Ableism Is a Major Barrier to Mental Healthcare

Coauthored by Sarah Fodero, MPH, Katie Wang, PhD, and Kathleen Bogart, PhD

Source: Disabled and Here / Creative Commons License

The largest socially marginalized group of Americans is struggling to access mental health care, the support many of them want. One in four Americans has a disability, and while people with disabilities are more likely to have mental health concerns and utilize mental health services, their needs remain largely unmet. In a recently published study, we investigated where mental health services fall short and how care can be improved for people with disabilities in the future.

We interviewed 20 U.S. adults in fall 2022 about their experiences seeking and receiving mental health services. Participants, ages 22 to 67, reported a wide range of visible and invisible disabilities and were diverse in terms of race-ethnicity, gender identity, and sexual orientation; notably, 80 percent of the sample identified as having multiple disabilities. Participants’ narratives revealed six overarching themes that demonstrate the various dimensions of ableism while seeking and receiving mental health care.

Misplaced Assumptions

This first theme represents instances where a participant’s disability identity was either viewed as the sole focus of mental health treatment or completely ignored. One participant described being denied therapy by their campus counseling center and referred to disability services after the initial consult in which their autism was revealed. Another participant described the opposite situation, “When I lost my vision, I sought out a therapist that could help me sort of work through all of the issues that came along with that. But they were more concerned about what happened with my childhood or something else.”

Medical Trauma and Gaslighting

The second theme exposed instances where providers discounted participants’ knowledge of their own medical needs or discredited their lived experiences. Participants described being invalidated or dismissed by providers when advocating for safe, effective care (for example, asking providers to wear a mask as a COVID-19 precaution, or requesting an autism diagnostic assessment).

Interpersonal Ableism

Within the third theme, participants reported various disability-based microaggressions from their providers. One participant was told that she should let others take on the work of community organizing due to the perceived burden her wheelchair would have on an event, while others described experiences of providers speaking with their family members rather than addressing them directly.

Lack of Disability Knowledge

“Not a lot of therapists are very well educated on chronic illnesses and disabilities,” a sentiment shared by one participant, was a common refrain and clearly articulates the fourth theme. Further, many discussed providers’ apparent lack of interest in educating themselves about disability-related topics or concerns.

Accessibility Challenges

The fifth theme captures the many environmental and technical barriers identified when accessing mental health services. Transportation to appointments and physical barriers in offices (for example, crowded rooms and hallways that are difficult to navigate with a wheelchair) were common challenges in accessing in-person care. Notably, telehealth also posed its own set of access barriers, with limited Internet access and lack of accessibility features in virtual meeting platforms (for example, captioning) as major pain points.

Systemic Ableism

The sixth theme underscores the deeply rooted ableist nature of mental health institutions, policies, and practices. One participant powerfully stated, “The established networks were built from their very beginning on eugenicist, cis-heteronormative, White supremacist ideals overtly and openly. And there is no version of that that will ever be even physically safe for a person like me to encounter.”

One final aspect of this study was an examination of the intersectional and compounding impact disability identities have on other marginalized identities in the context of mental health services. Insight into how people with disabilities navigate this intersectionality is one of the novel contributions of this study. One participant clearly articulated what this experience is like, “Socially I just really feel like I wouldn’t necessarily be acknowledged [for] all of my identities. And that’s kind of stopped me from seeking out mental health services.”

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Taken together, this study showcased resilience and adaptability as people with disabilities navigate the challenges of seeking and receiving mental health services. However, many participants also emphasized the crucial need for providers to meet them where they are, consider accessibility, listen, and trust them as experts on their own lived experiences. Providers can begin to bridge the disability divide through open, ongoing conversations instead of relying on stereotypical assumptions or avoiding disability-related topics altogether.

In addition to interpersonal consideration, systematic changes are needed to address the lack of disability competency training, the underrepresentation of disabled providers, and a lack of sensitivity to the unique concerns associated with intersecting marginalized identities among providers.

If you are a person with a disability seeking mental healthcare, look for someone with specialized training or experience in disability. Psychology Today has a feature to search for therapists with certain disability-related specialties, including chronic illness, intellectual disability, traumatic brain injury, ADHD, autism, chronic pain, and learning disabilities. Many providers offer a free initial consultation, which may be a good opportunity to inquire about prior experience working with disabled clients and familiarity with ableism.

Note: Participants for this study were selected from a larger online survey that investigated the mental health challenges and resilience of U.S. adults with disabilities during the COVID-19 pandemic. Findings from that study were detailed in this post.

Sarah Fodero, MPH, graduated from the Department of Social and Behavioral Sciences at Yale School of Public Health in 2023. She is passionate about disability advocacy and understanding the impact of ableism on health.

Katie Wang is an associate professor in the Department of Social and Behavioral Sciences at Yale School of Public Health. Wang's research broadly focuses on the role of stigma as a psychosocial determinant of mental and behavioral health inequities among diverse marginalized populations, with a specific emphasis on people with disabilities.