Nov 8, 20235 min read

Autistic Mental Health

Updated: Nov 7

Mental health difficulties are much more common in autistic people than in non-autistic people. According to one 2020 review, “nearly three out of four autistic people experience mental health problems”. Common mental health issues among autistic people can include (among others):

anxiety
depression
self-harm
suicide
OCD
psychosis
schizophrenia

At the same time, autistic people are often denied access to mental health care because our difficulties are blamed on us being autistic. However mental illness is not a core feature of autism.

So why are rates of mental illness so much higher in autistic people, and what can be done to help?

Trauma and Burnout

Science has not revealed any inherent deficit in autistic brains that make them more susceptible to mental health problems. However, autistic people are much more likely to have negative and even traumatic experiences such as bullying, unemployment, ‘mate crime’ and sexual assault, starting in childhood and continuing throughout our lives. Autistic people may even be deliberately subjected to abusive behavioural ‘therapies’ such as ABA or experience restraint and seclusion.

In addition, the world is simply not designed for the way autistic brains work, which can lead to frequent sensory dysregulation and/or emotional overwhelm. Society is not generally accepting of difference, which means autistics must constantly monitor themselves and try to conform to arbitrary social norms. We are expected to learn to communicate in ways that suit the predominant neurotype whilst PNTs do not make the same effort to understand and accommodate our needs and preferences (see also the Double Empathy Problem). At the same time, navigating the systems that are supposed to support us, such as education, health care, social care and benefits, can be exhausting.

The cumulative effect of constant invalidation and unmet needs can also be traumatic. Eventually having too many demands on us and not enough support can also lead to autistic burnout. The build-up of trauma and burnout can make us even less able to live up to society’s standards, and this is often when we are classed as mentally ill.

Now that we have an understanding of why autistic people are more likely to have difficulties with mental health, let’s look at some possible solutions.

Medication

It is important to note that medication cannot be used to ‘treat autism’, however, it may be useful for co-occuring mental health difficulties or ADHD. Some autistic people may react differently to medications or experience more side effects so it may take longer to settle on the right medication and the right dose. It may help to start on a low dose and build up slowly.

Talking Therapies

Common types of talking therapy offered by mental health professionals and therapists include:

Cognitive Behavioural Therapy (CBT)
Mindfulness Based Stress Reduction (MBSR)
Dialectical Behaviour Therapy (DBT)
Exposure Therapy
Behaviour Activation
Counselling
Psychotherapy

These talking therapies have been designed for the predominant neurotype and there has been very little research into whether they are effective for autistic people. According to NICE guidelines for autistic children, talking therapies should be adapted for autistic people, but knowledge and understanding of how to do this varies greatly between individual mental health practitioners, and most need more training.

It is possible to self-refer to talking therapies on the NHS without making a GP appointment. Exactly what is offered depends on local services. It is often a one-size-fits-all approach such as a 6-week block of CBT, but it is worth seeing what is available. Accommodations can be requested such as shorter sessions, more sessions, information in advance about what to expect, use of concrete language instead of metaphor and so on.

Alternatively, some charities offer counselling at low or no cost or private therapy, if affordable, allows the freedom to choose the type of therapy along with the therapist and the number of sessions. Some private therapists will offer reduced rates for those on a low income.

There are neurodiversity-affirming therapists who do not see autism as a disorder or condition but as a part of natural human variation. It may be preferable to see a therapist who is neurodivergent. With any therapist or counsellor, it’s important to check their qualifications and that they are registered with a professional body like the British Association for Counselling and Psychotherapy (BACP), the UK Council for Psychotherapy (UKCP) or the National Counselling Society (NCP). However, the relationship with the therapist is the most important thing and asking for a free trial session before committing can ensure a good match.

When considering types of therapy and choosing a therapist, it’s important to think about appropriate goals for the autistic person, such as:

Support with wielding the mask
Processing trauma
Working towards living more authentically
Recovery from burnout
Managing social anxiety
Help with understanding and processing emotions

Non-Talking Therapies

For those who struggle to talk about feelings or find talking therapy doesn’t work for them, there are some alternatives. These can help with self-expression and processing feelings without having to put things into words. There may be some services available on the NHS but again it will be area dependent. A GP should know which services are in their area. Mental health charities may also offer some of these. There are many private options which will all have a cost.

Some alternative types of therapy include:

Art therapy
Music therapy
Dance therapy
Yoga therapy
Drama therapy
EMDR (Eye Movement Desensitisation and Reprocessing)

Occupational Therapy

This might not be the first thing to come to mind when dealing with mental health but OT can be useful if there are difficulties in doing necessary tasks. Some NHS trusts do employ adult mental health service occupational therapists. OTs can take a holistic approach to supporting you, such as:

Sensory strategies
Thinking about roles in life (past, present and future) and helping with those roles
Building up structure and routine in line with interests by adding more activities into daily life
Facilitating participation in meaningful activities
Help accessing employment
Making changes in the environment

Ensuring the OT is neurodiversity affirming can prevent the use of arbitrary neuronormative targets for social skills, reducing stimming etc..

Lifestyle and Environmental Changes

Autistics don’t just have to rely on professionals to help; there are also plenty of things that they can do for themselves and ways for the people around them to support them as well. All the therapy in the world won’t be enough for any autistic person if their environment makes them miserable or their needs aren’t being met. Some things to consider include:

stimming and sensory regulation
time for interests and passions
rest and recovery time
reducing demands
finding a community of peers - such as reading autistic autobiographies and blogs, following autistic social media pages, or joining groups (online or in person) - Autistic Parents UK offers several peer support services.
acceptance from others - this could be by sharing information with friends and family, setting boundaries with those who are unsupportive, or seeking out people who will be accepting
practical support to make changes in their life or with things they find difficult

Conclusion

Unfortunately, we live in a world that creates high levels of mental health difficulties in autistic people. Thankfully, there are things that can help such as therapy and medication, as well as making changes in lifestyle and environment.

Further Resources

These resources have all been created by autistic people with a mixture of lived experience and professional training.

Self Help