While families approach Square Peg Society seeking help with adult issues such as employment and housing, their underlying fear is that their adult offspring will live a life of poverty and isolation, after they are gone, or after they are no longer able to care for them. Often it is mental health issues – stress, anxiety and depression, not autism – that is impeding their success at work, post-secondary education, and independent living.
Our meeting was the first of several meetings we intend to host on ASD and Mental Health. The next will be in February, 2017. We want to better understand the prevalence and consequences of these co-occurring mental health conditions, which programs and treatments are effective for people with autism, and if they exist, and are affordable and available to people with autism.
As a background to these interests and concerns, we viewed 3 excerpts from an Autism Community Training (ACT) Webinar on Mental Health & Autism (October 2016). They are:
Background to ASD and Mental Health Dr. Karen Bopp
Why are Psychiatric Co-morbidities Important? Dr. Anthony Bailey
Role of the Certified Behavioral Analyst Dr. Richard Stock
Dr. Karen Bopp, (Ministry of Children and Family Development)
Background to ASD and Mental Health
As the incidence of ASD increases (1 in 78 in BC) so does the difficulty of identifying and distinguishing the differences presented by ASD and mental health issues. They can mask each other. They can exacerbate each other. They can be co-morbid. Currently, experts in Autism are not well versed in mental health concerns.
Comments from discussion: There is no funding for mental health issues for those diagnosed with ASD; autism funding is supposed to go specifically toward those issues that arise directly as a consequence of the autism. As a result, mental health issues often go undetected and untreated.
Existing Mental Health services: In BC, a doctor’s referral is required to see a psychiatrist, and once referred, wait lists are long. As well, not all psychiatrists have experience with individuals with ASD. We perceive a need for the right help at the right time from a specialist with an understanding of autism.
Appointments to a psychiatrist are covered under the Medical Services Plan (MSP). Both the Mood Disorders Association of BC (MDABC) and the various branches of the Canadian Mental Health Association (CMHA) also have psychiatric clinics. The MDABC offers psychiatric appointments at their Robson Street clinic – these are for mild mood disorders – anxiety, depression, and bi-polar disorders. A referral from a family doctor or walk-in clinic physician is required and these appointments are covered under MSP. There is approximately a 2 month wait list from receipt of the referral. Burnaby Mental Health, a Branch of CMHA offers psychiatric appointments, again requires a doctor’s referral, and is covered under MSP. There is about a week’s wait between processing the referral and intake for an appointment.
There are many psychiatric counsellors and behavioural therapists in BC who offer counselling appointments at hourly rates ranging from $175 – $250/hour. As well, both the MDABC and Burnaby Mental health offer counselling services to adults. MDABC has counselling services at their Pender Street location, on a fee-for-service basis. One-to- one counselling costs $85.00 per session, family counselling is $95.00/session, and there is also group counselling in the form of free drop-in social support groups. Burnaby Mental Health offers group counselling to adults 19 and over, referred by a doctor. They have two group counselling options: Rapid Access Anxiety or Rapid Access Depression. Following their intake participants are required to attend 4 initial sessions in their stream, which are, in turn, followed by eight Cognitive Behavioral Training sessions. There is usually about a 1 week wait between the processing of a referral to intake. These group counselling programs are covered by MSP.
Mood Disorders Association of BC, 604.873.0103 #1 for psychiatric clinic #2 for counselling services
Burnaby Mental Health, Mental Health Team, Burnaby 604.453.1900
Fraser Health New West 604.777.6800
Dr. Anthony Bailey
Why are Psychiatric Co-morbidities Important?
There has been a shift in intellectual ability. In the past three quarters of the population diagnosed with ASD had below average intelligence. Presently this proportion is reversed. Three quarters of this group has average or above average intelligence.
Based on a study of 300 school age children in BC the most likely co-morbid conditions with ASD were found to be anxiety, depression and OCD. (In girls, eating disorders may be an expression as well). Less present was the incidence of psychosis. Anxiety and depression tend to increase with adulthood from 25% to 51% and 6% to 32% respectively. The implications of this understanding suggest that because co – morbid conditions are so common they should be suspected by the observer.
Misdiagnosis may occur with the common co-morbid condition of ADHD, if accompanying social difficulties are missed. Mental disorders can be missed for various reasons in both children and adults. In a child, observation can be obscured by another identified condition such as ASD.
Psychological distress is expressed in different ways by children. In adults, symptoms can be missed because the individual has limited language skills or cannot identify their own emotional state. This may result in remaining in an anxiety provoking situation, from which others would remove themselves, until the point when there is a meltdown. When anxiety is expressed at home the family may presume this is an expected part of ASD behaviour.
Mental disorders can interfere with progress for example through repetitive thoughts.
Psychosis can be induced by stressful situations at school or work.
Family genetics studies focussing on anxiety and depression among relatives suggest that genetics is a risk factor for those with ASD, and though separate, is perhaps, an exacerbating, condition.
Environment can have a bigger impact on those with ASD than others.
Comments resulting from discussion: There are shut downs as well as melt downs.
The norm for those with Autism should not be a state of distress perhaps caused by, “unfriendly,” environments.
Richard Stock is a Board Certified Behaviour Analyst
Role of the Certified Behavioral Analyst
His services include long term planning for clients which can continue from pre-school to employment. A designed program would address the key areas of language, communication and social as well as repetitive behaviour, fine and gross motor skills, academics and functional assessments. Links to both home and school provide unity among a team of professionals.
Several examples were given of correcting problem behaviours that were inappropriate such as spitting or reciting dialogue from entertainment sources.
Comments from discussion: RDI was mentioned as an alternative to ABA as well as other programs that speakers suggested focused on a different relationship approach.
Speaker: Polly Guetta, Development Co-ordinator, Mood Disorders Association of BC
See above for existing mental health services offered through MDABC.
Check out: “What Helps, What Hurts?” for ages 18-30, to help identify problems & strategies.
Polly spoke on how to be proactive about mental health, how to build emotional resiliency and gave a brief overview of several kinds of mental illness.
The Mood Disorders Association of BC is a non-profit organization with these goals:
* To be proactive
* To identify the problem
* To fight against misconceptions about those with mental health problems.
Good mental health can be defined as a sense of well-being, an ability to handle life and realize abilities.
Emotional fitness enables the individual to be stronger, more confident, resilient, and to provide a meaningful contribution.
People with an optimal demonstration of well-being exhibit the following abilities:
1) Set achievable goals
2) Know when they need support
3) Don’t believe everything they think.
4) Strategize for tough days.
5) Practice compassion for self and others.
These skills can be learned.
Ref: courageworks.com (a free course in compassion)
The Wellness Wheel encompasses these areas:
Poor mental health can occur when demands exceed the ability to cope impacting body and mind. Polly suggested talking to trusted friends/family and/ or professionals such as a doctor who can provide referrals.