diff --git a/PSReadLine/Accessibility.cs b/PSReadLine/Accessibility.cs
index 4938da2..aae6c0f 100644
--- a/PSReadLine/Accessibility.cs
+++ b/PSReadLine/Accessibility.cs
@@ -2,6 +2,7 @@
 Copyright (c) Microsoft Corporation.  All rights reserved.
 --********************************************************************/
 
+using System.Diagnostics;
 using System.Runtime.InteropServices;
 
 namespace Microsoft.PowerShell.Internal
@@ -10,14 +11,82 @@ namespace Microsoft.PowerShell.Internal
     {
         internal static bool IsScreenReaderActive()
         {
-            bool returnValue = false;
-
             if (RuntimeInformation.IsOSPlatform(OSPlatform.Windows))
             {
-                PlatformWindows.SystemParametersInfo(PlatformWindows.SPI_GETSCREENREADER, 0, ref returnValue, 0);
+                return IsAnyWindowsScreenReaderEnabled();
             }
 
-            return returnValue;
+            if (RuntimeInformation.IsOSPlatform(OSPlatform.OSX))
+            {
+                return IsVoiceOverEnabled();
+            }
+
+            // TODO: Support Linux per https://code.visualstudio.com/docs/configure/accessibility/accessibility
+            return false;
+        }
+
+        private static bool IsAnyWindowsScreenReaderEnabled()
+        {
+            // The supposedly official way to check for a screen reader on
+            // Windows is SystemParametersInfo(SPI_GETSCREENREADER, ...) but it
+            // doesn't detect the in-box Windows Narrator and is otherwise known
+            // to be problematic.
+            //
+            // Unfortunately, the alternative method used by Electron and
+            // Chromium, where the relevant screen reader libraries (modules)
+            // are checked for does not work in the context of PowerShell
+            // because it relies on those applications injecting themselves into
+            // the app. Which they do not because PowerShell is not a windowed
+            // app, so we're stuck using the known-to-be-buggy way.
+            bool spiScreenReader = false;
+            PlatformWindows.SystemParametersInfo(PlatformWindows.SPI_GETSCREENREADER, 0, ref spiScreenReader, 0);
+            if (spiScreenReader)
+            {
+                return true;
+            }
+
+            // At least we can correctly check for Windows Narrator using the
+            // NarratorRunning mutex. Windows Narrator is mostly not broken with
+            // PSReadLine, not in the way that NVDA and VoiceOver are.
+            if (PlatformWindows.IsMutexPresent("NarratorRunning"))
+            {
+                return true;
+            }
+
+            return false;
+        }
+
+        private static bool IsVoiceOverEnabled()
+        {
+            try
+            {
+                // Use the 'defaults' command to check if VoiceOver is enabled
+                // This checks the com.apple.universalaccess preference for voiceOverOnOffKey
+                ProcessStartInfo startInfo = new()
+                {
+                    FileName = "defaults",
+                    Arguments = "read com.apple.universalaccess voiceOverOnOffKey",
+                    UseShellExecute = false,
+                    RedirectStandardOutput = true,
+                    RedirectStandardError = true,
+                    CreateNoWindow = true
+                };
+
+                using Process process = Process.Start(startInfo);
+                process.WaitForExit(250);
+                if (process.HasExited && process.ExitCode == 0)
+                {
+                    string output = process.StandardOutput.ReadToEnd().Trim();
+                    // VoiceOver is enabled if the value is 1
+                    return output == "1";
+                }
+            }
+            catch
+            {
+                // If we can't determine the status, assume VoiceOver is not enabled
+            }
+
+            return false;
         }
     }
 }
diff --git a/PSReadLine/PlatformWindows.cs b/PSReadLine/PlatformWindows.cs
index c7e0313..32cf653 100644
--- a/PSReadLine/PlatformWindows.cs
+++ b/PSReadLine/PlatformWindows.cs
@@ -79,6 +79,21 @@ static class PlatformWindows
     [DllImport("kernel32.dll", CharSet = CharSet.Unicode, SetLastError = true)]
     internal static extern IntPtr GetStdHandle(uint handleId);
 
+    internal const int ERROR_ALREADY_EXISTS = 0xB7;
+
+    internal static bool IsMutexPresent(string name)
+    {
+        try
+        {
+            using var mutex = new System.Threading.Mutex(false, name);
+            return Marshal.GetLastWin32Error() == ERROR_ALREADY_EXISTS;
+        }
+        catch
+        {
+            return false;
+        }
+    }
+
     [DllImport("kernel32.dll", CharSet = CharSet.Unicode, SetLastError = true)]
     static extern bool SetConsoleCtrlHandler(BreakHandler handlerRoutine, bool add);