frequently asked questions.
Why do we need suicide-risk tools specifically for autistic adults?
Autism doesn’t end at childhood - it's a lifelong neurodevelopmental difference.
Because autism is lifelong, we need to use adapted tools and provide autistic-led training to help clinicians accurately assess suicide risk in autistic adults.
Conservative estimates indicate autistic adults have a 5-to-7 times greater risk of dying by suicide than the general population. This is amongst the highest rate of any disability or other suicide prevention priority group (i.e., groups of people at higher risk than people in the general population).
The high level of suicidal thoughts and behaviour among autistic adults reflects that their mental health needs have been overlooked by the mental health sector for too long - rather than ‘core business’, autism was considered to sit within the disability despite the fact that professionals within the disability sector were also poorly equipped to manage complex mental health conditions.
In Australia, autistic adults have presented with suicidal thoughts or behaviour at healthcare institutions and were assessed, only to be sent home the same day. In some cases, this preceded another suicide attempt or escalation on the same day as discharge, sometimes with fatal outcomes. This is likely, in part due to social communication differences which are core to the autism condition, leading to minimisation of symptoms or failure to acknowledge the severity of presentation. This is unacceptable.
Autistic adults face unrecognised mental health pressures which is why neuro-affirming care is so helpful, as opposed to a traditional one-size-fits-all approach which can underestimate the risk to their lives.
Is autism the cause of the mental health and suicide crisis?
Being autistic does not make you suicidal.
Suicide risk comes from co-occurring mental health challenges like anxiety, depression, and trauma that come from living in a society that may not accommodate the needs of autistic adults.
Autistic adults experience marginalisation such as social isolation, bullying, and victimisation, and under-employment. These factors further compound poor mental health and elevated suicide risk.
Autistic adults are similarly marginalised when accessing healthcare services, especially if clinicians do not have the skills to work with them.
Shouldn’t the disability sector be handling this?
The disability sector isn’t set up to treat complex mental health issues, but mental health services aren’t usually adapted to help autistic adults. This service divide led to autistic people being “bounced around” between services and told that the services or professionals are not equipped or trained to work with them.
The purpose of the tools, resources and training contained within span.toolkit is to bridge the gap between disability and mental health systems. By acknowledging and building on the skills that mental healthcare clinicians already have, we firmly believe they are best suited to meet the mental health needs of autistic adults. In many instances, the “missing piece” was the voice of autistic people.
Our goal was to provide this voice, so that professionals can clearly hear what the autistic community needs to enable better and more appropriate support in a diversity of healthcare settings.
In addition, we draw on the expertise of professionals and services who, through a variety of innovative programs, are doing this. We document the broad, positive impact this has had on the health service as well as potential cost savings through avoiding higher-level care (e.g., inpatient care and return visits to emergency departments).
Why are mental health practitioners the right people to lead?
Suicide thoughts and behaviour are linked to the mental health conditions that co-occur with autism.
Autism-adapted tools and training can unlock the expertise clinicians already have, so they can use their skills to make decisions about treatment and support with confidence.
Our approach recognises that mental health professionals are the experts in their field, but also acknowledges that many have not received sufficient training in autism, particularly in adults, and the issue of co-occurring mental health conditions.
Through listening to, identifying, and incorporating the views and needs of healthcare professionals in the development of span.toolkit, we are confident that the resource will meet sector needs.
span.toolkit complements the way mental health care is delivered rather than replaces available expertise.
How do the tools help in a busy clinical setting?
We identified that one of the most important factors in suicide prevention among the autistic community was to first ask about suicide and second, to validate and believe the person’s response. For autistic people, this requires a level of understanding about autism, and the social communication differences inherent in the condition.
Our autism-adapted tools aim to address the barriers associated with these social communication differences - they are co-developed with autistic people, and are designed to be clear and quick to administer. The tools we provide in span.toolkit are also tested and peer-reviewed, so professionals can be confident in their use.
span.toolkit guides practitioners to assess distress and suicide risk without adding significant workload, and is easily integrated within existing healthcare systems and protocols.
The training is presented in a series of short videos, most are under 10 minutes duration, and can be watched during breaks.
Clinicians who have adopted the tools into their practice have reported that they use the adapted tools with non-autistic patients too, having found that the concrete language and visual response guides are helpful for use with different clinical cohorts who are experiencing distress - particularly clinical groups characterised by social communication differences or barriers.
span.toolkit is a great example of how transitioning toward inclusive design in healthcare provision can have wider benefits for all patients and service users.
Do the tools offer more than a risk rating?
Yes - our tools are designed to quickly identify thoughts and behaviour related to suicide, supports, and current stressors. Specific clinical recommendations are provided based on responses.
Risk stratification (classifying suicide risk as ‘low’, ‘medium’ or ‘high’) does not work and is a poor predictor of a suicide attempt; thus there is potential to miss people at risk.
In span.toolkit we adopt a conservative approach, where any suicidal thoughts or behaviour should be addressed as potentially leading to a suicide attempt. We encourage clinicians, in collaboration with the individual, to engage in ongoing monitoring, identify supports, connect the individual to appropriate services, take the time to develop a useful and individualised safety plan, and include suicide as part of any ongoing treatment or intervention plan.
Specifically, span.toolkit assessment:
-
treats anyone with a history of suicidal thoughts or behaviour as being at possible risk of a suicide attempt;
-
highlights which co-occurring conditions may contribute to suicidal thoughts and behaviour; and
-
provides clinicians with suggested, actionable information for triage and treatment decisions.
By moving away from the ‘low’, ‘medium’ or ‘high’ risk of suicide, our tools help clinicians to understand suicidal thoughts and behaviour as other mental health conditions that are treatable, and should be treated, so long as they are identified early.
Isn’t this just a niche issue?
No. Inclusive, neurotype-aware design which improves the standard of care for autistic adults is likely to benefit anyone with social, communication, sensory, or cognitive differences.
Do these tools actually work in practice?
Yes. The span.toolkit website features testimonials from clinicians, researchers, and autistic adults describing how using the tools can improve understanding and the standard of care on offer.
The screening and assessment tools we adapted have been used in both research and practice - for example, in the alcohol and other drug sector in Australia.
The toolkit is designed to supplement rather than replace existing professional guidelines, training, and tools, and to empower healthcare professionals to provide a higher standard of care for autistic and other neurodivergent populations.
What makes adult assessments different from those used for autistic children?
Children are still growing and need support that considers their developmental needs. Autistic adults present with decades of lived experience, which may include factors such as masking, trauma, and burnout - they need tools designed for their adult reality.
Autistic adults often say they are treated as ‘unreliable narrators’ of their own experience and that this did not help to foster a sense of trust in the mental health system. By using tools designed for and with autistic adults, and listening to and supporting their needs, you can play an important part in helping autistic adults to overcome past harms and build their trust in mental and other healthcare systems.
Why adopt autism-adapted tools now?
By engaging with span.toolkit, you are supporting the work of the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability, which called for accessible systems, better quality and safety in health care, and improved training and workforce skills.
The Australian Bureau of Statistics found that the total number of autistic Australians recorded between 2018 and 2022 jumped by more than 40 per cent.
The growth of the autistic cohort shows that there is a need to equip the mental health workforce with adapted tools and training so it can better support the next generation of autistic adults.
The autism-adapted tools and training within span.toolkit are a product of collaboration and extensive consultation with mental healthcare professionals, autistic adults, autistic and non-autistic researchers, autistic clinicians, and people with lived experience of suicide.
Our lived experience-led and evidence-based approach provides clinicians with a practical and reliable way to identify suicide risk and intervene earlier to help autistic adults.