People with disabilities represent a significant portion of the U.S. population and constitute the largest minority group in the nation. According to the Centers for Disease Control and Prevention, about 26 percent of adults in the United States live with a disability. American Indians, Alaska Natives and multiracial (or mixed-race) persons are more likely to report having a disability (nearly 38% for each group) compared to other racial and ethnic groups. Asian and White Americans report the lowest rates (18% and 27%, respectively). Additionally, women, older adults, people in rural areas, and adults with incomes below the federal poverty level are more likely to have a disability than others. This includes a wide range of physical, mental health, and sensory impairments. Consequently, people with disabilities often face significant inequities in many areas of life, including health, employment, and education.
President Bush signs the Americans with Disabilities Act into law in 1990
Compared to the general population, people with disabilities are more likely to experience behavioral health challenges including symptoms of anxiety or depression (56.6 percent versus 28.7 percent), substance use (38.8 percent versus 17.5 percent), and suicidal ideation (30.6 percent versus 8.3 percent) than adults without a disability. COVID-19 exacerbated these challenges, with 42.6 percent of individuals with a disability stating that the pandemic made it more difficult to access medical care or medication related to their disability. SAMHSA is engaged in a number of efforts to address the burden that COVID-19, specifically Long COVID, can have on behavioral health and we hosted a two-day meeting about the behavioral health effects of Long COVID, strategies for raising awareness, and translating policies into on the ground action.
SAMHSA and other federal agencies play an important role in addressing behavioral and mental health disparities and supporting people with disabilities. Much of this support stems from federal laws and regulations such as the American Disabilities Act (ADA), which is celebrating its 34th anniversary this year!
Here are some critical ADA milestones. Each law, decision, and initiative has helped build a more inclusive society for people with disabilities.
Acts and Declarations
Section 503 of the Rehabilitation Act of 1973, a precursor to the American Disabilities Act (ADA), prohibits federal contractors and subcontractors from discriminating against people with disabilities. It mandates that they actively recruit, hire, and promote qualified individuals with disabilities. This act laid the groundwork for future disability rights legislation by emphasizing the importance of equal employment opportunities. The Rehabilitation Act of 1973 also included Section 504, which prohibits disability discrimination under Federal grants and programs. Section 504 requires that health and human service programs that receive money from the Federal government provide people with disabilities access to their programs and activities. In May 2024, the U.S. Department of Health and Human Services (HHS) Office for Civil Rights updated Section 504 of the Rehabilitation Act, which provides robust civil rights protections for people with disabilities in federally funded health and human services programs, such as hospitals, health care providers participating in CHIP and Medicaid programs, state and local human or social service agencies, and nursing homes. Reflecting over 50 years of advocacy by the disability community, it advances the promise of the Rehabilitation Act and helps to ensure that people with disabilities are not subjected to discrimination in any program or activity receiving funding from HHS. Section 1557 of the Affordable Care Act of 2010 has recently been revised to strengthen protections for people with disabilities by reinforcing nondiscrimination in all health programs and activities receiving federal funding. In addition to providing protections against multiple forms of discrimination, this rule mandates that providers ensure effective communications with individuals with disabilities, providing free aides and services when necessary. Furthermore, digital health services, such as telehealth, must be accessible to people with disabilities, ensuring equal access to healthcare.
The Americans with Disabilities Act (ADA), a landmark disability rights law, was signed into law by President George H.W. Bush on July 26, 1990. According to the ADA, a disability is defined as a “physical or mental impairment that substantially limits one or more major life activities.” The ADA aims to prohibit discrimination and provide comprehensive protections to ensure that people with disabilities have the same rights and opportunities as everyone else to participate in the mainstream of American life. This includes equal opportunities in employment, education, public accommodations, transportation, state and local government services, and telecommunications. The ADA’s impact has been profound, transforming the landscape of American society to be more inclusive and accessible.
The Olmstead decision issued by the U.S. Supreme Court in 1999 was another pivotal development. It affirmed that under Title II of the ADA, individuals with disabilities have the right to live in community settings rather than being institutionalized. It is important to note that the plaintiffs in the case were those with mental health conditions as well as other disabilities. This decision underscored the significance of community integration, prompting greater funding and support for community-based services and enhancing the quality of life for many individuals with disabilities.
The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 further solidified that people with mental health and substance use conditions should not be discriminated against. This law requires that insurance coverage for mental health and substance use conditions be on par with benefits for medical and surgical coverage. This gave people with disabilities more access to mental health care and services by protecting and expanding their right to comprehensive healthcare.
Impact on Public Health and Equity
The American Disabilities Act and related legislation have significantly influenced public health by enhancing access to healthcare, education, and employment for people with disabilities. These laws have been instrumental in advancing equity and ensuring that people with disabilities receive equal legal protections. This is seen in the development of policies, programs, and initiatives aimed at addressing the unique needs of people with disabilities.
One such program is SAMHSA’s Protection & Advocacy for Individuals with Mental Illness (PAIMI) Program. PAIMI is a grant program that operates in all 50 States, the District of Columbia, and five territories that aims to help protect and advocate for the rights of individuals with serious mental illness/serious emotional disturbance. The State of Georgia’s PAIMI program played a large role in the Olmstead case reaching the Supreme Court when the state fiercely advocated for the right of individuals with disabilities to live in the community.
Other agencies are also working on inclusion, including the National Institutes of Health which officially recognized people with disabilities as a health disparity population in November, 2023. This designation acknowledges the distinct challenges and barriers that individuals with disabilities encounter in accessing healthcare and achieving optimal health outcomes. It is anticipated that this recognition will drive greater research efforts and funding directed towards mitigating these disparities, thereby enhancing health care and services for people with disabilities.
The American Disabilities Act has been a cornerstone of disability rights in the United States. Over the past three decades, it has transformed the lives of millions of Americans by promoting inclusion, accessibility, and equality. Including individuals with disabilities may help reduce stigma and discrimination, which are significant barriers to accessing behavioral health services, including mental health and substance use services. Increased accessibility and accommodations in healthcare settings have allowed individuals with disabilities to receive better behavioral health care and support, leading to improved health outcomes and quality of life for many individuals with disabilities.
As we celebrate the progress made, we must continue to advocate for policies and practices that uphold the rights and dignity of individuals with disabilities. Ongoing efforts are needed to address remaining disparities and ensure that all people with disabilities are treated equitably. We are committed to continued efforts of growth and learning and invite you to do the same.
This article was originally published on August 09, 2024, and can be found here.
