Full article: https://www.tandfonline.com/doi/pdf/10.1080/21582041.2021.1998589

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Who: Will Mandy

Journal: Autism Volume 26 Issue 2

Published: February 2022

Title: Six ideas about how to address the autism mental

health crisis (https://doi.org/10.1177/13623613211067928)

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The Autism Mental Health Paradox

This editorial looks at how autistic people are most likely to need mental health support but least likely to get it. It suggests six approaches to this problem

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The Problem

In 2008 it was found that: 70% of autistic children met the criteria for a psychiatric disorder and 41% for two or more.

A 2014 UK survey found that 44% of Autistic people wanted post-diagnoses mental health support but only 22% were offered it.

Mandy states:

‟Support systems for autistic mental health are, currently, not fit for purpose.”

This is because of :

‟long-standing systemic problems that result in professionals lacking the required resources”

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Solution 1:

Better Screening for Autism, Earlier

This is to ‟catch” autistic people before they develop mental health problems.

Mandy suggests this should also be targeted at people who have been shown to be likely to have undiagnosed autism such as:

• women with eating disorders
• homeless men
• people with treatment-resistant OCD

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Solution 2
Standardized, Evidence-Based Post-Diagnostic Support

This would include:

• Teaching autistic people about mental health and well being, emphasizing the positive aspects of Autistic traits (psychoeducation)
• Making use of video calls instead of in-person appointments (telehealth)
• Group sessions where autistic people can come together and share experiences (peer-to-peer support)

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Solution 3

Acknowledge That it is Our Environment That Causes Us Problems

Mandy writes: ‟we need greater acknowledgement that autistic people are often expected to live in environments that are profoundly unaccommodating to them”. This is because the current medical model still sees mental health problems as a result of an autistic person’s individual characteristics and expects them to change.

The social model has enabled a shift in thinking which has led to more understanding & protection of Disabled people’s rights.

However, the binary distinction between social & medical doesn’t reflect real-world complexity.

Shakespeare argues for the bio-psycho-social model, which states that Disability is not caused by oppression alone, but is multi-factorial, & includes physical, psychological, and social factors.

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Solution 4:

Systematic Training for Mental Health Professionals

This would be included alongside other mandatory training like diversity and safety, to improve understanding of autistic people.

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Solution 5:

Adapt Services to Better Suit Autistic People

This would take advantage of current knowledge of autism in mental health services to provide specialist pathways for autistic people but Mandy notes that more knowledge is needed in this area.

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Solution 6:

Research Autism-Specific Causes of Mental Health Difficulties

Mandy notes that it should not be assumed that what causes mental health problems in neuro-typical people is the same as for autistic people and that PTSD, OCD Eating disorders and anxiety might have “autism-specific risk factors” and we should have treatments that target those.

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Thoughts & Questions
It’s disappointing to read that general medical understanding is still so far behind what autistic people have known, and been asking for, for years.

• If solutions 2 and 5 are based on mental health services, wouldn’t this prevent autistic people from accessing them until they have a mental health crisis?
• Does placing support (and post-diagnostic support) under mental health umbrella incorrectly class being Neurodiverse as an illness, not a diversity?

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The ideas don’t address the underlying causes, which are underfunding and lack of resources.

Mandy ends by noting that it is essential to involve autistic voices in the design of autism care and services and asks for ‟authentic partnerships between researchers, clinicians and the autism community.”

Autistic people may prefer to lead rather than just be a partner in the provision of their care.