Barriers to mental health service use among people with disabilities during the COVID-19 pandemic

People with disabilities (PWD), who constitute 25% of the adult U.S. population, consistently report a higher prevalence of psychological distress than do people without disabilities (Okoro et al., 2009). The COVID-19 pandemic represents a uniquely challenging period of time during which systematic and interpersonal forms of ableism have exacerbated pre-existing mental health disparities for PWD (Lund et al., 2020). The pandemic has also disrupted crucial care services, including mental health treatment, routinely used by PWD (Drum et al., 2020). Pre-pandemic studies focusing on individuals with intellectual and developmental disabilities highlighted disability-specific barriers, such as stigmatizing attitudes and lack of disability awareness among providers, as major factors hindering access to mental health services (Whittle et al., 2018). However, little research has examined how such barriers, along with other demographic and psychosocial factors known to influence treatment access, have shaped PWD’s mental health service use since the start of the COVID-19 pandemic.

In an article published in Rehabilitation Psychologyopens in new window, an interdisciplinary team led by Katie Wang at the Yale School of Public Health addressed this research question by conducting a two-wave survey among 183 U.S. adults with a wide range of visible (e.g., cerebral palsy) and invisible (e.g., autoimmune and chronic pain conditions) disabilities. In the fall of 2020 and 2021, participants completed measures assessing demographic and disability characteristics, pandemic-related stressors (e.g., worries about COVID-19), depression, anxiety, disability-specific barriers to accessing mental health services (e.g., anticipated disability stigma from providers, concerns about accessibility), perceived need for mental health services, and mental health service use. The authors found that anticipated disability stigma from providers significantly predicted a lower likelihood of mental health service use. They also found that specific subpopulations of the disability community (i.e., women, transgender and gender-diverse individuals, individuals with pre-pandemic mental health conditions, and younger individuals) have greater mental health needs and that low-income PWD were less likely to use mental health services.

The findings from this study provide initial vital descriptive data pertaining to the mental health service use patterns of PWD during the COVID-19 pandemic. Given that anticipated disability stigma from providers was identified as a significant barrier to mental health service use, the authors underscore the urgency of providing disability competency training and stigma reduction interventions to mental health professionals. Additionally, they emphasize that when researchers and practitioners develop and implement mental health interventions for PWD, it is especially important for them to do so with an eye toward addressing the needs of multiply marginalized members of the disability community.

This article is in the Clinical Psychology topic area.

Drum, C. E., Oberg, A., Cooper, K., & Carlin, R. (2020). COVID-19 & adults with disabilities: Health and health care access online survey summary report. American Association on Health and Disability. https://aahd.us/wp-content/uploads/2020/05/COVID-19_Summary_Report.pdfopens in new window

Lund, E. M., Forber-Pratt, A. J., Wilson, C., & Mona, L. R. (2020). The COVID-19 pandemic, stress, and trauma in the disability community: A call to action. Rehabilitation Psychology, 65(4), 313–322. https://doi.org/10.1037/rep0000368opens in new window

Manning, R. B., III, Cipollina, R., Lowe, S. R., Bogart, K. R., Ostrove, J. M., Adler, J. M., Nario-Redmond, M. R., & Wang, K. (2023). Barriers to mental health service use among people with disabilities during the COVID-19 pandemic. Rehabilitation Psychology, 68(4), 351–361. https://doi.org/10.1037/rep0000512opens in new window

Okoro, C. A., Strine, T. W., Balluz, L. S., Crews, J. E., Dhingra, S., Berry, J. T., & Mokdad, A. H. (2009). Serious psychological distress among adults with and without disabilities. International Journal of Public Health, 54(1), 52–60. https://doi.org/10.1007/s00038-009-0077-zopens in new window

Whittle, E. L., Fisher, K. R., Reppermund, S., Lenroot, R., & Trollor, J. (2018). Barriers and enablers to accessing mental health services for people with intellectual disability: A scoping review. Journal of Mental Health Research in Intellectual Disabilities, 11(1), 69–102. https://doi.org/10.1080/19315864.2017.1408724opens in new window

Robert B. Manning III is a first year PhD student in clinical psychology at Miami University. His research explores how different levels (i.e., structural, interpersonal, and internal) and types (e.g., mental health, sexual orientation, disability, etc.) of stigma independently and interactively contribute to mental and behavioral health disparities for minoritized individuals.

Rebecca Cipollina, PhD, is a postdoctoral fellow in the Center for Interdisciplinary Research on AIDS at Yale University in the School of Public Health. Cipollina’s research program employs her training in social and health psychology to document when and why discussions of socially derogated identities are avoided despite their positive impact on health and belonging for people with non-visible and visible marginalized identities (e.g., LGBTQ+ identity, disability).

Sarah Lowe, PhD, is an associate professor of social and behavioral sciences at Yale School of Public Health, with secondary appointments in the Department of Psychiatry at Yale School of Medicine and at the Yale School of Nursing. Lowe is a clinical psychologist and psychiatric epidemiologist whose work focuses on the long-term mental health consequences of potentially traumatic events, and the pathways linking exposures to outcomes.

Kathleen Bogart, PhD, is an associate professor of psychology at Oregon State University specializing in the social psychology of ableism. In 2019, Bogart co-edited the Journal of Social Issues special issue on Ableism, and is also an associate editor of Personality and Social psychology Review and Rehabilitation psychology. She is the co-founder of the Disability Advocacy and Research Network (DARN) for psychologists and students who have and/or specialize in disability.

Joan M. Ostrove, PhD, is a professor of psychology and director of the Serie Center for Scholarship and Teaching at Macalester College in Saint Paul, Minnesota. Ostrove is particularly interested in the relationship between psychology and social structure. Her primary research projects examine alliances across differences of social identity (especially in the domains of disability and race).

Jonathan Adler, PhD, is a professor of psychology at Olin College of Engineering, senior lecturer at Harvard Medical School, and chief academic officer of Health Story Collaborative, a non-profit focused on amplifying patient stories in the medical ecosystem. Adler is also editor of Personality and Social psychology Review. His research focuses on identity development and its association with well-being, with a particular emphasis on these processes among people with disabilities.

Michelle Nario-Redmond, PhD, is a professor of psychology and Biomedical Humanities specializing in stereotyping, prejudice, and disability studies. Nario-Redmond’s research focuses on group identification, wellness, political advocacy, and social change. In 2019, she published: Ableism: The Causes and Consequences of Disability Prejudiceopens in new window, and was the 2021 recipient of the Society for the Teaching of psychology's Promoting Diversity, Equity, and Inclusion Award.

Katie Wang, PhD, is an associate professor of social and behavioral sciences at Yale School of Public Health. Wang’s research 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 and individuals with mental health and/or substance use disorders.