UCLA

Autistic LGBTQ+ people are at a greater risk for mental health challenges than their autistic non-LGBTQ+ counterparts and experience disparities in access to healthcare (Wallisch et al., 2023). Yet, we know little about the first-hand experiences of autistic LGBTQ+ people in the mental healthcare context. This community-partnered phenomenology explored the mental healthcare experiences of Autistic LGBTQ+ young adults, including barriers and facilitators to receiving care. This study was built in partnership with 5 autistic LGBTQ adults who co-designed each aspect of the research, from development of the interview protocol through data coding and interpretation of findings. Twenty autistic LGBTQ+ young adults (18-28 years old, MAge= 23.3 years) from across the United States participated in semi-structured online or written interviews about their mental healthcare experiences. Almost half of those interviewed identify as nonbinary, gender fluid, or gender expansive, and the majority identify as transgender. Eighty-five percent of interviewees reported that they have anxiety, 70% endorsed depression, and over half (55%) reported that they have ADHD. Although some participants had affirming mental healthcare experiences, the vast majority faced barriers in accessing services. Six themes emerged from participant’s descriptions of their experiences with the mental healthcare system, including: 1) disbelief & denial of autistic LGBTQ+ identities, 2) intersectional identities and multiple diagnoses complicate the road to an autism diagnosis or self-identification, 3) accessing care through existing relationships & systems I am already part of, 4) ‘reading’ potential therapists for safety, 5) providers’ lack of fluency in supporting diverse autistic clients, and 6) alternatives to the traditional mental healthcare system. After being dissatisfied with their care and at times actively turned away by providers, participants found and created their own pathways to healing through both individual practices and community care. These findings emphasize the importance of community connectedness in supporting autistic LGBTQ+ mental health. We describe several implications for provider training, addressing diagnostic disparities, and investing in avenues of community care. In the context of increasing anti-LGBTQ+ healthcare legislation in the United States, it is critical that we implement changes to make mental healthcare accessible and affirming for autistic LGBTQ+ young people.