Understanding autism and mental health Autism is a neurological difference which means that autistic people sense the world differently and think in a different way, in the same way that some people have different coloured hair from others or have particular talents that others do not. Sadly, many autistic people do also suffer from mental health issues – some estimates put this at around 50% of autistic adults in the UK battling depression or anxiety. This resource looks at the possible causes for the prevalence of mental health issues among autistic people, what this may mean for those affected, and how they can be helped and supported. Why individuals with autism are more likely to experience mental health problems Links between autism and mental can occur for a variety of reasons, and, just like the impact of autism, will be different for every individual. There are, however, several broad areas where autism may lead to mental health issues. Firstly, the world is not designed for autistic people. Their brains work differently to the thinking behind almost everything they encounter in their lives every day, be it the way places are designed, the way processes are supposed to work, or the way information is conveyed. Effectively, many autistic people are constantly translating everything they encounter to try and make sense of it in their own terms. Living full time in a place that does not make sense to you is overwhelming, and inevitably takes a toll on your mental health. Many autistic people struggle to understand how much of the world works, and this is nothing to do with lack of intelligence. You could be the most intelligent person in the world, but if you have not learned to speak Japanese you will still not understand a word said to you in that language. If you don’t understand how things work, it is much harder to predict and prepare for what may happen in the future. This in turn can lead to heightened anxiety, a condition that many autistic people struggle with. Anxiety can be absolutely crippling and lead to near paralysis in terms of making progress in your life. Combine the difficulty many autistic people have with understanding the world and thus predicting what may happen in the future with their need for routine and difficulty coping with change, and life can become very hard indeed. The situation can easily become an ever-deteriorating loop. If you do not know how to predict the outcome of an action, you will both worry about what may happen and be unable to prepare yourself for the possible outcomes because you don’t know what they are. This worry breeds further anxiety and speculation about what may happen, which inevitably leads to thinking up worse and worse scenarios. It is a horrible position to be in, and one that many autistic people experience on a regular basis. Anxiety, unfortunately, is rarely solved by a logical assessment of the situation, as it is deeply rooted in emotions and fears. Many autistic people have struggled throughout their life. They may well have experienced long periods of not being understood, of being derided or bullied for being different, have struggled to gain employment despite being highly skilled, had difficulty building relationships because they struggle with social skills and so on. All of this can contribute to mental health issues such as depression and may also combine with chemical causes for this disorder. Just to add insult to injury, depression and anxiety often go hand in hand, with one feeding off the other. Autistic people are fighters – they have to be to make any progress in life and have likely been fighting prejudice, lack of adjustments and being mocked or worse for being different. But fighting is exhausting mentally. Masking, the strategy many autistic people use for much of their lives to effectively act the role of a neurotypical person in many situations, is also exhausting. If you constantly put too much strain on your arm, leg or back, the ultimate result is almost inevitable – an injury which may be serious and take a very long time to recover from, if a full recovery is even possible. The same applies to mental health. The constant strain under which many autistic people operate takes a huge toll on their mental health, which can and does result in a variety of conditions which are then extremely hard to escape. What types of mental health problems might an autistic individual experience? As outlined earlier, perhaps the two most common mental health conditions experienced by autistic people are depression and anxiety, for a range of reasons. These can lead to the person withdrawing from the world and seeking to isolate themselves to prevent further hurt and damage. The combination of anxiety and depression is a particularly potent cocktail which has the potential to do huge damage to the mind of an autistic person who is likely already struggling. They may instinctively fear the worst in any situation, partly because the worst may actually have happened to them in the past and partly because they know that they will struggle with change and a change for the worst will be awful for them to handle. They are also mystified by how much of the world works, so when thinking through possible outcomes of a situation, they may find it much harder to assess the likelihood of possible outcomes and eliminate the more unlikely ones. In the mind of an autistic person, an outcome which is almost impossible in reality may become almost a certainty and leave them then worrying about how they will manage when that inevitable (to them) result takes place. As the worst possible outcome is usually the one with little or no possibility of escape or resolution, this can lead an autistic mind to go round in circles attempting to escape from an apparently locked room and becoming more and more depressed and despairing. Many autistic people attempt to manage their lack of understanding of the world by working through many possible outcomes in their heads and devising responses – they like to make plan B, C, D and so on. Again, evaluating all these options constantly is exhausting and can lead to further mental health issues as well as usually ending up with more focus on the worst possible and usually highly unlikely outcomes. All other mental health conditions, such as bipolar disorder, eating disorders and schizophrenia can and do affect autistic people. Because of the pressures of living as an autistic person in a neurotypical world, these conditions may well be experienced more acutely and harder to fight through. How to support an individual with autism who is experiencing mental health problems The best thing you can often do for an autistic person experiencing mental health problems is to be there for them and listen to them. They do not expect you to solve their problems, and you should not attempt to diagnose mental health issues unless you are a trained professional. What can be immensely helpful is to signpost professional support that is available and encourage the person to consider it. If they are reluctant to access help, they may welcome the chance to talk through their reasons for this. Above all, listen to and respect what the person says. Many autistic people have tried and tested strategies for getting through dark times and know what works best for them, even if this makes no sense to you. Unless the person is in danger, let them handle the situation how they choose to while gently pointing out other possible options as appropriate. Trying to force a particular course of action may lead to an extremely negative response – many autistic people have been ordered around for much of their lives, frequently into situations that do them further harm. Reassurances about the worth of the person and things they have accomplished may well be welcomed but try to avoid empty platitudes like “everything is going to be fine.” What autistic people with mental health issues need are good friends that accept them completely as they are and with whom they can be their true selves. This alone gives them a break from masking and pretending and will help the healing to begin. Where to find more help There is a wealth of help and information available depending on the condition, person affected and their circumstances. Here are some links to key sites as a starting point: National Autistic Society a series of resources covering the effect of individual mental health conditions on autistic people. Young minds – a guide to mental health for autistic young people, including helplines. Mind – the UK national mental health charity has a page and links to other resources about autism and mental health. NHS – lots of information about autism, including other conditions such as mental health and how to get help. Download the PDF resource Other Resources What is Non-Verbal Autism? This resource aims to provide a range of information, support and ideas about how to help a child with autism. What causes autism? This resource is intended to give an overview of what is understood about the causes of autism, and the issues that arise from this. Understanding meltdowns Understanding meltdowns in autistic people. What meltdowns are, how they are caused and how to support someone experiencing sensory overload.