Mental health impacts of COVID-19 on people with disabilities: A call to action

Emerging evidence has continued to document the disproportionate consequences of COVID-19 on people with disabilities in the United States and globally. Since the beginning of the pandemic, the Disability and Health Journal (DHJO) has published 24 articles focused on the risks and outcomes of COVID-19 on people with disabilities, including eight articles in this issue.1, 2, 3, 4, 5, 6, 7, 8 These and other publications point to the unequal physical, social, and mental health impacts of the pandemic on people with disabilities.

Despite higher rates of poor mental health, social isolation, trauma, and violence, people with disabilities have always faced significant challenges in accessing behavioral health services.^{9 , 10} These challenges include the stigmatizing attitudes of mental health practitioners, lack of reliable and accessible transportation options, financial barriers, and the scarcity of mental health practitioners who are willing to support and are knowledgeable about the needs of people with disabilities.¹¹ During the COVID-19 pandemic, and the resulting increase in social isolation and disruptions in social networks and support systems, there has been an unprecedented rise in mental distress, stress, and anxiety among people with disabilities as documented in this issue.^{1 , 5 , 6} Undoubtedly the continued uncertainty and the long-term physical, social, and economic effects of the pandemic will continue to disproportionately impact the mental health of people with disabilities,¹² highlighting the urgent need for improving access to mental health services for people with physical, sensory, and cognitive disabilities.

The COVID-19 pandemic has also impacted paid and family caregivers, and other direct care workers who support people with disabilities, in multiple ways. There is evidence that caregivers also experience higher levels of distress and negative mental health consequences along with fatigue and other somatic symptoms.^{13 , 14} While DHJO has not published articles related to increased caregiver distress or anxiety, there is acknowledgement of the increased burden placed on caregivers during this time.^{12 , 15 , 16} Further reports would be of interest.

The albeit temporary but important federal policy to expand telehealth behavioral services during the public health emergency is one promising strategy to increase access to behavioral health services for people with disabilities (https://www.commonwealthfund.org/blog/2020/using-telehealth-meet-mental-health-needs-during-covid-19-crisis). Although ensuring the accessibility of telehealth for counseling and mental health care to all people with disabilities and their caregivers is essential, there are notable limitations to telehealth services as a long-term solution for people with disabilities. These hurdles have been identified in a previous DHJO article¹⁷ and include the lack of access to broadband technology, smart phones, and computers. Other barriers include the absence of private spaces to have confidential conversations with behavioral health providers, especially for people with disabilities needing paid and family caregiver support. People with cognitive limitations, including intellectual and developmental disabilities, may require facilitation from direct care support to benefit from this approach.² Other long-term strategies to consider are addressing the need for mental health parity, increasing the number of mental health professionals qualified and trained to provide care to people with diverse disabilities, increasing access to disability-competent integrated care, increasing home and community-based services to include peer supports. These strategies would benefit from exploration of effectiveness and best practices.

The heightened mental health inequities experienced by people with disabilities during the pandemic calls for urgent policy and programmatic changes in behavioral health service delivery for people with diverse disabilities. Local, state, and federal governments in collaboration with disability-led community organizations must address the mental health of people with disabilities through inclusive, accessible, and affordable behavioral health services.