While much of the media portrays American society as a population of able-bodied, fit, and confident individuals, statistics show that 61 Million (or one in four adults) living in the United States have disabilities of some type. Furthermore, disabled adults report frequent mental distress five times as often as non-disabled adults. For those living with comorbid conditions, mental health and disability are often inextricably intertwined.
Physical disabilities may be visible to others or not so obvious. What constitutes a physical disability? It is one or more medical conditions that limit or impair the individual’s ability to function in society fully. These include conditions affecting a person’s cognitive, mobility, vision, speech, or hearing abilities.
The Unique Mental Health Experience of Those With Physical Disabilities
Mental health impacts those with physical disabilities differently than individuals who do not have them. While it may not be apparent to others, those with physical disabilities often struggle to make complex adjustments in their daily life. They may be limited in how much they can travel or navigate their surroundings. They may also have to exert much more effort to get around or accomplish simple tasks, and this can leave them exhausted, stressed, upset with their lack of progress, and frustrated to the point of giving up.
It is not that the person with physical disabilities does not want to participate fully in life, but they often face formidable hurdles and lack a support system to help them through difficulties. They may not recognize that their mental health and disability contribute to worsening quality of life. If they realize that comorbid conditions are dragging them down, they may have no one to help them cope. They do not want to bother others or be a burden, and well-intentioned family members, loved ones, and friends may exacerbate their disability and mental health concerns.
The Relationship Between Physical Disabilities and Mental Health
What is the relationship between physical disability and mental health? First, physical disability affects a person’s mental health. Disabilities and chronic illness are directly tied to mental health. Dealing with chronic disease or comorbid mental disorders with a physical disability is incredibly draining. It can also have a compounding effect, one condition negatively affecting the other.
Here are some examples of how mental health and disability may intertwine:
Anxiety and Stress
If access to work, shopping, driving, and getting around at home or in the neighborhood is a constant issue, this adds to the stress and creates anxiety. How will any of this get resolved? Will it last forever? These are questions those with comorbid mental health and disability conditions deal with daily. The combination of physical pain from a disability and the symptoms of underlying or developing mental health disorders is a reality all too common.
Lack of Self-Esteem
A person’s self-esteem erodes if they do not feel confident in their daily functioning abilities. Besides feeling insecure, they experience diminished self-worth. It can be an extraordinary challenge to overcome low self-esteem, and it often requires outside help to ensure progress toward goals.
Worrying About the Future
Life is tough enough to cope with for those with comorbid mental health and disability conditions. There is often a never-ending worry about what the future holds and how they will be able to continue to survive under potentially deteriorating conditions. When there are no or few people to talk with about these concerns, that only magnifies the problem.
Difficulties Maintaining and Establishing Relationships
For someone with mental disorders and a physical disability, it can be challenging to meet new people, establish good relationships, and maintain them once they begin. Individuals with comorbid disabilities and mental health issues may perceive being pitied. Or they may not openly communicate what is happening to them.
Uncertainty About Medical Treatment
Another issue that can plague those with a co-occurring mental health disorder and physical disability is uncertainty about their medical treatment. Are they receiving the best treatment for their physical disabilities and mental health? Could it be better? How do they navigate the treatment and coordinate it between multiple providers to ensure the best possible outcomes?
Although discrimination in public against those with comorbid disabilities and mental health disorders is illegal, that does not mean it does not occur. Bias against those with disabilities is pervasive in America, and individuals often face it at work. Experiencing discrimination can add to anxiety and depression.
Barriers to Seeking Care
The reasons support is lacking for this community are varied, but they are surmountable with appropriate help. The four major ones include insufficient or unattainable integrated care, a higher incidence of poverty and unemployment, barriers in communication, and mental healthcare barriers.
Insufficient or Unattainable Integrated Care
Physical disabilities, whether or not they coexist with mental health issues, often require ongoing or constant medical attention. This may be painful, expensive, and difficult to obtain. While undergoing hospitalization, medical procedures, and repeat doctors’ visits, the individual may put seeking care for mental health concerns aside. Coupled with the fact of insufficient integrated care in medicine, people with comorbid mental health and disability often cannot get treatment for both.
Higher Incidence of Poverty and Unemployment
Individuals with a disability and mental health issues have a higher incidence of poverty and unemployment. This is true both in America and around the world. Those with disabilities and mental health issues also face higher life maintenance costs. Dealing with pain, poverty, physical limitations, and the inability to find gainful employment can lead to depression and anxiety or worsen existing mental health disorders.
Barriers in Communication
Physical disabilities may make communicating difficult for individuals who need mental healthcare. Besides the reluctance to ask for help for fear of being stigmatized, it is often hard to verbalize what they need. Those with a mental health disorder and a physical disability may find communicating their needs more of a challenge.
Mental Healthcare Barriers
This category is the most widespread, affecting people with coexisting mental health and disability issues. Infrastructure is often lacking for those with disabilities, and access to adequate health care may be limited. When someone wants mental health care, there may not be support from family, friends, or caregivers. The stigma of seeking mental health care often prevents individuals from seeking and getting the help they need.
The Importance of Building Support for Those with Physical Impairments
No one likes to think about people suffering and being unable to get the care they need. It is human nature to block out unpleasant reality, even when the facts are painfully obvious. Yet it is also human nature to want to help others, especially those in need. It can be a delicate balance to bridge the gap, but those with mental health and disability issues desperately need support.
Think of the seniors living on fixed incomes who cannot get around without the help of others. Traveling to medical appointments, counseling, and even navigating the often-confusing labyrinth of medicine can be more than they can manage. Individuals with mental disorders and physical disabilities may face even more significant challenges. Isolation and loneliness exacerbate their reality of lack of support—even more reason to find ways to build support for those with physical impairments.
Sports and fitness programs accessible to those with physical impairments can support physical and mental health. Such programs can build muscle, improve strength, gain flexibility, boost mood and self-confidence, and improve functional abilities.
When seeking to support someone with a physical impairment, with or without a mental health disorder, it is essential to ask what they need. Never assume to know what is best but inquire about what may make things easier or more effective.
Make sure to listen to what they say. Also, speak using simple sentences that are single concepts. This is not talking down to the individual. It is straightforward and presents a single thought to digest. Let them have their say even if the individual has a cognitive or speech impairment. Refrain from interrupting them as they speak. Respect their right to make decisions and participate fully in their care.
Community mental health services are essential to supporting those with physical disabilities and mental health issues. Not only is this convenient for individuals who need the support, they appreciate being able to receive help for both physical and psychological health concerns. Access to medications, counseling, supportive therapies, and being treated as a “whole person” is integral to supporting those with comorbid mental health and disability issues.