People with disabilities represent a significant portion of the US population and are the largest minority group in the country. According to the Centers for Disease Control and Preventionapproximately 26 percent of adults in the United States live with a disability. American Indians, Alaska Natives, and multiracial (or mixed) people are more likely to report having a disability (nearly 38% for each group) than other racial and ethnic groups. Asian and White Americans report the lowest rates (18% and 27%, respectively). In addition, women, the elderly, people in rural areas, and adults with incomes below the federal poverty level are more likely than others to have a disability. This includes a wide range of physical, mental and sensory impairments. Consequently, people with disabilities often face significant inequalities in many areas of life, including health, employment and education.
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 vs. 28.7 percent), substance use (38.8 percent vs. 17.5 percent), and suicidal ideation (30.6 percent vs. 8.3 percent ) from non-disabled adults. COVID-19 has exacerbated these challengeswith 42.6 percent of people with disabilities saying the pandemic made it more difficult to access medical care or medication related to their disability. SAMHSA is working hard to address the toll that COVID-19, specifically Long COVID, can have on behavioral health, and we hosted a two-day meeting on the health impacts of Long COVID, strategies for awareness and translation field 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 comes from federal laws and regulations like the Americans with Disabilities Act (ADA), which is celebrating its 34th anniversary this year!
Here are some critical ADA milestones. Every law, decision and initiative has helped create an inclusive society for people with disabilities.
Acts and Declarations
Section 503 of the Rehabilitation Act of 1973, a precursor to the Americans with Disabilities Act (ADA), prohibits federal contractors and subcontractors from discriminating against individuals with disabilities. It requires the active recruitment, hiring and promotion of people with special needs. This act laid the groundwork for future disability rights legislation, emphasizing the importance of equal employment opportunities. The Rehabilitation Act of 1973 also included section 504, which prohibits disability discrimination in 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 US Department of Health and Human Services (HHS) Office for Civil Rights. updated Section 504 of the Rehabilitation Actwhich provides strong civil rights protections for people with disabilities in federally funded health and human services programs, such as hospitals, health care providers participating in the CHIP and Medicaid programs, state and local human or social services agencies, and nursing homes. Reflecting more than 50 years of advocacy by the disability community, it advances the promise of the Rehabilitation Act and helps ensure that people with disabilities are not discriminated against in any program or activity that receives funding from HHS. Section 1557 of the Affordable Care Act of 2010 was recently revised to strengthen protections for people with disabilities by strengthening nondiscrimination in all federally funded health programs and activities. In addition to providing protection against multiple forms of discrimination, this rule mandates that providers ensure effective communication with people with disabilities, providing free helpers and services when necessary. In addition, 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 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 mainstream American life. This includes equal opportunity in employment, education, public accommodations, transportation, state and local government services, and telecommunications. The impact of the ADA was profound, transforming the landscape of American society into a more inclusive and accessible one.
The Olmstead decision issued by the US Supreme Court in 1999 was another pivotal development. He affirmed that under Title II of the ADA, people 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 issues as well as other disabilities. This decision underscored the importance of community inclusion, prompting greater funding and support for community-based services and improving the quality of life for many people with disabilities.
The Paul Wellstone and Pete Domenici Mental Health Equity and Parity Act of 2008 further reinforced 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 comparable to benefits for medical and surgical coverage. This gave people with disabilities more access to mental health care and services while protecting and expanding their right to comprehensive health care.
Implications for Public Health and Equity
The ADA and related legislation have significantly impacted public health by enhancing access to health care, education, and employment for people with disabilities. These laws have been instrumental in promoting equality and ensuring that people with disabilities receive equal legal protection. 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 Program for Individuals with Mental Illness (PAIMI). PAIMI is a grantmaking program operating in all 50 states, the District of Columbia, and five territories that aims to protect and advocate for the rights of people with serious mental illness/severe emotional disturbance. Georgia State’s PAIMI program played a large role in the Olmstead case reaching the Supreme Court when the state strongly supported the right of people with disabilities to live in the community.
Other agencies are also working on inclusion, including National Institutes of Health which officially recognized people with disabilities as a population with health disparities in November 2023. This designation recognizes the unique challenges and barriers people with disabilities face in accessing health care and achieving optimal health outcomes. It is hoped that this recognition will lead to greater research efforts and funding to mitigate these disparities, thereby enhancing health care and services for people with disabilities.
The ADA has been a cornerstone of disability rights in the United States. Over the past three decades, it has changed the lives of millions of Americans by advancing inclusion, accessibility and equity. Inclusion of people with disabilities can help reduce stigma and discrimination, which are significant barriers to accessing behavioral health services, including mental health and substance use services. Increased accessibility and accommodation in health care settings have allowed people with disabilities to receive better behavioral health care and support, leading to improved health outcomes and quality of life for many people with disabilities.
As we celebrate the progress that has been made, we must continue to support policies and practices that uphold the rights and dignity of people with disabilities. Continued efforts are needed to address remaining inequalities and ensure that all people with disabilities are treated fairly. We are committed to continuous efforts to grow and learn and invite you to do the same.
