A qualitative exploration of the experiences of adults with physical disabilities in acute mental health services

Background: Disabled people are disproportionately affected by inequalities in engaging mental healthcare, including inaccessibility, ableism, and exclusion. Some research has indicated that this may mean that Disabled people do not receive care until the point of mental health crisis, yet specific barriers with acute mental health services (AMHS) may further exclude those most in need. Despite this, research focused on barriers to and facilitators of disability-affirmative AMH care is relatively sparse. Objective: The present research aimed to explore how Disabled people with physical disabilities (DPPD) experience and navigate AMHS. Methods: Through purposive sampling, eight DPPD with direct experience of AMHS and four disability advocates with indirect experience were recruited. All participants engaged in semi-structured interviews focused on the experiences of DPPD in navigating AMHS. Results: Through Reflexive Thematic Analysis, five themes and six subthemes were generated. The five themes were: Barriers to access, inflexibility and exclusion in acute mental health care; Lack of holistic care: integrating physical and mental health; Silencing and epistemic injustice; Discrimination, intersectionality, and identity; and Disability competence and professional avoidance. Conclusion: AMHS can play a vital role in supporting DPPD experiencing acute mental health (AMH) needs, however interpersonal and structural ableism often means that this care is inadequate, and indeed may cause further harm. Based on these findings, several clinical recommendations can be made for systemic changes within AMHS to improve accessibility, beyond basic service availability, and facilitate more disability-affirmative care for DPPD.