Inclusion Makes ALL Lives Better.

Inclusion and accessibility are variably seen as either unnecessary expenditure, feel-good or philanthropic add-ons or important ways of levelling the playing field so that everybody can have meaningful participation in the things they want to do and the places they want to go. Depending on how much value you place on a life that is different from yours...

What is sadly overlooked in all of these views is the benefit that these adjustments also bring to the lives of people who don't have barriers in the way of accessing the opportunities they enjoy and/or need. I have seen occasional articles pointing this out: for a starting point you could try Joanna Grace's TEDx talk here (less than 15 minutes) or follow her on social media as she frequently explains much better than I can the myriad reasons why and how inclusion benefits everyone and not just those it is "aimed at." Or have a chat with me and I'll ramble at you about it!

I just felt like highlighting this again today after a soul-warming conversation I had earlier. I consider myself incredibly fortunate to have both a mental health team and midwife who are thoughtful and responsive and keen to work in an inclusive way, making adjustments to support me so that I receive care that is as beneficial to me as possible. I truly believe that this makes a daily difference to my wellbeing and ability to cope with and enjoy life. A current part of this work is creating a plan to reduce my anxiety and distress around accessing the hospital where I will likely be giving birth and may need to visit for antenatal care. I was discussing with a member of my mental health team some proposed steps in this antenatal plan including pre-recorded and live videos as preparation for brief non-appointment visits. 

And then came the conversation: "Well, wouldn't that [pre-recorded tour] be useful to a lot of other people as well?" "Couldn't they make it available to everybody?" and even better, "Is that something that would be useful for our service to do as well?" 

Yes, yes, and yes! Especially during these restricted times where visiting places is not routinely allowed and people are encouraged to stay at home unless there is very good reason not to, I can't think of many people who wouldn't find the availability of a photos or a video tour or street-view style navigation useful and anxiety-reducing. Birth can be a stressful and anxious time for many people with or without additional difficulties. And likewise pretty much everybody attending an unfamiliar mental health service is going to experience high levels of anxiety which may be slightly reduced by knowing what to expect visually when they arrive. Many venues began to create videos when they reopened after the first lockdown, to explain their covid-secure measures, and I have heard countless reports from friends who have found this really helpful. How fantastic to have professionals around who think one step beyond what you have said and constantly reflect on potential wider implications - the people who truly listen and seek proper understanding are the ones who make strides in care not just and not least for specific patients but also for wider best practice.

Adjustments and accommodations made to make care and environments more accessible and inclusive to me as an autistic person don't just benefit me. Because my needs are perhaps more overt in some areas than other people's and I am fairly aware of them, I can actually help make things better for the general population. With the help of the people around me who have great ideas and are willing to put in the extra work to support me, we can speed up improvements of systems that will help everyone and might otherwise have taken much longer to come to light.

When your communication needs can't be accommodated

At the risk of becoming ranty, I'm turning to trusty Mr Blogger once more to solve all my life's problems. I mean, to help me process things that happen and deal with my emotions in a non-destructive way, of course!

I have a particular problem at the moment and I can't find a way to solve it. I've tried really hard to make it work and I've resiliently asked for help and expressed the problem multiple times, but to no avail. Hence I fear this is just going to turn into a rant.

I knew there would be difficulty in having all my post-discharge support remotely (in hospital, I had support to access remote appointments and to debrief after them and still had trouble managing), and I knew the adjustment from 24/7 care to 2 remote appointments a week would be challenging. I also knew that the phone and video calls were my only option, so I got on with it. I found things that helped: using my headphones so I can hear better and am not filtering out extra sound to hear the voice on the other end, buying extra data so I can take my support team for walks - it's easier to engage and process when I'm outside, and once I've used the movement to help me regulate at the beginning of the call I usually feel better able to sit somewhere and manage the rest of it. I take time out in my sensory cave when I'm feeling overwhelmed after a call. I am trying so hard to make it work.

All these things help, and mean that on a good day I can get benefit out of an appointment even though I come away exhausted and often realise shortly afterwards that I didn't say what I needed to say, or that I didn't process something properly and missed out some conversation that could have really helped both of us.

But on a bad day I can't communicate properly. I can't say things at all so the person doesn't even think I'm communicating (often they probably think that I'm managing with the remote conversations because I am engaging and talking about some useful stuff). They go away because they think it's a bad time to talk, and I'm left feeling even more alone, hopeless, trapped and useless because my one chance at getting some help has failed. I have to survive until the next opportunity. Which I still can't access properly because I'm still autistic. 

I have a meltdown afterwards. The only way I can get help is by dialing another number. I don't know why I think this will help. Maybe I don't, but it's the instructions I've been given and it's my last shot at trying to help myself. I'm working on resilience. Keep on trying. Unsurprisingly I struggle with that phone call. Eventually they get some information out of me. They say they'll get my nurse who knows me better to ring me back. I can't tell them that I've only spoken to her 4 times anyway and another phone call is going to add to my distress and overload, not solve anything.

She rings back later and it's a disaster for both of us. She shouldn't have been put in that position, but it wasn't anyone's fault. I couldn't give them the information they needed. I'm the problem. Another meltdown. It's a good job I've lost all sense of public decorum or awareness of anything beyond my distress or I'd be very embarrassed by my behaviour.

I get home and stay safe the rest of the day, thankful for the presence of Mr Peggy. All the blankets, time to write an email apologising for my distress on the phone and trying to explain my problem (this email to send via my other nurse, because they're the only one I'm allowed to email). Comedy TV. They all help me keep calm until the night time. The odd half hour of sleep here or there. The anxiety builds before the second of my scheduled phone calls of the week, with the poor Peg from yesterday. I can hardly bring myself to answer it. It's my last attempt at engaging in this remote support - I'm going to have to go it alone after this. I know where that is likely to lead.

The phone call doesn't help. She can't fix anything (not her fault), I can't fix anything. She goes away, not wanting to overwhelm me with telephone conversations, but meaning I'm support-less for another 8 days. "Ring the office or the crisis team if you need any more support." Great plan.

I've tried all avenues, so I guess it's like it's always been: you have to cope alone and you should be able to. I spent seven months being told it's OK to be different and have different needs, and being helped to work things out, but none of that's true in the real world. Your needs are unreasonable. The 8 days may well be longer, because I'm not sure I can face the disappointment and distress of another phone call and its aftermath. 

Sometimes lockdown is really 💩

And the OT, insurance people and car servicing people trying to ring of me may as well go stick their heads in an oven (although actually, often if you explain your difficulties they do accommodate and communicate by email...).

When ASC becomes ASD: do I need help?

Although I technically class as having a disability, I don't tend to consider myself as disabled. Generally speaking I am well-enough adapted to function in mainstream life without my autism spectrum condition disabling me significantly. I know my strengths and weaknesses, I no longer feel that I must participate in situations I find especially difficult and I am surrounded by people (family, friends and colleagues) who understand me enough to allow me to function my best and partake in full time work, leisure activities and as much socialising as I require.

Recently it was suggested that I may find it beneficial to have some kind of advocate or support person to help me in certain situations such as medical appointments. I took this as very caring overdramatisation (definitely a word, if you were wondering), along with many of the other things that were said at that time. People who care about me and want the best for me but take things a bit too far.

As I reflected I realised a part of my mind knew they were right about many of the things, but the uppermost part - the poorly part - disagreed. They suggested a person to support me again. I considered the idea enough to mention it to family members who very sensibly didn't take one "side" or the other, and merely allowed conversation around the matter.

You see, I have autism and a mental health condition, but I am highly functioning. I am fiercely independent and a perfectionist. I have always been a high achiever; someone who doesn't need help. This now means in my head that I don't deserve help, I am not eligible for help and that I am being greedy, wasting people's time and resources and being attention-seeking if I accept (or, perish the though, ask for) help. And if I tried asking once and was rejected, then no chance! And anyway, I've had loads of help for my mental health and my workplace go above and beyond to support me and let me perform to my potential.

Until yesterday.

I've had a recent health blip related to my mental health. I asked for help just before I wasn't able to any more, and then my brain went to the place where it didn't want any help. Everybody had stepped into action but I didn't want it. They were all looking after me when I couldn't do that for myself, and I had a follow-up appointment yesterday when things had evened out somewhat health-wise.

I was on a high when I came out: the doctor was happy for me to be working because I'd told her I felt better, my tests had improved. In fact, she said that perhaps I'd had a virus the previous week accounting for my symptoms. Yippee! Back to normal just like I wanted.

But half an hour later I found myself in tears. I realised my colleagues were absolutely right. She hadn't asked any of the right questions, and because of that I hadn't given her the right information. I didn't know how to tell her, or correct her mistakes, or question her conclusions. I didn't even process that she had got it so wrong until after that. When the people that know me - Mr Peggy, work Peggies, CMHT Peggies, urgent care practitioner Peggies and even mental health charity Peggies - are all concerned, that should make me question the judgment of one GP who gives a different opinion. I let her tell me it was all fine. That's what my sick brain wanted to hear anyway - it will have a field day with that. But there's a part of me somewhere that wants to be well, and if it saw this happening to someone else it would shout, and shout loudly.

She was right in a way: I am genuinely feeling better and I am genuinely fit to be at work, but she was not right about the rest of it and I did not have the processing capacity or the communication and social skills to address that.

So I come to conclude that perhaps I am more "disabled" than I thought. Maybe I need some help.

I'm so thankful I have such wonderful Peggies looking out for me

I'm not 100% convinced so if anyone has experience of using an advocate or somebody to help them with navigating difficult situations, (eg. helping them to identify and communicate what is in their head and to work out confusing questions about recovery, work, autism and mental health) please get in touch - I'd love to hear from you about how it worked, what worked, what didn't etc etc.