By Dr. Yona Lunsky, Clinician Scientist in the Dual Diagnosis Service and Director of the Health Care Access Research and Developmental Disabilities (H-CARDD) Program
October is Autism Awareness Month in Canada – an opportunity for mental health care providers to become more aware of what Autism Spectrum Disorder (ASD) is, and perhaps more importantly, what it feels like to have ASD and need mental health supports. I think it is important for us to discuss these very issues. Today I offer some suggestions for health care providers on how we can make mental health services a little more “autism friendly”.
What clinicians need to be aware of:
How accessible are mental health services to people with ASD? The research tells us that mental health issues are quite common, but that mental health providers don’t feel competent to provide them. It might be ok for clinicians to say: I can’t provide this sort of service, you need to see a specialist, so long as there are specialists. But what happens when there is no one else to go to? Either we need more specialists, or we have to become more specialized ourselves.
Here at CAMH, we can do both by advocating and building the capacity for more mental health specialists in ASD, and at the same time, by all of us improving our skills. Not sure how? Look around. A starting point is learning directly from those with ASD and their families. Keep in mind that you likely already work with many individuals who have some of these difficulties.
Here are a few areas to consider:
• Identify that ASD is part of the presenting picture
We need to be more skilled at recognizing autism in mental health care. Not all individuals will have a diagnosis pinned to their sleeve. And if they think making this diagnosis known will prevent them from obtaining services, they will not want to share that information. It is ok to ask about autism in our assessments, especially if patients understand that sharing this information will lead to a more supportive encounter.
• Recognize mental health issues early
ASD in itself should not be thought of as a mental health problem. But having ASD in environments that are not accommodating can lead to mental health problems. About 70% of youth with ASD have an associated emotional or behavioural problem, or would meet criteria for a psychiatric condition. These issues are also prevalent in over 50% of adults, with depression and anxiety being the most common presenting concerns. We need to talk about and promote mental health before serious issues develop. This means being responsive to family needs, making our schools safe and supportive places, nurturing friendships and preventing isolation. It is about building on strengths, and not just focusing on problems.
• Be aware of overlap between physical and mental health concerns
Mental health and physical health issues overlap with one another. Long term use of psychotropic medications, commonly prescribed to those with ASD, can lead to physical health problems, and so can inactivity, and poor diet. Left untreated, physical health problems like an ear infection or an abscessed tooth can lead to some to some distressed behaviours in someone who is not very skilled at communicating their internal experiences. Mental health assessments need to recognize how closely tied the physical and emotional can be.
• Treat every interaction as a therapeutic encounter
It is hard for anyone to ask for help, but having a traumatic health care experience can make asking for help a second time even harder. In our research with families we learned that parents of youth don’t seek mental health services because the steps to do so are too overwhelming, and because they hope that things might resolve on their own. In contrast, parents of adults don’t see mental health services because of how poor their experience was previously. As clinicians, we need to recognize that every interaction with the health care system is a therapeutic intervention. There are a few simple things we can do, even if we don’t feel like the expert, that can make an experience more positive and promote future service use.
A few simple strategies that we should all apply:
Be sensitive to the senses and reduce over stimulating environments, particularly when someone with ASD is under stress.. Take note of lighting, sounds, crowds. Allow for and encourage different tools to cope with sensory overload (sunglasses, headphones).
Make more time. This doesn’t mean speaking slowly or louder but means checking that what you saying is understood and that you are understanding what is said.
Listen: you aren’t the only expert in the room. Because people with ASD experience the world in unique ways, they can teach us about what works best for them, and so can their loved ones.
Admit what you don’t yet know: If you have seen one person with ASD, you have seen one person with ASD. Mental health presentations are complicated and require knowledge of what is typical and atypical for that one individual. You might feel a pull to have a quick answer or solution, but recognizing that it will take some time to figure out, communicating that and creating a space to do so can be very validating for the person, and serve them better in the long run.
For more information on ASD and mental health resources, you can visit the following:
• Dual Diagnosis Resources on Portico
• Surrey Place Centre’s site includes a number of clinical tools to assist with mental health and behavioural issues. The section on Health Watch Tables includes a specific table outlining key areas to consider for individuals with autism across the lifespan.
• The Autism Parent Resource Kit is an online resource to help parents, caregivers and families better understand autism and the range of services and support available in Ontario.
Both Autism Ontario (http://www.autismontario.com/) and Autism Canada (http://www.autismcanada.org/) have many helpful resources for service providers, individuals with ASD and families.
Here are a few additional examples of Ontario based videos which explain more about the lived experience of ASD
• Autism Grows Up
• Travels With My Brother
• Carly’s Café – Experience Autism Through Carly’s Eyes
• Autism Ontario has a vimeo channel with a series of videos for different audiences