Understanding the Communication Needs of Autistic Individuals To Facilitate Engagement (UNITE): Exploring Mental Health Hospital Ward Rounds in Practice.

Autistic people are more likely to have co-occurring mental health difficulties and more at risk of a hospital admission. Arguably, their diagnosed communication differences may be contributory factors to this risk. Communication difficulties are also potential barriers for client participation in their care. However, less visible barriers are also at play because of the ways autistic people are represented in clinical interactions and power relations in mental healthcare. The UNITE research is a mixed qualitative methodologies study, drawing on two data sources. First, it involves the analysis of twelve video recordings capturing hospital ward rounds, employing critical discursive psychology as the analytical framework. Second, it incorporates thirty-six interviews conducted with staff and clients, which were analysed using reflexive thematic analysis. Each provided evidence to address separate but related research questions regarding the character of autistic communication needs, and the extent of involvement in ward rounds. Collectively, they provided evidence to address a third question about how to promote client voices in their care. The synthesis found a deficit approach still dominated staff understanding of autistic communication needs and the existence of mental health overshadowing. Many clients did not attend their ward rounds and when they did attend, institutional ways of conducting business meant that clients were not involved meaningfully, and the power of psychiatry was evident. Positively, there was evidence of client involvement activity in routine care processes markedly in the learning disability service. A nine voices model is suggested to help staff to think about how they tacitly evoke client voices. This research makes an important contribution to the field of autism. Its identification of the deficit based approach to understanding autistic needs, mental health overshadowing and the resultant loss of autistic identity for individuals in mental health hospitals shines a spotlight on how communication differences are being overlooked.