Visions Journal

Assisting people who are neurodiverse

Adam Armstrong MSW, RSW

Reprinted from the The Many Faces of Neurodiversity issue of Visions Journal, 2023, 18 (3), pp. 18-20

Supporting the needs of neurodiverse clients in the rural landscapes of BC is no easy task. It comes with significant challenges for our systems of care and the professionals working within them.

Those who have ventured into BC’s lesser-known regions will be familiar with its stunning vistas of mountains, lakes and forests. Bordered between the Pacific Ocean along its west coast and the Rocky Mountains to the east, there are few other places in Canada, let alone the world, that have such a diversity of landscape and nature. After being across Canada a few times, I would be challenged to think of a province or territory that has the same allure and magnetism as BC.

But our varied geography creates unique hurdles when providing helping services. Weather, distance and the mountainous landscape that covers roughly 75 percent of BC are real factors in determining who has access to services. One unmistakeable truth is that programs shaped by evidence-based models of care are sparse in rural BC. More often than not, they’re non-existent.

Geographical factors in health outcomes for neurodiverse people

BC’s geography is a challenging reality for many who live in the far regions of our province. Often, the most appropriate interventions may be offered exclusively through a program that operates from a larger urban space. That means specialized services and team-based programs are inaccessible outside of cities. This contributes, in part, to gaps in health outcomes for neurodiverse people: those who can access services often do better than those who cannot.

One of the most striking examples of this disparity can be seen in the under-service of Indigenous People. It’s no wonder Indigenous health and mental health outcomes sometimes pale in comparison to those of non-Indigenous populations—barriers to accessing services are a key factor.

In a remote setting, a common scenario for individuals with persistent mental illness is that they leave home to be hospitalized in the closest city, such as Prince George. Once discharged back to their home—which may be 50 kilometers down a forestry logging road—there is little in the way of care planning that can support the client and minimize the chances of them getting ill again. Without evidence-based follow-up they may decompensate (lose psychological balance) as they return to their isolated home.  

Many robust mental health programs are based on strong evidence—such as those for early psychosis intervention, intensive case management and people who fall under the mandate of the Mental Health Act. These programs have shown that comprehensive case management works, providing the best outcomes we know of for the neurodiverse population. However, making the trek to get these programs from cities to the outlying areas of the wilderness would be impractical and expensive, going far beyond our means in funding and organizational capacity. This results in imbalanced opportunities for care, depending on where you live.

Providers tackle BC’s landscape

An example that illustrates imbalances in service access is assessment for care planning. Whether it’s a home assessment or a cognitive appraisal by an occupational therapist, assessments are often available only in communities within easy geographic access for the care provider. Considering how beneficial a genuine in-person appraisal may be to the neurodiverse client who could qualify for home support, and their over-representation in many remote communities, the extent of these services in remote areas is lacking compared to what is needed.

Providers are left to navigate a minimal social safety net while considering how the environment impedes routine and structure in the day-to-day. We pay close attention to travel time, weather conditions and potential road closures, since these are factors that hinder accessibility. Frequent cancelled appointments and legwork to find alternative support can result, none of which are preferable. In many cases, support may be a concept, but it is not a reality.

In my organization, all travel to communities stops when temperatures near minus 40 degrees, and it’s typical of a Northern BC winter to have several days per year where this is the case. Colleagues of mine who serve BC’s Southbank are at the mercy of the Francois Lake Ferry schedule, since they can only access the service area by crossing the lake. Community members and service providers all need to be aware of when the ferry is arriving and departing, which can create additional challenges for appointment bookings.  

Communities find their agency

In the absence of adequate, available, evidence-based program models for several types of neurodiversity (like developmental delays, fetal alcohol spectrum disorder and mood and psychotic disorders), remote mental health providers evolve to be more eclectic in their service delivery. Clinicians typically adjust and tweak their models and may adopt new strategies, such as relying on informal helping systems. That means community groups, social clubs and local organizations may be part of a client’s support system.

It can be challenging to use a broad range of models and tailor our services to the values and realities of the area we work in, all without veering outside of professional guidelines. Since most service providers are not from the communities they serve, we are continuously adapting to a cultural landscape very different from our own, and we are relatively isolated from other providers. We may also be privy to information about clients from community gossip, which requires us to stick close to our client relationship. But we also have access to intergenerational histories that we simply could not get elsewhere.

After practising for a number of years in some of BC’s distant places and witnessing the resilience of communities, I think the disparity in access to formal services becomes part of who people are. In the absence of formal help, people gain independence and an extraordinary ability to believe in themselves. It seems like if a service has never been provided, there is no concept of it; in its place, there’s natural self-sufficiency.

We typically refer to this as “agency,” and in rural BC, I have witnessed this agency in resounding strength at the individual, family and community levels. Clients and communities have an incredible ability to believe in themselves as their own agents of change. I strive to keep this in mind and recognize this strength when assisting them to overcome life’s challenges.

Related Resources

Ideas to improve accessibility in remote practice

After years of providing service, a few ideas that come to mind to support the best interests of the neurodiverse population throughout BC are to:

• Expand the curriculum in health care training to include “rural and remote practice theory.” By doing so, developing practitioners will gain exposure to, and interest in working in remote Canada. They will be more equipped to provide services, since their training will allow them to tailor their models for rural settings.  
• Recognize the challenges of employee recruitment and retention by offering incentives, like moving allowances and accommodation assistance (e.g., funding for rent). The more interest organizations have from the workforce, the easier it will be to develop sustainable programming.
• Develop virtual platforms to improve access to service. Virtual service can reduce wait times and cancellations, especially for appointments that don’t need to be held in person. Virtual platforms can also increase accessibility for those who may be unwilling to see a health care professional in person.