What are the key issues surrounding public transport and mental health?

Simon Calder

The Centre for Transport Studies at University College London (UCL) carried out an online survey of people with mental health conditions in order to establish the difficulties that people with mental health conditions have when travelling and to identify ways in which these can be overcome.

There were 385 respondents to the survey, all of whom had one or more mental health conditions. Half the respondents said they are unable to travel by bus and train because of their mental health condition.

Some frequent public transport problems, such as delays, missed connections and out-of-order toilets, present far greater challenges for those with mental health conditions.

But the report, by Professor Roger Mackett, makes clear that there are opportunities for both the industry and fellow travellers to make journeys easier for people with mental health conditions.

These are the key points.

What kinds of worries do people have about trains?

For many of the respondents, panic attacks on trains are brought on by overcrowding, having to cross a high or wide gap between the train and the platform and tight connections with the next train because of delays.

But problems can start at the station, and the report recommends: “Network Rail and train operating companies should ensure that the design of ticket machines is improved to make them more intuitive and less confusing by consulting with people with mental health conditions about the design.

“Pay-as-you-go (PAYG) ticketing on railways should be extended nationwide in order to, amongst other benefits, remove the need to speak to a member of staff in order to buy a ticket.”


The Department for Transport is working on plans for a potential PAYG area in Southeast and has allocated funds to Transport for the North to roll out PAYG in the north.

Noise is also distressing for some people. There is also a call for more quiet carriages, and for rules to be more strictly enforced.

The concept should be extended to stations, says the report. Network Rail and train operating companies should provide quiet areas on stations where people with mental health conditions can get away from crowds.

The Rail Delivery Group, representing the rail industry, says station are becoming more accessible – not only for those living with mobility disabilities but also for people affected with less visible illnesses.

Last week, Network Rail opened a new assisted travel lounge in Birmingham New Street at a cost of £175,000. The aim is to provide a calm and relaxing environment.

How good is special assistance?

While rail, bus and airport operators are improving care for people with mental illness, the help provided can be patchy.

Special assistance should certainly be requested by people with serious mental health conditions, but the respondents to the survey said the quality is uneven. A man in his fifties said: “You can turn up and there is no one to assist you, or they bring a wheelchair. Why? I can walk. It’s my mind that is affected.”

Professor Mackett said: “Apart from better behaviour by their fellow travellers, factors that would encourage them to travel more by bus and train are clearer information before and during travel, better trained staff, and, in the case of train, being able to contact a member of staff in person when onboard."

Some respondents mentioned concerns about hot food. What is the problem?

For many anxious travellers, vomiting in public is a significant fear. Many people with mental health conditions feel sick and become distressed when other passengers are eating hot food in a confined environment.

The report recommends: “Transport operators should ban the eating of hot food on public transport except in designated areas.”

What about interactions with staff?

On buses, nearly half the respondents said that having to talk to drivers makes them anxious.

A woman in her thirties said: “Buses are particularly difficult, and therefore my last resort option for travel, as there is no way of using them without being forced to speak to the driver, and also there's lots of anxiety about not knowing what to ask for.

"I will sometimes buy an all-day travel pass even though I know I will only make one single journey because it's easier to ask for."

Professor Mackett recommends that concessionary bus passes should be made available to people with mental health conditions who have difficulty communicating with staff.

He recommends that transport operators should ensure that all passenger-facing staff receive training about how to interact with people with mental health conditions, in particular bus drivers and station assistance staff.

The European Union requires all drivers of regular buses and coaches to complete disability awareness training.

Transport for Wales (TfW) has introduced a system called the Orange Wallet Scheme, which it says is particularly designed for passengers with an autism spectrum disorder.

TfW says: “The wallet has plastic pockets where you can put words and pictures to help you communicate your needs to transport staff across Wales.

“Show it to the station and onboard staff when you're travelling or buying a ticket. They're trained to recognise the wallet and provide appropriate help.” The card is available free from some local libraries.

Virgin Trains has introduced JAM cards, standing for Just A Minute, which travellers can use to indicate discreetly to staff that they have an invisible disability.

What about other passengers?

People can be made to feel anxious by bad behaviour by others even if it is not directed towards them. Another woman in her thirties said: “Just the other week, when on a bus home from a mental health support appointment, some of the other bus users were inconsiderate, abusive to each other, shouting and swearing etc.

“One lady's comments to another particularly upset me. I cried behind my sunglasses and hid my panic attack from all of them until I got home.”

Where is transport most difficult?

The report says that services in rural areas must be improved. But at the other end of the transport spectrum, the London Underground is singled out as the most problematic for people with mental health conditions. Many respondents said that trains stopping in tunnels between stations – as they are prone to do – can trigger panic attacks.

A woman in her thirties said: “I’m petrified of going on London Underground – I’m claustrophobic and scared that we’ll get stuck in the tunnel and won’t get help and I’ll die there.”

Are there any examples of good practice?

Yes. One positive experience was reported by a woman in her twenties travelling on Megabus from Victoria Coach Station in London to Manchester.

“I usually make sure I’m really early and in the front of the queue so I can select a seat in a place that feels most comfortable and less anxious.

“In this particular journey, my train to London Victoria was delayed, meaning I only arrived at the coach station five minutes before the coach was due to depart. I was already very anxious and upset, so when I discovered the bus was completely full and everyone was already seated, and there were only two seats left (both in unsuitable places for me), I had a full meltdown.

“The staff were brilliant however. One recognised me from a previous incident. They let me wait for 90 minutes in the mobility/disabled waiting room until the next bus.

“They also gave me priority boarding, and two reserved seats on the next coach in my preferred location, which meant I didn’t have to sit next to anybody else as I find this difficult.

“This was the first time anybody had ever shown me this much compassion in a time of distress while I was in a public place.”

Public transport users, as well as staff, should be more aware of the needs and behaviour of people with mental health conditions, to help build confidence, reduce distress and provide empowerment to enjoy the freedom to travel that many of us take for granted.