YuLin Zhen, Photography Editor

Pam, an African American woman with a mental health disability, doesn’t enjoy going to therapy. Whenever she goes, she rarely discusses her emotions or how she can become mentally healthier; instead, she focuses on explaining and educating her therapist about her disability. 

“I wanna talk about how [my condition] makes me feel,” she told Yale researchers, “not rehearse my diagnosis.”

Katie Wang, associate professor of public health, led a study at the School of Public Health this month revealing the discrimination faced by people with disabilities like Pam when seeking mental healthcare. 

According to interviews with disabled individuals, ableism causes and exacerbates the disparities in mental health care.

Mental health care is a sector that Wang believes especially typifies discrimination people with disabilities face. She hopes that her research inspires changes in mental health practices that prioritize treating individuals no matter their disabilities.

Healthcare settings are commonplace for people with disabilities to face discrimination. Previous research has indicated that disabled individuals experience higher rates of mental health distress, including depression and anxiety, and are usually left unsatisfied with their care. Wang wanted to understand why this was the case and what barriers people with disabilities were facing when trying to access psychotherapy services.

Wang and her team interviewed 20 adults in the United States with disabilities in fall 2022 about their experiences with the American mental health care system. The interviewees came from various backgrounds, including race, gender and sexual orientation. They also had a range of disabilities, ranging from physical to mental.

The team asked the individuals about the barriers that they experienced when seeking mental health care as well as if they experienced ableism when talking to their providers. 

“They showed a lot of resilience and shared deeply personal stories and were brave about it,” Sarah Fodero SPH ’23, a co-author of the study, told the News. “We asked a lot of really direct questions about their experiences and how providers treat them. But I think folks were happy to share the negative experiences. Many articulated that they wanted to participate in the study in order to help other people.” 

Interviewees expressed annoyance with psychologists either overemphasizing or ignoring the role their disability played in their mental health. One participant with autism trying to access mental health care was redirected to disability services even though her main concern was not related to her autism. Participants in the study also felt that providers frequently invalidated their experiences and needs.

“One of the most difficult barriers to remove is the attitude of people towards people with mental disabilities,” Carmen Correa-Rios, the operations director of the CT Center for Disability Rights, told the News. “We have people walking in when they’ve been accused of different things, and they feel everything is in their head. It’s not only in their head.”

Instances of interpersonal ableism between patients and psychologists, uncovered by the study, included various microaggressions directed toward people with disabilities — for example when psychologists addressed the family members instead of the patients themselves. According to Joan Ostrove, professor of psychology at Macalester College and co-author of the study, this can make patients feel unsafe, unseen, invalidated and frustrated.

Systemic ableism refers to the institutional barriers that make it difficult for people with disabilities to access mental health care. 

Some hospitals’ harsh cancellation policies negatively impact people with disabilities, for example, because they might need to cancel appointments at the last minute due to unpredictable disability conditions.

Another example of systemic ableism, according to the study, is the use of telehealth.

“The lack of universal design features or accessibility features are in a lot of the telehealth software people are using,” Wang told the News. “Telehealth software really does need to be accessible, both for screen reader users and for people. But there are others who have disabilities that make it more difficult to use telehealth altogether.” 

Lastly, some people with disabilities experience compounding discrimination because of their race or sexual orientation. They found it difficult to not only find providers who understood what it is like to live with both identities but also couldn’t understand if the discrimination they received was based on their disability or their other identities.

Though the study did not interview many individuals with intellectual disabilities or those above the age of 60, Wang believes that her research clearly lays out various ways that people with disabilities experience ableism in their mental health care.

According to Fodero, who’s also visually impaired, hearing the stories of these individuals was not only sad but deeply validating, as she could relate to the many experiences of the individuals she interviewed.

Fodero shared that some people with disabilities believe that the current U.S. medical system is not geared to treating individuals with disabilities, which exacerbates the problem. The system sees people with disabilities as a medical anomaly more than a minority population. This creates a lack of disability competency training among physicians, a lack of flexible health insurance plans and other systemically ableist policies.

Addressing the problem 

According to Correa-Rios, one of the easier ways to address ableism in mental health care is by increasing disability competency training in the standard curriculum of medical students and psychologists. Exposure to topics they might not understand helps professionals to see people with disabilities as not incompetent or medical phenomena but as actual patients who need mental health care. 

Roger Jou, an instructor of clinical child psychiatry at the School of Medicine, also believes this shouldn’t be a one-and-done; physicians should learn about disabilities throughout their careers.

“[Physicians] need to understand it’s not always one size fits all,” Correa-Rios said. “You can have two people with the same disability who need a completely different approach. So by asking ‘How can I help you?’ the person will in one way or another let you know what is the best way to help them.”

Wang believes that increasing the number of psychologists who have disabilities themselves — through recruitment and ensuring workplace accessibility —  “will do wonders” in reducing ableism in the mental health care experience.

She also suggested that healthcare institutions should be more flexible with appointment and cancellation procedures. 

It could also mean further community-based participatory research to continue to uncover deeper analysis of ableism in the mental health space.

Further community-based participatory research on ableism and other forms of discrimination is needed, Ostrove believes. 

However, during Donald Trump’s presidency, Fodero fears it will be harder for people with disabilities to gain equal access to mental health care in various ways.

Trump’s removal of diversity, equity and inclusion programs at various agencies will make it harder for clinics and institutions to hire psychologists with disabilities. The possible removal of certain research funding may make it difficult to conduct more research into ableism in the future. 

By providing a voice to people with disabilities, Fodero hoped to inspire conversations about the needed structural changes.

“First seek to understand, then to be understood,” Jou wrote to the News when asked what psychologists can do to fight ableism in mental health care. “Apologize and commit to doing better. Quoting Maya Angelou, ‘Do the best you can until you know better. Then when you know better, do better.’”

According to the CDC, adults with disabilities report experiencing frequent mental distress almost five times as often as adults without disabilities.

FAREED SALMON
Fareed Salmon covers Community Health & Policy for the SciTech desk. From Richmond, TX, he's a sophomore in Jonathan Edwards College majoring in History.
KALINA BROOKFIELD
Kalina Brookfield covers Community Health and Policy for the SciTech Desk. She is a first year in Grace Hopper College from Boston, MA.