Worst of both worlds

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

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

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.


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,

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