The rights of disabled people are now enshrined in law and reflected in policy at national and international levels. As a result, in many countries disabled people can access financial and social care support, through mechanisms like independent living payments. They are also entitled to reasonable adjustments or accommodations, to facilitate their access to education, employment and goods and services. Although the disabled people's movement still has some way to go to achieve its full demands, and recent advances have been threatened by reduced welfare spending, these measures have been very welcome. However, despite the fact that people with mental health problems are potential beneficiaries of these policy developments, as ‘disabled people’, application in a mental health context has not been straightforward. For example, the demand for ‘reasonable adjustments’ throws up specific challenges in the context of madness and distress.

In this chapter, we identify some tricky issues that may underlie difficulties in putting disability policy in to practice in relation to madness and distress. The first issue is that madness is, by definition, unsettling, especially as it relates to notions of unreason and irrationality. This throws up particular difficulties and challenges which relate to the second issue, the pathologisation of madness. As a result of their perceived unreason/irrationality, people with mental health problems are actively pathologised and socially excluded. In the light of these first two issues, individuals are then faced with a third: the problematic adoption of a ‘mentally ill’ and/or disabled identity. Taken together, these issues present major obstacles for people who experience madness and distress, preventing them from benefiting from wider disability policy.

Some disability activists, particularly advocates of the social model of disability, have been hesitant to discuss the personal difficulties and limitations which may result from an individual's impairment, and other ‘impairment effects’ (such as pain and discomfort). This arises from a fear of locating the ‘problem’ back with the individual, rather than locating it, where it is seen to belong, in discriminatory social relationships and structures. Similarly, some radical mental health activists have been reluctant to engage directly with the issue of mental impairment which cannot be simply reduced to disabling social arrangements.