Feature: Rethinking healthcare and mental health legislation

David Crisp explains why Government proposals to reform the Mental Health Act will ensure that mental illness is the only reason for detention, and not autism or learning disabilities, in themselves.

It is somewhat of an irony that, while autism is classified under the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), little is known about its psychiatric aspects.

In truth, autism is a neurodevelopmental, rather than a psychiatric disorder or a form of mental illness.

Sometimes the presenting symptoms of autism are not the core deficits of social interaction and social communication, but superimposed psychiatric problems such as anger outbursts, depression and hyperactivity.

Unfortunately, these problems are often ignored by professionals as being part of autism itself or, conversely, and perhaps more concerning, autistic behaviours are too often misinterpreted as psychiatric disorders.

In the latter interpretation, this can lead to many autistic individuals being institutionalized incorrectly for perceived mental ill-health concerns.

Sometimes refusal to consent to medical treatment by autistic adults can be misinterpreted as a form of self-harm, or self-neglect, when, in reality, there has been little or no attempt to acknowledge the sensory and socially communicative difficulties associated with being in a hospital environment.

There is currently no medication that is universally effective in autism. Yet medications are often prescribed inappropriately for both control of maladaptive behaviours and the treatment of other medications such as seizures.

Furthermore, every year, hundreds of autistic people and those with learning disabilities fall victim to detention under the Mental Health Act.

This is why I, and the autistic community in the UK, welcome the Government proposals to reform the Mental Health Act, which will ensure that mental illness is the only reason for detention, and not autism or learning disabilities, in themselves.

The new proposals firmly suggest that money should be spent on community services, where people can be treated in their own homes or closer to their families, at a fraction of the cost for inpatient hospital services.

I, myself, have experienced maltreatment and misdiagnosis within my own family, over many years, which I am not at liberty to discuss here, except that this is the reason why I believe this topic needs to be discussed.

In an article published in The British Journal of Psychiatry by Hollins et al, the authors argue: ‘Since autism and intellectual disabilities are not mental disorders, they should be excluded from the Mental Health Act. Their current inclusion is held to be discriminatory, resulting in unjust deprivation of liberty.’

Statistically, autistic adults and young people have been found to have much higher incidents of co-morbid conditions than neurotypicals, including seizures and mental illness. 

All too often an autistic person may be misdiagnosed as having a mental illness or personality disorder, and then maybe made to take medication for a condition they do not have. Conversely, in the UK, one-quarter of autistic adults are denied access to mental health services due to a diagnosis of autism.

So the questions remain what needs to be done?

There has to be a way to separate autism and learning disabilities from mental health disorders.

Undoubtedly, autistic adults and children can have co-morbid psychiatric disorders. Sometimes, these can be dismissed as simply being a part of their autism presentation. However, sometimes autistic behaviour is incorrectly misdiagnosed as psychosis or neurosis, when the individual may simply be reacting to a stressful situation or environment.

Unfortunately, the mishandling or failure to provide adequate provision for autistic adults and children; especially since the pandemic, may not simply be a case of a few bad apples, but a feature of the inpatient system.

To conclude, autism is not a mental health disorder or condition, but rather a ‘lifelong condition that affects how people communicate, relate to other people, and how they experience the world around them.;

Inevitably, some autistic individuals may need to be institutionalized. However, due to inadequate service provision, too many autistic people really struggle, eventually hitting complete crisis; and facing being put in a hospital that doesn’t meet their needs.

Legislators and mental health professionals need to listen to the growing number of voices, especially amongst the autistic communities themselves, so that autistic people aren’t inappropriately detained or sectioned, and are afforded the same rights as their neurotypical peers.

Photo by Martha Dominguez de Gouveia