In Times of Need: Psychiatric Emergency Department Presentations in Autistic Adults

Background: Autistic individuals exhibit greater vulnerability to mental health challenges than the general population, yet they lack access to adequate mental health care. Barriers to seeking and receiving adequate mental health care, such as minority stress, adverse life events, discrimination, and stigmatization can result in increased reliance on general and psychiatric emergency departments (ED/PsyED) during mental health crises. There is however limited research detailing PsyED use in autistic adults. Methods: This large-scale retrospective chart review analyzed PsyED visits by autistic adults (aged 16 to 63) in an urban psychiatric hospital in Canada from 2018 to 2020. Data were collected from 345 autistic patients who had 1027 PsyED visits during this 3-year period. Demographic information, psychiatric and neurodevelopmental diagnoses, and reasons for PsyED visits were characterized. Predictors of reasons for visiting PsyED were examined using mixed-effects logistic regressions. Differences between single-time and recurrent visitors were explored. Results: Autistic patients were mostly white (56.2%), Canadian citizens (79.1%), heterosexual (50.7%), and assigned male at birth (72.2%). Many were of low socioeconomic status, with one-third earning less than 15,000 Canadian dollars yearly. Most (84.3%) had at least one co-occurring mental health condition, with 54.8% having two or more. Rates of attention-deficit/hyperactivity disorder and intellectual disability were both around 20%. Most frequent reasons for visits included suicidality (42.9%), aggression (24.6%), and mood symptoms (16.1%). Reasons for visiting PsyED were associated with specific mental health and neurodevelopmental diagnoses. Recurrent visitors (40.3%) did not differ in sociodemographic characteristics from single-time visitors, but had more complex clinical presentations. Conclusion: Mental health needs of autistic adults were high and complex in the PsyED setting, particularly those needing recurrent emergency visits. Addressing service gaps and barriers to ongoing mental health support is essential to enhance the continuity of care.