As the nation contends with an ongoing opioid epidemic and mental health crisis, a new series of reports on suicidality and substance use disorders (SUDs) sheds light on yet more fundamental weaknesses within the US health care system, in this case, on critical services and supports needed by adults with disabilities.

Drawing on rapid reviews of the research literature and interviews of technical experts and people with lived experience, the reports examine screening and treatment of suicidality and SUDs. Both are urgent public health problems, especially here in the United States, in large part because of long-standing systemic weaknesses (link updated 2/19/2025) in the nation’s behavioral health care systems and adverse social determinants of mental health.

The reports find that many barriers to screening and treating suicidality and SUD—barriers such as stigma, provider shortages, and inaccessible services (PDF)—are often magnified for people with disabilities.

The Centers for Disease Control and Prevention reports that over 70 million, more than 1 in 4, American adults have a disability. The impairments and functional limitations they experience are numerous and often overlapping, vary over the life course, and can even be episodic. These include physical and sensory impairments, intellectual and developmental conditions, and mental illnesses and disorders. The latter, especially, are among the most costly and are often undiagnosed, misdiagnosed, and untreated.

As a group, disabled people have long experienced above-average rates of exclusion, disenfranchisement, poverty, and incarceration, making access to effective health and social care all the more important. For screening and treating suicidality and SUD, this new research documents many additional barriers people with disabilities face when seeking care: inaccessible facilities and service settings, bias and unawareness among providers, and a lack of evidence on specialized screening tools and treatment approaches for people with specific types of disabilities.

The pros and cons of screening for suicidality are still actively debated, with some arguing that the assumed benefits are overestimated and possible risks underestimated (similar issues arise with SUD screening). The potential risks and unintended consequences of universal suicide screening include: false positives and overdiagnosis; increased anxiety and stigmatization; involuntary commitment and loss of autonomy; loss of privacy and confidentiality; overmedicalization of social, economic, and societal problems; and overburdening (already inadequate) health and social care systems. But the need for effective, adaptive, and supportive behavioral health approaches is clearly urgent.

Perhaps most importantly, this new series highlights tools and approaches to screening and treating suicidality and SUD, and facilitators for serving disabled people needing behavioral health care. Not surprisingly, many of these still need to be studied, refined, and validated with care, and in close collaboration with disabled people themselves, be they (potential) clients, providers, or researchers.

Given that physicians themselves experience higher-than-average rates of suicide and substance misuse, it is clear that the nation’s health and social care systems are in need of fundamental reform. As these new reports document, a major strand of these reforms should be improvements in research, policy, and practice that can prevent behavioral health problems and support the behavioral health and well-being of Americans with disabilities.