A Neurodevelopmental Perspective on Navigating Section 136: How Can Police Officers and AMHPs Help Reduce Distress?

By Sarah Clark

Understanding Autism: A Neurodevelopmental Perspective

Having been (inappropriately) detained on a number of occasions under Section 136 of the Mental Health Act, without reasonable and practical steps taken to assess whether I lacked capacity, I aim in this blog to suggest steps and guidance for professionals when faced with autistic people in suicidal distress.

I was previously under a Community Mental Health Team for some fifteen years and misdiagnosed with Emotionally Unstable Personality Disorder (EUPD). It wasn’t until I attended lectures on autism during my MSc in Clinical and Developmental Neuropsychology that it dawned on me that I could be autistic. A year later, in May 2022, I was formally diagnosed as being autistic. I was also diagnosed with hypermobile Ehlers-Danlos syndrome (EDS) in February 2020.

Over several decades, I have experienced suicidality due to severe physical pain from EDS and associated conditions. However, when I disclosed my thoughts of suicide, police officers and other professionals often just automatically assumed these thoughts stemmed from "mental illness" without making any effort to discern whether I had the capacity to make decisions about my care.  This led me to having to make the point that some people with chronic physical conditions can be suicidal without being mentally unwell. 

Interestingly, since my autism diagnosis, although I’ve still struggled with suicidality and had contact with police during episodes of acute distress caused by physical pain, I have not been detained under Section 136 in recent years—something I’m hugely grateful for. Previously, when EUPD was seen as my sole diagnosis by all professionals, any contact with police for a welfare check almost inevitably resulted in a Section 136 detention.

Recognizing Autism Without a Formal Diagnosis

Autism is a neurodevelopmental difference, often characterized by differences in communication, social interaction, and sensory processing. Autism is not a mental illness but a neurodevelopmental difference. This distinction is vital for professionals tasked with making decisions under Section 136. Misunderstandings about autism can lead to inappropriate interventions that paradoxically exacerbate risk and distress rather than alleviate it.

However, what happens when a person is undiagnosed? Police officers, AMHPs and doctors can still consider whether an individual might have autistic traits by observing certain behaviours and interactions:

·       Literal Communication: Difficulty understanding abstract language or metaphors.

·       Sensory Sensitivities: Overwhelm caused by bright lights, loud sounds, or chaotic environments.

·       Stimming Behaviours: Repetitive actions like rocking, hand-flapping, or fidgeting, often used for self-regulation.

·       Difficulty with Eye Contact: A tendency to avoid or find eye contact uncomfortable (although some autistic people can make eye contact with no difficulty).

Professionals can potentially engage with people who know the individual, such as family, friends, or carers, to gain additional insights into their needs. If autism is suspected but unconfirmed, it is still essential to adjust practices to account for potential sensory sensitivities, communication differences, and the impact of environmental stressors, and avoiding restrictive practices as far as possible.

Autism, when viewed through the lens of the medical model, is often described in terms of perceived deficits—such as challenges with social communication, sensory processing differences, and repetitive behaviours.

However, it is vital for practitioners to adopt a neuro-affirmative, experience-sensitive, and strengths-based perspective, focusing on the individual's unique abilities and lived experiences rather than solely emphasising challenges or deficits.

Why Poor Mental Health Often Co-Occurs with Autism

The co-occurrence of poor mental health in autistic individuals is influenced by multiple factors:

·       Social Isolation: Difficulties forming and maintaining relationships can lead to profound loneliness.

·       Masking and Camouflaging: Many autistic individuals suppress their authentic selves to fit societal norms, leading to mental and emotional exhaustion.

·       Sensory Overwhelm: Environments that fail to accommodate sensory sensitivities can trigger stress and anxiety.

·       Stigma and Discrimination: Persistent misunderstandings and marginalization contribute to low self-esteem and hopelessness.

These factors can collectively create a heightened vulnerability to suicidal ideation, making it imperative for professionals to adopt a nuanced and empathetic approach.

Recognizing Suicidal Crises in Autistic Individuals

A suicidal crisis may manifest very differently in autistic individuals. Traditional markers, such as verbal expressions of intent, may be absent or obscured by literal communication styles or masking behaviours. Instead, professionals should remain alert to less conventional indicators:

·       Changes in Routine or Behaviour: Withdrawal from preferred activities or rigid adherence to routines despite evident distress.

·       Non-Verbal Communication: Increased use of stimming, agitation, or avoidance behaviours.

·       Rumination and Obsessive Thoughts: Persistent fixation on themes of death or self-harm, which may be expressed indirectly.

Separating Mental Health from Environmental Factors

It is essential for police officers and AMHPs to carefully consider whether a person’s distress stems from a mental health condition, environmental factors, or sensory overwhelm. By exploring these possibilities, professionals can better tailor their approach and avoid exacerbating distress.

For example, sensory overwhelm from loud noises or bright lights could be the primary trigger for a person’s crisis, rather than a psychiatric condition. Addressing the sensory environment is crucial, but should be considered separately from assessing mental health.

The Role of Masking in Assessing Risk

Masking—the deliberate suppression of autistic traits to conform to societal expectations—can complicate risk assessments. An individual may appear calm and composed outwardly while experiencing intense internal distress. It is essential to look beyond obvious surface behaviours and build trust to uncover the underlying emotional state.

Environmental and Sensory Factors

What professionals often term “challenging behaviour” often stem from environmental and sensory triggers. Bright lights, loud noises, and chaotic settings can overwhelm an autistic individual, escalating their distress, and compromising their communication abilities.

Recognizing these factors, and taking small steps to make reasonable adjustments can help de-escalate crises and inform supportive interventions.

The Impact of Section 136 Detention

For autistic individuals, detention under Section 136 can be a profoundly traumatizing experience. Factors contributing to this include:

• Physical Contact and Restraint: These can trigger sensory overload and exacerbate feelings of vulnerability.

• Coercion and Detainment: The lack of autonomy in a Section 136 suite can intensify distress.

• Sensory Overwhelm: The clinical environment—with its bright lights, noise, and unfamiliarity—can lead to sensory shutdowns or meltdowns.

These experiences not only fail to address the crisis but can also result in long-term trauma, reducing trust in mental health services.

Alternatives to Section 136 for Autistic Individuals

Whenever possible, alternatives to Section 136 should be explored. These include:

• Crisis Support Networks: Engaging family, friends, or trusted community members to provide immediate support.

• Specialist Autism Teams: Consulting professionals with expertise in autism to inform decisions.

• Safe Spaces: Identifying or creating environments that reduce sensory stimuli and promote calm.

Creating a Safety Plan

A proactive safety plan can prevent crises and provide a roadmap for managing distress. Key elements include:

• Sensory Preferences: Identifying environments that are calming or triggering.

• Communication Strategies: Establishing clear, non-confrontational ways to express distress.

• Trusted Contacts: Listing individuals who can provide support during challenging times.

• Interests and Hobbies: Incorporating activities that bring joy and stability.

How can professionals help?: De-escalation Strategies

When faced with a crisis, the priority is to reduce immediate distress. Effective strategies include:

• Maintaining Calmness: Use a soft voice, neutral body language, and steady eye contact (if appropriate).

• Co-Regulation: Offer calm presence and reassurance, helping the individual regain emotional equilibrium.

• Building Rapport: Ask about their interests, pets, or favourite activities to create a connection.

• Avoiding Restraint: Physical intervention of any kind should be a last resort, as it often exacerbates distress.

Supporting Decision-Making

Autistic individuals may experience challenges with executive functioning, particularly during crises. Allowing extra time for responses and simplifying choices can help.

It is vital to assume capacity and make every effort to discern whether distress stems from a mental health issue or an environmental factor and sensory overwhelm, due to loud noises, bright lights, distressing environments, or being restrained.   

Reducing Distress: Practical Recommendations for AMHPs and Place of Safety Teams

Creating an environment and approach that minimizes distress can make a significant difference for autistic individuals. Here are proactive steps that AMHPs and place-of-safety teams can take:

1.     Be Aware of Body Space: Ensure interview spaces are not cramped and allow for comfortable communication.

2.     Speak to Trusted People: Engage with family members, carers, or friends who know the person well to understand their baseline behaviours and needs.

3.     Environmental Adjustments:

o   Reduce sensory stimuli such as bright lights or loud noises.

o   Offer quiet, low-stimulation spaces for individuals to self-regulate.

o   Provide access to familiar items like weighted blankets or comfort objects.

4.     Communication Strategies:

o   Use clear, concise, and direct language.

o   Allow extra time for responses and avoid pressuring the person.

5.     Build Trust and Rapport:

o   Speak calmly and respectfully.

o   Acknowledge the person’s distress without judgment.

o   Ask about their hobbies, interests or pets to create a connection and build rapport. 

The Importance of Listening and Validation

Autistic individuals often feel "othered" by society, which can compound feelings of despair and lack of thwarted belonging.  Listening without judgment and validating their experiences can make a significant difference. Acknowledge their struggles while reinforcing their inherent worth and dignity.

Conclusion

Intervening in a suicidal crisis involving an autistic individual requires a thoughtful, informed, and compassionate approach. By understanding the unique challenges faced by autistic individuals and adapting practices accordingly, AMHPs can provide support that is not only effective but also affirming of their humanity.

Section 136 should always be a measure of last resort. With the right tools, strategies, and mindset, we can create a system that respects neurodiversity, promotes trust, and fosters hope—even in the darkest moments.

Sarah Clark is a late-diagnosed autistic individual with an interest in the overalps between autism and Ehlers-Danlos syndrome, a mental health advocate, Expert-by-experience autism trainer, author, photographer and has an MSc in Clinical and Developmental Neuropsychology. 

Website: https://floatawaytrauma.wordpress.com/publications/

Twitter: @sarah_clark_84

LinkedIn: Sarah Clark