In February of this year, I sat across from three professionals in my sixth Mental Health Act Assessment (MHAA) since the age of 16 and thought ‘the odds have been stacked against me from the very start of this assessment. Simply because I am autistic.’ I didn’t believe there was any way I would get out of that room without being sectioned, and I believed that was because I was autistic.
Autistic people face discrimination in various parts of the healthcare system, and MHAA’s are no exception. These are carried out by an approved mental health professional (AMHP) and two doctors to decide whether an individual should be sectioned under the Mental Health Act (1983) (MHA). This legislation enables someone to be detained in hospital against their wishes for assessment and/or treatment of a mental health condition.
Every year, approximately 50,000 people are sectioned[1] and in February 2026 it was recorded that 2110 autistic people and/or people with a learning disability were detained[2]. However, considering that a 2025 review found that 89-97% of autistic adults aged 40 and over are undiagnosed[3], it is likely that significantly higher numbers of autistic people are sectioned than we know.
The conclusion of my MHAA was that I was to be sectioned. I don’t dispute that I was unwell. I also don’t dispute that there have been other times that the MHA has quite probably saved my life. But, whilst I awaited the outcome of that particular assessment, despite the fact that I was engaging with the crisis team, attending a day hospital, taking my medication, and the fact that other professionals thought hospital wasn’t necessarily required, it was glaringly obvious to me what the outcome would be. I believe that because of my autism, I never stood a chance of a different decision being made that day.
Fundamentally, the decision comes down to the AMHP and doctors gathering information and then assessing your mental state through observation and interview-style questions to decide whether or not you should be in hospital. But what happens when the assessment itself is what is influencing the individual’s mental state, presentation and distress, rather than any mental illness? Or, when professionals misinterpret autistic people’s communication, behavioural and social differences as signs of mental illness?
Autistic people are systematically disadvantaged in MHAA. I went into mine already in autistic meltdown because it had been sprung on me with no notice, and there was immediate uncertainty over the outcome. Autistic people tend to struggle with change, uncertainty and meeting new people, and I’d been given no time to process what was happening or to prepare, so I was already distressed. Mental health professionals use a Mental State Examination (MSE) to assess presentation – but this is based on neurotypical norms. It assesses eye contact, facial expressions, speech, body language, behaviour, mood, thought content and insight. My distress meant that I didn’t make eye contact, I paced around the room, I began drawing on the whiteboard – all attempts to cope with my distress, but which could easily be interpreted as symptoms of a mental illness.
Autistic people experience social and communication differences. The professionals – strangers – began firing question after question at me. Little to no regard was given to the fact that the questions themselves were increasing my distress, nor to the fact that I needed more time to process and answer them. Amidst a lot of tears, I recall saying to my nurse sat beside me, “I can’t answer this, there are too many questions, and these people are going to make decisions about my life”. Autistic people can need longer to process information and need it to be specific and clear. I couldn’t cope with the speed and tone of the questions and didn’t always understand what was being asked. This increased my distress, thereby influencing their perception of my mental state.
Regardless of the fact that my distress was so heavily impacted by the situation, it contributed to them justifying detaining me. My thoughts were racing and appeared all over the place – of course they did, I have ADHD, and I was distressed; I appeared upset – of course I did, the questions by nature were upsetting; I was unable to explain how I would keep myself safe – of course I couldn’t, because I was so overwhelmed that I couldn’t think clearly. Autistic people’s lack of eye contact, stimming, meltdowns and shutdowns may all be interpreted as evidence of a mental health condition or presence of risk, when the assessment itself may be a primary driver of their presentation, or their autistic traits may be being misinterpreted.
We talk about the need for reasonable adjustments at work, at school, even in healthcare appointments – but what about when it comes to such life-altering situations involving legal decisions like whether someone should be detained under the MHA? Where are the reasonable adjustments then? They could be as simple as:
- Ample notice being given
- Questions provided in writing as well as verbally
- Extra time given for questions to be processed
- The individual being able to write down answers
- Consideration given to the sensory environment
- The individual having a trusted person with them
It is crucial that reasonable adjustments are implemented during MHAA’s, and imperative that mental health professionals understand how autism affects any autistic people they are assessing. Otherwise, autistic people will continue to be systematically disadvantaged during an assessment that has the potential to be life-altering. I will always have to live with the effects of the decision that was made that day, in an assessment that discriminated against me simply because I was autistic.
[1] NHS Digital. (2025). Mental Health Act Statistics, Annual Figures, 2024-25. https://digital.nhs.uk/data-and-information/publications/statistical/mental-health-act-statistics-annual-figures/2024-25-annual-figures
[2] NHS Digital. (2026). Statistics on people with a learning disability and autistic people in mental health hospitals, AT: February 2026, MHSDS: January 2026. https://digital.nhs.uk/data-and-information/publications/statistical/learning-disability-services-statistics/at-february-2026-mhsds-january-2026
[3] Kings College London (2025). Around 90% of middle-aged and older autistic adults are undiagnosed in the UK, new review finds. https://www.kcl.ac.uk/news/up-to-90-of-middle-aged-and-older-autistic-adults-are-undiagnosed-in-the-uk-new-review-finds