Public transport and mental health are closely linked.
For people with mental health conditions and neurodiverse people, it's a vital lifeline. It can be a route to more independence, to a social life and to essential healthcare appointments.
But for many, transport comes with challenges that cause fear and anxiety. And if we do nothing to improve it, we risk increased isolation, loneliness and poor mental health.
When it is right, having transport, the ability to move around the world, is the most important thing. I would put it above relationships, or anything else.
Our 2023 research shows that people with mental health problems face some common challenges when using public transport.
- People: Research participants talked about being overwhelmed by the ‘human churn’ of public transport, particularly in dense urban areas. Some people feared the unpredictability of others, that trouble might break out around them, particularly on buses.
- Abuse and assault: Many people had experienced abuse on public transport. This ranged from rudeness and impatience, to sexual assault, racism or disablism.
- Staff attitudes: Several people mentioned the attitudes of bus drivers, taxi drivers or other transport staff, being rude, impatient or abusive.
- Sensory overload: Sensory processing was a significant challenge for many. People talked about the overwhelming noise of buses and trains. Some also mentioned the overwhelming visual information to process, particularly at large stations.
- Space: People talked about restricted space on buses and the London underground, narrow seats and aisles and the discomfort of having to be so close to others. Some felt trapped on transport like trains, where it’s hard to escape when panicking. Finding space for a wheelchair presented an additional challenge for buses, trains, as well as taxis.
- Access and accessibility: It is challenging for people with mental health difficulties and/or neurodivergent people to qualify for travel concessions or support. And those with hidden disabilities or conditions often didn’t feel comfortable asking for help or using priority seating.
What can we do to improve public transport for people living with mental health problems?
Our research also revealed practical strategies and solutions to improving public transport for people with mental health problems.
- Independent travel: Some people found ways to travel independently, whether by car, scooter, bicycle or taxi. For some this was a choice, and for others, a necessity.
- Technology: The use of noise cancelling headphones, listening to music, or playing games on their phones helped distract people from their surroundings.
- Individual strategies: Some people had a favourite seat. Some wore sunglasses to avoid eye contact. And others chose to travel with a partner or friend.
- Advance planning: Many people went to considerable effort to plan their journeys, avoiding peak times and making back-up plans should things go wrong.
- Peer support and collective action: Several people talked about the value of sharing strategies and learning from each other. They suggested a website and app to share information, resources and strategies.
Recommendation for local and national government
The study indicates a lack of awareness about both hidden disabilities and the sunflower lanyard. There are many ways in which these issues could be highlighted and brought to public attention. Equally, there are local policies that could be adopted at a national level to make it easier for people with hidden disabilities to travel.
One way we recommend tackling this is through campaigns to raise public awareness about hidden disabilities and conditions affecting people’s ability to travel. Another way is to raise awareness of the various ways people can get support to travel, bringing this information together and making it easily accessible.
Recommendations for travel companies
The study highlights inconsistencies in awareness and training across the transport companies and their staff. It also highlights a general need for an inclusive approach to hidden disabilities and to review safety measures for people experiencing abuse or assault.
- Training for transport staff co-produced with people with lived experience of the challenges.
- Adverts and/or announcements on trains and buses to draw attention to hidden disabilities.
- To consider codesign with disabled people to look at new and different uses of space.
- Rear entry on buses with card readers (for those who find the visibility of boarding the bus at the front challenging).
Recommendations for health and social care services, and VCSE organisations
Health and social care services and VCSE (voluntary, community and social enterprise) organisations need to pay greater attention to the context surrounding a person’s appointments, particularly where they know that the person experiences challenges in travelling.
Our recommendations include:
- Supporting people to re-engage with public transport e.g. through peer support.
- Developing a website for people to share tips and suggestions to support people in the use of public transport.
- Flexibility with appointments that renders the idea of arriving late less stressful – or responding positively to people who request appointments in the middle of the day.
We worked with partners to undertake three strands of research into transport and public mental health, exploring the challenges and possibilities facing: people with psychiatric diagnoses; people living with dementia; and mothers of babies and young children. All three areas were led by people with lived experience of the challenges.
You can find each summary report below, or read our full report which combines our research findings.
Mental health problems and transport
The aim of this study was to explore and reveal more about the role and value of transport for people living with mental health problems, as well as the barriers it presents and ways in which these barriers might be overcome.
Dementia, transport and mental health
People who are living with dementia frequently highlight the importance of getting out and about in the community. They report that this enhances their wellbeing, self-confidence, independence, social contact and stimulation. However, they also describe the stress and anxiety – and even trauma–that they experience if arrangements are not accessible or when things go wrong.
Maternal mental health and transport
The early months and years after having a baby can be a vulnerable and isolating time. Many mothers rely on public transport to access antenatal and postnatal appointments, baby and toddler groups, and friends and family. As such, transport plays an important role in the physical and mental wellbeing of mothers, infants, and families. Navigating transport systems is complicated by bringing babies and small children along, and these difficulties are enhanced considerably when a mother is feeling anxious or distressed.
About the research
The aim of this research was to explore the accessibility needs of people with mental health difficulties when using transport. The research covers three themes: concerns for people with existing psychiatric diagnoses; the relationship between dementia, mental health, and transport; and transport and maternal mental health.
This project was funded by Motability, the national disability charity. The charity has oversight of the Motability Scheme, which enables a disabled person to use all or part of their higher rate mobility allowance to pay for the lease of a new car, scooter or powered wheelchair.
Partners and researchers
Thank you to researchers Alison Faulkner, Jolie Goodman, Philly Hare, Rachael Litherland, Laura Richmond, Emma Ormerod, David Crepaz-Keay and the people living with dementia, people with experience of mental health difficulties and mothers with experience of mental health difficulties involved in this study.
- Innovations in Dementia is a not-for-profit Community Interest Company (CIC). People with dementia are at the heart and start of all their work. They promote a positive but realistic view of dementia, demonstrating that, although it is life changing, it does not have to be life ending. They support people with dementia to live with hope and keep control of their lives.
- DEEP stands for the Dementia Engagement and Empowerment Project – it is the UK network of dementia voices. DEEP consists of around 80 groups of people with dementia – groups that want to change things. Some groups come together for support and friendship in the beginning. Many become involved in campaigning and awareness raising about dementia. They all have a voice.
- Maternal Mental Health Alliance (MMHA) is a UK-wide charity and network of over 120 organisations, dedicated to ensuring women and families affected by perinatal mental health problems have access to high-quality, comprehensive perinatal mental health care. They bring the maternal mental health community together and make change happen by combining the power of real-life experience with clinical and professional expertise.
- Mothers for Mothers offer maternal mental health and wellbeing support, advice and information to women, birthing people and their families in Bristol, North Somerset and South Gloucestershire. As mothers who have lived experience of depression, anxiety and isolation during pregnancy or after the birth our one or more of our babies, they understand how hard early parenthood can feel and how difficult it can be to ask for help.
- Sister Circle is a charity putting women’s health first. They provide women living with complex situations with practical and emotional support during pregnancy, access to sexual and reproductive health services and counselling to heal from traumatic experiences. Their support is delivered by amazing volunteers, recruited from local communities, and provided with six-week trauma focused training programme.