Mind and body together

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