Double Discrimination | NAMI

Experiencing discrimination based on a disability can lead to many issues, including quality of life and mental health struggles. . People with a disability live in poverty at nearly three times the rate of their non-disabled peers. Access to health care is also a major issue — in a 2019 survey of individuals eligible for both Medicare and Medicaid benefits, 75% of respondents reported having at least one disability. Compared to dual-eligible individuals who did not have a disability, these respondents were more likely to have difficulty accessing needed health care services. Nearly 40% reported that their health plan would not approve or cover care, 16% were unable to get transportation to their doctor’s office, and 12% could not afford their care.

In addition to the “obvious” discrimination in housing, employment and accessibility, people living with disabilities also experience pressure to assimilate to a culture that engages in ableism. Throughout mainstream media — television shows, movies, magazines and images on social media — people with disabilities are almost always depicted either as secondary characters who need the help of non-disabled peers or as inspirational heroes who have overcome tragic circumstances. They are rarely shown simply as people with the same wants, needs and complexity as anyone else.

The intersection of having a disability and living with a mental illness creates a unique identity, with complex needs and concerns. Disability and mental health issues are closely tied together, and for individuals who experience both, issues of discrimination can be compounded. This “double discrimination” often leads to more challenging health outcomes, including higher rates of death by suicide and institutionalization. Research findings show that people living with disabilities including mental illness were four times more likely to attempt suicide than individuals with neither disability nor mental illness.


Where The Discrimination May Be Experienced

Although the U.S. has made strides in expanding opportunities to people living with disabilities, there is still a long way to go to ensuring true equity. The Equal Employment Opportunities Commission (EEOC) works to enforce employment laws that make it illegal to discriminate against people with disabilities, but bias that impacts hiring, retention and development opportunities remains a prevalent challenge. Some companies still employ practices that discriminate against people living with disability through loopholes or inaccurate disclosure of their practices.

Job descriptions can often give preference to people without a disability through subtle language or non-essential position requirements, either intentionally or unintentionally. (e.g. prioritizing the ability to interview over the ability to do the job, requiring excellent communication skills for all positions regardless of the type of communication necessary to perform the job, etc.)

Employers can also disqualify applicants with disabilities who may otherwise have the appropriate skillset and experience by including physical requirements that may not actually be necessary for the job. For example, an office desk job may include a requirement that the applicant be able to lift between 25-50 pounds — automatically disqualifying or imposing difficulty for someone with mobility issues or physical limitations, regardless of how qualified they are to perform all other job requirements.

People living with a disability can also feel that they are at a disadvantage as soon as they start seeking employment. While anyone can experience anxiety about job interviews and searches, a person living with a disability must manage this intense stress as well as navigating reactions from recruiters and hiring managers to their physical or cognitive differences. These experiences can feel overwhelming and trigger mental health symptoms.

The challenge of finding a job with a disability and a mental illness is even more complicated. Employers may be influenced by stigma and automatic assumptions, affecting how they view candidates who openly discuss or request accommodation for a disability. Research has shown that employers are less willing to hire candidates who self-identify as a person with a disability, believing whether there is evidence or not, that the existence of a mental health may impact their productivity and performance.

Dating/Social Life
In order to make social connections and spend time with friends and family, people living with disabilities often experience the burden of needing to investigate whether their accessibility requirements can be met to join a gathering. This often requires planning ahead and arranging for access solutions that their peers without disabilities may not even be aware of as the person with the disability fears they will no longer be invited/included if they share this burden with others.

When seeking romantic connections, people with disabilities may experience rejection and feelings of being deemed as less desirable if the person they are interested in is more focused on physical characteristics and possible limitations than shared interests, humor and personality. There is also the concern of how the person they are interested in romantically, or even platonic friends, will manage how others will respond to being with someone who has a disability. Will the parents object to their son or daughter dating someone with a disability? Will the stares and comments in public push people away or result in tense interactions? Will a business refuse service or behave in a manner that is embarrassing or condescending? Will a child point and ask questions like, “what is wrong with that person?” The emotional land mines combined with physical challenges may trigger traumatic stress or anxiety.

With that said, finding and maintaining friendships or romantic relationships for people who are living with both a disability and a mental illness can be more than a little daunting. It’s common to have concerns about disclosing a mental health condition, and this is compounded when you are already worried about being seen differently due to other disabilities.

Experiencing this conflict and concern about disclosure may lead a person to hide their mental health concerns to avoid stigma or judgment. It takes incredible courage and strength to be honest about everything you are experiencing. It is also important to note that this kind of transparency and disclosure can also have the potential upside of creating stronger relationships and helping to develop a system of support.

People living with a disability frequently develop coping skills and strategies to navigate an inaccessible society that may at times treat them as invisible. Requiring accommodations and support to navigate daily life can be daunting and exhausting. Experiencing these difficulties can lead to strains on mental health, and even a sense of defeat — but it can also motivate people with disabilities to develop the strength, resilience and creativity to confront their struggles and strive for fair and equal treatment for both themselves and others.


How To Cope With Double Discrimination

Facing discrimination for both disability and mental illness can be frightening, but it is possible to find strength and community. You don’t have to struggle in silence because you are not alone. Connecting with support groups and resources for people with similar needs and experiences can be the first step to holistic health, supporting mind and body wellness.

Support Groups
Thanks to the broad reach and low barrier to access of social media, many diverse advocates and groups are able to share their voices and build communities of support. One strategy to identify such networks is to research the different Facebook groups and Twitter feeds that support mental and emotional wellness for people with disabilities. Affinity groups such as Mental Wealth MattersDisability Support Group or Rising Strong provide opportunities to virtually socialize with people who can empathize with your struggles and offer resources for education, employment and both physical and mental health care. Social media has connected people from around the world to share their experiences, offer mutual support, and offer a place to belong that may be both freeing and helpful.

Talk to Your Doctor
Openly talking to your primary health care provider about your struggles with mental health can be a good source of information. Ask questions, explain your concerns, and do not be afraid to advocate for yourself. Questions you can ask include:

  • Can you provide me with recommendations for mental health specialists?
  • Are there mental health resources at your practice and/or partnering practices that I may qualify for?
  • Might the medications or treatment I am receiving have mental health side effects I need to monitor and manage?
    • Could the medications I am taking interact in ways that could affect my mental wellness?
  • The current treatment plan I have makes me feel _____. Are there other options for me?
    • Are there other options besides medication to alleviate my symptoms?

Though this is not an exhaustive list of questions, it can serve as a starting point to guide a more in-depth conversation with your health care provider and create a collaborative care plan, determining what steps you can take to begin addressing any mental health issues.

Advocate and Fight Discrimination
Facing double discrimination is incredibly tough, but one of the best ways to cope is through raising your voice and advocating for yourself and others who face similar challenges. You can be a part of the change that needs to happen to address stigma. Either by writing about it on a blog or social media or having honest conversations with friends, family members, coworkers, peers or elected officials — remind people that those living with disabilities want to be treated with dignity, respect and self-agency.

Tell those who you are close to and/or need to influence that you want to be able to experience the highest quality of life possible. People with mental health conditions have an equal right to live in a world that accepts people for who they are and recognizes their contributions to society. Engaging in these conversations can not only feel cathartic and empowering, but also contributes to the important work of reducing discrimination for others with disabilities.

NAMI HelpLine is available M-F, 10 a.m. – 10 p.m. ET. Call 800-950-6264,
text “helpline” to 62640, or chat online. In a crisis, call or text 988 (24/7).