Barriers to Mental Healthcare for Autistic and Non-Autistic Adults: An Investigation of Number, Severity and Type of Barriers Encountered

= 158) completed an online survey assessing 29 barriers adapted from the Barriers to Healthcare Checklist, rated by presence and severity. Barriers were categorised as person, provider or system related. Analyses of variance compared groups on the mean number and severity of barriers, and chi-square tests compared group incidence of each barrier. Overall, systemic barriers (e.g. cost) and difficulties with system navigation (e.g. finding services) were the most commonly reported barriers and rated as the most severe. Autistic participants experienced a significantly higher number and severity of barriers than non-autistic participants. Provider-related barriers (practitioners' knowledge, attitudes and skills) were particularly severe for autistic groups. In contrast, person-level barriers (e.g. sensory sensitivities), though often reported in general healthcare, were less impactful in mental healthcare. Findings suggest that efforts to improve mental healthcare access for autistic people should prioritise addressing the most frequent and severe barriers: system and navigation challenges, and practitioner knowledge and skills in autism.Lay abstractAutistic people often experience poor mental health but face many challenges when trying to access mental healthcare. These challenges can include things like high costs, difficulty finding the right support or healthcare professionals not understanding autism. We looked at whether autistic adults face more or different barriers to mental healthcare compared to non-autistic adults. We surveyed over 500 adults, including those with a formal autism diagnosis, those who self-identified as autistic, and non-autistic adults. The survey asked about 29 possible barriers to getting mental healthcare. These included things related to the person (such as anxiety, sensory sensitivities or difficulty finding services), the healthcare provider (like psychologists' and psychiatrists' lack of autism knowledge, or poor communication) and the healthcare system (such as long waiting lists or high cost). We asked whether participants had experienced each barrier and how much each one affected their ability to get help. We found that nearly everyone experienced some barriers, especially challenges with the healthcare system and knowing how to find help, but autistic participants faced more barriers and were more strongly affected by many of them than non-autistic participants. Compared to non-autistic people, autistic people had a lot of problems with providers which prevented them getting the care they needed. We concluded that, to improve access to mental health support for autistic adults, we need to focus on the most common and harmful barriers: making the system easier to use, reducing costs and improving practitioners' understanding of autism and working with autistic people. By addressing these areas, we can help ensure that autistic people receive the mental healthcare they need.