Disability, Mental Health, & Substance Use: Part II

Dive Deeper

Coast to Forest Web Library

Please note that we use a combination of person-first (e.g., person with a disability) and identity-first language (e.g., disabled person) in this article in acknowledgment of differing preferences within the disability community. When speaking to an individual it is always best to ask if they prefer person-first or identity first language.

This article does include information relating to suicide and suicidal behavior. If you or someone you know may be struggling with suicidal thoughts, you can call 988 for free, confidential support from the National Suicide Prevention Lifeline. For ASL services, click the “ASL Now” button at https://988lifeline.org/. For services in Spanish, call 988 and press option 2.

Part II: Understand the Context

Part I outlined two main definitions of disability and highlighted how people with disabilities are disproportionately impacted by mental health and substance use challenges. This section will dive deeper into the context behind the information covered in Part I.

The disability community is the largest minority group in the United States, with 1 in 4 adults having at least one disability. People with disabilities face discrimination, stigma, and prejudice because of their disability or disabilities. This is known as ableism and can be fueled by the false assumption that people with disabilities are less capable, competent, or valuable than people without disabilities. Similarly, sanism refers to discrimination, stigma, and prejudice based on mental health conditions. An example of a sanist belief is the idea that substance use is a moral weakness rather than a medical condition.

One in four U.S. adults have a disability.

This graphic is based on information from the Centers for Disease Control and Prevention.

Ableism and sanism have been present throughout history and continue to impact disabled people today at the systems level. For example, the practices of restraint and seclusion are used in in hospitals, nursing homes, and schools and have been found to be traumatic and psychologically distressing. These practices may also worsen symptoms of mental health conditions, especially for people with post-traumatic stress disorder (PTSD). Despite this evidence, restraint and seclusion practices are still used around the country. 

Ableism and sanism also impact how people interact with individuals with mental health conditions and/or substance use disorders based on implicit (unconscious) and explicit (conscious) biases. Bias refers to the tendency to view disability either positively or negatively. Furthermore, both ableism and sanism can negatively impact things like care seeking and diagnosis, treatment participation/dropout, and self-stigma, which creates additional barriers to mental health and substance use recovery. These issues negatively impact the disability community through disproportionate rates of unemployment or underemployment, houselessness, poverty, incarceration, medical trauma, and premature mortality compared to the general public. 

The impacts of ableism and sanism can be amplified when combined with other minority identities such as disabled people of color, disabled members of the LGBTQ+ community, or disabled people living in rural areas. For example, people with disabilities living in rural areas may live in an area without mental health specialists or public transportation, making long distance travel a barrier to care. Additionally, disabled people living in rural areas may be less likely to have insurance that includes mental health coverage and often face mental health stigma in their community. 

That said, the disability community has actively been advocating for changes for a long time. People with disabilities were key players in the deinstitutionalization movement, which pushed for community-based treatment and the end of forced institutionalization. Olmstead v. L.C. marked a major victory for the movement as the Supreme Court used the Americans with Disabilities Act (ADA) to determine that states cannot discriminate against disabled people by keeping them in institutions when they could be in community-based treatment. Additionally, in more recent years there has been the start of Mad Studies, a “field of scholarship that brings together theory, activism and creativity, drawing on the lived experiences, thinking, history and politics of people who variously identify as mad, psychiatric survivors, mental health consumers/service users/patients, voice hearers, plural/multiple, neurodiverse, and/or disabled”. To learn more about the current work being done in this area, visit the Mad Studies Network or International Mad Studies Journal