*For the purpose of this post, I’ll be using the word disabled to mean people with a physical impairment. I do consider mental health problems to be a disability, but for clarity, I’ll refer to mental health separately.

So my brain whirred into action last night, thanks to an Instagram post by the amazing feeding of the fox. There’s a type of self-harm that’s rarely mentioned; self-neglect comes up in the context of depression.

I’ve never seen a discussion around the connection between disability or chronic illness and self-harm or disabled people deliberately not taking care of their physical needs as a way of self-harming. There are times when I say yes when I should say no, times when I will push myself because I don’t feel I deserve to rest. And times when I don’t take painkillers because it’s an indirect way of inflicting pain on myself, or going to places that aren’t accessible and doing things when I’m not well enough.

Any disabled person will also tell you there is a big divide in the treatment of physical and mental health problems, the two rarely mix, and the mental health services are not always good at recognising the impact that physical disability or chronic illness can have on mental health.

They don’t understand that the things that could benefit you mentally aren’t always possible physically (like going for a walk or having a bath). Being told I should do more exercise after I’ve explained that I have chronic pain and chronic fatigue can result in me feeling lazy and making myself do things that result in pain or injury and an increase in fatigue and related symptoms.

This is where the lack of understanding or knowledge of the connections between mental health and physical impairments is such a problem. For me, it can be an increase in symptoms, but for others, it can be much worse.

Then there’s the other side. Health services that treat your body as if your mind isn’t a part of it. Although I’ve always been disabled to some extent, in the last couple of years, my mobility has got worse, and I’ve been using mobility aids and dealing with more pain and fatigue.

At the beginning of 2017, I tried to access psychological therapy for long-term health problems. I wanted help accepting my chronic illness and dealing with no longer being able to do the things I used to and things people my age can do. I wanted some support in balancing my physical and mental health.

It took several months for them to tell me that they don’t offer support for chronic pain, between that they rejected me because I was under mental health services (I was in the process of being discharged and they were completely different services), they then said my self-harm made me too much of a risk and they said they didn’t think I’d be able to manage classroom based psychoeducation (thanks for that).

Last time I checked, neither my body nor my brain can function without the other, yet services treating each are still very separate and mental health services are often not accommodating for people with physical impairments. They often aren’t accessible, and there’s also an assumption that if you’re disabled and have mental health problems, then of course you’re depressed because you’re disabled, because who wouldn’t be?

Ableism, unfortunately, is still well-rooted within the medical profession and even within the disability communities, there is still too much separation of physical impairment and mental health issues.