Women, Disability anD mental Distress This page has been left blank intentionally Women, Disability and mental Distress Julia l.T. SmiTh © Julia l.t. smith 2015 all rights reserved. no part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise without the prior permission of the publisher. Julia l.t. smith has asserted her right under the Copyright, Designs and Patents act, 1988, to be identified as the author of this work. Published by ashgate Publishing limited ashgate Publishing Company Wey Court east 110 Cherry street Union road suite 3-1 Farnham burlington, Vt 05401-3818 surrey, GU9 7Pt Usa england www.ashgate.com British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library The Library of Congress has cataloged the printed edition as follows: smith, Julia l. t. Women, disability and mental distress / by Julia l.t. smith. pages cm includes bibliographical references and index. ISBN 978-1-4094-5400-7 (hardback) – ISBN 978-1-4094-5401-4 (ebook) – ISBN 978- 1-4724-0709-2 (epub) 1. People with disabilities–Mental health–Great Britain. 2. Women with disabilities– Mental health–Great Britain. 3. People with disabilities–Mental health services–Great Britain. 4. Women with disabilities–Mental health services–Great Britain. I. Title. rC451.4.H35s65 2015 362.2–dc23 2014028905 ISBN 9781409454007 (hbk) ISBN 9781409454014 (ebk – PDF) ISBN 9781472407092 (ebk – ePUB) II Printed in the United Kingdom by Henry ling limited, at the Dorset Press, Dorchester, Dt1 1HD Contents Acknowledgements vii Introduction 1 1 Living with a Physical Impairment: Is Mental Distress Inevitable? 9 2 Accessing and Using Mental Health Services 35 3 Counselling, Disabled People and Loss 53 4 Gender, Disability and Mental Health 79 5 Future Mental Health Provision: A Need for Change? 103 6 Looking to the Future 127 References 143 Index 157 This page has been left blank intentionally Acknowledgements To each of the women who gave of their time to talk openly about their personal experiences of mental distress, a sincere debt of gratitude is owed as without their participation this book would not have been possible. In sharing their experiences, these women spoke of a hope that the book would serve to be a helpful and informative resource to professionals within mental health and social care who within their various roles sought to support disabled women who experience mental distress. Similarly, it was hoped that the book would be of help to disabled women who like themselves had experienced, or were experiencing mental distress and I hope on their behalf that these wishes will in the months and years ahead be achieved. Secondly, to friends too numerous to mention who, throughout the writing process offered continuing encouragement and support and in so doing helped me to reach the finishing line a big thankyou to you all. Finally, to close family and dear friends who, for over thirty years have unfailingly provided care, support, love and friendship this book is dedicated to you. This page has been left blank intentionally Introduction Through the latter decades of the twentieth century within the UK, increasing amounts of attention began to be paid to meeting the individual support needs of both mental health service users and people with a physical impairment. Evidence of this can be found both in the expanding body of literature that had begun to examine mental health and physical impairment from a range of perspectives and the increased range of service provision offered by a growing number of health and social care providers for individuals within each group. In contrast, the mental and psychological health needs of individuals living with a physical impairment and who experience diagnosed mental distress have largely been overlooked by health and social care service providers, practitioners and organisations for whom the main focus or area of interest is either mental health or physical impairment. The lack of attention which historically has been paid, both in theory and in practice, to meeting the mental health needs of people with physical impairments who experience mental distress has resulted in the absence of a comprehensive knowledge base of how best to support such individuals which in turn has led to their mental health needs remaining neglected, and subsequently left unmet. Likewise, the subject area of physical impairment and mental health had until the latter decades of the twentieth century received little attention within the academic, policy and research literatures but where it was examined, a medical approach was overwhelmingly adopted by the literature with physical impairments and mental health issues viewed as ‘illnesses’ or ‘conditions’ and with minimal focus on the individual per se. Predominantly, the literature has been underpinned by two key assumptions: firstly, that a physical impairment per se will be a cause of psychological distress and that affected individuals will need to adjust to their ‘loss’ in stages before they can become ‘psychologically whole’ again (Turner and Noh 1988); and secondly, that the solutions to an individual’s mental distress are to be found within the individual and the text will examine both assumptions. In addition it will discuss literature which, in the latter decades of the twentieth century, in contrast to an entrenched medical perspective, began to examine the topic area of physical impairment and mental health from a social perspective. Within this literature attention began to be given to the potential for social and cultural barriers such as societal attitudes towards impairment or barriers to service provision to impact on the mental well-being of people living with physical impairments. In shifting the focus from an individual’s impairment onto disability, the social model of disability (and its history and relevance within the context of women’s personal experiences which will be discussed) uses the term to refer to disabling social, environmental and attitudinal barriers rather than a lack of functional ability.