Autism is not a mental health condition but autistic adults and children suffer disproportionately from poor mental health. Too often, when reaching out for help, there aren’t any services available. Our research also suggests even when an autistic person is offered treatment, therapy is not adapted or adjusted to support their needs so they are unable to benefit fully from it. Making changes (also known as ‘reasonable adjustments’) to the way the therapy or the service is delivered can make a huge difference. 

This guide is designed to help you understand what reasonable adjustments are, what adjustments have helped other autistic people, and to support you to ask for adjustments you might need. There is also a template letter you can download and adapt to ask for reasonable adjustments. 

What are reasonable adjustments? 

Autistic people are entitled to reasonable adjustments under the Equality Act 2010. The NHS and other services have to make sure that people with disabilities can use the same services as people who do not have disabilities. In order to do so they might need to make some changes to how they deliver their service to suit someone’s individual needs. This means that mental health services must make changes or adjustments to how they provide their services if it is reasonable to do so. This is called making reasonable adjustments.  

All services have a duty to consider in advance what they can do to make their services accessible to everyone using them. We know from our research, however, that in many services staff do not have enough knowledge of autism to understand what changes they might need to make. Although staff working in mental health services should ask you what adaptations and adjustments they can make, sometimes it can be useful to think about what might help you and ask for them yourself. You can ask for the adjustments at any point, not just when you first get referred to a service. It may also be helpful for you to get support from friends, family or an advocate to think about what changes might be best for you.

Adjustments that services can make include:

• reasonable adjustments before therapy starts
• reasonable adjustments to your therapy sessions.

Whether something is reasonable depends on the size of an organisation, the resources they have to make adjustments and the type of services they provide. It also depends on what changes or adjustments are needed and how practical or easy it is to make them.

What reasonable adjustments could I ask for?

Your therapist should help you to understand what adjustments are possible as well as what you might need. This is a conversation you should be able to have many times, both when you are first referred to a service and during your therapy.

Based on our mental health survey of 1,500 autistic adults, here are some of the changes that some people have found work for them: 

Reasonable adjustments before therapy starts

• Contact with the service – if you find speaking on the phone difficult, you could ask if appointments could be arranged over text or email instead.
• Information before therapy starts – do you need more information before therapy starts? Some people found that being told who their therapist was, what therapy would look like, what would be expected of them and visual information such as pictures of the waiting and therapy room helped them to prepare for their first session and lowered their anxiety. You could also ask for this to be provided in a pre-appointment letter or email.
• Waiting rooms – waiting rooms can be overwhelming. Some services are able to make their waiting rooms better sensory environments by minimising clutter and reducing bright lighting for example. Or you could ask if you could wait outside or in your car and be contacted when your therapist is ready to see you.
• Number and length of sessions – you could ask to change the number and length of sessions you are offered. You might, for example, need more time to process what your therapist is saying or you could need more time to build initial trust. It might be possible to offer you more or longer sessions. Alternatively, you might find it easier if sessions are shorter, so you don’t feel overloaded. 

Reasonable adjustments to your therapy sessions

• Bringing someone with you to sessions – for some people, having a chosen person to attend sessions with them has made a big difference. They might help you to express how you are feeling. Or you could do the majority of the session alone but have your chosen close person come in at the end to listen to any homework the therapist sets to help with strategies you have been working on.
• The therapy room – are there adjustments that can be made to the room to make it easier for you to engage in sessions? Could changes to the lighting be made? Is there a way of minimising outside noise? You could bring something from home into the room such as a cushion to make you feel more comfortable.
• For video calls – would a video session work better for you? If you are undertaking therapy sessions over video call, could you ask if your therapist can use a neutral background? Would you find it easier to turn your camera off?
• Communication support – how can your therapist adapt their communication for you? Does it help you to understand when people write things down? Does it help when you write things down? Could they give you some visual support too such as drawing things or providing drawings? Some people find it easier to communicate if they are doing something else at the same time such as drawing or painting. Some people find it difficult to always fully focus during the session so being able to record sessions and play them back later is really useful.
• Session structure - some autistic people and therapists find it really useful if the session follows an agenda. This is something that can be agreed together and used throughout sessions to maintain focus. Having the same agenda every session really helps some people to know what to expect.

These are just some of the examples that autistic people have shared with us. It is not a full list of all the adjustments you could ever ask for or what might help. Having ongoing conversations with your therapist about what might work best for you is a really good way to make sure everything in the sessions is as helpful as it can be for you. 
 

Letter/email template

The following template can be used as the basis of writing a letter or sending an email asking for reasonable adjustments. To personalise the template to your own situation, simply copy and paste the text and add the specific details in the areas shown in bold text within square brackets.

Dear [name of the person or service you are writing to],

Subject: Reasonable adjustment request

I am autistic and would like to ask you to make some adjustments to support me to use your service. These will help me to take part in therapy and get the most from it.

The National Autistic Society and Mind have created a Good Practice Guide at www.autism.org.uk/talking-therapies to support professionals to make adaptations and adjustments for autistic people. Here are some that I think would help me.

[Consider the adjustments described above, and include examples that would be helpful for you before therapy and during therapy. You might also want to add why these adjustments are important for you.]

The Equality Act 2010 says that services, including mental health services, have a duty to make reasonable adjustments for a person with a disability so they are not at a disadvantage when compared to someone who does not have a disability. 

These adjustments include:

• changing the way things are run
• changing the physical environment
• providing extra aids and services.

If it is reasonable for the service to make a change, then it should be made.

I believe that as an autistic person, under the Equality Act 2010, I am entitled to the reasonable adjustments I have requested. I know they would help me engage with your service.

I would be happy to discuss this request [insert preference, for example ‘via email’] in more detail, but I would like a written response within 14 days.

Yours sincerely,

[Your name and perferred contact details]