In recent years, more attention has been paid to the support needs of mental health service users and disabled people. However, the experiences and support needs of people who fall into both these categories have tended to be overlooked.

New user-led research is to explore the mental health experiences and support needs of people with physical impairments. The project, funded by the Joseph Rowntree Foundation in association with Mind, has already produced an information booklet for disabled people who have mental health support needs, together with a questionnaire about experiences of services, and a review of the research.¹

Anecdotal evidence illustrates the damaging effects of a "Berlin Wall" between mental health and disability services. One disabled woman said: "I was refused accommodation in several supported housing projects for mental health services because of my physical condition, and the usual services for physically disabled people wouldn't take me because I self-harmed. I couldn't go to a self-harm survivors' conference because of the lack of access, and a local counselling service didn't feel they had the experience to work with a disabled person"

There is little recognition that some disabled people will experience mental health difficulties that may have nothing to do with their physical impairment. Moreover, there is evidence that people with mental health support needs may be more likely to sustain physical injury:one study of people admitted to a spinal injury unit found that one in five had previous mental health support needs. There is also evidence that long-term users of mental health services may be more likely to acquire physical impairments, sometimes as a side effect of medication. They are also more likely to experience other factors associated with increased vulnerability to physical impairment, such as drug or alcohol abuse.

Where professionals have recognised disabled people's mental health support needs, the focus tends to be on depression, often assuming that physical impairment in itself causes depression. One woman was told by a psychiatrist: "If I was disabled, I'd be depressed". She later found that the diagnosis on her medical notes was "Understandable personality disorder because of her disability".

There is little recognition of the mental health consequences of negative attitudes, inaccessible environments, segregation and social isolation, which are all factors that impact on disabled people's mental health. So too are experiences of violence and abuse. Yet much of the evidence relating to this is anecdotal. One disabled woman wrote of the emotional legacy of segregation in childhood that it was "almost a lifespan of isolation, of painful separations", and of a need to grieve "for the loss of touch, love, sexuality, personal growth".² There seems to be little acknowledgement of the consequences of a denial of physical affection, intimacy and close relationships.

Services themselves can be disabling. Again, anecdotal evidence suggests that mental health professionals' reactions to physical impairment can sometimes get in the way of recognising mental health needs. Most people fear physical dependency. People fear, and are often disgusted by, incontinence. Communication impairment is often assumed to mean cognitive impairment. The historical segregation of disabled people means that many people working in the mental health field are unfamiliar with physical impairment. Those offering "talking treatments" are no more immune from prejudicial attitudes. Disabled people who seek or are offered these treatments may experience increased psychological distress as a result of being turned away (because services are not accessible to them) or because the attitudes of the counsellor or therapist may be oppressive. At the very least, disabled people who seek counselling or therapy from so-called mainstream services may find they have to "educate" the counsellor or therapist about impairment and disability.

It is important to recognise that physical impairment and disabling barriers may not be the only or most important influence on mental health support needs or, indeed, how someone is treated by mental health support services. Race, gender, sexuality, social and economic circumstances, and childhood experiences are likely to be part of the experience of mental health.

The Disability Discrimination Act 1995 places an obligation on all services to be fully accessible to disabled people. However, services will only achieve this if opportunities are created for disabled people's experiences to be understood and recognised. We hope that our research will make a contribution to this.

Nasa Begum is policy adviser, Mind; and Jenny Morris is an independent researcher.

References

¹ The booklet and questionnaire are available from: Mind, 15-19 Broadway, London E15 4BQ. Tel. 020 8221 9666. Copies of the research literature review are available from Jenny Morris, 101 Calabria Road, London N5 1HX. Tel. 020 7359 2935.

² A Mcfarlane, "Loss", in LKeith (ed) Mustn't Grumble: Writing by Disabled Women, The Women's Press, 1994.

³ R Olkin, What Psychotherapists Should Know about Disability, Guilford Press 1999; D Reeve, D. "Oppression within the Counselling Room", Disability and Society, 15 (4), pp. 669-682, 2000