People with disabilities represent a significant portion of the U.S. population. According to the Centers for Disease Control and Prevention, about 26 percent of adults in the United States have a disability. American Indians and Alaska Natives and people who identify as “Other” or “Multirace” are more likely to report having a disability (both nearly 38%) than 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 and mental impairments. Despite being the largest minority group in the nation, people with disabilities often face significant inequities 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 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 exacerbated these challenges, with 42.6 percent of adults with a disability who had received a diagnosis of mental health or substance use conditions 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, specifically Long COVID, can have on behavioral health and 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 Americans with 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.
Timeline of Acts and Declarations
Section 503 of the Rehabilitation Act of 1973, a precursor to the 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.
Section 504 of the Rehabilitation Act of 1973 prohibits discrimination in programs and activities receiving financial assistance and in those conducted by any Executive agency or by the United States Postal Service (USPS). This policy helps people with disabilities benefit from and receive programs and services.
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 by the U.S. Supreme Court in 1999 was another pivotal development. It affirmed that under Title II of the ADA, individuals with disabilities may not be unjustifiably segregated and have the right to receive services in the most integrated setting appropriate to their needs. It is important to note that the plaintiffs in the case were those with mental health 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 most 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.
In May 2024, the U.S. Department of Health and Human Services implemented updates to its regulations under Section 504 of the Rehabilitation Act. These revisions bolstered protections against discrimination in health programs and activities that receive federal financial assistance, to foster greater inclusion and accessibility for individuals with disabilities. These changes are anticipated to improve access to healthcare, and other essential services, thereby reinforcing the rights of and opportunities for people with disabilities.
Impact on Public Health and Equity
The ADA 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 when they officially recognized people with disabilities as a population with health disparities 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 ADA 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.