The Real Reason Autistic Adults Struggle with Mental Health (And It’s Not Autism)
Bridgette Hamstead
Autistic adults struggle with mental health at alarmingly high rates, but the real reason is not autism itself. The widespread assumption that autism is inherently linked to anxiety, depression, and suicidality is both misleading and harmful. It shifts the focus away from the actual cause of distress, which is not being autistic but rather living in a world that refuses to accommodate, accept, or value autistic people as they are. The high rates of mental health struggles among autistic adults are a direct result of ableism, forced masking, exclusion, and systemic barriers that create a hostile and exhausting environment. Instead of blaming autism, society should be looking at how it systematically pushes autistic people into isolation, burnout, and despair.
One of the biggest contributors to poor mental health in autistic adults is the lifelong expectation to mask. From an early age, autistic people are taught, explicitly or implicitly, that their natural way of being is unacceptable. Whether through behavioral therapies, social skills training, or everyday social interactions, autistic children learn that success in life depends on their ability to hide their autistic traits. They are told to make eye contact even when it feels painful or unnatural, to suppress stimming even when it helps regulate emotions, to endure overwhelming sensory environments without complaint, and to mimic neurotypical speech patterns even when their own methods of communication feel more natural. This pressure to mask does not end in childhood. Autistic adults carry these lessons into workplaces, relationships, and social settings, often continuing to perform neurotypicality at the expense of their well-being. The cognitive and emotional strain of masking for years or decades leads to chronic exhaustion, identity confusion, and a deep sense of disconnection from oneself. Studies show that autistic adults who mask frequently experience higher levels of anxiety and depression, with many reporting that they no longer know who they truly are without the mask.
Ableism also plays a central role in the mental health crisis among autistic adults. Society consistently treats autism as a defect rather than a valid neurotype. Autistic people are bombarded with messages that frame their existence as a burden, a challenge to be managed, or a problem to be solved. Media portrayals of autism often emphasize suffering and tragedy, reinforcing the idea that autistic lives are inherently less fulfilling or valuable. Autism awareness campaigns tend to focus on children, ignoring the reality that autistic adults exist and need support. This erasure and devaluation contribute to a profound sense of alienation. Many autistic adults internalize the belief that they are broken, leading to low self-esteem, self-doubt, and increased vulnerability to mental health struggles.
Systemic barriers further compound these issues by making essential services and opportunities inaccessible to autistic people. Healthcare is notoriously difficult for autistic adults to navigate. Many doctors and mental health professionals lack training in autism, leading to misdiagnosis, inadequate treatment, and dismissive attitudes. Autistic adults who seek therapy for anxiety or depression often find that their therapists do not understand autistic experiences and may even try to "fix" their autism instead of addressing the actual sources of distress. In the workplace, autistic adults face discrimination, lack of accommodations, and hostile environments that leave them underemployed or unemployed at disproportionate rates. The expectation to function in rigid, high-pressure settings without support leads to chronic stress and burnout. Many autistic adults are forced to choose between working in environments that harm them or facing financial insecurity, a choice that takes a significant toll on mental health.
Social isolation is another major factor that contributes to the mental health crisis in the autistic community. Many autistic adults struggle to form meaningful connections, not because they lack the desire for relationships, but because social norms are designed around neurotypical expectations. Friendships and romantic relationships often require levels of social energy and communication that can be difficult for autistic individuals to sustain. Autistic people may be misunderstood, excluded, or treated as burdens in social settings, leading to loneliness and deep feelings of rejection. The lack of autistic-centered communities further exacerbates isolation, as many autistic adults do not have access to spaces where they can interact with others who share their experiences.
The combination of masking, ableism, systemic barriers, and isolation creates the perfect conditions for mental health struggles to thrive. It is no surprise that autistic adults experience higher rates of anxiety, depression, and suicidality when they are forced to navigate a world that constantly tells them they do not belong. The most tragic part of this reality is that it is entirely preventable. Autism does not cause mental illness. It is the way autistic people are treated that causes the pain.
Addressing the mental health crisis in the autistic community requires a complete shift in how society understands and approaches autism. Instead of forcing autistic people to conform to neurotypical norms, there needs to be widespread acceptance and accommodation. Autistic individuals should not have to mask to be respected. They should not have to justify their need for quiet spaces, sensory-friendly environments, or alternative communication methods. Healthcare professionals must be trained to understand autism in adults, recognizing the ways that autistic people experience and express mental health struggles differently from neurotypical individuals. Employment policies must be restructured to allow for flexible work arrangements, clear communication, and support for autistic employees. Most importantly, autistic adults need access to community, peer support, and spaces where they can exist without judgment or pressure to change.
The high rates of mental health struggles among autistic adults are not an inevitable consequence of autism. They are a reflection of how deeply ableism is embedded in every aspect of society. The solution is not to fix autistic people but to fix the systems that harm them. If society truly cared about autistic well-being, it would stop pathologizing autism and start listening to autistic people about what they actually need. Until that happens, autistic adults will continue to struggle—not because of autism itself, but because of a world that refuses to accept them as they are.