interests. An injury or illness that ends one career might allow the person to explore an earlier interest that they’d previously abandoned: art, music, medicine, law, business.

When a person’s life work is derailed by accident or injury, it’s understandable that they focus on the unfairness of this ending. Your job as a counsellor may be to remind them that the end of one thing can be the beginning of something else—and it may be just as good, or even better.

Job accommodations

The types of accommodations needed by people with physical or neurological disabilities most often entail flexibility in location and hours of work. The Covid-19 pandemic showed us just how many types of work can be done remotely in an era in which we have so many forms of communication.

While there are advantages to having all employees working in a single location for the same hours, you can help employers consider whether the advantages outweigh the disadvantages. Consider these scenarios:

  • A person having a Crohn’s flare-up may need frequent dashes to the bathroom that disrupt the workplace and embarrass the individual. Occasional days of remote work may allow them to work full-time hours even during a flare-up.
  • A person recovering from a mild traumatic brain injury (MTBI, or concussion) might find it hard to work full days in a busy office with bright lights and a lot of ambient noise. But they might be able to come in early, while they’re fresh and the office is quiet, and work a half day. As they recover, they might even be able to work more hours at home later, after a rest.
  • A person with fibromyalgia may be able to work a full day remotely but may not be able to manage the additional time and effort of commuting. Or they may be able to work in short spurts, with rests in between. If some office time is required, perhaps they could work shorter hours on the days they have to commute. They’d likely prefer a small reduction in their hours and pay to losing their job entirely.

It can be very discouraging for people with physical and neurological disabilities to have to choose between working a full day at the job site or taking a sick day (paid or unpaid), with nothing in between. In addition to the scenarios described above, alternatives include shifting from salaried to contract work, full-time to part-time work, and job sharing. These forms of employment are becoming more prevalent and may offer a variety of benefits. You can help your clients and potential employers examine these alternatives, any of which may work well for different people.

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