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Important Context for Counselling Persons With Mental Health Disabilities

Mental illness often affects thought, mood, perception, orientation, or memory. A person with a mental health disability can be described in a respectful way as a person with a mental illness, a person with a psychiatric disability, or a person being treated for a mental disorder.

Avoid using the term for the disability to describe the whole person. For example, do not say, “She’s a schizophrenic” or “He’s a psychotic.” Also avoid terms that suggest pity or victimhood. For example, do not say, “He suffers from depression” or “She’s a victim of schizophrenia.”

Be aware of terms that demean persons with mental illness. The words crazy, lunatic, psycho, psychotic, neurotic, mad, maniac, demented, mental, and loony describe behaviour. Again, they should not be used to describe a person.

Except in legal use, the terms insane and insanity are derogatory.

Types of mental health disorders

Clients with mental health disorders may have trouble with major life activities. These include working, going to school, and taking care of themselves. Mental health disorders usually begin during adolescence or young adulthood but can start at any age. The symptoms are often hidden except during acute phases.

The standard criteria for classifying mental disorders is the Diagnostics and Statistical Manual of Mental Disorders (DSM-5). The DSM is published by the American Psychiatric Association. Classification of mental disorders in the DSM has changed over the years. Some disorders have been added and others removed. The following sections describe a number of mental health disabilities.

Anxiety disorders

Anxiety disorders relate to distress or fear. They may include anxiety or panic attacks. Focused anxieties are called phobias. Anxiety disorders are the most common psychological disorders.

The following are examples of anxiety disorders:

  • Social anxiety disorder is a fear of social situations, such as speaking in front of people or going to public events.
  • Panic disorders are repeated and unpredictable panic attacks. They may involve sweating, shortness of breath, and a sense of choking or fainting. The fear that a panic attack may happen is called anticipatory anxiety.
  • Post-traumatic stress disorder (PTSD) includes flashbacks, frightening thoughts and memories, and anger or irritability. It is a response to a terrifying experience. Often the person was physically harmed or threatened with harm.
  • Agoraphobia is a fear of open, public places.

Antidepressants or anti-anxiety drugs can help clients handle anxious thoughts. Cognitive behaviour therapy can also help. Drowsiness is often a side effect of drug treatment. It may affect the counselling process.

Eating disorders

Eating disorders are a serious disturbance in eating patterns. A person might eat too much or too little. Eating disorders have psychological, social, and biological causes. Most persons with eating disorders have a distorted perception of their own body. Sometimes this is caused by society’s concern with being thin.

The most common eating disorders are anorexia nervosa, bulimia nervosa, and binge eating disorder. Most persons diagnosed with an eating disorder are female. However, males can also have eating disorders.

Persons with anorexia may also have anxiety disorders, depression, or substance abuse issues. Some persons with anorexia or bulimia recover. Others will have challenges through adulthood. They may lose functioning and balance in their lives. They may also face physical problems, such as kidney failure or heart conditions.

Successful treatment combines monitoring of physical symptoms with:

  • Cognitive therapy
  • Behavioural therapy
  • Nutritional counselling
  • Body image therapy
  • Education
  • Medication, if necessary

Mood disorders

Depression and bipolar disorder are mood disorders. These are also called affective disorders. The most common are bipolar (manic-depressive) and unipolar (depressive) disorders. Mood disorders involve noticeable and persistent mood disturbances. These colour a person’s view of the world.

Mood disorders may cause the following problems:

  • Loss of interest
  • Trouble with social skills
  • Trouble with memory
  • Trouble with performance skills
  • Grandiose thoughts
  • Unrealistic thinking (impaired insight)
  • Rapid thought processes
  • Manic periods, in the case of bipolar disorder

Mood disorders are treatable with antidepressants, education, and psychotherapy, such as cognitive behaviour therapy. However, many persons diagnosed with mood disorders fail to seek or maintain treatment.

Personality disorders

The Public Health Agency of Canada says that personality disorders cause “unhealthy patterns of thinking, functioning and behaving.” These patterns begin in childhood or adolescence and do not change over time or in different situations. Clients may show many different behaviours.

Personality disorders include:

  • Anti-social personality disorder
  • Obsessive-compulsive personality disorder
  • Borderline personality disorder
  • Dissociative identity disorder
  • Narcissistic personality disorder
  • Oppositional defiant disorder
  • Paranoid personality disorder
  • Histrionic personality disorder

Persons with these disorders tend to:

  • Have trouble getting along with other people
  • Be irritable, demanding, hostile, fearful, or manipulative
  • Have disturbed thoughts or emotions
  • Have poor impulse control

Self-harm is a symptom of both borderline and dissociative personality disorders. It includes many forms of self-inflicted injury. People who self-harm are not usually seeking to end their own life. They may be trying to relieve emotional pain or discomfort from a history of trauma or abuse. The most common form of self-harm is skin cutting. It is most common in adolescence and young adulthood.

Treatments include intensive personal and group psychotherapy and antidepressant drugs. Family and community support is important.


Persons with schizophrenia show disturbances in language, communication, thought, and perception. These may affect career counselling and work search processes.

These persons may have:

  • Attention deficits
  • Abstract thinking disturbances
  • Planning and problem-solving deficits
  • Memory deficits
  • Trouble with organizational skills
  • Verbal memory deficits
  • Hallucinations and delusions

Schizophrenia usually requires intense treatment. This may combine medication, education, primary care services, and hospital care. It also involves community services such as adequate housing and employment.

The most common form of treatment is drug therapy. Some antipsychotic drugs have significant side effects. These may range from drowsiness to blurred vision to weight gain. Patients may not be able to do certain activities, such as using machinery. Though it has side effects, prescription medicine helps control symptoms. It helps patients to hold a place in society.

Problem gambling

Problem gambling is almost always a hidden disorder. Unlike substance abuse, it has no physical signs, so it is hard to detect. According to the DSM-5, problem gambling is an impulse control disorder.

Showing 5 or more of the following signs points to problem gambling:

  • A need to bet increasing amounts of money to get the desired excitement
  • Repeated attempts (and failure) to control or stop gambling
  • Feelings of restlessness or irritability when trying to control gambling
  • Use of gambling to escape from problems
  • Frequent attempts to win back losses
  • Lying to cover up the extent of gambling
  • Stealing to finance gambling
  • Risking a job or important relationships
  • The need to rely on others for money because of gambling losses
  • Preoccupation with gambling

Substance abuse

Substance abuse is the continued use of substances despite negative effects in major life areas. It is also defined as a progressive dependency on a substance that may trigger other mental disorders. If a person stops using the substance, it causes withdrawal.

Long-term heavy alcohol use can lead to many problems. These include stomach ulcers, sexual problems, liver disease, brain damage, and many kinds of cancer. Inhalant abuse damages the central nervous system. This leads to behaviours similar to those caused by psychotic disorders.

The first step in treatment is to quit using the substance (detoxification). This may be followed by psychotherapy, counselling, continuing education, and 12-step recovery programs.

Coexisting disorders

Some mental health disabilities coexist with other psychological disorders. This is also known as dual diagnosis.

Health Canada classifies coexisting disorders into 5 categories:

  1. Substance use and mood and anxiety disorders
  2. Substance use and severe and persistent mental disorders (including problems related to anger, impulsivity, and aggression)
  3. Substance use and personality disorders
  4. Substance use and eating disorders
  5. Other substance use and mental health disorders (including sexual disorders and problem gambling)

In working with clients with coexisting disorders, keep in mind the following:

  • Mental illness increases the risk of developing an addiction.
  • Addiction affects psychiatric treatment plans.
  • Though the conditions are separate, they interact in ways that make diagnosis, treatment, and recovery more complex.
  • Symptoms of mental illnesses may affect addictions treatment. For example, stimulant abusers will experience an emotional crash as part of withdrawal.
  • Symptoms of mental illnesses may result from addictions. For example, depression or anxiety may result from the loss of a job or a marriage related to the use of drugs.
  • Untreated addiction problems can contribute to a relapse of the mental illness. Likewise, untreated psychiatric problems can contribute to a relapse of the substance use disorder.
  • Mood disorders often accompany anxiety disorders and personality disorders.
  • Persons with depression are more likely to develop chronic diseases, such as diabetes.
  • Personality disorders often co-occur with substance abuse, sexual dysfunction, anxiety disorders, eating disorders, and depression.
  • Over time, symptoms may become hard to tell apart.
  • Disorders can develop independently at different times.

Barriers and challenges

Desire to function

“The level of people’s ability to cope always amazes me. No matter if a person has been diagnosed with depression, schizophrenia, or bipolar disorder, they continue to desire to function in a healthy manner. They want to be loved, be productive, get respect—no different than any other person.”

—Sandra Taylor, Alberta Health Services

Complexity of treatment and recovery

Treatment for mental illness must reflect its complex origins. A variety of treatment strategies can improve a person’s functioning and quality of life. Examples are psychotherapy, cognitive-behavioural therapy, medicine, and occupational therapy.

Persons with mental health disabilities play an important part in their own recovery. However, they can’t simply “snap out of it” or “pull themselves together.” They don’t lack willpower, nor are they weak.

These persons may have cyclical periods of ability and disability. Many develop successful strategies for their periods of disability. Supports such as workplace accommodations help them do so.

Responses to medication

It is not always possible to tell if the traits a person with a mental health disability exhibits are caused by the disorder or its treatment. The side effects of drug therapy are important in the counselling process. They often present major barriers to career and employment options. These include both overt and more subtle side effects. Examples are mood swings, decreased psychomotor control, and trouble concentrating.

Some employment barriers are straightforward. An example is not being able to operate high-speed equipment. Others are more subtle. They relate to the impact of a client’s symptoms on the public, potential employer, or counsellor.


Response to stress is as individual for persons with mental health disabilities as it is for persons without these disabilities. Stress can be caused by anything from struggling with basic self-care to managing finances to relationship difficulties. People do not always understand the triggers of stress. You can help clients determine what causes stress and then help them find practical coping strategies.

Suicidal behaviour

Suicidal behaviour is highly correlated with mental illnesses, especially borderline personality disorder and depression. Women have a higher rate of attempted suicide, but the mortality rate for men is 4 times that for women.

The following are categories of factors associated with suicidal behaviour:

  • Predisposing factors are enduring factors that make one vulnerable to suicidal behaviour. Examples are mental illness, abuse, a family history of suicide, and trouble with peer relationships.
  • Precipitating factors are specific events or triggers that create an acute crisis. Examples are the suicide of a friend or the sudden onset of financial difficulties, personal conflicts, or rejection.
  • Contributing factors increase the effect of either predisposing factors or precipitating factors. Examples are risk-taking behaviour, ongoing substance abuse, physical illness, and a history of unstable family relationships.
  • Protective factors decrease the risk of suicidal behaviour. Examples are resiliency, a sense of humour, tolerance for frustration, adaptive coping skills, healthy family relationships, and a strong network of support.

Treatment programs seek to address the factors that influence suicidal behaviour.


Seeing the whole person

“People thrive on unconditional positive regard. Approach an individual with a mental illness no differently than you would anyone else. Have the belief in people that they can accomplish what they need to accomplish.”

—Sandra Taylor, Alberta Health Services

According to the Canadian Mental Health Association, persons with a serious mental illness face more stigma at work than those with other disabilities. Stigma may cause anger and avoidance behaviours. It affects employment options, career advancement, and quality of life at work.

Though people now have more awareness and understanding of mental illnesses, false beliefs persist. Perhaps the most damaging is the belief that persons with a mental illness are a danger to society. In fact, research shows that they are no more likely than the general public to commit crimes or act violently.

Another myth is that these persons cannot keep a job because they are less intelligent and have trouble learning. Some people also falsely believe that mental illness is caused by personal weakness.

Try to deal directly with the myths and stigma facing your clients. For example, you can:

  • Play an advocacy role in the community
  • Help clients develop or enhance appropriate social skills
  • Encourage them to join self-help groups
  • Help them learn more about mental disorders and treatments

A time of change

The media is making people more aware of the importance of mental health at work. Also, research in the mental health field continues to move forward.

You can help your clients by staying on top of new developments in treatment and management of symptoms. Encourage them by sharing new medical research breakthroughs. Health-care services may offer more choices for treatment plans and community support services.

New treatment strategies, inclusive work settings, and supported employment opportunities offer hope for a brighter future.

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