Approaches to improving mental healthcare for autistic people: systematic review
Sofia Loizou, Tamara Pemovska, Theodora Stefanidou, Una Foye, Ruth Cooper, Ariana Kular, Anna Greenburgh, Helen Baldwin, Jessica Griffiths, Katherine R. K. Saunders, Phoebe Barnett, Matilda Minchin, Gráinne Brady, Nafiso Ahmed, Jennie Parker, Beverley Chipp, Rachel Rowan Olive, Robin Jackson, Amanda Timmerman, Suzi J. Sapiets, Eva Driskell, Bethany Parsons, Debbie Spain, Vasiliki Totsika, William Mandy, Richard Pender, Philippa Clery, Kylee Trevillion, Brynmor Lloyd‐Evans, Alan Simpson, Sonia Johnson
Abstract
BACKGROUND: Autistic people have a high likelihood of developing mental health difficulties but a low chance of receiving effective mental healthcare. Therefore, there is a need to identify and examine strategies to improve mental healthcare for autistic people. AIMS: To identify strategies that have been implemented to improve access, experiences of care and mental health outcomes for autistic adults, and to examine evidence on their acceptability, feasibility and effectiveness. METHOD: A co-produced systematic review was conducted. MEDLINE, PsycINFO, CINHAL, medRxiv and PsyArXiv were searched. We included all study designs reporting acceptability or feasibility outcomes and empirical quantitative study designs reporting effectiveness outcomes. Data were synthesised using a narrative approach. RESULTS: A total of 30 articles were identified. These included 16 studies of adapted mental health interventions, eight studies of service improvements and six studies of bespoke mental health interventions developed for autistic people. There was no conclusive evidence on effectiveness. However, most bespoke and adapted approaches appeared to be feasible and acceptable. Identified adaptations appeared to be acceptable and feasible, including increasing knowledge and detection of autism, providing environmental adjustments and communication accommodations, accommodating individual differences and modifying the structure and content of interventions. CONCLUSION: Many identified strategies are feasible and acceptable, and can be readily implemented in services with the potential to make mental healthcare more suitable for autistic people, but important research gaps remain. Future research should address these and investigate a co-produced package of service improvement measures.