I grew up physically disabled, being pushed from pillar to post by every type of doctor, test, and physiotherapist you could possibly think of. Five years into the journey of begging for more support for my physical health, I was admitted to a psychiatric unit after almost a year of mental health crisis. When I entered that space, I didn’t know I would also be handing over control of managing my conditions and supporting my body in exchange for supposed protection of my mental health.
The lack of attention to – and exercise of – my muscle tone and joint issues led to me losing my already-limited mobility. My legs continued to collapse under me for two years after admission, and my fatigue, pain and Postural Orthostatic Tachycardia Syndrome increased exponentially. I had no idea my admission would leave me chasing a version of my health which I would never quite get back again.
Culture change is desperately overdue
The way physical health or disability is treated in psychiatric units is both a practical and cultural issue. The spaces themselves are literally built without the consideration of a physically disabled person: many units have no accessible rooms and bathrooms, no lifts and carpets that a wheelchair cannot smoothly move across. Kitchen counters and serving hatches are too high, doors are not wide enough, hallways are long and winding; all the things that a non-disabled person may not notice.
But possibly even more crucially, is the issue of culture amongst staff within psychiatric units, as the people with the power. Power structures in psychiatric units are already an incredibly difficult issue – with patients left powerless, without support to advocate for themselves – and this is often heightened by physical disability. I know many people who have been inpatients who were denied the use of their mobility aids around the unit and forced to walk without them due to ‘hospital policy’, with completely fallacious ideas about safety cited and critical physical health appointments cancelled. Many staff believe they don’t need to know about physical health and disability, because it ‘isn’t what they are there for’, but we cannot leave those aspects of ourselves at the door just because our mental health is also needing focus.
I knew of and advocated for my physical needs during my intake assessment. But a fifteen year old in the midst of a crisis should not have to hold full responsibility for making sure their physical health needs are met. The culture in units sees staff believe that patients are at best clueless, and at worst, lying, exaggerating, or attention seeking.
Neoliberalism encourages a false silo
Physical health and mental health should not, and cannot, be siloed in the way they constantly are by society and the state, and this is particularly true for those of us who are disabled and/or chronically ill. Pain, fatigue, dizziness and symptoms which change the way you can interact with the rest of the world mean you are often left isolated. Where neuronormativity and ablenormativity rule amongst a capitalist society, not being able to keep up with traditional time structures, work, and social norms all change your relationship with your mind and your body.
In our current version of society under neoliberal capitalism, where work is prioritised above all else and disabled people are constantly scapegoated by the Government as the reason working class people continue to be entrenched in poverty whilst the rich get richer, it is no wonder that our mental health is generally worse.
Aside from existing disabilities, it should also be noted that mental health crises and the trauma of psychiatric units have physical impacts, too. Trauma can change the body and stress responses can be extremely physical. Units deprioritise physical health as if we are not whole people who need to be supported holistically, and it leaves many in a worse position than when they entered. There is a deep irony, to me, that many of us end up costing the system more because of the impacts of being institutionalised, in a society that is desperate for us to cost less, be less, exist… less.
This year, I was part of a roundtable with the Joint Committee of Human Rights looking into the Mental Health Bill, which has now been given Royal Assent. Physical accessibility was one of the first things brought up on my table, including lack of accessible bathrooms and bedrooms, and the isolation that can present when social or educational activities take place in inaccessible spaces. This issue was flagged in the roundtable summary from Lord Alton to Wes Streeting. It was fascinating to note the continual shock and surprise of those we spoke to about how we were treated, when it is so normal to those of us who experience it.
Units must change
Units urgently need more understanding of, and genuine attention to this issue going forward. That includes becoming more physically accessible, addressing their underlying culture, and doing away with the line drawn between mental and physical needs – it isn’t real, and does more damage than many know.
Almost ten years later, I am still facing the consequences of the lack of care towards my physical health. The way units treat physical health cannot continue: for those of us who are multiply disabled, and those who become so, the impact is long-term and devastating.