Autism and mental health – strategies for those with dual diagnoses

Jeanette Purkis

How Autistic people experience the world is still not well understood by many mental health clinicians. As many Autistic adults – and particularly women – are undiagnosed, mental health clinicians may assume they communicate and behave like a non-Autistic person would in the same situation, leading to all manner of misunderstandings.

By Jeanette Purkis

I have a diagnosis of Autism and atypical schizophrenia. I live an amazing and fulfilled life, working full-time, writing articles and books, giving presentations about Autism and mental health but my life is also very challenging at times. This article presents some strategies and information which may assist others on the Autism spectrum who also experience mental ill health issues.

Mental illness is a common experience among people on the Autism spectrum. Autistic people can have all the same mental health conditions that non-Autistic people experience. We can have mental illness conditions misdiagnosed, poorly treated or missed completely. Autism often results in mental illnesses looking or presenting differently to what psychiatrists and mental health workers are used to. Many Autistic people also have alexithymia – or ‘emotion blindness’. This means that it can be hard for us to articulate what emotion we are feeling. In my case, the emotional states I can recognize in myself are sad, angry, excited, very anxious or in crisis or meltdown. When a psychologist or psychiatrist asks me ‘how do you feel?’ it can be very difficult to pinpoint what is actually going on emotionally within myself, particularly if I am mentally unwell at the time.

How Autistic people experience the world is still not well understood by many mental health clinicians. As many Autistic adults – and particularly women – are undiagnosed, mental health clinicians may assume they communicate and behave like a non-Autistic person would in the same situation, leading to all manner of misunderstandings.

Some tips for Autistic people around managing mental health:

– You may be prescribed medication by a doctor to address and lessen the impact of your mental illness symptoms. Psychiatric medications can affect Autistic people differently than how they affect neurotypicals. If you have to take medication, ask the doctor what it is used for, why you have to take it, what the more common side effects might be, what to do if you have any concerns about the medication or any side effects and how long the doctor expects you will need to take it for. In most cases, you have the right to decline psychiatric medication or seek a second opinion.

– You aren’t the only person experiencing mental illness and Autism. There are lots of us ‘out there’ who will have an understanding of what you are going through and with whom you can share experiences and support one another. Social media is a good place to find Autism and/or mental health support and social groups.

– Try to establish and maintain a collegiate relationship with your mental health worker(s) where they listen to you and respect you. Being able to have an open conversation with a clinician by raising concerns and being able to disagree if you don’t like what they say is very important. It is your health, after all.

– Anxiety is a universal experience for Autistic people, and often it is severe. There are a number of strategies for addressing anxiety, including mindfulness meditation, deep breathing, distraction or medication. You may find it helpful to try a few strategies.

– Mindfulness is a practice based on Buddhist meditation techniques. It focuses on experiencing the present moment. The aim is to not dwell on the past and regrets and to not worry about the future but stay focused in the present. Many people benefit from mindfulness for a number of reasons, including anxiety and other mental health issues.

– Deep breathing can be helpful to address the physical element of anxiety. Anxiety tends to be both an emotional experience and a physical one. Deep breathing which helps alleviate the physical sensation of anxiety also effects the emotional experience.

– Distraction is often considered the gold standard in addressing a number of mental health issues, including anxiety. Distraction basically means engaging in an activity which focuses your attention. While your attention is focused on the activity you will notice the mental health distress less. Distraction is a temporary ‘fix’ but it is often a highly effective one and helps you to get through a difficult period without suffering as much as you otherwise would have.

– Practice things which help improve and maintain your mental health, including:

  • Eat healthily and exercise regularly
  • Engage in meaningful activity. This does not need to be paid work but can be anything you find valuable and is enriching for your life
  • Seek help for mental health issues if you need to. There is no shame in asking for help. In fact it is a sign of strength to ask for assistance when you need to.
  • If you have them, spend time interacting with pets. The love and attachment of your animal friends is a big protective factor for mental health.
  • Try to avoid toxic humans – people who continuously put you down, belittle you, abuse you or use you for money or other favors.
  • Reward yourself for positive effort and achievement. It doesn’t need to be a big reward but mark occasions of success.
  • Try to get enough sleep. There are a number of resources (books, websites etc) aimed at Autistic people who have difficulties getting enough or quality sleep.
  • If you are of a creative persuasion, use that to maintain your health – write a journal, poetry or book, paint, sing and make music – anything which gets your creative brain working and focussing of productive creative activity.
  • Be aware that mental health crises – and meltdowns – while an awful thing to experience, generally don’t last much longer than 1/2 hour to an hour at the most. Build some strategies for managing crises when they occur.
  • Read uplifting books, watch movies and listen to podcasts of inspiring Autistic people and/or those with a mental illness.
  • View adversity as a teachable moment. This probably won’t work when you in the middle of the adversity happening, but it can be effective when reflecting on the difficulty after a period of time. Ask yourself ‘what do I do differently now as a result of that experience?’ or ‘What lessons did that teach me?’

Further information on mental health and Autism can be found in Dr Emma Goodall, Dr Jane Nugent and Jeanette Purkis’ book The Guide to Good Mental Heath on the Autism Spectrum
Please note that this article is one person’s opinion and should not be taken as clinical advice.


Jeanette Purkis is an author, public servant and passionate advocate for Autistic people and their families. She is the author of ‘Finding a Different Kind of Normal: Misadventures with Asperger Syndrome’ – an autobiography, and ‘The Wonderful World of Work: A Workbook for Asperteens‘- an activity book about employment for teens on the Autism spectrum. Jeanette has also contributed to other books, journals, blogs and websites. Jeanette has a diagnosis of Asperger Syndrome and atypical schizophrenia. Follow Jeanette on her website.

The Mental Health Shift as a topic about autism is part of the Autism Shift – a new series about our shifting views on Autism

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