The short answer
- Autism is not a mental illnessIt is a lifelong difference in how the brain develops. Mental health problems are separate, they are more common in autistic people, and they can be treated.
- They are easy to put down to autismClinicians and families can read anxiety or low mood as part of being autistic. Masking, and difficulty naming feelings, hide them further.
- Ordinary NHS help, adaptedNICE says talking therapy for autistic adults should be more concrete and structured, with more written down. Ask for this, and for the adjustments that help.
- Ask why each medicine is prescribedNICE says antipsychotics should not be used for autism itself. STOMP, the NHS programme against over-medication, covers autistic people.
If somebody needs help now: in England, call NHS 111 and choose the mental health option, day or night. Call 999 or go to A&E if a life is at risk. Samaritans answer on 116 123, free, at any hour, and Shout takes texts on 85258.
The starting point
Autism is not a mental illness, but mental health problems are more common
The NHS describes autism as something you are born with: a difference in how the brain develops, not an illness, and not something to be treated or cured. A mental health problem such as depression is different. It can start at any time, it can get better, and it has treatments.
Words this page uses
- Autism
- A lifelong difference in how a person experiences the world, including communication and sensory input. This page says autistic person, which many autistic people prefer; some prefer person with autism.
- Mental health problem
- A condition such as anxiety, depression, OCD or an eating disorder, which affects mood, thoughts or behaviour and can be treated.
- Masking
- Hiding autistic traits to fit in. It is tiring, and it can hide distress from other people.
- Alexithymia
- Difficulty recognising and describing your own emotions. It is common in autistic people and makes feelings harder to report.
- Diagnostic overshadowing
- When a new problem is put down to a condition the person already has, so it is not assessed or treated.
The NHS lists anxiety, depression and eating disorders among the conditions autistic people are more likely to have, alongside epilepsy and ADHD. The National Autistic Society says there is no single reason. Being misunderstood or not accepted by other people, social isolation, and daily life in places that are too loud or too unpredictable all add stress over years. Some autistic adults also have a learning disability, which is separate again.
Keeping the two apart matters. Autism does not need fixing, and nobody should be offered treatment to make them seem less autistic. Anxiety or depression does need help, and it should not be left untreated because someone assumes it comes with autism. Autism in adults is the guide to the rest of this section, and disability care at home covers support more widely. If the person has not been diagnosed, getting an autism diagnosis as an adult explains the route, and you do not need to wait for a diagnosis to get help with mental health.
Six to know about
What anxiety, depression, OCD, eating disorders and poor sleep can look like
Each card below reads the same way: what the problem can look like in an autistic adult, what it is easy to mistake it for, what to ask for, and where to go. Take the one that fits to the appointment.
Anxiety
What it can look like
Worry that does not switch off, a stronger need for sameness, avoiding places that used to be manageable, more meltdowns or shutdowns, and a racing heart or upset stomach.
Easy to put down to: Being set in their ways, or “just autism”.
What to ask for
- Talking therapy adapted as NICE describes: concrete, structured, and with more written down
- A quiet place to wait, and the same therapist each time
Where to go
Refer yourself to NHS Talking Therapies (age 18 and over), or see the GP.
Depression
What it can look like
Low mood that lasts weeks rather than days, losing interest in things they cared about, withdrawing further, more repetitive behaviour and more meltdowns.
Easy to put down to: Autistic burnout, which can look similar and needs fewer demands and rest as well as any treatment.
What to ask for
- An assessment that does not rely only on a questionnaire, because rating feelings on a scale can be hard
- A medication review at a set date if tablets are started
Where to go
The GP, or NHS Talking Therapies. The GP can refer to the community mental health team if it is severe.
OCD
What it can look like
Unwanted, frightening thoughts, and checking, cleaning, counting or redoing things to stop something bad happening. The person usually finds these distressing.
Easy to put down to: Routines, stimming and intense interests, which are part of being autistic and are usually wanted and calming.
What to ask for
- A clinician who understands autism, so that routines are not treated as symptoms
- Cognitive behavioural therapy for OCD, adapted for autism
Where to go
Refer yourself to NHS Talking Therapies, or see the GP.
Eating disorders: ARFID and anorexia
What it can look like
A list of safe foods that keeps getting shorter, eating too little without noticing hunger, losing weight, or strict rules about food and exercise. In ARFID the restriction is about the food itself, such as its texture or smell, rather than body shape.
Easy to put down to: A limited diet that has always been part of how they eat. A short menu is not an eating disorder unless it is harming health or daily life.
What to ask for
- An eating disorder assessment that takes sensory needs into account
- Changes to food made slowly, keeping the rest of the routine the same
Where to go
The GP, who can refer to an eating disorder service.
Sleep problems
What it can look like
Finding it hard to wind down, lying awake for hours, or waking in the night. Poor sleep makes anxiety, low mood and meltdowns harder to manage.
Easy to put down to: A bad habit, or something to push through.
What to ask for
- A GP review of sleep, including whether any medicine is affecting it
- Changes to light, noise and the evening routine to be tried alongside any tablets
Where to go
The GP.
Thoughts of suicide or self-harm
What it can look like
Talking about not wanting to be here or about being a burden, giving belongings away, self-care slipping, or self-injury. Some autistic people show few outward signs, and someone who masks can seem fine.
Easy to put down to: A flat tone or a matter-of-fact way of saying it, which can make it sound less serious than it is.
What to ask for
- To be listened to and taken seriously
- A safety plan written with them, saying what helps and who to contact
Where to go
Call 999 or go to A&E if a life is at risk. Otherwise the GP the same day, NHS 111 and the mental health option, or Samaritans on 116 123.
Many autistic people live with high levels of anxiety. The National Autistic Society says research varies, but around 40 to 50% of autistic people may receive a clinical diagnosis of anxiety. Uncertainty, busy and noisy places, and the effort of masking all feed it. Depression can look like autistic burnout, and the two can happen together, so it is worth asking for both to be considered. More frequent meltdowns and shutdowns can be an early sign that anxiety or low mood is building.
Two of the cards need a closer look. The National Autistic Society separates OCD from autistic repetitive behaviour by how it feels to the person. A routine, a stim or an intense interest is usually soothing and wanted. An OCD compulsion is unwanted and driven by fear that something bad will happen. On eating, Autistica notes that autistic people are diagnosed with anorexia at higher rates than other people, and that some autistic people are diagnosed with anorexia when what they have is ARFID, where food is restricted because of how it feels, smells or tastes rather than worry about weight. It is possible to have both. Beat is the UK eating disorder charity, and it supports families as well as the person.
Sleep affects all the others. The National Autistic Society says autistic people often have trouble sleeping, including difficulty winding down. Light, noise and the evening routine are the first things to look at, and sensory needs at home covers the bedroom and the rest of the house.
Why it gets missed
Why mental health problems are missed in autistic adults
NHS England's guidance for mental health services on meeting the needs of autistic adults sets out several reasons problems are missed or misread. Knowing them helps you explain what you are seeing when you ask for help.
Everything put down to autism
Diagnostic overshadowing
Feelings that are hard to name
Alexithymia
Seeming fine in the appointment
Masking
Questionnaires taken literally
Rating scales
Pain read as distress
Physical causes
Help that is hard to reach
Phone-only access
A family member can help most by writing down what has changed and when. Sleep, eating, time spent in their room, meltdowns, and things they have stopped doing are all useful, with dates. Notes like these help when the person finds it hard to describe how they feel. Masking and later diagnosis are covered in autistic women and late diagnosis.
NICE tells professionals to discuss with autistic adults whether and how they want their family involved in their care. An adult who has capacity decides that, and the team has to respect it. You can still tell the GP what you have seen, even if they cannot tell you anything back.
Getting help
Getting help: the GP, NHS Talking Therapies and the mental health team
Autistic adults can use the same NHS mental health services as everyone else. The National Autistic Society points out that services have a legal duty to make reasonable adjustments under the Equality Act 2010. The usual route is below. Nobody needs a referral to see the GP or to contact NHS Talking Therapies.
- 1
Write it down before anyone is contacted
TodayWhat has changed and since when, what the person wants help with, and the adjustments that make appointments possible. The autistic adult can write it themselves if they prefer, and it goes to every appointment. - 2
See the GP
The usual first stepAsk for a longer appointment, or the first one of the day, and send the written notes in advance. The GP can treat, prescribe, refer, and record the adjustments the person needs. - 3
Refer yourself to NHS Talking Therapies
Aged 18 or over, registered with a GPFor anxiety, depression, OCD and related problems, you can refer yourself without seeing the GP. Say at the start that you are autistic and list the adjustments you need. - 4
Ask about the community mental health team
Through the GPFor severe or long-lasting problems, or an eating disorder, the GP refers to specialist services. NICE says staff treating autistic adults should consider asking a specialist autism team for advice on adapting treatment.
Talking Therapies can be found through the NHS service search: find NHS Talking Therapies for anxiety and depression. The National Autistic Society's advice on seeking help for your mental health includes a template letter for asking a service for adjustments.
Treatment deals with the clinical side. Some autistic adults also need practical support in the week, such as help keeping a routine, getting to appointments, or company on a hard day. Mental health support at home explains what a support worker does and what stays with the clinical team. A council care needs assessment can pay for some of this, and social care support for autistic adults explains how to ask.
If you are paying privately, you can search for carers near you and compare their rates. PrimeCarers is an introductory service, not an agency or a care provider. The autistic adult, or the family where the person wants them involved, chooses the carer, meets them first, and agrees the hours, the routine and how contact works directly with them. For many autistic adults the same person at the same time each week matters a great deal, and you can keep working with the same carer. Every carer's identity and right to work are checked, they have an enhanced DBS check (or PVG in Scotland, Access NI in Northern Ireland) issued within the last 18 months, and they are interviewed online. Carers are insured while they work, which is separate from the checks. There is no way to search for carers by autism or mental health experience, and we do not check qualifications, training or references, so what a carer says about their experience is their own account for you to ask about.
Adjustments and medicines
Reasonable adjustments to ask for, and why each medicine is prescribed
An adjustment is a change to how a service works so that a disabled person is not at a disadvantage. For autistic adults the most useful ones are usually small, and NICE describes how therapy should be adapted.
| What to ask for | Why it helps | |
|---|---|---|
| Before the appointment | Written details of what will happen, how long it lasts and who you will see. Contact by email or text instead of phone calls. | Uncertainty is a common cause of anxiety, and a written plan can be read again without having to ask. |
| Waiting | A quiet place to wait, or permission to wait in the car and be called in by text. | A crowded, bright waiting room can use up the energy needed for the appointment. |
| In the room | Plain language, time to answer, questions in writing, and a family member or advocate present if the person wants one. | NICE says to use plain English and avoid metaphor, ambiguity and hypothetical situations. |
| In therapy | A more concrete and structured approach with written and visual material, rules made explicit, and regular breaks. | These are the adaptations NICE lists for cognitive and behavioural therapy with autistic adults. |
| Over time | The same clinician each time where possible, and the adjustments recorded on the NHS record. | NHS England tells services to offer continuity of staff. A recorded adjustment does not have to be explained again. |
Before the appointment
- What to ask for
- Written details of what will happen, how long it lasts and who you will see. Contact by email or text instead of phone calls.
- Why it helps
- Uncertainty is a common cause of anxiety, and a written plan can be read again without having to ask.
Waiting
- What to ask for
- A quiet place to wait, or permission to wait in the car and be called in by text.
- Why it helps
- A crowded, bright waiting room can use up the energy needed for the appointment.
In the room
- What to ask for
- Plain language, time to answer, questions in writing, and a family member or advocate present if the person wants one.
- Why it helps
- NICE says to use plain English and avoid metaphor, ambiguity and hypothetical situations.
In therapy
- What to ask for
- A more concrete and structured approach with written and visual material, rules made explicit, and regular breaks.
- Why it helps
- These are the adaptations NICE lists for cognitive and behavioural therapy with autistic adults.
Over time
- What to ask for
- The same clinician each time where possible, and the adjustments recorded on the NHS record.
- Why it helps
- NHS England tells services to offer continuity of staff. A recorded adjustment does not have to be explained again.
Services must make reasonable adjustments under the Equality Act 2010. NHS England's Reasonable Adjustment Digital Flag records them on the person's national record, and publicly funded services must be able to read it by 30 September 2026.
Ask the GP surgery to add the adjustments to the Reasonable Adjustment Digital Flag. Reasonable adjustments, the dentist and STOMP explains how. It was written with learning disability in mind, but the flag and the law work the same way for autistic adults.
Medication for a mental health problem should follow the NICE guidance for that problem, the same as for anybody else. What NICE CG142 rules out is medication for autism itself. It says not to use antipsychotics or anticonvulsants for the core features of autism in adults, and not to use antidepressants routinely for them. STOMP, which stands for stopping over-medication of people with a learning disability and autistic people, is NHS England's programme against prescribing psychotropic medicines for the wrong reasons. NHS England says autistic people are thought to be 7 times more likely than the general population to be prescribed an antipsychotic.
In a crisis
What to do in a crisis, and if someone talks about suicide
NHS England says autistic people are at higher risk of suicide than the general population, and the national suicide prevention strategy for England names autistic people as a priority group. Autistica says every suicide is preventable with the right support at the right time, so it is right to act early.
- Worried today
Talk to the person, then the GP
Say what you have noticed, plainly, and give them time to answer, in writing if they prefer. Ask the GP for an urgent appointment the same day.
- Any time
NHS 111, the mental health option
In England, call 111 and choose the mental health option to speak to a mental health professional, day or night. Family can call on someone's behalf.
- Not ready to call
Samaritans or Shout
Samaritans answer on 116 123 at any hour. Shout is a free text service on 85258, which some autistic people find easier than a phone call.
- Life at risk
Call 999 or go to A&E
If someone has seriously hurt themselves, or cannot keep themselves safe. Stay with them if you can.
- Afterwards
Ask for a safety plan and the right review
A written plan, made with the person, of warning signs, what helps and who to contact. If a hospital admission is being considered, ask about a care and treatment review.
If someone tells you they are thinking about suicide, believe them and listen. Autistica gives this advice. An autistic person may say it in a flat or factual way, and that does not make it less serious. The National Autistic Society suggests a safety plan that lists the warning signs, what helps, who to contact and how to make the surroundings safe, and its page on suicide links to a version written for autistic people. Autistica's page on suicide and autism explains what research has found.
NHS England's policy says autistic adults who are in a mental health crisis, or at risk of admission to a mental health hospital, should be placed on a dynamic support register and offered a care and treatment review. The review looks at whether the right support in the community could avoid the admission. If an admission is being talked about, ask the mental health team whether a review has been offered.
Questions
Questions people ask about autism and mental health
No. The NHS describes autism as a difference in how the brain develops that a person is born with, and says it is not an illness. The National Autistic Society says the same. Autistic people are more likely to have mental health problems such as anxiety and depression, and those can be treated like anyone else’s, with adjustments.
Yes. Anyone aged 18 or over who is registered with a GP can refer themselves for anxiety, depression and related problems, and a diagnosis is not needed. Services must make reasonable adjustments, and NICE describes how therapy should be adapted: more concrete and structured, with written and visual material, plain language and regular breaks. Say you are autistic when you refer.
Many autistic people eat a limited range of foods, and the National Autistic Society says that is not an eating disorder unless it is significantly affecting everyday life. Warning signs are weight loss, a list of safe foods that keeps shrinking, or not getting enough to eat. ARFID is about the food itself, such as its texture or smell, and anorexia usually involves strict rules about eating and weight. See the GP if you are worried.
The National Autistic Society suggests asking how it feels to the person. Autistic routines, stimming and intense interests are usually wanted and calming. OCD compulsions are unwanted and driven by fear that something bad will happen if they are not done. Some people have both, and a clinician who understands autism can tell them apart.
Not for autism itself. NICE says antipsychotics should not be used to manage the core features of autism in adults. They may be prescribed for a mental health condition such as psychosis, or in limited circumstances by a specialist. STOMP, the NHS programme against over-medication, covers autistic people, and anyone can ask the GP for a medicines review. Do not stop a medicine without talking to the prescriber first.
Believe them and listen, even if they say it calmly. If they have hurt themselves or cannot keep themselves safe, call 999 or go to A&E. Otherwise, help them contact the GP the same day or call NHS 111 and choose the mental health option. Samaritans answer on 116 123 at any hour, and Shout takes texts on 85258. You can call 111 on someone else’s behalf.