Millions of children, adolescents, and adults across the United States and throughout the world experience long-term disabilities that significantly affect their lives. These disabilities include developmental disabilities such as mental retardation and autism, physical disabilities, vision and hearing impairments, and a host of medical, genetic, and neurological conditions.

In recent years, more attention has been paid to the mental health needs of these groups of people. Unfortunately, it has been found that people with disabilities are more likely to develop mental health disorders, and when they do, they have a harder time finding effective treatment. Among the reasons for increased mental health problems are frequent social problems they encounter such as feeling segregated and not really a part of society, being rejected and stigmatized because of their disabilities, and having restricted opportunities for employment, education, social and recreational activities.

As we have learned more about the mental health problems people with disabilities experience, we are now in a position to explore ways in which we can promote mental health for these individuals. Optimally, efforts to enhance emotional well-being would begin early in childhood and continue throughout individuals’ lifetimes. Anyone involved in the life of a person with a disability plays a role in promoting positive mental health in a variety of ways. Three major areas important to mental health are promoting a positive sense of self, enhancing the environment to improve understanding and adjustment, and teaching skills that increase ability to adjust and obtain needed resources.

Promoting a positive sense of self

Beginning in childhood, it is important for parents and caregivers to put much effort into helping their children with disabilities develop a positive and healthy sense of who they are. Parents and others need to continually send the messages to children that

• Their value is unconditional and comes simply from being themselves,
• They are unique individuals with unique abilities,
• Everyone has strengths and weaknesses and they are more “abled” than “disabled,”
• They have something to offer other people, and
• They are capable of having control in their lives.

These messages can be sent directly by showing and telling people how we feel about them, talking to people about how they feel about themselves, and by talking about the experiences people have in everyday life. Messages can also be sent in indirect ways such as engaging in play, using role-playing, using art to express feelings, and engaging with a person though books, music, and games that address these issues.

Whatever approaches are used, it is imperative that the development of a positive sense of self be a top priority. Individuals with disabilities who develop a positive sense of self are likely to be happier, less vulnerable to the high level of negative experiences they are likely to have, and less likely to develop mental health problems.

Enhancing the environment to improve understanding and adjustment

A second area of focus in promoting mental health is optimizing environments in order to maximize opportunities for individuals with disabilities to adjust and cope effectively. One of the most important things others need to provide is a high level of social support. There is evidence that inadequate levels of social support are associated with increased mental health problems. To provide needed social support, families, friends, and caregivers need to take the time to really listen, discuss, respect, love, and be there when needed. For children with disabilities, parents need to take more initiative to ensure their children are coming to them with concerns, fears, problems, and issues, to make themselves available to their children, and to read signs their children may need some special attention. Caregivers need to make sure that interacting, sharing, and giving positive, focused attention are as important as, or more important than, “taking care” of people with disabilities. Finally, both families and caregivers need to allow relationships with individuals with disabilities to be mutual rather than one-sided, offering those with disabilities the opportunity to give as well as receive support.

There are other important ways to optimize environments to improve understanding and adjustment.

• It is important to empower both children and adults with disabilities to have as much control as possible in their lives. Having control through making choices and decisions is an important aspect of mental health and self-esteem.
• Parents and caregivers need to help prepare people with disabilities for changes and challenges they will face in life, such as school placement, transition to work, and changes in living situations.
• Environments need to be structured to maximize opportunities for people with disabilities. People with disabilities do not need to be protected or sheltered from real life. They need to be able to be involved fully in families and communities and to experience a wide variety of social, educational, occupational, recreational, and spiritual opportunities.
• Parents and caregivers need to support the hopes, dreams, and faith of people with disabilities.

Teaching skills that increase ability to adjust and obtain needed resources

Additional requirements for mental health involve being able to obtain what one needs from the environment and being able to adjust when the environment changes. To do this effectively, people must possess certain skills. Individuals with disabilities may, depending on the type and severity of disability as well as age, need additional help learning important skills. While some of these skills may be taught formally, many need to be learned through everyday life. This again points to the importance of both children and adults with disabilities having as many experiences and opportunities to learn as possible, and being highly involved with other people in order to learn through modeling, interacting, and practicing skills.

There are many types of skills that have been found to be important to mental health and there are many ways people with disabilities can learn them. These include modeling and feedback by others, practice through role-playing, playing games that teach skills, focused play with children, and practice in group or family situations. The types of skills that need to receive attention include:

• Coping skills play a valuable role in adjustment to everyday problems as well as major life changes and transitions. Everyday life provides people with disabilities many opportunities to practice coping and this can be an effective way to learn, particularly if there are other people involved to support, help process, and give feedback.
• Social skills are essential for obtaining social support, needed assistance, and for taking care of oneself in problem situations.
• Skills to recognize, understand, express, and manage feelings are critical to mental health, yet these skills receive very little attention. When feelings such as anger, frustration, anxiety, sadness, and hopelessness are not dealt with, more severe emotional or behavioral problems can develop. Parents and caregivers need to take the time to really listen, help their children recognize what they are feeling, put those feelings into words or express them in another way, and explore ways to cope with the feelings.
• Skills that allow people to enjoy life are also very important. Without adequate skills such as recognizing what activities they might enjoy, how to express those wants and desires, and how to access these opportunities or accommodate for certain disabilities, individuals often are left with few enjoyable experiences to look forward to in life.

Summary

We have made progress in recent years in understanding and addressing the mental health needs of people with disabilities. People with disabilities experience more challenges and are subjected to more negative social conditions than most people. As a result, they are more vulnerable to mental health problems. As we have identified some of the factors involved in this, we are in a position to use our knowledge to begin focusing on promoting mental health for people with disabilities. Childhood is an ideal time to start teaching, supporting, and creating opportunities for children with disabilities to learn how to feel good about themselves, adjust and cope with the many challenges they will face, and feel like valued members of our communities. Changes also need to occur on a societal level, from how we view people with disabilities to the opportunities that we afford them. In order to make a difference, the issue of promoting mental health for people with disabilities will require much more attention than it has received.