Many people with Autistic Spectrum Disorder (ASD) also experience mental health issues.
Often their needs assessment and finding the right health services can be complex. Services need to take a collaborative approach although they often have different models of care, eligibility criteria and places of work.
In 2014 the Ministry of Health (the Ministry) clarified eligibility for all people diagnosed with ASD. This clarification applied to people with ASD who have no coexisting eligible disability, such as an intellectual disability. It has helped create a consistent national approach to eligibility criteria for access to disability support for people with ASD.
Within the Ministry, the Office of the Director of Mental Health, the Mental Health Service Improvement Group and Disability Support Services (DSS) agreed to work together to support the implementation this clarification. All are committed to working together to ensure the best outcome for people with ASD.
Implementing this clarification requires that the local District Health Board (DHB) Mental Health services and Needs Assessment and Service Coordination (NASC) work together. It also requires a commitment and acknowledgement that complex situations may require collaboration to find pragmatic ‘whole of health’ solutions. To help facilitate this process, the Ministry implemented the ASD Panel.
Challenges of cross-service provision
One of the most noticeable differences between Disability Support and Mental Health services are the models of care. The disability-related needs of people with ASD tend to change only slowly. Therefore, disability funded services are reviewed annually or when a significant change occurs in the person’s circumstances. Disability service models are designed to moderate the impact of a disability and support people to live the life they want. Mental health services, on the other hand, are designed to address mental health needs through a recovery approach. Mental health conditions are often episodic in nature. Mental health interventions tend to be shorter and occasionally the person needs an acute intervention. As a person recovers from an episode of mental illness, specialist mental health care is followed by discharge to the care of the primary health provider (usually the person’s GP).
The ASD Panel
The ASD panel was set up to help facilitate access to services for people whose needs don’t fall within a single service. Often people whose situation is referred to the panel have diagnoses that are unclear and whose support needs include mental health and disability support services. The panel does not have the mandate to make funding decisions. Rather, it makes recommendations to the local Needs Assessment and Service Co-ordination (NASC) or corresponding mental health service on the types of supports needed to help the person live a more independent life.
Essentially it helps to facilitate the best services for the person and share accountability between the two services.
When aspects of a person’s mental health treatment impacts on their ability to benefit from disability support services, a joint approach is imperative. If services cannot agree on diagnoses or service provision, either the mental health service or the NASC can ask the ASD Panel to assist. Typical points when these happen are when:
- A diagnosis is unclear
- There is disagreement about the extent of the support needs
- There are difficulties in deciding the differential responsibility for the support (as this often has budget implications)
- There is lack of support service options in the local area.
Upon receipt of referral, the ASD Panel considers all information presented. Often this includes assessment information, a brief history of successful and less successful interventions and the rationale for the proposed support options.
The panel meets fortnightly when required. Meetings are focussed on defining the issues and finding the right solution for the person. If no existing services can meet the person’s needs, the ASD Panel may recommend a personalised response that encompasses elements from both mental health and disability models of care.
In the two years since this joint approach has been operating, there have been marked improvements in collaboration between services. In the 2015/16 year, over 1300 people who had ASD as their primary support need, were referred for support services, but only one percent required assistance from the panel.
Jenny* is a 17-year-old woman with ASD. She has been living with her family while attending a local high school. Her younger brothers do not have ASD. Jenny is supported at school through access to Ongoing Resource Scheme funding as she has limited verbal skills.
About two years ago Jenny began to experience episodes of acute anxiety. At these times she would become aggressive, seek solitude and resist attempts to calm her down or to follow her. She would go to some lengths to seek isolation from others, and on one or two occasions became lost when leaving her home or the school grounds.
Over time, these acute anxiety attacks became more frequent and her aggression more focussed on her brothers and parents. Jenny had been receiving respite but this seemed to be contributing to her isolation. This was because she was leaving home for her respite and said she felt lonely when away from family.
Assessment through the local Child and Adolescent Mental Health Service resulted in a diagnosis of depression and anxiety so medication and therapy was offered. Jenny’s behaviour continued to be aggressive at home. While her anxiety seemed to be less severe, her behaviours continued to cause concern.
A Behaviour Support Services referral was made to the provider to work with Jenny, her family and the mental health team to address her challenging behaviours. Respite was arranged at home rather than out of home, and ways of supporting Jenny when she was anxious were introduced by the mental health service and incorporated into the behaviour support plan.
Some on-going telephone communication between the Behaviour Support Service and the local Child and Adolescent Mental Health Service was required to ensure their respective interventions worked well together, as well as providing regular contact with the family. Over time, Jenny has made progress and her family are better equipped to help her when things start to escalate.
*Jenny’s name has been changed.
About the author:
Amanda Bleckmann is the manager of the Family and Community Support Team, Disability Support Services at the Ministry of Health, who oversees the ASD work programme (supplied by MOH).
¹In this article, we have used ‘ASD’ instead of ‘autism’ because the formal diagnostic term is ‘Autism Spectrum Disorder’, abbreviated to ‘ASD’.
By Amanda Bleckmann
This article was first published in Altogether Autism Journal Issue 3, September 2016 read the latest edition.