Autistic Adults and Mental Healthcare: A Systematic Review of Professionals’ Perspectives and Experiences, and an Interpretative Phenomenological Analysis of Autistic Adults’ Experiences of Psychiatric Hospital Admissions

Objective
Autistic people experience significant barriers to accessing appropriate mental healthcare and are disproportionately represented in psychiatric inpatient settings, where they often experience poorer outcomes. Research suggests that mental health services can be incompatible with autistic people’s needs, yet limited literature has explored both professionals’ perspectives and autistic people’s experiences. This review and qualitative study aimed to deepen understanding of the barriers autistic people encounter within mental health services from both professional and autistic perspectives.

Methods
A systematic review of qualitative research was conducted across five databases. Twenty-two studies published between 2014 and 2025 were analysed using thematic synthesis, with methodological quality assessed using the Critical Appraisal Skills Programme checklist. In addition, a qualitative study using interpretative phenomenological analysis explored the experiences of seven autistic adults admitted to psychiatric inpatient settings through semi-structured interviews.
Results
The systematic review identified three superordinate themes: “tensions in clinical approaches to supporting autistic patients”, “the challenges of meeting autistic needs in under-resourced and neuro-normative systems”, and “the perceived complex nature of autistic presentations”. The IPA study identified four themes: “misunderstanding and minimisation of autistic needs”, “pathologisation and judgement of autistic distress”, “finding pockets of safety in an inconsistent environment”, and “autistic voicelessness and strategic masking”. Across both studies, experiences were characterised by unmet needs, limited understanding of autism, inconsistent adaptations, and neuro-normative and stigmatising attitudes. However, compassionate, person-centred care and pockets of safety were also identified.

Conclusions
Findings indicate that autistic people’s experiences of mental healthcare are shaped by interacting professional, systemic, and cultural factors. Limited autism knowledge, inadequate resources, perceived complexity of autistic presentations, and cultures of control and pathologisation can contribute to distress, misunderstanding, and poor outcomes. Systemic and cultural changes, alongside improved autism-specific training and person-centred approaches, are needed to reduce barriers and improve autistic people’s experiences of mental health services.