Guidelines for Selecting a Neurodiversity-affirming Mental Healthcare Provider

As Autistic adults, seeking help for our mental health can often be more taxing than it is helpful due to the many additional barriers we face.

Yet, with around 50–70% of Autistic people experiencing mental health intersections, the need to have neuro-affirming support has never been greater.

Barriers to Mental Healthcare

There are many barriers that leave us with unmet mental health needs, including:

• a lack of knowledge among providers about Autism which can lead to them dismissing our mental health concerns as being, simply, “part of our Autism”;
• an outdated understanding of Autistic social motivation which leads some providers to believe that Autistic adults are uninterested in developing social, romantic or therapeutic relationships;
• a use of language that invalidates our identity and perpetuates outdated stereotypes, such as, “You don’t seem to have Autism because you have good eye contact and are empathic”;
• a use of abstract language to describe concepts like Cognitive Behavioural Therapy;
• a failure to acknowledge conditions that are not part of the DSM-V but are very real to those with experiential knowledge, such as Pathological Demand Avoidance or Rejection Sensitive Dysphoria;
• physical environments that do not accommodate our sensory needs;
• therapies that do not accommodate our individual communication needs, such as talk therapy for individuals with receptive language challenges;
• reliance on therapies that don’t acknowledge potential alexithymia or interoception challenges;
  resources that do not accommodate our communication differences such as videos without subtitles or text options;
• administrative redtape that further exacerbates executive functioning struggles such as referral processes, establishing mental health treatment plans to access government subsidies, even having to make phone calls to book an appointment, etc.
• trouble navigating a complex system where there is a lack of collaboration between mental health providers, disability services and other sectors including employment, education, justice and housing.

This all underscores the urgent need for targeted, systemic change and for mental health services and resources designed for and with Autistic people.

Six ways to check whether a mental health provider is neuro-affirming

We don’t want to provide an exhaustive list because we know – if you’re seeking mental health help – you’re exhausted enough. So we reviewed the latest research and formulated 6 questions to ask to determine whether a mental health provider is likely to provide a neuro-affirming, individualised service, or not.

1. What professional development or self-directed study have you done to update your knowledge of Autism and frequently co-occurring conditions?

Our knowledge of Autism has come a long way in the last 20 years. If your mental health provider achieved their qualifications a while ago and haven’t kept abreast of the latest developments, they may still believe many harmful misconceptions and have outdated notions of what approaches are beneficial.

And who provided your training or produced your self-directed study materials?

Were they created by or with Autistic people and do they place an emphasis on care that promotes

Were they created by or with Autistic people and do they place an emphasis on care that promotes Autistic wellbeing? Or, rather, do they encourage the masking of our Autistic traits at the expense of our wellbeing?

2. Is your practice an Autism-friendly environment?

Do they offer telehealth consultations as well as in-person consultations? Do they have sensory tools on hand that you can use? Are the videos they use captioned? Is there plenty of parking? Can you make appointments online? Make a list of what you need for an environment to accommodate your unique Autistic profile and ask whether a prospective practice can meet these needs.

3. How would you describe Autism?

How Autism is referred to – especially by healthcare providers – impacts how society views Autistic people and, crucially, how you view yourself. If they use deficit-based and pathologising language, leave immediately. You are not inherently broken or diseased, you simply have a different neurotype. You may like to download and share this letter to show prospective mental health providers what respectful, neuro-affirming language looks like.

4. How do you individualise your approach to your clients’ mental healthcare?

You cannot meet a client’s needs if you do not see them as having unique needs. As the old adage goes, “If you’ve met one Autistic person, you’ve met one Autistic person.”

• Will the mental healthcare provider try to get to know your sensory profile and make accommodations so you feel as comfortable as possible? For instance, will they dim the lights, shut the door to reduce background noise, or refrain from wearing perfume during your sessions?
• Can reception give you a call when your session is ready to start so you can wait in your car and bypass the overwhelm of a waiting room?
• Can they adjust their schedules to give you more time or increase the frequency of appointments to manage your medication? Autistic adults can be at increased risk of side effects of psychotropic medications used in mental healthcare.
• Can the provider reduce abstract language and use literal, concrete terms to explain concepts?
• Can they provide you with a written list of any items you need to action in between sessions?
• Can they increase the use of visual supports by using video models of relaxation exercises or allow you to record them modelling it on your phone so you have a take-home visual reminder?
• How will they get to know your triggers and make you feel safe? Healing our mental health can only begin when our immediate safety needs are met.

5. Will you get to know and leverage my strengths and passions in treatment?

We know that identifying and mobilising an Autistic person’s strengths can boost self esteem, promote Autistic flourishing and is a key component of a neuro-affirming approach to mental healthcare. If you’re experiencing high levels of stress or anxiety, engaging in your interests can be an effective coping strategy and should be encouraged by your mental healthcare provider.

6. Will you provide practical and achievable steps to promote my progress?

Providers can help you meet your mental healthcare goals by providing practical and realistic recommendations on how to navigate life situations that impact your mental health. Some providers focus heavily on Autism itself or adverse childhood experiences that may not be helpful in managing your day-to-day activities. For example, if you’re socially anxious, it may be more helpful to talk through recent situations and identify practical coping mechanisms rather than to analyse the early childhood experiences that may have triggered your social anxiety. A good provider will regularly check-in with you about how you’re finding therapy, take on board your feedback and modify their approach as necessary.

Ultimately, the provider should be willing to collaborate with you to design a client-centred approach and style that works with your neurology, not against it.

Because Autistic individuals – just like everyone else – have the right to access mental health services that validate their identity, and feel safe in doing so.