“Why does someone need to have a crisis before anyone will do anything?”: Perspectives of Autism Intensive Support Team staff

Autistic adults have a heightened risk of developing mental health conditions, but limited access to autism-informed community support, which is an internationally recognised issue. Consequently, the risk of crisis and hospitalisation is increased. Intensive Support Teams (ISTs) were created as part of the NHS Transforming Care Agenda (TCA) to work directly with autistic people and/or people with an intellectual disability and their families or indirectly with other professionals to prevent hospitalisation. Little is known about the functions of ISTs for autistic people, a pertinent issue given the rising number admitted to mental health hospitals in England. The present qualitative study aimed to explore the perspectives of multidisciplinary professionals working within ISTs for autistic adults in England to provide insight into team functions and barriers or facilitators to reducing hospitalisation. Using convenience sampling, eight multidisciplinary professionals from four NHS England Trusts completed a brief demographic survey and individual semi-structured interviews conducted online. Data were transcribed verbatim and thematically analysed (Braun and Clarke, 2006). Four overarching themes and eleven subthemes were identified: (1) Developing new autism-informed approaches to care, (2) Policy in practice, (3) Gaps in mental health provision, and (4) Transforming care. The present findings highlight factors which enable ISTs to reduce hospital admissions of autistic adults, for example, utilising a collaborative and flexible approach. It also highlights the systemic issues which hinder the function of the IST, including a lack of autism-informed community support and a lack of resources. Suggestions of changes to the IST and wider mental health system may support international incentives to reduce reliance on mental health hospitals and to improve mental health support in the community for autistic adults. Further research conducted with autistic people and their families, and staff working in/with ISTs is now needed to clarify inconsistencies in IST eligibility criteria and better understand facilitators for change. • Intensive Support functions are facilitated by collaboration and flexibility. • Proactive mental health support for autistic adults is needed in the community. • Possible changes to Intensive Support Teams were suggested. • Challenges to applying aspects of English national policy were identified.