Adapting Safety Planning for Autistic Adults with Trauma Histories: A Thematic Analysis from a UK Community Service

Background : Autistic people face an increased risk of trauma and suicidality, yet there is limited research on how to adapt suicide prevention interventions to meet their needs. This study explored the specific safety planning needs of autistic adults and assessed how these are addressed within a UK community mental health service. Methods : A retrospective review of clinical records was conducted for 118 patients who received safety plans over a one-month period. Of these, 38 (32%) were identified as either diagnosed or suspected autistic. A pragmatic thematic analysis evaluated how their needs were understood and supported. Results : Two overarching themes and five sub-themes were identified as barriers to effective safety planning: (1) Overwhelmed and disengaged (including overstimulating environments, masking, and low support systems); and (2) Rumination, self-concept and risk (including rejection, suppression, and uncertainty about the future). Autistic adults expressed preferences for in-person sessions, trauma-aware clinicians, more time to process information, flexible pacing, and additional support. Conclusions : Important differences in emotional regulation, sensory sensitivities, and cognitive inflexibility create unique safety planning needs for autistic individuals. A holistic, strength-based approach is needed to foster trust, support emotional expression, and accommodate sensory needs. Flexibility, clarity, and follow-up are critical components of care. Implications : Effective safety plans for autistic people should (1) address sensory and communication needs in crises; (2) create calming, predictable environments; and (3) remain responsive to fluctuating internal states such as pain, hormonal shifts, or social overwhelm. Services should prioritise autism-informed training, individualised care, and identity-affirming approaches. Further research should investigate the roles of rumination and command hallucinations in autistic suicidality, especially among women and underrepresented groups.