 Good evening, everybody and welcome to tonight's MHPN webinar on mental health and well-being in autistic youth and young people during transitions. It's lovely to have you here all tonight. I'm Nicola Hulfrey and I'm your facilitator for this evening. So I'm just here to share with you the expertise of all the wonderful panellists that we have tonight. Before we get going, I would like to start with an acknowledgement of country. So MHPN would like to acknowledge the traditional custodians of the land, seas and waterways across Australia on which our webinar presenters and participants are located. We wish to pay our respects to the elders past, present and future for the memories, traditions, culture and hopes of Aboriginal and Torres Strait Islander peoples. And welcome any Aboriginal and Torres Strait Islander people joining tonight. And I would like to particularly pay my respects to the none of all people of the land on which I'm joining tonight. So I'm Nicola Hulfrey, as I said, I'm a clinical psychologist and I'll be facilitating tonight's panel. As we go in tonight, we just want to start with a quick self care message. So the purpose of this webinar is to give health professionals and others joining the perfect the skills they need so they can help people more effectively in the future. Personal stories of illness and well being a very important MHPN often includes consumers and carers on our panel. The chat box is however not a forum for personal stories. It's designed to compliment the panel discussion by allowing professionals to share resources and their experiences of practice. So thank you for respecting that and keep the chat around the content and sharing insights and so forth. If any content in tonight's webinar causes you distress, however, please seek care if you're required. You can call beyond blue on 1300 224 636 or contact your GP or local mental health service. So let's get into it. So tonight's panel, we have an amazing panel for you tonight, which I can't wait to hear from the bios bios have been sent through already. So I'm not going to read them out. I think it's best to hear from the panel learn a little bit about them and what interests them in this area and what they bring to tonight's panel. So with that, I warmly welcome all four panellists, but I'd like to start with Claire Pickett, who's a general practitioner with lived experience from New South Wales. Welcome, Claire. So Claire, just kick us off tonight. Tell me as a GP, what are all of us? What have you seen as the benefits of having a lived experience when supporting patients? Oh, well, I should say, Nicola, I'm from Victoria. Sorry, I pressed you on the border. I apologize. That's a terrible scare. No, that's alright. Look, I think being autistic myself, it's allowed me to have a really good working knowledge of like the challenges and joys of an autistic life. And it's really helped me to connect very well with my autistic patients as a communication area of communication can sometimes be a challenge for autistic people. But when it's an autistic doctor and an autistic client or patient, it goes very smoothly. Wonderful. Thank you, Claire. And welcome, Jasmine. We have Jasmine Deakin, who I hope is in SA or from SA. Yes, a social worker with her own lived experience as well. So Jasmine, earlier, we talked about why you wanted to be a social worker. Could you tell us all a little bit about what you've discovered along the way of your journey? Yeah, it's actually kind of a funny story. I never really planned where I would end up with a social work degree. There's kind of the altruistic answer of wanting to help people. But I soon realised that there was a little bit more to it. If we kind of look at it, that I wanted to work and help people on things like that. But I also wanted to figure out how the world worked. And a lot of that that I now have learned is because I'm autistic and, you know, had that sort of experience of finding my journey through the disability sector, finding myself, you know, I didn't find all those answers about how the world works. But definitely got, you know, to a point where, yeah, I was able to find my own journey and find my fit serving my autistic community. That's wonderful. Your own journey as well as helping no doubt with everybody else that you're interacting with. Thank you. And Professor Tony Atwood, clinical psychologist. Welcome, Tony. Glad to have you on board. Can you tell us all a little bit what they do to work in the area that you do? I think many years ago, meeting two classically autistic children. And what has enchanted me in a way is identifying someone who thinks, perceives, relates and learns in a different way, not a defective way, but is just different. And what I found in the challenges that many autistic people face, it's often not the autism, it's other people. And what other people may do to destroy self-esteem and abilities and so on. So I have to do a lot of repair work for what neurotypicals have done at high school or at work in various places. So I'm a bit of an apologist for neurotypicals. Thank you, Tony. Yes, got a lot to answer for. And lastly, but certainly not lately, we have Professor Julian Troller, a neuropsychiatrist. Welcome, Julian. Lovely to have you rounding out the panel tonight. Could you share it with us, Julian, if there's something different or similar in terms of what piqued your interest to work in this area? Thanks, Nicola. I'm coming to you from the land of the Bedigal people, the traditional custodians of the land here at UNSW Sydney. It's a real pleasure to be here. I think my journey began as a young doctor, realising how little I knew about autistic people and how little I knew about neurodiversity. When I later specialised as a neuropsychiatrist, I began seeing people with very complex needs in the neuropsychiatric unit in which I worked. And I became much more aware of the enormous gap in health and well-being for autistic people. And now I'm in a situation where I'm really privileged to be working with a team to do a lot of research and examination of that issue and to try and look at some solutions. And so that's, in essence, the journey that I've undertaken. I'm just painfully aware of the huge gaps. For sure. And hopefully tonight we can fill some of those gaps with some of all of their wonderful knowledge. So as with any of these sessions, the ground rules are pretty straightforward. Please be respectful of each other and our participants and panellists, and keep comments on topic in the chat box. So we'll be hearing from each of our panellists in turn, and then we'll get to a Q&A. As I said, we've got the learning outcomes up there for you. I'm sure you're very familiar with them, as you are with the case study. So with that said, rather than go through that and take up precious time, I think if we're right to go, I would love to lead in, first of all, we have Claire and her response to the case study. So if you're ready, I'll pass over to your very capable hands, Claire. Thanks, Nicola. Well, so let's look at the case study. So Jess has sadly reached severe autistic burnout, and this was bound to happen, given the circumstances of her life at the moment. This is something that can be prevented. And we need to learn about autism in order to understand how to prevent these things happening. We don't want her being in burnout. It's not good for her self-esteem. So where did it all start to go wrong? Next slide. So she was diagnosed at 15, which is fantastic. Many girls and women are not picked up this early. So we've got a terrific opportunity while she's at home and with her parents cooking dinner, taking care of the home, etc. for her to have a bit of time to really get to know what autism was all about, and understanding herself and how her brain works. So we all know as clinicians, the DSM5 definition of autism, which is deficits based. It's all talking about the deficits of autistic people in comparison, supposedly to neurotypical people. But we now see autism as a difference. So in order for us to understand autism, well, we need to see the strengths and we need to know what one must do to live and thrive as an autistic person. So the autistic brain is unique and beautiful and has been there since the beginning of humanity. And humankind has benefited from autistic people at all stages of human advancement. So we need just to feel this and to understand it and to feel strong and pride in her autistic identity. It's helpful to have a few people that you know, famous people. So when you're talking to Jess, you can use them as examples of autistic people to feel proud with. But these are important principles. Next slide. Next slide. Thank you. So these are listed the essential tools she needs to know. And that you need to know also as her clinician, so how to drive her brain. So neurotypical people learn to manage their brain by modelling and following what's going on around them in society. They're in the neuro majorities. So TV teachers, peers are all going to be feeding back how to live a good neurotypical life. This doesn't happen for autistic people. So we need to teach ourselves and teach autistic people all about the tools that are required to understand the autistic neurotype. Autistic energy accounting is really important. And Tony is going to go over that when he does his section. So meltdown, shutdown, burnout, masking, camouflaging, these are all terms that you need to become familiar with and understand what they mean. In for GPs, interceptions are really important one. Autistic people don't get the signals back from their body as to what's wrong. A lot of the time and can make it difficult sometimes to diagnose conditions in autistic people, but even just as simple as knowing when to drink, when to go to the toilet, when they're tired, that sort of thing. We all struggle a bit with interception as autistic people. Next slide. So the trajectory in the milestones of an autistic life are not the same as the trajectory of a neurotypical life. So autistic people will often be advanced in certain milestones and then not so advanced in others at different times in our lives. So we have to be aware that it's a difference and we mustn't sort of shoehorn autistic people into a neurotypical life pathway. So for an autistic person, after having done Year 12, a gap here is ideal because Year 12 will sap so much energy out of an autistic student that we don't really want to start uni already behind in our energy. Autistic people can very rarely manage full-time university and part-time work. So let's not try and do that. And if we do, you know, we know that cooking, washing clothes, self-care organ are fall by the way, way aside. So let's not set people up for failure. Only engage in casual work if it's just fun and it's a pleasure or an outlet, not if it's taxing. And think about part-time uni. Autistic people love learning and let's allow autistic people to learn really well and thoroughly because that will just be a pleasure for them. Next slide. So where to from here? So Jess is now in crisis. You might have trouble having her explain to you what's going on in her life. She'll probably be in a little bit shut down. So our job as clinicians is to validate and make her feel good about getting as far as she's got irrespective of the circumstances and making sure that she's aware of the environment that's a problem. It's not her. The environment just wasn't set up correctly for her. So now that we're in this position, we need to stop all non essential energy depleters. And I would be very keen for her to stop her job. At least we need to think about that. She's near the end of semester. So I would suggest going home to her loved ones and her lovely shed and her dad and her GP. The role is there to get some special consideration delay some of those assessments. We might be able to solve which some of her subjects, but if we can't, that's just how it is. So we need to breathe, take stock, regroup. Let's relaunch her gently away. But it won't be quick. Usually burnout takes a while to get over. So she may not be back at uni straight away. It might take six months before she is able to enter back into uni again. But let's now get all that education done that obviously didn't happen when she was 15. Let's educate parents, all the family. It's going to be useful for all the family remembering autism runs in families. So she won't be the only person in a family who's on the spectrum. So it's good for everyone to learn all the terms and all the essential tools. So we wanted to live a really good life in her 20s. If we just recruit our loved ones, a GP tertiary educators, you know, tertiary institutions are fantastic with neurodivergence. I've popped some resources up there. Autistic YouTube is a fantastic. And if you want to learn about all those essential tools, having a look at these on YouTube will actually help you the nice, nice and easy ways to learn about them. And I've put a resource up there for GPs as well. Thank you. Thank you so much, Claire. I think it's lovely to think about the validation, right? That she's made it to university. It's amazing. And just she's not alone in finding the first little bit difficult. So I think it's lovely to kind of remind people sometimes of actually how far they've come and how well they've done. So thank you, Claire. That's wonderful. I'm going to hand over now to you, Jasmine. Thank you. Thank you. So when we think of navigating your way to adulthood, it can be really confusing and overwhelming. All of these transitions often can become even more overwhelming for an autistic person. So firstly, we need to consider the constant stampede of expectations that Jesse might place on herself, but also the others might place on her as well. And what they mean for her identity and inclusion in society. So if we're thinking rules, social norms, expectations, trying to fit into that neurotypical standard, these rules aren't always explicitly taught in a way that we understand their value based in that everyone has different rules based on age, culture, and so on. And rules differ with context, situation and timing as well. So for many autistic people, it can feel like everyone got a guidebook. And in terms of trying to navigate this world, autistic people's guidebook got lost in the post. And if it did arrive, it kind of feels like we have to read it extra hard, or we're translating it from a different language. Next slide. So we can see Jesse hasn't fully accommodated for her needs or really fully explored what autism means to them. This will be a journey of adjustment as she transitions again and again, then changing jobs, moving houses, parenthood, aging. What needs to be solidified is a confidence to be authentically Jesse to truly meet her needs. We must acknowledge the negative reflections we must support with our knowledge and affirmation. Only then will we see development from a pattern of distress and disconnection. So if we think about what this might look like for Jesse, where there might be feelings of autism being a sentence to a life struggle, explore the joys of being autistic through passions, strengths and comforts. Open the opportunity for autism to bring strength, not just weakness, seeing thriving and not just thriving and not just surviving. Where Jesse might feel alone on this journey, link her to a neuro community of people that can relate affirm and connect with her. Where Jesse might feel like an imposter presenting less than the stereo less like the stereotype. Explore masking and internal perceptions of her experience, develop that self compassion that they deserve just as much support as any other autistic person. With supports come an optimized lifestyle rather than an overwhelming survival mode. With the notion of incurability, Jesse might think what's the point of even trying through education and accommodations. She will soon have a new perspective of thinking authentically as themselves, rather than sort of needing to cure or make like make changes to who you know who she is. So next slide. Not one singular professional is going to meet Jesse's needs. But where we need to start looking is that each and every support person requires a lens of neuro affirming practice, no matter what their unique skills are. When we think of neuro affirming practice, we think person centred, dynamic, flexible. There's not really one answer to being neuro affirming for an autistic person. We're all too diverse. It's about using this lens in a way to see people like Jesse as they start to see their true self. To give some prompts in the right direction. We're all diversely human. It's just looking at who the world's designed for the neuro typical deconstructing that privilege and using empathy to consider what it might be like if your neuro type wasn't accommodated. The way Jesse might connect, regulate and communicate differently. It might be different to what you're used to. So you might need to tune in. Predictability isn't just repetitiveness, though it might be. Predictability is safe, accessible experiences where you're welcome, comfortable and have choice and control. Consider environmental disability factors before assuming lacking capability and deficits. For people like Jesse, we can see she's very capable. Unpack the differences between what Jesse is capable of and when moments where her plate is too full. But Jesse, who's fiercely compassionate and passionate, it might be that they are really passionate about being independent and may reject support at times, even when it's obvious they might need it. So deconstructing any ideas about outsourcing and support as being the direct opposite of independence for autistics is really important. Instead looking at it as a pathway to sustainability, confidence and increased capacity. Apart from the more obvious reflections of being overloaded contributing to burnout, Jesse suppressing herself to fit a mould will only add to that exhaustion and overload further. Nurture identity and accommodations. Don't forget your gender diverse non heterosexual, culturally and linguistically diverse autistic folk as well. They have their unique experiences, rich history and culture that adds to autism and always there's always so much more to learn. And learn from those experts as well. And I don't mean just the ones with degrees. There's a diverse community who have contributed to widespread cultural change, expertise and authentic connection in so many ways. By Jesse being authentic and compassionate within themselves and affirmed and supported by those around them. Jesse has more opportunity to thrive instead of just survive. No matter where her life takes her and whatever part you have to play. Next slide. So if we think a little bit further about what this might look like for Jesse, no one singular professional is going to meet all of her needs nor be an expert in every area of Jesse's supports. As you can see here, there's an example of what Jesse's team might look like if they have access to all the professionals and even further in their journey. At different points in Jesse's journey, the health, mental health and allied health system all have a part to play in meeting the diverse needs of this autistic person. When we think of social workers, they specialize in thinking holistically. So we're thinking families, communities and systems, looking beyond the individual as well as looking at them themselves. Often as a social worker, working with autistic people like Jesse, we're required to step away from the notion of individual deficits and look at the wider systems that might be disabling for Jesse. Some ways this could occur could be to help Jesse navigate some of those complex intersections and also some crisis that might pop up along the way. So we're thinking finance, family dynamics, financial dynamics, education, employment and relationships. It also might be support to navigate income support, as mentioned with dropping back on some of that work. Also other areas like the housing sector and disability sector opening further access. If we help Jesse prepare for these transitions holistically by coordinating these supports and offering community options, we can also explore contributing to systemic change from a social policy angle as a social worker. So looking at the whole community approach and offering more opportunity and inclusion for people like Jesse. I acknowledge as an autistic person it can sometimes be easier to see what's disabling in an environment from a lived experience, but that's where developing neuro-affirming practice and working as a team is the first step to supporting any person and making a huge impact on an autistic person's life. Thank you. Thank you, Jasmine. That's amazing. I think the capability versus capacity. I love that. Like all of us have capability and some things and sometimes we can't do it. You know, it depends on how we're going. So it's so much to say, but I'll be quiet. That was wonderful. Thank you so much. Tony, over to you. OK, thanks, Nick. If you could have the next slide. First of all, I am delighted with the two presentations so far, but also nervous because they were so good and they were often speaking from the heart. And that was so important in this situation. Now, my perception is going to be as a clinical psychologist. So what do I see in reading the information on Jesse? Now, one of them is then maybe signs of ADHD, attention deficit, hyperactivity disorder, because there seem to be problems with executive functioning, planning, getting things done on time, et cetera. Now, roughly 70% of autistic individuals will also have signs of attention deficit disorder. That's the majority. And it means that when she's at university, there may be aspects that in the past parents have guided her teachers at high school have been very supportive, but there may not be that framework or structure to support her. So in suggesting there may be a possibility of screening for ADHD, it doesn't mean automatically out with the Ritalin or the Dexamphetamine. It's really a question of how good is she at organizing, planning, time management, prioritization itself? It's something that may need to be recognized and supported. Now, there's also, again, with my clinical hat, the possibility of an eating disorder. She's not eating much and she's going without food and so on. So that may be a possibility. One in three of those with an eating disorder also have characteristics of autism and under stress, burnout, but a whole range of things then we really are looking at other things, perhaps development. Now, there also needs to be an exploration of her concept of autism and her concept of self. That concept of self can often be built upon the negative comments of others, the rejections, the criticisms, the humiliation, the characteristics of others may not build up her self-esteem. One of the most difficult questions for an autistic person to ask, answer that we may have in a diagnostic assessment is who are you? And often the autistic person says, I don't know. I know who I'm supposed to be, but I don't know who is the real me or on that a bit later. But it's also work on the concept of self and what is the concept of autism? Because it seems that when she was at high school, she noticed autistic people were ridiculed and rejected by her peers. So she may have had that negative concept of autism. Now, also guidance in creating a friendship network, I think is going to be important. She was described by one of the people in her sharehouse as a loner. And she's now going through a lot of change. Autism and change doesn't go together very well. She's left home. She's actually there are so many changes occurring. How capable is she of coping with that stress? There's also the romantic relationship that she has there that can cause its own sort of issues too. But it seems that Dean is her main social contact, but she doesn't seem to have a best friend to talk about some of those issues. So what has been mentioned is energy accounting for stress management developed by a friend and colleague of mine, Maya Tode from Denmark. She's a clinical psychologist and she's autistic. And yes, we tend to think of autism in information technology, also in the arts. But it's also in the caring professions, including psychology and psychiatry. Now, what she noticed was that every so often she would have episodic depression and she was leaving home at the time. She was the same age as Jesse and she was learning about bank accounts and decided, OK, I'm going to use bank accounts as a metaphor for stress management. And in my day, there are certain things in my energy bank account that drain me of energy, but there are certain things that are a deposit. What we will do is go through with the individual. What drains you of energy? Often in autism, it's social sensory huge amounts of energy in coping with your anxiety, change, past experiences. But also what I would say in psychological astronomy, certain people are black holes and they just suck out all your energy. You know who they are in your own personal life, but some people just take away energy and don't give it in return. It's coping with change. It's daily living skills. So what you do is you go through one of the things that drain you of energy, currency, zero to 100. What is the range? Socializing maybe 40 to 90, but also being very sensitive to negative moods and other people that empathy, in fact, is very powerful in autism. It's emotional empathy. It's picking up the emotional states of others and being infected by it. What are your deposits? Often in autism, it's solitude. It's being in nature. It's being with pets. It's a whole range of things. And if your life is not in balance, you must in your diary for the next week, write in non-negotiable those activities that refresh your energy levels. If not, you're going to head for depression and it's going to be cyclic or depression. So we would do energy accounting. Meier and I are writing a book on that should be published. I'm doing the final stages of the review tomorrow should be published later this year. OK, next slide. Now, as has been alluded to, if you are doing energy accounting or checking burnout, it's useful to know what are the ultimate stress levels for that individual. And the question is, can you leave home, be a student and also have part-time employment? It seems to be too much. Now, first of all, with the university, there is literature for autistic students and university staff published by Jessica Kingsley publishers. So it's not just the student fitting in. It's also the university staff knowing how to facilitate her inclusion in tutorials, et cetera, and the problems that you may have with essays and organizing them. Now, we hope that the university has a neurodiversity help. For social, emotional and practical help. Do the university know and they do need to know that she has autism? Now, there's also literature on autism and employment. Michelle Garnett and I have written a book called Autism Working. So should she choose to stay on with part-time employment? This will go through the challenges and how to explain herself to others. OK, we take the next slide. Now, there is also a range of programs that can help develop social skills. The Pia's program developed in California by Elizabeth. I forgot her second name. But Elizabeth, she has developed a very good program called the Pia's program to develop social skills. Also, in Brisbane, we have Code Blue for Autism, which are now doing programs by the internet platform. We also have a program called the Pia's program. We also have a program called the Pia's program to develop social skills, social network. Also, strongly recommend joining group activities for university students, like the university Dungeons & Dragons. Yes, a great way to meet autistic people. It's also joining a choir. It's a drama group or hiking. She seems to be isolated from that social network. OK, if we take another slide, thank you. It's a concept of self. It's going through what are your qualities in your personality and abilities that may be attributable to autism. But also, discovering the authentic self, what we have to do is often one of those autistic characteristics, eye contact, for example, that could be confusing or abrasive to others. Now, you can teach eye contact and reading faces. You've got 400 facial expressions you've got to identify in a fraction of a second. It's going to take you years. Or do you explain I'm the sort of person who tends to look away when you're talking, helps me concentrate on what you're saying. I'm the sort of person who gets very enthusiastic talking about Hollywood movies. But I'm not good at reading signs of boredom. If I'm boring you, please tell me and I'll stop. But I'm not good at reading signs. So it's to explain yourself to others rather than change. It's also connection with other autistic young adults at university and on the internet. Those who really know and understand who have a credibility, people will say, well, what would they know they're not autistic. These are people who can help. Now, it's also not only explaining her autistic characteristics to other students to protect other students, but very importantly, her partner Dean and exploring romantic relationships. Now there's a very good book. I got a copy of it here. 22 things a woman with Asperger syndrome wants her partner to know. So there may be an issue of relationship counseling because there's going to be conflict. There's going to be confusion. The amount of affection that's needed for reading the signals and providing the right level, the art of conversation. So another dimension we need to explore with her is in terms of romantic relationships, but how Dean can help her in a variety of ways. Okay, guys, I think my time is well and truly up. Now, Nicola, could we move on? Thank you, Tony. Yeah, I love it. I think all of these things, right, it's like they're bringing the implicit explicit. We all need this in life to talk about what we need and what we don't need. And I think rather than relying on people to fix themselves, just giving them the confidence to be able to say what they need help with is a beautiful suggestion. Thank you, Tony. Julian, over to you. Thank you. Thank you so much, Nicola. If we could have the next slide, please. So I'm going to take our journey a little bit back toward the topic area of education for Jesse as she faces many challenges in transitioning from her family to university and employment. And I'm going to divide that into some issues surrounding Jesse herself and in her immediate environment at university. Issues from the perspective of the healthcare providers involved in supporting her and issues that are broader in terms level issues that I think we need to be aware of as we think about the challenges in this space. Firstly, we've already touched on very significant issues related to the age and stage of autism diagnosis for Jesse. Jesse's been challenged by the negative stereotypes of neurodiversity and the diagnosis that has occurred at a pivotal time when there's almost maximum to the development of further mental health issues and we need to be aware of that vulnerability and put building blocks in support Jesse to develop resilience. There is the sense in which coming from a rural setting in Victoria, the supports related to the diagnosis and the need to disclose in certain places may not have been adequate so far. So we need to be thinking about supporting support Jesse to get the supports that they need. We've identified already significant complexity across several different domains and so we need to be aware of how those complex support needs will impact what happens next. And we've seen significant transition issues from school to university and dislocation from those supports that are really pivotal around connection with family with pursuit that they enjoy together. And significant dislocation perhaps even from Dean we don't know if they're at the same university and indeed in the same city at the moment. Next slide please. So for Jesse at university it's very important that in transitioning from the family environments in rural Victoria to the university that reconnection with the appropriate healthcare supports are found and there's some background research that may need to be done via support through a good new general practitioner to connect Jesse to those supports and there's also a need, as Tony said to explore what they look like in the educational setting. Particularly universities are now very much aware of the need to support students who are neurodiverse by providing those adjustments in the tertiary education space. That does require the student to be very proactive in that each course the student engages with they must show to the new course coordinators what those adjustments look like. So there's an onus on the student to carry those forward and that can be quite burdensome. There's the need for establishing new friendships, intimacy and those informal networks that are important buffers against further development of mental health issues and there are significant risk factors really at play here. There's the pressures of living and work there's the financial strain there are the environmental triggers that Jesse may encounter in perhaps a city university based situation as opposed to a rural environment and there's a need as others have emphasised to really look at those self management strategies I think pivotal from my point of view in terms of mental health self regulation eating sleeping adequately. There's also the need I think to look at what happens if and to have management plans worked out to deal with potential emerging crises it's too late once someone gets into the emergency department in a crisis to really address the issues. What we do need to do is to take a proactive approach to work out with the person what will work for them at various stages of escalation of need. Next slide please. In terms of the healthcare provider issues people of my generation and perhaps for the next couple of generations of healthcare providers trained have received little to no training in this area so we come into this space with lack of knowledge lack of confidence and we don't know the care pathways as we should and so we have a great need I think to educate ourselves to do a better job we need a way of practising that is interdisciplinary and the richness that you've seen demonstrated in this interdisciplinary space tonight I think is a great testament to the benefits of engaging at that level. We also know that we're very poor at preparing autistic people in the healthcare journey and engaging them as partners in that journey and that I think is a very important thing. Next slide please. And then at that broader systems level we need to come into this with a degree of awareness of the poor coordination and lack of interconnectedness of our support systems across disability, health and human services and to a certain extent that means that we have to go the extra mile to ensure that bridges are formed where they don't exist for those that we support. We must be aware that the ways in which we're supported to practise through remuneration such as MBS item numbers is woefully inadequate in supporting people in their healthcare journey who have more complex needs so we need to make allowances for that by building in double appointments spending extra time with people. We need to be aware that there's a need for us to train and build our skills in this area and we also need to be aware of the significant administrative constraints on us to do a good job and I'll finish there and we can have some discussion I think. Thank you Julian. Yes so many good points I think it's the working we know I'm a psychologist who's worked a lot with people with histories of trauma and adversity and so forth and a lot of what we're talking about the curiosity and helping people to understand what they've been through and what their strengths and thought there's a lot of crossover in terms of looking for the strengths rather than the deficit model. So we're going to go to the Q&A but first of all I just want to bring your attention to this it's very exciting so the MHPN is keen to establish inter-disciplinary network professionals working with people who are living with autism so all providers of mental health care and autism related services are welcome to access this free support and education it's very exciting that will be delivered via the network so you can click on the QR code if you're very tick savvy and know what you're doing or you can register your interest via emailing Amanda I should have checked the pronounces in oskiak at ahpn.org.au so that's a great opportunity those asking about resources you will get them at the end of the webinar but let's go forth into the Q&A so luckily we've got some time for Q&A we had hundreds of questions before the webinar so we will not be able to answer every one of them individually but we've also had some fantastic questions come through on the Q&I Q&A function so if you have some that you want answered we can please send them through we've had a couple Tony I'm going to come to you first if that's okay with regards to self and sense of self that you talked about so I'll just read you a couple that have come through so Shannon is asking if there's first of all a framework you talked a little bit about those are there any frameworks that you might use in terms of supporting autistic clients to develop their self concept and the second one is similar maybe similar from Christine around strengths autism strengths and I'll come to you Tony but I think Claire you might be able to pick up on this as well in terms of that self-identity forming and repair what are some of the strengths or particular characteristics autistic young people might not see in themselves that you could help highlight so they're thinking I think from a practitioner working with a young person to help them point out what might be their strengths that they might not know that they have that they're not autistic colleagues have so first of all Tony to you any frameworks or ways for working with that sense of self okay I would like to spend about a day it's so important because a sense of self gives you resilience acts as an antidepressant it's very important often the sense of self for autistic individuals especially young adults has been based on the criticisms and rejections of their peers not the compliments and inclusion and so their view tends to be very negative also a characteristic of autism can be very self critical and have a level of expectation greater than any parents greater than any teachers and disappoint themselves so often now when you ask a typical person young adult who are you often the definition of self is based on their social network and accurate descriptions of personality now an autistic person may describe the self by what they know and what they do so that's a difference in that and a typical person will have a rich vocabulary to describe personality types but in autism there may not be that vocabulary we have as you know as a psychologist alexithymia absence of words to describe thoughts and feelings Michelle Garnett and I have coined the term alexipersona not having the words to describe personality types now if you ask that person what type of person are you I don't know but what I found if you give a list of personality qualities 50 or so and ask the person to circle or highlight those you get yes, yes, yes and you start to develop it you need an external prompt to do that so first of all we have to often undo the damage of the criticisms and rejections of their peers but also see their qualities in personality and ability and having a positive sense of self we try and do that with okay these are your qualities but who are your heroes what qualities would you like to have harry potter for example right we do a diary system so that in the next week or month whenever you have demonstrated that particular quality in personality and abilities it goes in this book and this becomes testimony to your evolving and strengthening sense of self so you're seeing how you're moving towards the person you want to be or consolidating for example sense of humor right that that joke was brilliant let's put it in your this is me book so we created this is me book of what are your qualities in personality abilities etc so nicola that was condensing a very long wind attack oh it's brilliant and I think the again it resonates you know when I work a lot with children and young people like how do you feel is they don't have the repertoire but if you put a whole lot of things in front of them they will tell you yes no yes no I think it's you know what we would call scaffolding thank you Tony Claire I wonder if you've got anything to add in terms of are there things that you've particularly seen in your clients or patients that you might often point out to them that they don't know a particular strengths or attributes that they have well I think there are some things that autistic people will have in common and I see this in my patients but also my friends and colleagues are autistic and I often talk to my patients about this but there is a depth about autistic people that we I'm not sure if it's only autistic people that can see it in each other or whether others can see in autistic people but there is a depth that is incredibly encompassing of a really complex in a world and a complex understanding of systems in the world and we do see that coming out in various areas of employment but just the person themselves has an absolutely wonderful deep world that they're living in and usually a really extensive knowledge of the areas that they're interested in and that doesn't even include the talents of art or music or engineering all the things that autistic people tend to really shine in those areas and so I would usually try and talk to them about those particular things that we all share as humans but also autistic people in particular I think is really useful and then there goes all the other things that we often see listed and I think is very true is that honesty and openness and understanding other's suffering seems to come along with the autistic you know identity and I think there are a lot of things that are just incredibly beautiful and these are the things and this is what we need to try and get across to people especially in those early years of first being diagnosed because it can be very hard when you're first diagnosed and I think that seeing other people, elders in the autistic community living strong, beautiful lives can really help you as a young person feel safe because I think you would find the first Google search is not going to come up with a strengths based approach necessarily it's going to be very much that deficit space and I want to come back to that point there's some questions around some of the points that were made earlier around I think people are trying to understand the difference between the kind of very strong empathy that some people might feel versus difficulty reading emotions so we'll come back to that but maybe if you guys can ticker away with that I mean no but every person is individual but Jasmine I wanted to come to you to see if you wanted to add anything to that around particular strengths or things that you might point out to people that you're working with you might want them to develop their sense of self and I've got another question which we have come from Julieta I think it's a really good question and she's framed it really nicely confidentiality versus support and it's around if a young person who may have had a recent diagnosis of autism does not want that shared with school educators and others versus maybe a family or caring carer wanting to share that information to ensure the supports are in place that we've just all talked about so I was wondering if you had any insights Jasmine perhaps around how to frame that conversation or if you've had any experience with helping someone come to diagnosis is a multi-layered thing some people it's a relief some people it feels terrible so yeah any tips on how you might navigate that if that's not too big a question Jasmine for you to dive into we need to off mute sorry I'll do my best and if I don't answer it fully then feel free we can clarify but in terms of starting with strengths I think the biggest thing to take back is reframing I guess the positive and negative version of a strength versus weakness so if we're thinking an autistic person who might have really great attention to detail and very observant one person might see them as picky and see really pinpointing on little things where another person might see it as they see something that others don't and have a unique perspective the same as their interests which are often really really big passions and for one person it might be seen as hyper fixation for another person if you could use that as a way to connect with that person or looking at it as a unique expertise then you're more likely to be able to engage with that person much more deeply and the same similar to what Claire had highlighted about the emotional regulation or emotional experience that if we look at it negatively as the reactive and the negative emotions we really miss that depth and intensity of the joy and the comfort and the almost like feeling things a thousand percent that goes both ways but in terms of I guess the disclosure side and a confidentiality which from what I gathered there's that balance of wanting to have a bit of privacy about their experience but also receive the support firstly I would be highlighting that there's probably a bigger strength of disclosing before experiencing a crisis or work disengagement if possible and the reason that I say that is that you can demonstrate those autistic strengths and be able to scaffold that support before it becomes a crisis response there's going to be varying reactions from an employer we're still as a culture as a society developing understanding around autistic people particularly in the workplace and spaces like that where it's about means of production and means of productivity but I guess that's where the workplace can be optimised there will be a big big strength for that autistic person whether it's aligned with their sensory preferences or needs their communication the expectations that are set so from where I touched on the rules and that they're not explicitly taught or there's these different scenarios that if that was much clearer there may be actually a lot more understanding about their role or what's expected of them or what boundaries they could set to achieve that balance that's great, I think what you're talking about as well is choice and control right, you know, offering the young person or adult themselves some choice and control about what they share but also making it targeted about what they need and how they might get those needs met in a way that's going to be beneficial often in an employment space it really is about, you know, tying into those strengths and whether they're soft skills of just how someone I guess can connect with something, focus feel, you know, I guess motivated by something but it can also be the wider passions and interests that could be tied into, you know, really something brilliant out of, you know, an employment opportunity beautiful, thank you Jasmine Julian, I've got one for you well, it's for anybody but Julian, I'm wondering if I come to you talk quite a bit about the transitions a question from Catherine she's noticed a number of her clients with autism was successful at school until year 10 then severely dropped off in their grades and they were wondering if that might be common if you had anything to offer on that that's a really interesting scenario if I could just add to the previous question as well I think it's absolutely key that we respect someone's wish to not self disclose and explore why the adjustment to diagnosis is a really interesting experience in neurodiversity many people experience a very positive feeling with diagnosis some people also experience significant grief particularly if diagnosis is delayed and some people end up feeling well if only I'd known this earlier there's a sense of lost opportunity but for many it really opens doors and begins a journey of self exploration awareness that can really be very positive as we've framed and understanding why this young person may wish to not disclose may take some time may take many sessions of exploration before we can get to a point where they're comfortable moving forward so just in terms of this issue of difficulty at particular times we must remember that time year 9 and 10 at school is a really very difficult time for many it's a time where we have an increase in cognitive demand so the type of work that you have to do shifts from being very much given to you and set for you to a direction where you have to be able to form your own structure you have to be much more self directed in your learning style and you're negotiating all sorts of issues with peers at around that time so I think in exploring why someone is apparently having more difficulties it's really important that we see this within a developmental pathway through school and understand the stresses on students at that particular point and support them with whatever they need at that time there's also the possibility of course that someone is experiencing an emerging mental health issue that's responsible for some elements of the difficulty and that really does need to be monitored for because now at a time where core disorders are really beginning to emerge so a person's mental wellbeing may really be beginning to deteriorate so those are some of the things I would look for at that point. Thanks Julian it's not only young people living with autism right there transition from year 10 to college is a tricky one for a lot of young people Claire I'm wondering there's a question here about what is being done to educate professionals about this work and we've talked about while we're doing this tonight and the network and so forth but Jennifer was particularly curious about for GPs is there anything that you wanted to add in terms of what might be being done in the medical profession particularly for GPs around educating them around working with young people or anyone with autism Yes it was a bit of a fight for a voice I think yeah so we had a whole issue of Australian Journal general practice on neurodiversity 18 months ago and that was very well received but yes it's it's fighting with so many other diseases and groups that yes at this stage there are a few of us out there trying to educate as much as we can but it's just trying to get a space to do it in so it's a crowded space it's a crowded space absolutely I wonder this might be no questions a quick one but Julie and sorry quickly back to you Alisa would like to know what might be the differences between a neuropsychologist and a neuropsychiatrist when supporting a person with autism spectrum autism for example roles and responsibilities assessments example Thank you so the typical example I would give is the neuropsychologist role would be largely to do with assessment of the cognitive strengths and weaknesses of that individual in order to help support them plan adjustments that they may need to make in their learning for example if it's a young person at school a neuropsychiatrist is a psychiatrist of practices in that intermediate land between neurology and psychiatry with an awareness of how the brain works and applying an understanding of neuroscience to their practice and using the assessment of the neuropsychologist in helping that person with their journey so I think that's the key difference that I see I mean I work regularly with neuropsychologists and I think it's another piece of the puzzle we haven't spoken about tonight it's particularly relevant where you have someone with an additional learning disability and so I think sometimes a really thorough assessment of a person's learning and thinking skills and a specific assessment of additional problems that may be present such as ADHD and other learning the problems is really a key thank you we've only got a few minutes left I've got a question that's come up in lots of different forms and shapes from Judith most recently but I might start with you Tony but Jasmine and Claire I'd be really interested in your perspectives if we can which is around resistance resistance to talk to an answer if a young person the family or carers or others around them believe they may have autism talking to anyone about it or help seeking what can those people around the young person do in the interim to provide support okay now is this that the person themselves is resistant or the family is resistant good question this one is framed as I'm the mum and I think my child has maybe have autism but they won't speak to me I can't get them to be assessed what can I do in the interim to help them okay one of the issues is that often an autistic teenager will have seen their peer group be very cruel to autistic individuals unfortunately there is in Australian schools if anybody makes a social faux pas the criticism is what's the matter with you are you autistic or something so sometimes they may fear the reaction of their peer group more than the actual diagnosis itself that I have seen what they've done to those who are different teenagers are very intolerant of anyone who's different by definition an autistic person is different and they don't want to be rejected and humiliated by their peers which may be one of the major reasons why they don't want that to be recognized within the family though there can be an issue that this is opening a can of worms that this particular teenager is not the only one on the spectrum in the family and it could be dad who says yeah just like me so nothing wrong with me I'm fine nothing wrong with me so obviously nothing wrong with my son and other people like the apple doesn't fall far from the tree so there can be all sorts of issues within the family as to whether autistic features are recognized or not so it is a very delicate area that you have to go through Jasmine I'm wondering if you had anything to add in terms of if you had a young person in your life that didn't really want to talk to anyone about this what might you do in the interim to try and support them I think there could be definitely you know I think Tony put it really well in terms of that normalization and offering that positive narrative around autism because often that is constructed by you know peer reflections or observations of other people not fitting in there's also you know a spotlight to be put on autistic role models and showing autistic people thriving I think that things like that will be really important to that person in that they could then start to explore you know that strength base or what that unique personhood looks like for them rather than it just being about what makes them different or what makes them divergent or odd in society so yeah really considering that narrative there's lots of role models that are booming on tiktok and youtube and things like that that you know a young person could easily be able to find so many people sharing a lived experience and not always negative and connecting with that neuro community and diverse community as well you know the more diverse communities the more accepting often they are perfect I'm just aware of time I'm just clear one chance just if you wanted to add anything to that conversation yes I think I agree completely with both Tony and Jasmine I guess the thing is do we have to immediately expect the young person or the person to identify with being autistic I think sometimes it's enough just to select the person be and if you're the parent actually manage life and help them as if they are but without using that label just for a little while until they sort of have time to have it all sink in and filter if it takes a year or two but you're supporting them and helping them I don't think there will be any issue with that so the notion of educating yourself in terms of how to best support your child regardless of diagnosis yeah and just do the energy accounting yourself knowing what they can do and can't do and sign them up for the football team the flute lessons and everything it's just sort of just make sure you're managing them as if they as an autistic person but just don't need time let them have time I think yeah and people do that since it's the othering stuff right it's like if you have a shy kid you know you make adaptations or yeah or you have a kid that's got lots of energy you would make adaptations so that bringing it back into the normal okay I'm going to have to ask us all to wrap up so I'm going to give you all a minute to say if there's one thing you're going to take home message for all of us joining tonight and I'm going to go in reverse order so I'm going to start with you Julian if that's okay so if there's a takeaway message for the audience tonight or what would it be mental health professionals I think a really passionate group who have a strong desire to do healthcare really well but as professionals we're really ill equipped to work in this space from our basic training and we need to take those steps along an incremental journey to gradually up skill and improve our practice doing so will benefit autistic people enormously and also support those around them so I'd really encourage people on that journey of professional development thank you Tony Tony yes healthcare people yeah in whatever branch of healthcare you're going to go into whether it be from adolescence to geriatrics it can be eating disorders it can be substance abuse and things like that you're going to meet autistic people and unfortunately as a group they are more prone to mental health issues so you need to be able to screen for autism it should be one of the first things on your mind when you have a new intake this person who's got an eating disorder for example then you start to think gender dysphoria is another one could they be autistic in which case that may change the approach you have to that individual and a degree of compassion and understanding so one take home message is please think autism when you are meeting a person for the first time just to see if this may be a factor thanks Tony Jasmine I think looking at the narrative that we all contribute to whether we're a professional a parent a community member a friend looking at how we are portraying that narrative either to a person or to the community about autism and looking at seeing these people as whole people and not just their deficits and being able to flip those negatives like I mentioned before as well another thing that I'd like to highlight is don't just be inspired by autistic people actually hold space for us we deserve those promotions we deserve those scholarships we deserve all those opportunities to thrive and not just sort of survive and you know roll through that's all thank you Claire well mine's along the same vein as Tony I think think of all those undiagnosed autistic people out there and there are thousands think about your patients with anxiety with your transgender people eating disorders as Tony already mentioned but so many other things where autism is often part of the picture so please think of autism with your patients and remember all the essential tools if you can learn them you're really going to be going so well with your patients and thank you for being curious because this is what we we really need as a community thank you Claire thank you everyone I mean I think you left on a beautiful note Claire curiosity right it's that's what we should be with anyone that we're engaging with curious about what's going on for them what's going well and that notion of pulling it all together and moving away from those kind of stereotypical notions we have of any any one type of person so I want to thank you for I think we will all agree an amazing panel conversation tonight I've learned so much I've really thoroughly enjoyed it and I know our participants have from the feedback that's coming through particularly around how lovely that we're talking strengths like we're talking how we can work well together to optimize people's lives and not from that depth of space so I want to thank everyone that's contributed for that I think it's a really really important conversation it's just a privilege to be a part of so in the last three minutes I've got a little bit more admin but I want to thank our panellists wholeheartedly for everything that they've shared tonight and for the resources that you have kindly shared which will be sent out to everybody so we do have a feedback survey that you can see on the screen now it's really useful we do look at it it's used to shape what we do how we do it future topics so please it will only take you a minute or so so please go ahead and fill that out if you can it is recorded webinars are recorded I know some of you joined late or different time zones or had to probably duck out to attend to the million other duties you have tonight the recording will be shared and sent out and is available on the website so don't worry about that we've got some new webinars coming up as I said the resources and slides will also be shared so don't worry about that all of the things that people referenced will be in there so a few webinars to pique your interest the next MHPN webinar is a three day online conference from the 28th to 30th of March called all together all together better that's hard to say mental healthcare in a changing world so there's 20 sessions that you can pick and choose from check it out amazing professional development for all of us emerging minds my old workmates running some webinars in May and June the first one being decolonising mental health when working with Aboriginal and Torres Strait Islander children and families and the second one responding to childhood bullying so we all know how important that is and particularly given the conversation tonight so notifications for when you can register will be coming out on the webinar page on the website there's also a podcast that you can do before I finish again I want to thank everybody for joining us but I also would like to acknowledge the lived experience of people and carers who have lived with mental illness in the past and those who continue to live with mental illness in the present those caring for them and those wanting to do the best by them so thank you everybody for your time tonight I think we all agree it's been a great session and go well and take care thank you