Mental Health Among People with Disabilities: Local Health Departments Can Promote Awareness on Dual Diagnosis

By Evelyn Arana, NACCHO Health and Disability Fellow

Click image for more promotional graphics on Mental Health Month from NAMI.

In recognition of May’s Mental Health Month, organizations and people across the US are raising awareness for mental health. NACCHO joins the National Alliance on Mental Illness, Mental Health America, and other organizations nationwide in recognizing the importance of addressing mental health illness. It is also important to recognize the increased risk of mental health illness among people with disabilities. Local health departments (LHDs) can embrace Mental Health Month and play a fundamental role in efforts to increase awareness of mental health illness among people with disabilities. NACCHO’s Health and Disability team offers LHDs support and guidance in increasing awareness of mental health illness among this population.

People with disabilities often take on a strong mental toll. They may suddenly have major life impairments or may have been born with one. When measuring social determinants of health, people with disabilities fare poorly, having a lower likelihood of receiving an education, a higher likelihood for unemployment, and a higher likelihood of living in poverty. In fact, people with disabilities are five times more mentally unhealthy than those without disabilities. Their experiences of stigma, discrimination, and difficulties in accessing health care are likely to cascade into a diagnosable mental disorder. Moreover, adults with disabilities are three times more likely to commit suicide than adults without disabilities.

Little attention has been paid to the experiences and support needs of people that have both a disability and a mental health illness. This may in be part be due to healthcare providers treating health issues directly related to the disability while not inquiring about other health issues, including mental health. Among people with intellectual or developmental disabilities, mental health disorders are sometimes thought to be the same as having an intellectual or developmental disability. It is important that this dual diagnosis – the co-existence of a disability and mental health problems – be increasingly recognized among this population. There is a clear need for public health efforts to increase awareness of the prevalence of mental health illness among people with disabilities. LHDs play a fundamental role in increasing awareness for mental health for this population and to promote mental health screenings.

How Local Health Departments Can Help
Increasing mental health awareness and screening among people with disabilities and their providers is challenging. Efforts from LHDs should target people with disabilities, their families, caregivers, and other providers on the importance of identifying and screening for mental health illness. To incorporate people with disabilities into their mental health awareness work, LHDs should work to promote the inclusiveness and accessibility of their mental health resources and incorporate people with disabilities, as part of their community outreach efforts. The following suggestions may help your LHD increase awareness and screening of mental health illness among people with disabilities:

  • Partner with disability and mental health organizations: Together, brainstorm ways to address mental health among people with disabilities. Invite these organizations to take an active role in assessing the inclusiveness and accessibility of your health department’s resources on mental health. Include these organizations on your advisory boards, research teams, and planning committees. For more information view NACCHO’s fact sheet “Directory of Community-Based Organizations Serving People with Disabilities.” and the US Health and Human Services’ “Organizations with Mental Health Expertise.”
  • Partner with local primary health clinics: Providing mental health care is a responsibility that is increasingly falling to primary care providers. Partnering with these clinics may help them understand the prevalence of mental health among people with disabilities. Any resources or outcomes from meetings with disability and mental health organizations should be shared with your local primary health clinics.
  • Ask people with disabilities to help make your LHD mental health resources more inclusive: Invite people with disabilities to evaluate the accessibility of your health department’s mental health resources. Also invite them to brainstorming sessions that discuss mental health among people with disabilities. The disability community is diverse and has the greatest understanding of their needs and preferences. People with disabilities may also help disseminate resources across their local disability community.
  • Practice multimodal communication: Provide at least one form of communication for each type of communication disability to ensure that everyone can access information. Use alternative formats for written communications, including printed documents with large text, electronic documents, and audio recordings. Learn about sign language interpreting and video remote interpreting (VRI) services for in-person communication. Become comfortable using teletypewriters (TTYs) or computers with TTY capabilities, telephone relay services, and video interpreting services (VIS) for telephone communication. Remember, communicating with people who are deaf, are hard of hearing, or have speech disabilities doesn’t have to be complicated. Simple solutions such as writing communication on paper, smart phones, or computers can be very effective. For more information view NACCHO’s recent fact sheet, “Five Steps for Inclusive Communication: Engaging People with Disabilities.”
  • Invite people with disabilities to work or volunteer in your LHD: By recruiting people with disabilities, LHDs can make their efforts to increase awareness of mental health more effective, inclusive, and empowering for people with disabilities. Recruiting students with disabilities as interns or fellows can help build the next inclusive generation of public health workers that will help debunk the stigma surrounding mental health illness and promote mental health screenings. For more information view NACCHO’s report titled, “Strategies for Successfully Including People with Disabilities in Health Department Programs, Plans, and Services.”
  • Take Action. A major focus of Mental Health Month is to fight mental health stigma, educate the public and advocate for equal care. LHDs should hold forums, public discussions, and information campaigns in support of Mental Health Month to increase awareness for mental health among people with disabilities.

Additional Resources

The NACCHO Health and Disability Fellowship is supported by the Centers for Disease Control and Prevention (CDC), Cooperative Agreement #5NU38OT000172-04-00 and the Disability and Health program.

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