July is Disability Pride Month, marking the anniversary of the Americans with Disabilities Act signed in July 1990. It is a month set aside to recognize the disability community as a community, with its own history, culture, identity, and political history, rather than as a collection of medical problems to be managed.
For psychiatric care specifically, the month is a useful prompt for two conversations that do not happen often enough. The first is about the mental health needs of people with disabilities, who experience depression, anxiety, and other conditions at elevated rates and often receive inadequate care. The second is about the long history of psychiatry‘s complicated relationship with the disability community, which has not always been a relationship of partnership.
At resilience psychiatry in East Setauket, our practice treats patients with a wide range of disabilities: physical disabilities, sensory disabilities, chronic illnesses, autism and other neurodevelopmental conditions, and the secondary mental health conditions that come with them. This article walks through what disability affirming psychiatric care looks like in practice, what we treat, and what to expect.
What “Disability Affirming” Actually Means
The phrase “disability affirming” is used the way “culturally affirming” or “LGBTQ affirming” is used. It refers to clinical care that recognizes disability as a legitimate way of being in the world, not as a deficit to be eliminated. The clinician does not treat the patient’s disability as the problem to be solved. The clinician treats the conditions the patient came in for, while respecting the patient’s identity and their relationship to their own body, mind, or sensory experience.
In practice, that translates into specific clinical behaviors.
The clinician uses the language the patient uses about themselves. Some patients prefer a person ‘s first language (“person with autism”). Some prefer identity first language (“autistic person”). The clinician follows the patient’s lead.
The clinician does not assume the disability is the cause of every psychiatric symptom. A patient with cerebral palsy who is depressed has depression. A patient who uses a wheelchair and has anxiety has anxiety. The conditions can be treated. The disability does not need to be “fixed” first.
The clinician does not assume the disability is the cause of nothing. Living with disability in an inaccessible world is a real source of stress. A clinician who refuses to acknowledge the impact of inaccessibility, ableism, and the cumulative load of managing a body or mind that the world is not designed for is missing part of the clinical picture.
The clinician adapts the practical setup to fit the patient. Accessible office. Telepsychiatry options for patients who cannot easily travel. Visit length adjustments for patients who fatigue. Written follow up for patients with cognitive or memory differences. Sensory accommodations for autistic patients.
The clinician treats co-occurring physical conditions as part of the picture, not as someone else’s problem. Pain, fatigue, medication interactions with the patient’s other medications, and the cumulative load of multiple medical appointments all factor into the psychiatric plan.
The clinician does not push a normative recovery model. Recovery for one patient means returning to work. For another, it means being able to enjoy a hobby again. For another, it means reducing the frequency of panic attacks from daily to weekly. The patient defines what success looks like.
The Mental Health Picture for People with Disabilities
The numbers are stark and consistent. The reports that adults with disabilities in the United States experience frequent mental distress at roughly four to five times the rate of adults without disabilities. The and the have documented for decades that people with disabilities have higher rates of depression, anxiety, post traumatic stress, and suicidal ideation than the general population, and lower rates of accessing psychiatric care, partly because of physical access barriers and partly because of clinician knowledge gaps.
The pattern is not because disability is a mental illness. It is not. The pattern is because living in an inaccessible world, managing chronic medical conditions, navigating insurance and benefits systems, and absorbing low expectations and stigma from the surrounding culture is exhausting. Sustained exhaustion is a fast path to clinical depression and anxiety.
Disability affirming care does not pretend otherwise.
Conditions We Treat in Disabled Patients
The conditions are largely the same as we treat across our patient base. The clinical presentations sometimes look slightly different because of the patient’s disability context.
Depression. Often shaped by chronic pain, accessibility barriers, social isolation, and the cumulative weight of managing complex medical care. Treatment is the same evidence based and used for all patients, with attention to medication interactions, fatigue, and the patient’s actual daily life.
Anxiety. Often heightened by uncertainty about medical events, accessible logistics, and reasonable concerns about future independence and care. We work on what is actionable and what is not.
Post traumatic stress disorder. Many disabled patients have trauma histories that include medical trauma, abuse (rates of abuse against people with disabilities are several times the general population rate), and the trauma of acquiring a disability in adulthood through injury or illness.
Adjustment disorder. Newly acquired disabilities, progression of chronic illness, and changes in independence are clinical situations where adjustment disorder is common and treatable.
Chronic pain and the mental health side of it. Pain and depression interact tightly. We do not manage pain directly (that is the role of pain medicine), but we work with the mood, sleep, and anxiety pieces that pain produces.
Autism in adults. Many of our autistic adult patients come in for anxiety, depression, or co-occurring ADHD. We do not treat autism itself as a condition to be eliminated. We treat the conditions the patient came in for, and we adapt the clinical interaction to fit how the patient communicates, including written notes, longer or shorter visits, and clear structured agendas.
Co occurring chronic illness. Lupus, MS, chronic fatigue syndrome, fibromyalgia, long COVID, type 1 diabetes, and other chronic conditions frequently produce mental health symptoms that need their own treatment. The psychiatric care has to coordinate with the patient’s other medical care, not work around it.
What We Do Differently
Some specific things our practice does to make disability affirming care concrete.
Telepsychiatry. Many of our disabled patients use it because traveling to the East Setauket office is hard, exhausting, or impossible. The clinical care is the same online as in person, and for many patients online is significantly less burdensome.
Visit length flexibility. Some patients need shorter visits because they are fatigued. Some need longer visits because they communicate in ways that require more time. We adapt.
Written summaries. For patients with memory or cognitive differences, or patients who simply prefer to refer back to a written plan, we send a clear written summary of the visit plan after each appointment.
Sensory accommodations. For autistic patients and patients with sensory sensitivities, we work on the video and audio environment to fit. Lower light, no harsh sounds, minimal background visual distractions in the clinician’s frame.
Reasonable family or caregiver involvement. Some patients have a caregiver who is part of their daily life. Where the patient wants that person in the visit, we accommodate. Where the patient prefers privacy, we hold that line.
Slower pacing on medication decisions. Patients with disabilities are sometimes over treated or hastily treated by clinicians who do not understand the patient’s other medications, other conditions, or actual goals. We move more carefully. The treatment plan is built with the patient, not for them.
A Word About Autistic Adults
We see a meaningful number of autistic adults in our practice, including many who were diagnosed late in life. The clinical work is rewarding and the patient population is underserved. Most of these patients come in for anxiety, depression, ADHD, or sleep concerns. They often arrive having had previous psychiatric care that did not understand them, sometimes care that pathologized their autism itself.
Our approach is to treat the specific condition the patient came in for, communicate clearly and concretely about plans and decisions, respect the patient’s preferences about social or sensory dynamics in the visit, and not insist on changes to autistic communication or behavior as a treatment goal unless those changes are what the patient is asking for.
Crisis Resources
If you are in crisis right now, please use these resources before you finish this article.
This is available twenty four hours a day. Voice, text, and online chat options are all available. The line is free and confidential.
The company maintains a national helpline at 1-800-662-HELP.
For Suffolk County and additional local options, see our website.
The maintains educational materials and peer support resources for people with disabilities and their families.
A Note on Out of Network Care
Resilience Psychiatry is an out of network private practice. For some disabled patients, particularly patients on Medicaid, Medicare, or fixed disability incomes, this is a barrier. We will be straight about cost on the first call. For patients for whom out-of-network care is not financially possible, we will help identify alternative options including community mental health centers, Federally Qualified Health Centers, and sliding scale clinics.
We do not want financial constraint to be the reason a patient does not engage with care.
How To Start
If you are an adult on Long Island, in New York, or in Florida, with a disability or chronic illness, and you would like to start psychiatric care, . We work in English and Spanish. We use telepsychiatry extensively for patients for whom travel is a barrier. There is a sixty to ninety minute conversation that builds the plan from your actual life, not from a generic template.
If you are in crisis right now, please call or text 988 or visit us.
Disability Pride Month is a useful prompt. The care, the respect, and the standard should be year round. We treat patients with disabilities the way we treat all our patients: with attention, with care, and with the goal of helping the person sitting across from us (or on the video) live the life they actually want.
Specific Accommodations We Have Made for Patients
Examples of how visit format adjusts to fit individual patients. These are not standard for every patient. They are tailored to the specific patient’s needs.
For autistic patients who prefer minimal verbal small talk, we begin visits with the agenda directly, skip the social warm up, and write a clear summary at the end so the patient has it in writing.
For patients with chronic fatigue or post viral fatigue conditions (including long COVID), we offer shorter, more frequent visits rather than the standard 30 minute follow up, because the patient cannot sustain a longer conversation without crashing afterward.
For patients with significant chronic pain, we adjust visit timing to fit pain patterns (early morning or late afternoon depending on what is easier), and we keep visits to manageable length so the patient is not in pain trying to focus.
For patients with cognitive differences, we send written summary notes after each visit, repeat key decisions, and confirm understanding before ending the call.
For patients who use augmentative and alternative communication (AAC) devices, we work at the patient’s communication pace and do not push for verbal responses.
For patients with severe sensory sensitivities, we keep the clinician’s video frame calm, neutral light, no harsh background visuals, and we discuss the audio environment in advance.
The point of all of these is the same. The visit fits the patient, not the other way around.