Article 39 is proud to share the following blog to begin our series of reflections shared by members of our Expert Panel.
This first blog is written by Abi T, a lived experience expert and activist. All views and experiences are her own.
July is Disability Pride Month and a key time for us to discuss barriers faced by disabled people, their rights, and how we can make society more accessible. Within mental health settings, especially inpatient units, the focus is usually on managing psychiatric distress but the needs of young people that fit into more than one diagnostic box are often missed. Many young people in mental health inpatient units are also neurodivergent or live with physical health conditions and disabilities.
Unfortunately, the healthcare system can sometimes see a person through a very narrow lens. When a young person like me enters a mental health setting, we’re often expected to leave physical health needs or neurodivergent struggles out of the conversation. The lack of support for our overlapping needs can turn an environment that should be supportive into another inaccessible setting that harms our recovery.
When the Environment Becomes a Barrier
Inpatient settings are expected to provide a space for healing and recovery, but the physical environment can easily become a barrier when a building is not set out with physical disability in mind. On one unit I was placed in, essential spaces like the art room and therapy rooms were located on the top floor. There was one staff-only elevator, and this was being used for storage. Despite promises that the psychologist would come downstairs to meet me somewhere more accessible, this rarely happened. My physical health and mobility challenges meant I was consistently unable to use art to improve my mood and was prevented from accessing therapeutic support.
This is not just one inaccessible unit. Another unit featured a dining room only accessible via a flight of stairs. For someone with physical disabilities, regularly being able to climb those stairs safely was impossible and I ended up missing meals, leading to a decline in my health and mood. This same unit would lock us out of bedrooms during the day which prevented me from using my room as a safe space during autistic meltdowns or instances of sensory overload. I have a fatigue-inducing condition and lack of access to my bed meant I was also often falling asleep in hallways and being scolded by staff.
The Danger of Seeing Things from Only One Angle
Failure to consider health more holistically goes beyond just buildings. Mental health units often fail to take steps to maintain positive physical health such as helping young people to access essential medical appointments or providing regular blood pressure checks. During some admissions that lasted several months, I was only given a blood pressure check twice and missed several key appointments, leading to discharge from some NHS services. I have heard similar stories from other young people.
Because units often view everything through a psychiatric lens, they can make decisions like abruptly stopping important pain medications. Although it is common for some units to start from scratch with psychiatric medications, doing the same with physical health medication can have severe consequences in terms of pain, leading to a lot of distress. Lack of understanding of the difference between mental health distress, aggression, and autistic meltdown can also lead to traumatic interventions like sedation and unnecessary use of restraint being used, which can leave young people with long term trauma and distrust in medical professionals.
The Power of Reasonable Adjustments
Reasonable adjustments are not special treatment and are a vital way of reducing inequalities and lack of access. In an inpatient mental health setting, this means ensuring all patients can physically access dining areas and therapeutic spaces. It can also mean giving young people access to their bedrooms so they can make their own choices about how to manage fatigue and sensory needs. It may also involve training staff to recognise and support distress experienced by neurodivergent people, such as autistic people and those with ADHD. Continuing to provide physical health treatments and support is important as well. Young people are not defined by just one mental health label, like everyone else, they are multifaceted with a range of identities, strengths, and challenges.
Moving Forward
When a unit doesn’t make reasonable adjustments, patients are left feeling unsupported, dismissed, and misunderstood. Recovery cannot happen if a young person is excluded from essential spaces, forced to cope with unmanaged pain and physical symptoms, or left unsupported with their neurodivergent traits. For Disability Pride Month, we need to call on mental health systems to view everyone, including young people, as whole people. Instead of forcing patients to adapt to a rigidly built system that wasn’t designed for them, we need to encourage mental health settings and systems to adapt to the needs of the people they aim to support.
