No reflection in the mirror

SUMMARY Lesbians with disabilities have atypical life experiences- they are virtually invisible within the mainstream culture. Both women with disabilities and lesbians experience societal, familial and economic pressures that directly impact their lives and the range of options available to them. When a lesbian is also a woman with a disability, the combination of these pressures has important mental health implications. This article explores the issues and barriers related to disabled lesbians accessing mental health services. Because no systematic research on the mental health needs and experiences of lesbians with disabilities exists, it is unknown how many of them are in need of, access, or are denied appropriate mental health services. The little research that exists on the mental health needs of women with disabilities has either excluded or ignored the particular experiences associated with lesbian identity. Like wise, lesbian mental health research has historically overlooked disabled women's identity and experiences. Shared experiences and other similarities, such as discriminatory attitudes in the health service system, social stigma, and self-devaluation, are discussed within the context of disabled lesbians' compounded risk for mental health problems. Service access and barriers, key therapeutic issues, and cultural competency are discussed as additional issues that emerge when addressing mental health services. We also examine how lesbians with disabilities have proactively networked, caring for each other through informal supports within their communities, and have creatively developed their own strategies and resources. The paper concludes with a discussion of new efforts toward gaining visibility, successful strategies for mental health practitioners in addressing issues and challenges associated with providing care to lesbians with disabilities, and recommendations for further research.