Why is the hidden disability of autism so visible in mental health inpatient services? The autistic view from personal stories.

Autistic individuals are overrepresented on mental health wards in the UK compared to in the general population. This has implications for the provision of mental health care. It is important to understand why this minority group appear to be more inclined to reach mental health crisis and require inpatient admission. All individuals have rights to equity of access to mental health support, autistic people are no different in this regard. Uniquely this study takes a life story approach to gather personal stories of autistic people through loosely semi-structured interview to gain their perspective. Using Interpretative Phenomenological Analysis (IPA), analysis was checked with each participant to agree a shared interpretation, guarding against the double empathy problem, before looking across the five stories for any commonalities. Themes for risk of mental health hospital admission emerged as: “being different, not fitting in”; “not believed, misunderstood”; “negative sense of self” and “unhelpful support not addressing needs”. Protective themes against mental health hospital admission were “trusting relationships”, “understanding self” and “using skills for a purpose”. This study has evidenced hospital admissions for autistic people due to mental health crisis is not simply a clinical concern but a relational, rights-based issue that requires societal and systemic change to meet statutory commitments to inclusivity. In addition, the thesis demonstrates methodological implications for authentic coproduction with autistic people, providing recommendations towards best practice.