What is the purpose of this guidance?

This guidance supports people working in mental health, learning disability and autism inpatient services to have a greater understanding of autism-informed inpatient care.

It sits alongside the co-produced Culture of care standards for mental health inpatient services.

The following 3 approaches are integral to the standards’ practical application in inpatient mental health settings:

• Autism-informed inpatient care
• Culturally competent inpatient care
• Trauma-informed and harm-aware inpatient care

Autism and neurodivergence

Our understanding of autism has shifted significantly over time. Traditionally, research into autism has focused on deficits and impairments, and there is a lack of information about the kind of services and support that best help autistic people flourish.

We are learning more about the autistic experience from the autistic community and through autistic-led research. This paradigm shift moves away from the medical model of deficits to understand autism through a neurodiversity lens.

Neurodiversity is the diversity of all minds, and neurodivergence refers to those whose minds function in ways that diverge significantly from the dominant societal standards of ‘normal’.

Neurodivergence encompasses autism, attention deficit hyperactivity disorder (ADHD), dyspraxia, dyslexia, Tourette syndrome, and learning disabilities; but there is no definitive list.

Those with experiences of trauma, mental health conditions and acquired brain injury can, among others, be considered neurodivergent.

Research estimates the prevalence of neurodivergent conditions in adults in the UK at about 15% to 20% when all conditions are considered together. This figure is likely to increase in future because of growing awareness of neurodiversity in the UK.

Autism is a lifelong neurodevelopmental difference that influences the way a person interacts and communicates with others and experiences the world around them.

Autistic individuals often experience differences in sensory processing, which can significantly impact daily living.

Traditional theories of autism suggest that autistic people lack empathy and have challenges in social interactions and communication.

However, the ‘double empathy problem’ reframes this idea – instead finding that the misunderstanding and miscommunication are between neurotypes: each of the 2 people in the interaction has difficulty understanding the other one; the ‘problem’ is not located in the autistic person.

Autism-informed care aligns with neurodivergent affirming practice but focuses specifically on the needs of autistic people. Many autistic adults experience high degrees of unmet health needs, leading to long inpatient stays.

The busy, bright, noisy, unpredictable hospital environment may contribute to dysregulation and overwhelm (meltdown and shutdown).

Services that are not autism-informed may interpret this overwhelm and attempts to regulate as ‘challenging behaviours’ and respond with behavioural approaches.

An autism-informed approach understands the cumulative impact of the sensory and social environment and makes systemic adjustments to support regulation.

An autism-informed approach aims to facilitate a ‘bridging’ of this gap in understanding while taking into account sensory and cognitive differences and specific needs of autistic individuals to improve the accessibility of healthcare and outcomes for autistic individuals.

Assessment process

Autism diagnosis involves a specialist assessment, usually carried out by a team that may include a psychiatrist, nurse, psychologist, or speech and language therapist.

The process often begins with a GP referral and includes gathering detailed developmental history and observations of how a person communicates, interacts, and behaves.

For children, parents and teachers may be asked to provide input, while for adults, family members or partners can contribute useful information.

Inpatient mental health teams can offer an initial autism screening. This is not a full diagnostic assessment, but it can help identify whether a formal referral for assessment would be useful.

A diagnosis can help individuals access appropriate support and services, but it can also take time due to waiting lists and service availability.

See the NHS website for more information about getting an autism assessment.

Why autism-informed care is needed

Autistic people face significant health inequalities and die younger, on average, when compared to the general population.

They are at high risk of mental health problems, self-injury and suicide. Studies have found that autistic women are 13 times more likely to die by suicide than non-autistic women, and two-thirds of autistic adults self-report suicidal ideation.

Camm-Crosbie et al identified that the following contributory factors impact on autistic people’s wellbeing and likelihood of seeing suicide as their future:

• Difficulties in accessing treatment and support.
• Lack of understanding and knowledge of autistic people with co-occurring mental health difficulties.
• Lack of appropriate treatment and support.

The same study reported that autistic individuals have been excluded from mental health services because of their autism diagnosis. Doherty et al stated that:

“Failure to identify and respond appropriately to an autistic person is likely to lead to a range of negative consequences for the individual and the service. A negative patient experience can prevent autistic people seeking support again or holding off until their health has deteriorated significantly.”

Autistic people who are detained under the Mental Health Act are more likely than the general population to experience restrictive practice, including long-term segregation.

Black people are over 4 times more likely to be detained under the Mental Health Act than White people in England and therefore Black autistic people are likely to face compounded risks.

The Use of Force Act 2018 has a specific aim to reduce the inappropriate use of force, including for people with a learning disability and autistic people.

The quality of life for older autistic adults (aged 50+) is considerably poorer than that of non-autistic adults, with social isolation and loneliness being 2 major issues.

Many older adults also face additional barriers to diagnosis and research shows that those diagnosed later in life are more likely to have co-occurring mental health conditions, including mood and anxiety disorders.

The Mental Health Act Code of Practice states that all reasonable adjustments required under the Equality Act 2010 must be made to adapt and respond to each individual’s needs.

When autistic individuals seek support for their mental health, autistic differences must be recognised, understood and accommodated to improve accessibility and effectiveness of services.

What is autism-informed care?

Understanding what constitutes an autism-informed approach is still emerging and has yet to be defined in the literature.

We suggest that it aligns with a neurodivergent affirming approach but is specifically focused on autistic need.

Centres on autistic experience, rather than on neurotypical norms and perceptions

• Provides direct and accurate information and spoken and non-spoken approaches.
• Understands that every person has a unique sensory profile and may require systemic and individual adaptations to both the physical and social environment.
• Promotes and facilitates neurodivergent affirming communication.
• Respects individuals’ unique expressions of distress, joy or emotional regulation strategies.
• Understands fluctuating abilities and differences across different contexts.
• Accommodates autistic differences without seeking to fix.

Is neurodivergent affirming and identifies strengths and capabilities as well as challenges

• Recognises difference, strengths and abilities.
• Recognises everyone’s challenges without judgement or bias.
• Promotes autonomy, involvement and participation in ways that work for the individual.
• Avoids compliance-based practices (for example, reinforcement, punishment, or conditioning) and instead promotes collaboration, choice, and self-advocacy.
• Considers and supports understanding sensory needs and support profiling.
• Considers and supports an understanding of embodiment, regulation and survival responses (for example, flight, flight and freeze).
• Care feels welcoming and inclusive.
• Validates an individual’s own experiences.
• Is holistic and considers intersectionality and psychosocial needs.

Identifies factors that are significant to autistic people and considers how challenges can be mitigated and needs met

• Acknowledges the systemic inequity and responsibility to meet neurodivergent needs.
• Makes adaptations where reasonably possible and does not place expectation for change on the individual, acknowledging harm where adjustments are not made.
• Adapts interventions, therapies and approaches to increase their effectiveness for autistic people.
• Supports predictability and routine in care as much as possible.

How to deliver autism-informed care

Autism-informed care is not a manualised approach. Each autistic person will have their own unique profile of sensory differences and communication needs.

An individualised approach is necessary whereby practitioners embrace compassionate curiosity to work alongside autistic individuals and their families.

It requires recognition of the autistic individual as an equal partner and expert in their own experiences and needs, exploring the accommodations and adaptions that are beneficial.

The barriers to diagnosis are significant and services should take a needs-led approach.

There are existing models that provide a framework for facilitating individual planning and needs-based support. These frameworks can be used as a basis or template for co-creating individualised care plans with autistic patients within inpatient settings.

It is, however, important to ensure that any models used are evidence-based, dependant on the needs of the person, and that a ‘one size fits all’ approach is not used within services.

Gore et al highlight the tendency to group together autism and learning disabilities when applying behavioural frameworks and note that certain behavioural frameworks are not intended for person’s identifying as neurodivergent who do not have a learning disability.

Any autistic person who is admitted to a mental health hospital is also entitled to a care (education) and treatment review.

This is an independent review of their care and treatment and considers whether they need to be in an inpatient setting, and if so whether their care is safe, effective and least restrictive.

Making autism-informed adaptations must be everyone’s responsibility. Staff do not need to be autism specialists to provide good support to autistic people.

Often, autism-informed changes can be simple or low-resource to implement, and the consistent implementation of these small adjustments can make a large positive difference.

Adjustments include adaptions to the physical environment, consideration of processes and revisiting information provided to patients.

Yet many adjustments also come from practitioners adjusting their approach, maintaining curiosity while suspending judgement, or being able to create the space to co-regulate.

The Autistic SPACE framework is one example of an autism-informed approach. It encompasses 5 core autistic needs:

• sensory needs
• predictability
• acceptance
• communication and empathy
• within these, consideration of physical, processing and emotional space

The framework makes recommendations for how autistic SPACE can be implemented in practice; however the considerations are not exhaustive and would need to be considered and discussed to assure they meet the needs and wants of each individual.

Another example of an autism-informed approach is the SPELL approach. SPELL consists of 5 principles designed to create an environment suitable to meet autistic needs:

• structure
• positive approaches
• empathy
• low arousal
• links

The approach was initially created for use in schools but has been successfully expanded across healthcare settings. SPELL is person-centred, respectful, ethical and least restrictive first.

Useful links

• DAPB4019: Reasonable Adjustment Digital Flag – NHS England Digital
• NHS England » Accessible Information Standard – requirements (DAPB1605)
• NHS England » Sensory-friendly resource pack
• The Oliver McGowan Mandatory Training on Learning Disability and Autism | NHS England | Workforce, training and education
• NHS England » Dynamic support register and Care (Education) and Treatment Review policy and guide
• NHS England » Patient and carer race equality framework

References

1. Walker N. Neuroqueer heresies: notes on the neurodiversity paradigm, autistic empowerment and postnormal possibilities. Autonomous Press; 2021.
2. Mcdowall, Almuth and Teoh, Kevin and Beauregard, Alexandra and Gawronska, Julia (2025) Neurodiversity at work: bridging research, practice, and policy. Project Report. Acas. Downloaded from: https://eprints.bbk.ac.uk/id/eprint/55605
3. Doherty M, Neilson S, O’Sullivan J, et al. Barriers to healthcare and self-reported adverse outcomes for autistic adults: a cross-sectional study. BMJ Open. 2022;12(2):e056904.
4. Hirvikoski T, Mittendorfer-Rutz E, Bowman M, et al. Premature mortality in autism spectrum disorder. Br J Psychiatry. 2016;208(3):232–8.
5. Cassidy S, Bradley P, Robinson J, Allison C, McHugh M, Baron-Cohen S. Suicidal ideation and suicide plans or attempts in adults with Asperger’s syndrome attending a specialist diagnostic clinic: a clinical cohort study. Lancet Psychiatry. 2014;1(2):142–7.
6. Camm-Crosbie L, Bradley L, Shaw R, Baron-Cohen S, Cassidy S. People like me don’t get support: Autistic adults’ experiences of support and treatment for mental health difficulties, self-injury and suicidality. Autism. 2019;23(6):1431–41.
7. Doherty M, Haydon C, Davidson IA. Recognising autism in healthcare. Br J Hosp Med. 2021;82(12):1–11.
8. Department of Health and Social Care. Thematic review of the independent Care (Education) and Treatment Reviews. 2021.
9. Happé FG, Mansour H, Barrett P, Brown T, Abbott P, Charlton RA. Demographic and Cognitive Profile of Individuals Seeking a Diagnosis of Autism Spectrum Disorder in Adulthood. J Autism Dev Disord. 2016 Nov;46(11):3469-3480. doi: 10.1007/s10803-016-2886-2. PMID: 27549589.
10. Jadav N, Bal VH. Associations between co-occurring conditions and age of autism diagnosis: Implications for mental health training and adult autism research. Autism Res. 2022;15(11):2112–25.
11. Gore NJ, Sapiets SJ, Denne LD, Hastings RP, Toogood S, MacDonald A, et al. Positive Behavioural Support in the UK: A State of the Nation Report. Int J Posit Behav Support. 2022;12:ISSN 2047-0924.

Publication reference: PRN01727_i