Living life with a disability presents unique mental health challenges and needs, according Karen Larson-Hahn of the Courage Center. Larson-Hahn is a licensed psychologist with 20 years experience as a therapist, most of it in health and rehabilitation psychology. During a recent interview, Larson-Hahn offered her perspective on a range of mental health-related issues. According to Larson-Hahn, acquired disabilities and congenital disabilities can present very different mental health issues.
Individuals with Acquired Disabilities
An acquired disability is one that results from an external cause such as an accident or illness. She cites the work of Robert Marinelli and Arthur Dell Orto, who discuss the adjustment phases for individuals with acquired disabilities. The first phase is reassessment, the process of acknowledging that the change [disability] cannot be reversed. Reevaluation is the next phase, whereby the person’s identity and life structure are reexamined. What is the impact of the disability on future work, parenting and other life areas? Reintegration is the final adjustment, where the individual looks to the future and considers new roles in work, family and other life areas.
With acquired disabilities, both the individual and their family have to adjust to a sudden change. A person who was functioning well in mainstream society suddenly has an accident or illness. It disrupts the individual’s life as well as the family’s life. If this person was the breadwinner, they may lose the ability to work. This change can be very stressful for families. Likewise, if this person is a parent taking care of children, the parenting role may change as a result of physical or cognitive changes. The early phase of hospitalization and rehabilitation is the most likely time for family members to be involved. One advantage of a program like Courage Center is that clients are regularly evaluated for mental health needs.
Individuals with Congenital Disabilities
A congenital disability is one that is present at or shortly after birth. When a child has a disability, there are many potential mental health issues to consider. The developmental tasks that occur during the formative years present additional mental health challenges for children with some types of disabilities. Several life areas may be impacted by the disability, including play activity, participation in sports, school and vocational choices, and goals and dreams related to marriage, family and children. Visible physiological and sensory differences may pose mental health issues during those times when peer acceptance and a sense of belonging are especially critical. Children with disabilities may also have dependency challenges that prevent them from having the same autonomy as their peers.
Siblings may have their own set of mental health issues. For siblings, it is difficult to adjust to having their parents spending a lot of time away from home. Siblings may feel left out with their parents spending so much time in the rehabilitation and hospital setting. Often, children with disabilities need more and different kinds of attention. The siblings may not get the same level of attention as their sister or brother with the disability.
Likewise, the parents may feel torn in several directions, balancing between the needs of one child and the needs of other children, work, home and other responsibilities. In her work with children, Larson-Hahn’s experience has always included the child’s parents in any therapy.
Clearly, there are benefits of having a range of support services available to families. Rehabilitation centers such as Courage Center work with families from outside of the metropolitan area and from other states as well. However, this distance, coupled with work and other responsibilities, makes it difficult for some families to participate in all the available support services.
Advantages of a Multi-Disciplinary Treatment Setting
Larson-Hahn stressed the benefits of housing mental health services in the same facility as other rehabilitative services. Such settings provide staff the ability to coordinate and collaborate in treatment planning. They also facilitate a consistent approach across a continuum of services, which may include therapies (speech, occupational, physical, aquatic, recreational and mental health), support groups (e.g. traumatic brain injury programs) and consultation (e.g. assistive technology training).
Another benefit of the multi-disciplinary approach is the option of including psychiatric treatment. In the case of Courage Center, a neuropsychologist evaluates how an individual is functioning at a cognitive level. This evaluation is used to shape the rehabilitation program and strategies for working effectively with a person. There are also consulting psychiatrists available to prescribe psychotropic medications for clients as well as consulting services for staff.
Likewise, mental health therapists benefit from collaborating with speech therapists. With clients who have speech and language problems, a speech therapist can assist with communication. If the client uses an assistive technology communication device and something goes wrong with the device, once again a speech therapist can play a vital role. Individuals with speech difficulties may get parts of a word or sentence out but not the rest. “You want to be respectful and have the communication be as least stressful as possible,” said Larson-Hahn. “If filling in the gaps is more frustrating for the person, I don’t want to do that… The speech therapist may have ideas for how to facilitate the communication more smo-othly and efficiently and to give you some direction as the therapist.”
The benefit of having professionals from many disciplines involved goes both ways. If, for example, a client misdirects anger toward a speech or other therapist, the mental health therapist can step in and reframes the focus on what is really happening. The person can then be assisted in dealing with the anger and frustration of having a disability.
Looking to the Future
In looking to the future, Larson-Hahn sees education of everyone as a critical need. Often, clients are still dealing with misunderstandings or stigma from the people with whom they interact in the community. Clients with visible disabilities are sometimes assumed to have cognitive impairments. Individuals who use a cane or wheelchair may live independently, yet while attending a social event, these same individuals may be approached by people asking where their care attendants are. When asked how clients deal with these attitude barriers, Larson-Hahn said, “It is an ongoing challenge for some people. Some people are able to put it in perspective and move on. Others require some emotional support through their therapist, support group, or church.”
Larson-Hahn believes schools are an obvious place to start the education process. “I think at a very basic level in schools, we need to focus on inclusion versus exclusion. Lots of times kids with disabilities are separated out – put in special education or adaptive physical education classes. Sometimes they have different needs; yet, this [exclusion] also facilitates the feeling that they’re different.”
When asked how people can be taught to have compassion concerning these and other issues, Larson-Hahn said, “I don’t know that we always do a good job of teaching kids about disability, helping them to understand what it means to have a disability, and helping them to welcome kids with disabilities into their social circle and those kinds of things. I think part of the challenge is for the disability community to raise that awareness, legislatively or otherwise. I also think supporting candidates who are aware of these issues is huge.”
In closing, Larson-Hahn encouraged individuals and family members to check credentials and make inquiries regarding a mental health therapist’s experience in working with individuals with disabilities. Traumatic brain injury, stroke, spinal cord injury and a host of other disabilities create a range of mental health challenges that may require the expertise of psychologists specializing in health and rehabilitation services.
