Participants described what they view as dysfunction in various areas of autistic students’ social and cognitive abilities, such as “persistent difficulties in social communication” (SLT-5), “rigidity of thought” (SLT-20), and limited understanding of “emotions” (SLT-18) and ability to “to adapt and adjust to change” (SLT-13) in classroom engagement, peer and staff interactions, and engaging with mental health support. A few participants suggested that students must adapt to the neurotypical world and school life independently of their neurodivergence.

Participants reported a significant number of students either formally diagnosed or informally identified as being “on the radar” (SLT-3), with many only being recognized following mental health distress arising from unmet needs.

Most participants thought that autistic students struggle to attend therapy due to autistic traits.

Many reported appreciations for autistic students’ ability to think “outside the box” (SLT-12), recognizing that they are not a monolith and they “present in different ways” (SLT-16) in terms of struggles, strengths, and needs. Appreciation of autistic identity was emphasized by participants who have personal relationships with autistic individuals.

Many highlighted how environmental adversities, particularly demanding “sensory environment” (SLT-16), contribute to autistic students feeling “anxious” (SLT-9) and “overwhelmed” (SLT-19). Masking was linked to increased challenges in navigating social relationships, with participants noting that masking is “exhausting” (SLT-14) for autistic students and can lead to being a “school refuser” (SLT-9). Most considered the role of “reasonable adjustments” (SLT-7) to better accommodate autistic students in both classroom and mental health school support.

The majority of participants reported having a stand-alone policy on student mental health, while others mentioned that mental health provisions were integrated into broader school policies.

Regardless of whether policies on student mental health were standalone or integrated, participants shared a common goal of developing an “umbrella” (SLT-18) policy for mental health that serves all students and “fits all” (SLT-6).

These umbrella policies broadly mention SEND students, without any specification on different types of neurodivergences and/or autism.

Notably, those involved in SEND-related roles reported putting extra effort to ensure autistic students were not “left out” (SLT-1) in the SLT discussions.

Mental health awareness school efforts were commonly integrated into discussions and assemblies during “form time” (SLT-1), “nurture sessions” (SLT-2), “mental health week talks” (SLT-5) or “neurodiverse days” (SLT-17). There was no consideration of adaptations of material for autistic students attending these, where everyone has “the same provision” (SLT-11), and, in fact, autistic students were often struggling to attend due to sensory and social demands.

Participants also highlighted difficulties in communicating nuances around emotions, consent and boundary-setting, as well as autistic students’ struggles in engaging in discussions, which often required schools to consider “back up” (SLT-18) sessions to minimize the gap for autistic students.

To address these gaps, some participants suggested delivering PSHE in “smaller groups” (SLT-4) and using staff with “training and confidence” (SLT-2) to work with autistic students and support the regular teacher.

The PSHE curriculum was flagged as a primary provision for raising mental health awareness with notable limitations and potential negative impacts for autistic students, especially with sensitive topics like suicide or discussions on “sex and relationships” (SLT-2).

Self-harm, healthy relationships, and sex education were all reported to be top topics presented to students. Staff often relied on in-house training during Inset days or assembly meetings to gain in-depth information on how to approach these. Autism-specific awareness was largely absent and limited to sharing “learning profiles” (SLT-6) and generic good practice on “inclusion strategies” (SLT-9).

Autism training was considered important but was rare to be available.

Participants primarily relied on staff to record wellbeing, behavior or safeguarding related information on different platforms. Teaching staff, as daily points of contact, were key to pass their concerns through “observing students” (SLT-5).

During this identification process, staff with SEND duties familiar to the autistic student are often involved. While some mentioned using standardized screeners such as Strengths and Difficulties Questionnaire or emotional resilience scales, others wondered if these were appropriate for autistic students and noted the gap in autism-specific tools.

When it comes to identification, although participants thought that it was “easier” (SLT-6) to monitor autistic students and spot “changing behaviors” (SLT-16) than the broader student body, due to existing “care package[s]” (SLT-13) and “proactive check-in[s]” (SLT-2), identification of specific mental health issues was harder due to teachers’ misconceptions that anxiety could be “part of autism” (SLT-10).

During the identification process, most schools engaged parents to gather observations and share available support options. A common adjustment in the identification process included involving a “trusted audience” (SLT-16), such as parents or familiar staff, to help students feel at ease. Other adaptations included meeting in “alternative settings” (SLT-4), aligning discussions with students’ interests (e.g., during “football” [SLT-8]), or giving “enough notice” (SLT-3) to support preparation. Communication strategies ranged from using a “calmer way” of speaking (SLT-4) and “carefully chosen words” (SLT-15), to tools like “social stories” (SLT-11) and the “emotion wheel” (SLT-19), making the process more “ASD friendly” (SLT-2). Once needs were identified, common support pathways included counseling and conversations with pastoral staff. Access to additional services, such as school nurses or MHSTs (Mental Health Support Teams), varied. Many participants noted that support for autistic students was often “the same” (SLT-21) or “similar” (SLT-12) to that for non-autistic students.

In these pathways, participants were considering additional support, which often involved internal staff or external staff, such as “speech, language and communication team” (SLT-19), “specialist autism team” (SLT-6), “learning support team” (SLT-13) or “SENCO” (SLT-14), delivering emotional literacy, social skills, or zones of regulation interventions.

However, their involvement “do not tend to fall under the mental health needs area” (SLT-3) and the emphasis remains on interventions that focus on core autistic traits.

Participants expressed “worry” (SLT-14) and pressure over governmental expectations for schools’ role for mental health, which they felt were “unrealistic and unreasonable” (SLT-4) and did not reflect what is “doable in schools” (SLT-11) on a daily basis. Despite recognizing the “increasing mental health need” (SLT-17) among students, they noted a lack of government support, and that mental health is just one of many competing priorities.

Many found it challenging to “devote” (SLT-8) time to engage in actions to support autistic students’ mental health as they are “consumed” (SLT-2) by other responsibilities set by Ofsted and louder priorities in the “school corridor” (SLT-15).

Participants identified funding constraints, resource shortages, and long waitlists for both in-school support, such as counseling, and external services like CAMHs (Child and Adolescent Mental Health Services) due to “massive waiting lists” (SLT-6) and “strict criteria for referrals” (SLT-11) as primary barriers for schools’ capacity to organize adequate support.

Notably, autistic students faced additional barriers in accessing school support as many participants found supporting autistic students “hard” (SLT-2) and “tricky” (SLT-9) due to gaps in professional competence in the schools’ existing support capacity and felt they “do not know how to make it right” (SLT-15).

For example, counseling -the primary mental health support available in schools- is often inaccessible to autistic students, as counselors are not “trained in that [autism]” (SLT-10) and are hesitant to work with autistic students as it “frighten(s)” them (SLT-22).

Further, beyond long waitlists, participants highlighted additional challenges in coordinating mental health support for autistic students with local services and external professionals. Some participants reported facing rejection from local services, such as CAMHs, as students’ struggles were deemed “ASD problem” (SLT-8) rather than a mental health problem.

Even though autistic students accessed local services or MHSTs programs, some participants raised concerns that building “trust” (SLT-6) and “relationship” (SLT-12) with therapies and services may be challenging for autistic students due to the lack of adaptations in the service delivery.

The “shortage” (SLT-10) of external professionals competent to work with autistic students and the limited “resources to call upon” (SLT-7) often left school staff in “severe worry” (SLT-14) about who can support autistic students and who is out there.

While key staff (i.e., pastoral staff, mental health lead, inclusion staff) were consulted in shaping school policy and provision for mental health, input from parents or students was rarely considered. Some participants mentioned that most parents are sources of “trusted information” (SLT-7), with only a few sharing that information coming from the parent surveys may feed into decisions. Engagement with parents is mainly described as supportive for staff to figure out practical accommodations while reviewing EHCPs or pupils’ passports.

Participants acknowledged the challenges of parents of autistic students, noting they are “crying out of help” (SLT-15), not “confident” (SLT-2) in engaging with schools due to past negative experiences, and feel “stigmatized” (SLT-3) since schools do not openly talk about autism. They recognized parents’ “justified frustration” (SLT-8) as schools struggle to make things work to meet their child’s needs. Emphasizing schools’ role in advocacy, participants stressed the importance of “really listening” to parents (SLT-20) and building their “trust” (SLT-2) to foster positive relationships.

Strong parent-school relationships were seen as key to improving “proactive” (SLT-16) mental health provision for autistic students. Participants highlighted the “power of parent voice” (SLT-11) in raising staff awareness and facilitating an aligned approach with parents and school, given that parents know their autistic child better. However, only a few efforts were reported to be in place to strengthen professional-family collaboration such as running “parent sessions” (SLT-6) on mental health in rare cases, signposting information on the “school website” (SLT-4) or signposting to “different websites and organizations” (SLT-10), most often lacking any information on autism.

There is no evidence of individual student consultation (including consultations with autistic students). However, a few participants mentioned they relied occasionally on information from safeguarding platforms, student councils or form tutors regarding autistic students’ needs. It was unclear how this had a direct effect on school policy.

Participants highlighted the importance of “listening to the young pupil” (SLT-11) and “giving autistic children a voice” (SLT-12) to “guide” the school (SLT-6) on their school experiences, what they need from the school and “what would help them” (SLT-15). Allowing students the “power to talk” (SLT-11) in ways they feel comfortable and giving them “ownership” (SLT-22) of their support plans rather than relying on “adults imposing” solutions (SLT-2) was highlighted.

Participants recognized that student input could improve staff and peer awareness of “their [meaning autistic students’] neurodiversity and the impact that has on them” (SLT-20) and what they need through their lived experiences. This was seen as a way to foster “mutual understanding” (SLT-12) and reduce anxieties and challenges autistic students face in school.

Participants called for policymakers to provide clear, “research-based” (SLT-3) guidance on mental health support for autistic students. They emphasized the need for a “nationwide strategy” (SLT-16) outlining the roles of stakeholders (e.g., schools, parents, and the National Health Service) to provide more proactive support. Guidance should include “best practices” (SLT-12), “flexible range of different kinds of interventions” (SLT-20) and practical “Do’s and the Don’ts” (SLT-6) list linked with mental health support needs of students.

Participants emphasized the need for training to “upskill the staff” (SLT-16) on recognizing how autism manifests, distinguishing poor mental health in autistic students from neurotypical presentations, building relationships, effectively discussing mental health, responding to students’ mental health needs, and implementing adaptations with consistency in classroom practices.

Facilitation of partnerships with 3rd sector organizations to increase mental health awareness was described as desirable but irregular as “standalone events” (SLT-14), with a general lack of intention to support autistic students, where there were very rare mentions of partnerships to increase autism awareness.

Participants called for “having more of a network” (SLT-18) and collaboration with stakeholders who have expertise in working with autistic students to guide schools about what can work in schools and to train staff and support students.

Rather than accessing “a mental health professional that is not a specialist” (SLT-17) in autism, many call for “clear signposting” (SLT-9) path to resources outside of the school to access targeted support.

Findings highlight an urgent need to embed autism-inclusive principles within whole-school mental health systems. Drawing on the System of Care (SoC) framework (Stroul et al., 2010), schools should prioritize coordination, adaptability, and collaboration across education, health, and family sectors. Co-production with autistic students and parents is central to this process, ensuring that mental health strategies reflect lived experience rather than top-down assumptions. Only through an integrated, evidence-based, and collaborative approach can schools bridge the persistent gap between inclusive intentions and the realities of autistic students’ mental health support.

The co-existence of deficit-based and neurodiversity-affirming narratives within SLT narratives signals a critical need for consistent, system-wide professional development on autism and mental health. For practices to be inclusive and effective, SLTs and school staff must engage with neurodiversity-informed perspectives that recognize both strengths and support needs, rejecting pathologizing narratives that risk undermining autistic students’ wellbeing. This should be a national priority, embedded into school improvement strategies, supported by policy, and aligned with teacher and leadership training programs.

The current reliance on generic, one-size-fits-all mental health interventions overlooks the distinct experiences and needs of autistic students. Tailored strategies that consider sensory sensitivities, communication differences, and the effects of masking are essential. Schools should adopt inclusive practices developed in collaboration with autistic people and grounded in lived experience. Policies should also reflect a nuanced understanding of mental health and neurodiversity, moving away from blanket awareness sessions or identification procedures (e.g., standard wellbeing screeners) that may misidentify needs (Perihan et al., 2022) or exacerbate distress (Deighton et al., 2025b).

The systemic barriers identified, competing priorities, limited resources, and a fragmented professional landscape, point to a pressing need for enhanced coordination between educators and mental health professionals and investment in sustainable funding, autism-specific staff training, and accessible specialist support networks to strengthen school capacity. Given the increasing prominence of Education Mental Health Practitioners (EMHPs) in the school mental health workforce, further research is needed to understand their role in supporting autistic students. How they engage with school teams, adapt interventions, and navigate competing demands remains largely unexamined. Exploring their experiences could uncover opportunities for better integration, improved training, and stronger partnerships between SLTs and mental health professionals (Ellins et al., 2024). Therefore, clearer guidance and interprofessional collaboration with professionals such as EMHPs could be pivotal in enhancing school-wide mental health efforts.

This study underlines the importance SLTs place on parent and student voice, yet systematic mechanisms for incorporating these perspectives remain limited. Embedding participatory practices into school improvement processes is essential. Schools should formalize structures for co-designing mental health strategies with autistic students and families, ensuring that interventions are contextually relevant, sensitive, and effective. There is also a need for national training networks and knowledge-sharing platforms to support SLTs and staff in developing inclusive, evidence-informed provision.

To ensure that school-based mental health efforts are truly inclusive, future research must prioritize autistic students’ voices. Participatory research, grounded in neurodiversity-affirming practices, is essential for understanding how these students experience the mental health policies and interventions implemented by schools (Fletcher-Watson et al., 2019). Research that centers on autistic perspectives will be key in identifying both harmful practices and effective support strategies.

Lastly, more in-depth research is required into how SLTs lead systemic change for mental health and inclusion. This includes how they interpret policy, allocate resources, and collaborate across the system. Studies that explore leadership knowledge translation, stakeholder engagement, and adaptive capacity could inform the development of school-wide strategies that are both inclusive of autistic students and sustainable over time.