Disabled people

The Equality Act (2010) defines an individual as disabled if they have a physical or mental impairment that has a substantial and long-term negative effect on their ability to carry out normal day-to-day activities.

The 2021 Census asked people: “Do you have any physical or mental health conditions or illnesses lasting or expected to last 12 months or more?”. If they answered yes, a further question “Do any of your conditions or illnesses reduce your ability to carry out day-to-day activities?”

Women

The government’s Women’s Health Strategy 2022 highlights:

• Women with disabilities cannot always access face to face services, and are less comfortable talking to professionals about some topics e.g. contraception and pregnancy
• Women who have served in the armed forces may have specific physical or mental health needs as a result of their experience of service or injuries.
• Autism in women and girls is under-recognised and therefore under-diagnosed.
• Most carers are women and the burden of caring can impact on their ability to meet their own mental and physical health as well as progress in their careers.

Obesity

Among people with disabilities, excess weight is 11 percentage points higher than among those without disabilities.

Oral health – people with learning disabilities

• compared to the general population, people with learning disabilities have:
• higher levels of gum (periodontal) disease
• greater gingival inflammation
• higher numbers of missing teeth
• increased rates of edentulism (toothlessness)
• higher plaque levels
• greater unmet oral health needs
• higher levels of untreated tooth decay
• poorer access to dental services and less preventative dentistry

During pregnancy, people with health conditions may be taking medication which gives rise to concerns about the impact on the unborn. Women taking medication for their mental health face dilemmas in whether to discontinue their treatment during pregnancy.

• Some medications can impact the unborn child, though there is a lack of robust evidence.
• Stopping medication could lead to relapse.

Research into discontinuation of antipsychotic medications shows those who are younger (under 35) and those who have been taking their medications for less than a year are more likely to cease their medications in pregnancy.

Research into depression during pregnancy found that women who discontinued medication relapsed significantly more frequently over the course of their pregnancy compared with women who maintained their medication.

New parents can experience a range of emotional and mental health issues:

• Difficulty concentrating, poor memory, difficulties sleeping
• Practical and financial worries about coping with a new baby
• Unwanted and upsetting thoughts, heightened emotions
• Depression, anxiety and panic attacks, Perinatal Obsessive Compulsive Disorder
• Post partum psychosis
• Impacts of birth trauma

Adverse childhood experiences

Abuse, neglect or family dysfunction – can lead to ill-health and disabilities in later life.

In a 2014 UK study on ACEs, 47% of people experienced at least one ACE with 9% of the population having 4+ ACES

Relationship between number of ACEs experienced by a child increases and risk of poor outcomes

Risks of alcohol use, smoking, drug use, violence and mental illness outcomes were increased in individuals with any level of ACEs. Risks of high BMI, heart disease and respiratory disease were increased in individuals with ≥2 ACEs, and risks of type 2 diabetes, cancer and stroke in those with ≥4 ACEs only.

Impact of disability on children and young people’s mental health

Royal College of Psychiatrists’ report in 2017 Good mental health services for young people highlights some young people are at a much higher risk of developing a mental disorder and should be prioritised when developing mental health services:

• Young people with an intellectual disability – 6.5-fold increased risk of mental health problems.
• Young people with special educational needs – increased risk of conduct disorder.
• Young people with physical illness – increased risk of emotional and conduct disorder.

People with long-term conditions, including diabetes and heart disease, are two to three times more likely to have depression.

People with more than four physical health conditions are nearly seven times more likely to experience mental ill health than people in good physical health.

The Health Foundation highlights that for people with depression and/or anxiety:

• Almost three quarters have at least one other physical or mental health-related long-term condition; almost a third have 3 or more other long-term conditions.
• Chronic pain, hypertension and irritable bowel syndrome are particularly prevalent.

SMI patients are more likely (1.3 x for female and 1.2 x for male) to have one or more of the physical health conditions – patients aged 15 to 34 are 5 times more likely to have 3 or more physical health conditions and this health inequality reduces with age.

People with Learning Disabilities face considerable health and social inequalities. This impacts on both life expectancy and quality of life. A number of health conditions more prevalent and outcomes poorer for people with LD:

• Digestive Issues & constipation
• prevalence of diabetes is estimated to be twice as high
• Dental health outcomes are significantly worse
• prevalence of dementia is significantly higher than the general population
• Inactivity levels are higher

The number of people with LD living with obesity is higher

Cancer is the third most common cause of death of people with LD in England. – 1 in 10 chance of dying from the cancer, as opposed to a 1 in 36 chance in the general population. Tumours more often diagnosed at a late stage

Reasons for these health inequalities are often multifactorial. This includes genetic factors, poor access to services and poorer socio-economic outcomes. Housing, educational attainment, employment and social inclusion determine their health and wellbeing

Learning Disabilities Mortality Review (LeDeR) found almost half (46%) of adults had 7 to 10 long term health conditions when they died

Health inequalities experienced by people with a learning disability and/or autism are well established.

Learning from lives and deaths – People with a learning disability and autistic people (LeDer) data from 2021 shows:

• The average age at death for people with a learning disability
  is 23 years younger for men, and 27 years younger for women
  than the wider population.
• People of Black, Black British, Caribbean or African, mixed
  ethnic group and Asian or Asian British ethnicity died at a
  younger age in comparison to those of white ethnicity.
• Avoidable deaths (ie those considered preventable and treatable
  causes of death of people who died at younger than 75 years old)
  are significantly higher for people with a learning disability.

Recent research by the University of Cambridge found people with autism were:

• far less likely to say that they could describe how their symptoms feel in their body, describe their pain levels, and explain their symptoms.
• less likely to know what is expected of them when they go to see their healthcare professional.
• less likely to feel they are provided with appropriate support after receiving a diagnosis.
• over 7 times more likely to report that their senses frequently overwhelm them so that they have trouble focusing on conversations with healthcare professionals.
• over 3 times more likely to say they frequently leave their healthcare professional’s office feeling as though they did not receive any help at all.
• 4 times more likely to report experiencing shutdowns or meltdowns due to a common healthcare scenario (e.g., setting up an appointment to see a healthcare professional).

The study found high rates of chronic physical and mental health conditions, including arthritis, breathing concerns, neurological conditions, anorexia, anxiety, ADHD, bipolar disorder, depression, insomnia, OCD, panic disorders, personality disorders, PTSD, SAD, and self-harm.

• Frailty is linked to long-term conditions in middle-aged and older adults.
• Deprived communities, coastal communities, rural communities, and people from minority ethnic communities face some of the biggest health inequalities
• People who live in more deprived areas are up to six times more likely to die from alcohol-related liver disease than those who live in wealthier areas
• Lung disease continues to be a major factor in health inequalities. Someone from the most deprived section of society is two-and-a-half times more likely to have COPD
• Type 2 diabetes is 2-4 times more likely among people of South Asian, African-Caribbean and Black African descent
• People from some ethnic minority groups, especially Pakistani and Bangladeshi groups, are more likely than White British to report long-term illness and poor health. But on some measures Black Caribbean and Black African communities report better outcomes
  than their white peers.
• People from ethnic minority groups are more likely to live in deprived
  areas.

• 
• 

• Research shows carers are at increased risk of illness, and specifically musculoskeletal conditions, cardiovascular disease, generalised cognitive deterioration and function, and poor sleep.
• Carers are 16% more likely than non-carers to live with 2 or more long-term health conditions – Among carers living with 2 or more long-term conditions, arthritis and high blood pressure are the most common conditions.
• There is some evidence that indicates that mental health outcomes may be worse for carers compared to the general population
• Premature death, higher levels of disease and neglect of their own health care needs are known to be common amongst carers
• Impact of social isolation and lack of leisure time on mental and physical wellbeing

coming soon

coming soon