People with disability in Australia

Introduction

People with disability generally have poorer physical and mental health and more complex health needs than those without disability. This section looks at the health of Australians aged 18 and over before and during the COVID-19 pandemic, and the use of health services (including telehealth) during this period.

Physical and mental health status

The Household Impacts of COVID-19 Survey collected information about people’s health in its December 2020, January 2021 and May 2021 iterations.

This section looks at the self-reported health status of Australians with disability based on 2 common survey tools:

• self-assessed health status
• Kessler Psychological Distress Scale (K10).

These indicate that people with disability experience poorer general health and higher levels of psychological distress than people without disability.

Self-assessed health

Self-assessed health has varied throughout the COVID-19 pandemic for people with and without disability (Figure COVID.1). Between December 2020 and May 2021, the proportion reporting excellent or very good physical health:

• was much lower for adults with disability than for adults without disability (25% compared with 64% in December 2020)
• somewhat recovered between January and May 2021 (from 21% to 29% for adults with disability, and from 50% to 55% for adults without disability) (ABS 2020b, 2021a, 2021d).

Excellent or very good mental health was (Figure COVID.1):

• less likely to be reported by adults with disability than those without (38% compared with 50% in May 2021)
• for adults with disability, more likely to be reported in May 2021 (38%) than in December 2020 (30%)
• for adults without disability, similarly likely to be reported in May 2021 (50%) and in December 2020 (52%) (ABS 2020b, 2021d).

The results for physical health in the early stages of the pandemic were broadly similar to previous results for general health from the 2017–18 National Health Survey but deteriorated during 2021 (especially for people without disability). As reported in the Health section of this report:

• in 2017–18, 24% of adults with disability rated their general health as excellent or very good, compared with 65% of adults without disability (ABS 2018).

Health before and during COVID-19

In January and May 2021, the Household Impacts of COVID-19 Survey asked respondents to compare their current physical and mental health with what it was before COVID-19 (or March 2020). In May 2021, most people rated their current physical health about the same as in March 2020 (Figure COVID.2):

• 64% of adults with disability and 69% of adults without disability rated their physical health as about the same
• adults with disability were more likely than those without disability to say their physical health was worse or much worse in May 2021 (24% compared with 16%) (ABS 2021d).

The distribution of responses comparing current health with its March 2020 levels was similar for both groups in January 2021 (ABS 2021a).

Similarly to physical health, in May 2021 most people rated their mental health as about the same compared with what it was before COVID-19 (or March 2020) (Figure COVID.2):

• adults with disability and those without disability were equally likely to rate their mental health as about the same (68% and 67%)
• adults with disability (23%) and those without disability (17%) were also similarly likely to say their mental health was worse or much worse in May 2021 than before COVID-19 (ABS 2021d).

These response patterns were similar in the January 2021 survey (ABS 2021a).

Psychological distress

In November 2020, as well as March and June 2021, the Household Impacts of COVID-19 survey collected information about negative events or feelings experienced by respondents in the 4 weeks leading up to the interview. This allows identification of levels of psychological distress of people aged 18 and over.

People with disability were consistently more likely to experience high or very high levels of psychological distress than people without disability:

• in November 2020, 34% of adults with disability and 16% of adults without disability
• in June 2021, 29% of adults with disability compared with 17% of adults without disability (ABS 2020a, 2021e).

The results for people with disability were similar to 2017–18 results reported in the ‘Health’ section of this report, however, people without disability were about twice as likely to report high or very high levels of psychological distress during COVID-19 than before it:

• in 2017–18, 32% of adults with disability and 8.0% of adults without disability experienced high or very high levels of psychological distress (ABS 2018).

Activities to maintain health

In May 2021, similarly high proportions of adults with disability (87%) and without disability (89%) reported participating in one or more activities for physical health since March 2020 (ABS 2021d). The most common activities were similar for both groups and included (Figure COVID.3):

• walking regularly for transport, exercise, recreation or sport (55% for adults with disability and 61% for adults without disability)
• watching or changing their diet (47% and 49%)
• regularly doing physical activity (other than walking) (40% and 48%)
• getting enough sleep (37% and 40%) (ABS 2021d).

Similar proportions of adults with disability (77%) and without disability (71%) reported in May 2021 using one or more strategies to manage their mental health since March 2020 (ABS 2021d). The most common activities were also similar for both groups (Figure COVID.3):

• organising their home, life or other things (35% for adults with disability and 36% for those without disability)
• doing more of the things they enjoy (34% and 33%)
• practising thinking positively or setting achievable goals (32% and 28%)
• increasing levels of exercise or physical activity (27% and 31%) (ABS 2021d).

Use of health services

Use of telehealth services

In November 2020 and April 2021, the Household Impacts of COVID-19 Survey asked Australians aged 18 and over about their use of telehealth services in the previous 4 weeks, including any appointments with a health professional over the phone, by video conferencing, or through other communication technologies.

In April 2021, adults with disability (21%) were more likely than those without disability (12%) to report having had a telehealth consultation in the previous 4 weeks. For adults with disability, this was a decrease from November 2020 (30%), while remaining similar for those without disability (14% in November 2020) (ABS 2020a, 2021c).

The most common uses of telehealth services were similar across November 2020 and April 2021 and between people with and without disability. The most common uses reported by adults with disability in November 2020 were (Figure COVID.4):

• as a replacement for a face-to-face or physical appointment with a health professional (73%)
• for a prescription (39%)
• to manage a chronic health condition (25%)
• for a mental health service (20%) (ABS 2021c).

In November 2020, for people who did not access telehealth services, the most common reasons included (Figure COVID.4):

• the service was not needed – adults with disability were less likely to give this response (77%) than those without disability (92%)
• people preferred to speak in person with health professionals – adults with disability were more likely to give this response (22%) than those without disability (8.7%) (ABS 2020a).

Future use of telehealth services

In November 2020, about half (51%) of adults with disability said they would likely use telehealth services even once the COVID-19 restrictions were lifted, 30% said they were not likely to use them, and 19% were not sure. This pattern was similar for adults without disability, of whom 48% said they would continue using telehealth services, 32% said they were not likely to use them, and 20% were unsure (ABS 2020a).

Reasons to use (or not to use) telehealth services in the future were mostly similar for people with and without disability, with the following exceptions:

• convenience (the ability to use the service anywhere) was less important to people with disability
  • of the people who said they would use the service in the future or were not sure, 69% of adults with disability picked convenience as one of the reasons, compared with 80% of those without disability
• of the people who said they would not use the service in the future (or were not sure), people with disability were more likely to say they would not be using the service because
  • it was not recommended for their condition or treatment (12% for adults with disability compared with 5.4% for adults without disability)
  • they did not have the required technology (11% compared with 2.7%) (ABS 2020a).

​Use of mental health or support services

Adults with disability were more likely than those without disability to report that:

• they had used at least one mental health or support service between March 2020 and April 2021 (29% of adults with disability, compared with 13% of those without disability)
• they had needed but did not use a mental health or support service between March and December 2020 (11% and 5.4%, respectively)
• their use of mental health or support services had decreased between March and December 2020 (17% of adults with disability compared with 7.8% of those without disability) (ABS 2020b, 2021c).

The most common mental health or support services used in April 2021 were (more than one service could be reported):

• GP for mental health (20% for people with disability compared with 8.2% for those without disability)
• psychologist, psychiatrist or other mental health specialist (19% compared with 7.1% for those without disability) (ABS 2021c).

Similar proportions were reported in December 2020 (ABS 2020b).

Around 3 in 10 people with and without disability reported starting a new mental health or support service since 1 March 2020 that they had not used before (28% and 30%) (ABS 2020b).