Mental health and access to care for a neurodiverse sample during a time of crisis: What can we learn from COVID-19?

To assist planning for future crises, we aimed to compare mental health impacts of the COVID-19 pandemic on autistic and non-autistic adults with pre-existing mental ill-health by conducting an online survey with 532 adults. Participants self-reported mental health conditions and either an autism diagnosis (n = 181), self-identified autism (n = 167), or were non-autistic (n = 184). Self-ratings of mental health, need for mental healthcare and access to mental healthcare during COVID were compared across autism groups and other demographics. Open question responses were analysed using Reflexive Thematic Analysis. Most participants reported poor mental health, high needs for mental healthcare and great difficulty obtaining appropriate care during the pandemic. Younger participants reported poorer mental health; younger people and those with non-autism neurodiversity reported greater need for mental healthcare; neurodivergent participants and those with lower education levels reported greater difficulty obtaining care. Autism-status per se did not differentiate outcomes; instead, having pre-existing mental ill-health or non-autism neurodiversity seemed more salient. Thematic analysis identified four themes/sub-themes: “Greater mental health needs for most”; “Exceptions to the rule: improvements in mental health for some (mainly autistic people)”; “Navigating access to a scarce resource”; and “Telehealth: an enabler for some, a barrier for others”. Implications for future practice include prioritising those with pre-existing mental ill-health or neurodiversity, assisting clients with system navigation, and improving tele-mental-healthcare delivery, or alternatives, especially for neurodivergent clients.