Jenny Morris has been an independent research consultant on disability issues for 15 years. Recent work includes acting as special adviser to parliament's joint scrutiny committee on the draft Disability Discrimination Bill, and working on the Prime Minister's Strategy Unit project on improving the life chances of disabled people.   

Policy makers and service commissioners have often overlooked people who have both physical impairment and mental health support needs. A recent study of people with both types of need has found dissatisfaction with services.¹ Two-thirds said they had difficulty obtaining mental health services because of their physical impairments, while a similar proportion reported difficulty accessing physical disability services because of their mental health support needs.

Respondents believed that because they had physical and mental health needs service providers were less likely to respect their knowledge and opinions. And a failure to provide an environment that was accessible for disabled people could mean they were "shut out" of services, or received services of poorer quality.

By contrast, positive attitudes could partly overcome an inaccessible environment. Staff who recognised both types of need made all the difference but they often struggled to do so against structural, procedural and environmental barriers.

Community mental health services were appreciated when they recognised physical impairment as well as mental health needs. For instance, one respondent praised the care co-ordinator whose assessment covered both her mental health and physical needs. This resulted in direct payments so that she could meet both sets of needs.

But physical impairment needs were not always recognised or responded to in community mental health services. Sharon Bowler,* who has cerebral palsy, said: "They don't know how to say to me 'What help do you need? Do you need help into the building?'." Another respondent attended a work programme at a day centre and found the chairs at the centre difficult to sit on for any length of time but a more suitable chair was not made available.

Talking treatments received the highest rating of any service among respondents but it was often hard to find an accessible therapist or counsellor. Other services were also affected. Daisy Cox, who uses a wheelchair, was offered occupational therapy (OT) for her mental health needs but found it disempowering. "The OT department is across a huge bridge, so I can't self-propel that far. The door's narrow, there's a lift and I can't get my wheelchair into the place where the OT is, so Ihave to leave it in a nearby office and peg it."

There was a failure in several instances to comply with the Disability Discrimination Act 1995 by making "reasonable adjustments". One woman found the way to a formally accessible service was through a door that was normally kept locked and with boxes of paper stacked in front of it.

Some mental health professionals were unfamiliar with physical impairment, which led to problems. One interviewee with arthritis said of the mental health professionals she had been in contact with: "I don't think they understand chronic painÉ how it can grind you down."

In-patient experiences were often characterised by a lack of assistance and inaccessible environments.

One respondent said it was hard to make staff understand that she needed help getting out of bed. Jane Burns said: "My room had a heavy door. The shower was lethal: there was no alarm, no handrails and it was slippery. The distance down to breakfast was about the limit of my walkingÉ I couldn't serve myself because you queued up, picked up your meal and then took it over to your tableÉ I couldn't manage that." Another woman, who uses a wheelchair, told researchers she fell and broke her leg when trying to use the toilet unaided in a bathroom with no grab rails.

People often found that medication for physical impairment was withdrawn on admission to in-patient wards, and was not always available when they needed it. This caused distress, particularly if the medication was to control pain.

Several interviewees experienced such a lack of understanding of mental health issues from physical disability services that they were sometimes deterred from using such services. And communication between the two types of services was often poor or non-existent.

Naomi Blackwell, a long-term user of mental health services, found that her physical disability services took charge after she became disabled following a car crash. Her experience of rehabilitation and social services was that it was "almost like the mental health stuff didn't matter". She felt that her depression was now assumed to be due to the accident and resulting physical impairment and unemployment.

Adam Spiers, who lives in a residential home, found that once he developed mental health problems some of the care staff would not have anything to do with him. Spiers saw his care manager once a year and felt she didn't try to understand or respond to his mental health needs.

Almost everyone who took part in the study experienced a split in their needs across physical disability and mental health services. Sometimes the services were in different areas. One interviewee said: "I have to go to one town for my mind, another for my body." Lack of communication between the two types of service was common.

Mental health services should recognise that a proportion of their service users will have physical impairments. Needs relating to physical impairment must be taken into account to ensure equal access to services and treatments, and to adequately address mental health needs. Compliance with the Disability Discrimination Act should be monitored across all mental health services.

Front-line physical disability services need to work more closely with mental health services to meet the needs of those service users who also have mental health support needs. Care managers and other workers require local protocols for joint working, and information about mental health services and how to access them.

Unless these issues are addressed, those who have both physical impairments and mental health support needs will continue to be poorly served by both physical disability and mental health services.

*All names have been changed.

Abstract   

This article looks at people with physical impairments who also have mental health support needs and their experiences of both types of services. The research found that people experienced significant barriers to getting their needs met and that there was little communication between mental health and physical disability services. Individual workers could make a positive difference, but they were often struggling against barriers themselves.

References 

¹ The research was carried out by Jenny Morris in partnership with Mind. The full report, One Town for My Body, Another for my Mind: Services for People with Physical Impairments and Mental Health Support Needs, is published by the Joseph Rowntree Foundation and is available from York Publishing Services, Tel. 01904 430033. www.jrf.org.uk

Further information

J Morris, People with Physical Impairments and Mental Health Support Needs: A Critical Review of the Literature. York Publishing Services/Joseph Rowntree Foundation, 2004 www.jrf.org.uk

Contact author

Jenny Morris can be e-mailed at jenny@jmorris.demon.co.uk