People with autism are four times more likely to experience depression compared to their typically-developing peers. Despite this heightened risk, individuals with autism and other neurodiversities often encounter significant obstacles when trying to access appropriate mental health care. Whether it’s clinicians’ lack of specialty training, staffing shortages, or barriers related to insurance coverage, these factors can prevent neurodiverse individuals from receiving treatment for common mental health disorders such as depression, anxiety, and mood disorders—conditions they are already at a higher risk of developing. This is a critical issue that requires attention in the field of neurodiverse mental health care.
Diagnostic Overshadowing: A Major Barrier to Care
One of the most significant barriers to accurate diagnosis and treatment for neurodiverse individuals is diagnostic overshadowing. This phenomenon occurs when new symptoms or changes in behavior are dismissed as part of the individual’s existing neurodiversity, rather than being recognized as signs of a co-occurring mental health disorder. For example, a person with autism may begin engaging in new behaviors such as head-banging, crying, isolating themselves, or avoiding school or work. These symptoms may be seen as merely part of their autism or intellectual disability, rather than as a potential indication of depression, anxiety, or another mental health issue.
Jen Riha, the vice president of programs at I Am Boundless Inc., explains that many clinicians fall into the trap of attributing new behaviors solely to an individual’s neurodiversity, without considering the possibility of a mental health condition. “Rather than saying, ‘Maybe they have depression or anxiety and could benefit from mental health treatment,’ the tendency is to just write it off as part of their autism or intellectual disability,” she says. This can delay the diagnosis and treatment of serious mental health issues, leaving neurodiverse individuals without the support they need. This challenge is a key consideration in the discussion of neurodiverse mental health care.
The Shortage of Providers and Specialized Training
The lack of appropriately trained providers is another significant barrier for neurodiverse individuals seeking mental health care. A study published in Health Affairs by The RAND Corporation found that while 66% of specialty mental health clinics offer behavioral health care for any child, only 43% provide care for children with autism. Even fewer clinics employ providers who are specifically trained to address the mental health needs of children with autism or intellectual and developmental disabilities (IDD).
The shortage of trained clinicians is partly due to insufficient education in how to treat individuals with neurodiversities. Many clinicians are not adequately prepared to work with this population, as specialized training on autism and IDD is often limited or nonexistent in mental health programs. Riha, who is also a clinical counselor by training, notes that mental health programs may offer only a brief lecture or two on treating people with autism or intellectual disabilities. This lack of specialized education leaves many clinicians underprepared to recognize and address the unique challenges neurodiverse individuals face when dealing with mental health issues. It is a pressing issue that needs to be addressed for the future of neurodiverse mental health care.
Jonathan Cantor, a researcher at The RAND Corporation, emphasizes the critical shortage of providers trained to work with neurodiverse individuals. “There’s just not enough providers with the necessary training to provide care for this population,” he says. “The shortage of providers for both autism spectrum disorder and for mental health care in general makes it really hard to find someone who is qualified to offer the care that’s needed.” This ongoing issue highlights the need for a shift in neurodiverse mental health care training to better serve these individuals.
Efforts to Address the Shortage of Trained Clinicians
In response to this gap in training, organizations such as Catalight are taking steps to address the shortage of mental health professionals capable of treating neurodiverse individuals. Catalight, a nonprofit organization that provides evidence-based treatment for people with IDD, is launching a new training program in 2024 aimed at improving the ability of clinicians to treat anxiety and depression in people with autism or IDD. The program will offer certification to clinicians and provide them with the tools and techniques needed to modify their approach to working with neurodiverse patients. This training is a welcome step toward improving neurodiverse mental health care access.
“We realized there were a lot of clinicians outside of Catalight who needed this training, too,” says Doreen Samelson, Chief Clinical Officer of Catalight. “So, we’re expanding the program to ensure a wider pool of clinicians can receive the necessary education.” This initiative is a step in the right direction, as it will help ensure that more clinicians are equipped to treat individuals with neurodiversities and mental health disorders, ultimately improving neurodiverse mental health care for this underserved population.
Payment Barriers: Insurance and Medicaid Challenges
Even after neurodiverse individuals find mental health providers who are capable of treating their conditions, they often face another hurdle: the question of payment. For individuals with commercial insurance, accessing mental health care may not be much different than for their typically-developing peers. However, for those with Medicaid or an IDD waiver, the situation becomes more complicated.
In many cases, payers are less likely to engage with smaller providers offering specialized services for neurodiverse individuals, making it difficult for patients to receive care through insurance. As Stacy DiStefano, CEO of Consulting for Human Services, explains, “The real question isn’t whether neurodiverse individuals would benefit from mental health services—it’s how we can more seamlessly pay for those services and support them in a meaningful way.”
To address this, DiStefano advocates for the consolidation of care through mergers and acquisitions, which could allow smaller providers to offer a more integrated and financially sustainable range of services. “By consolidating care, providers can pool their resources and offer a more comprehensive set of services for neurodiverse individuals,” she says. She also encourages IDD providers to include mental health care as part of their offerings, as this would not only enhance the care provided but also help prevent financial instability by diversifying revenue streams. Such strategies could improve the availability of neurodiverse mental health care in underserved areas.
Moving Toward Comprehensive Care and Accessibility
As the need for better care and access to mental health services for neurodiverse individuals becomes increasingly apparent, steps are being taken to address these challenges. From improving clinician training to integrating mental health care with IDD services and creating more seamless payment models, the mental health care system is slowly adapting to meet the needs of this underserved population.
While the road ahead is still long, organizations like I Am Boundless Inc., Catalight, and others are paving the way for improved care. By investing in specialized training, increasing the availability of qualified providers, and streamlining payment processes, we can make significant progress in ensuring that neurodiverse individuals receive the mental health care they need and deserve.
The mental health struggles of individuals with autism and other neurodiversities should not be overlooked. With the right combination of education, resources, and advocacy, we can begin to dismantle the barriers that prevent neurodiverse individuals from accessing the care that could help improve their quality of life. It’s time for the mental health system to recognize these needs and act accordingly, ensuring that neurodiverse mental health care is accessible to all who need it.
