Seyda Cetintas
Jo Van Herwegen
Heba Al-Jayoosi1
Jane Hurry
Georgia Pavlopoulou- 1Group for Research in Relationships and NeuroDiversity (GRRAND), Faculty of Brain Sciences, Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, United Kingdom
- 2Department of Psychology and Human Development, University College London, London, United Kingdom
- 3Anna Freud Centre, London, United Kingdom
Background: Although school-based mental health initiatives are gaining attention, research remains limited on effective and sustainable implementation, especially for autistic students. School leadership play a pivotal role in shaping mental health initiatives. However, their roles and perspectives, particularly regarding autistic students, are under-researched.
Methods: We applied Reflexive Thematic Analysis to 22 semi-structured interviews with senior leadership teams’ (SLTs) members from state-funded mainstream secondary schools across six regions in England. Interviews were co-produced with an advisory team and adopted a curious stance to explore SLT members’ perspectives on promoting and supporting autistic students’ mental health.
Results: Using inductive coding and iterative discussions, we identified four key themes: (1) SLTs’ views and beliefs about autism and autistic students, (2) The use of one-size-fits-all approaches in mental health policy and provision, (3) The difficulty of overcoming and deepening systemic barriers in organizing mental health provision, and (4) The need to deepen participation with stakeholders and services. Findings revealed existing gaps and barriers in autism-informed provision and highlighted the changes and resources needed to facilitate mental health provision for autistic students from SLTs’ perspectives.
Conclusion: Results offer actionable insights for practice and policy, especially in light of the systemic and cultural challenges SLTs face.
Introduction
The number of autistic students in mainstream secondary schools in England has risen sharply- by around 135% over the past decade—with recent data indicating that one in 38 pupils was identified as autistic in 2023/24, and more than 70% of these learners now attend mainstream schools (Department for Education, 2024). As inclusive education becomes more deeply embedded in policy and practice, attention has gradually shifted from deficit-oriented models of disability toward holistic, strength-based approaches that emphasize belonging, wellbeing, and participation (White et al., 2023). However, despite these progressive aims, autistic students continue to experience disproportionate emotional strain in mainstream settings (Lukito et al., 2025; Pavlopoulou et al., 2025). This burden often stems from intersecting challenges-such as social stigma (Vincent et al., 2023), loneliness (Horgan et al., 2023), bullying (Maiano et al., 2016), sensory overload (Makin et al., 2017), and the cumulative effects of masking (Mesa and Hamilton, 2022)—all of which contribute to markedly elevated risks of depression, anxiety, and suicidality (Chou et al., 2020; Hedley et al., 2018; Hull et al., 2021; Mayes et al., 2013).
Mental health in autistic youth is increasingly prioritized in research (Benevides et al., 2020; Crane et al., 2019), policy (Department of Health and Social Care and Department for Education, 2021), and practice guidelines (Autistica, 2019; National Autistic Society, 2023). Schools are recognized as key settings for promoting mental health (Hoover and Bostic, 2021), and government policy encourages whole-school approaches (Garratt et al., 2024). Current initiatives focus on mental health literacy, early identification, and targeted support (Department of Health and Department for Education, 2017; National Institute for Health and Care Excellence, 2022; Public Health England, 2021). Despite policy backing, evidence on sustainable school-based mental health provision is mixed, shaped by school-level and systemic factors (March et al., 2022; Gee et al., 2021). Effective approaches involve multi-tiered frameworks, staff training, and co-production with communities (Fazel and Hoagwood, 2021; Foulkes and Stapley, 2022; Kern et al., 2017; March et al., 2024; Iachini et al., 2013; Tomé et al., 2021). Inclusion also requires structural adjustments and strong home–school partnerships (Roberts and Webster, 2022; Tucker and Schwartz, 2013).
Many schools in England offer universal mental health programs (e.g., mindfulness or coping skills), and some provide targeted interventions like counseling or CBT, though access is often cost- dependent (Marshall et al., 2017; White et al., 2017). While universal programs can improve awareness (Milin et al., 2016), concerns about limited impact or harm to vulnerable students are rising (Deighton et al., 2025a, 2025b; Foulkes and Stringaris, 2023; Ma et al., 2023). SEN students may be especially at risk (Deighton et al., 2025b). Autism-focused research in schools often centers on social skills interventions (Hugh et al., 2021), which may encourage masking and reinforce neurotypical norms (Pantazakos and Vanaken, 2023). Promising anxiety interventions (Perihan et al., 2022) often lack sustainability due to reliance on external actors. In contrast, neurodiversity-affirming therapies that value autistic perspectives show potential (Pantazakos, 2025; Silvester and Rankine, 2024), though popular programs like Zones of Regulation remain widely used despite limited empirical support (Mason et al., 2024; Pickard et al., 2024). This highlights a critical gap between policy ambition and the reality of effective, sustainable support in schools.
Leadership plays a crucial role in embedding sustainable mental health provision. Senior leadership teams (SLTs) shape school culture, staff development, and program implementation (Leksy et al., 2024; March et al., 2024; Suhrheinrich et al., 2021; Williams et al., 2021). Their actions influence collaboration, resource allocation, and long-term outcomes (Cumming et al., 2022; Gee et al., 2021; Herlitz et al., 2020; Koh et al., 2023). However, many leaders report limited preparation in mental health and neurodiversity (Daly et al., 2025; Moore et al., 2024; Papa, 2018). SLT beliefs shape how mental health provision is delivered to autistic students (Mugabekazi and Mukanziza, 2025; Pollock and Briscoe, 2019). Leadership that centers around empathy and strengths-based approaches is linked to more inclusive outcomes (Carroll and Hurry, 2018).
Despite the well-established significance of school leadership, research examining how school leaders support mental health provision remains limited (Adams et al., 2023). In England, research capturing the views of SLTs has predominantly concentrated on system-level priorities such as leadership pressures, policy implementation, and workforce wellbeing, with limited attention to their role in directly supporting student mental health (Department for Education, 2025; Lupton, 2023; Scanlan and Savill-Smith, 2021). More critically, there is a marked absence of research specifically exploring how SLTs support autistic students’ mental health. The depth and specificity required to understand the nuanced practices and experiences of SLTs in this context remain underexplored, as existing research on school-based mental health promotion and support tends to rely on general staff surveys (Garside et al., 2021; Sharpe et al., 2016; Smith et al., 2018). This gap highlights the need for focused, stakeholder-informed research that centers the SLT perspective.
About this study
This study explores how SLT members in mainstream English secondary schools promote and support autistic students’ mental health. Guided by the System of Care (SoC) framework (Stroul et al., 2010), it examines how leaders understand and apply policy, adapt practices, and coordinate support in inclusive ways. We wanted to know:
1. What strategies do SLT members use to support autistic students’ mental health?
2. What support do SLT members need to do this effectively?
3. What barriers and facilitators do SLT members encounter?
Methods
We adopted a qualitative research design, using semi-structured interviews derived from three sources: (1) existing literature, (2) observations made by a small advisory group of three professionals with lived experience in practice, and (3) personal and professional interests of authors around the experience of neurodivergent education students. The advisory group’s role included refining pre-study considerations, offering feedback on what should be included and checking for clarity and relevance of interview schedule for the SLT role. Their input enhanced contextual relevance and readiness, credibility, and transferability of findings (Cargo and Mercer, 2008). The interview schedule included questions that explored SLTs’ practices at both policy and implementation levels, focusing on awareness, identification and support initiatives, and perceived barriers to and needs for implementation. See examples in Table 1.
Table 1. Sample interview questions from SLT interviews.
Ethical approval for the study was granted by the Research Ethics Committee at IOE, UCL’s Faculty of Education and Society, in February 2023. The study was advertised via Twitter, LinkedIn, school contact forms, school office emails, and charity newsletters. The eligibility criteria required participants to work (1) in a senior leadership position, (2) in mainstream secondary schools, (3) in England and (4) to have at least one registered autistic student in their school at the time of the study. Those interested in taking part completed an online background questionnaire, which could be accessed upon providing consent, and submitted their email addresses to schedule an online interview via a Qualtrics form. The background questionnaire collected data on participants’ demographics, diagnoses, professional experience, autism and mental health training, and self-rated autism knowledge. It also gathered information on school-level mental health provision and SLT structures, including the existence and review of mental health policies, stakeholder collaboration, and the perceived alignment of these policies with the needs of autistic students (see Supplementary material 1).
The interviews were conducted from March 2023 to December 2023 via Zoom or Microsoft Teams programs, with participants given the option to have their video on or off. On average, the interviews lasted 73 min (range = 36–97 min). The interviews were recorded and transcribed using Zoom or Microsoft Teams’ built-in transcription software and checked thoroughly for inaccuracies.
Participants
Participants included 22 SLT members (17 women and 5 men) from state-funded mainstream secondary schools across six geographical areas in England, encompassing four maintained schools and 18 academies. Most participants (n = 20) had over 10 years of teaching experience, while two had less than 10 years’ experience. The participants held multiple roles at school. The most common main roles were SENDCo (n = 8) and assistant headteacher (n = 10). Among all participants, 17 had mental health training, and 14 had some form of autism training. Table 2 below provides detailed demographic, geographical, professional, and training information for the participants. Table 3 below presents the roles at school per participant.
Table 2. Information on demographics, professional background, and training received.
Table 3. Participants’ role(s) at school.
According to the background data, most participants (n = 15) reported that their school had a mental health policy, while a few either did not have one (n = 3) or were unsure (n = 4). Among those with a policy (n = 15), the majority (n = 13) indicated it lacked specific provisions for autistic students’ mental health; only one believed it did (n = 1), and one was unsure (n = 1). Overall, just five participants felt their school’s policy aligned with the needs of autistic students, while others reported misalignment (n = 7) or uncertainty (n = 10). Table 4 presents participants’ views on school mental health policies, stakeholder coproduction, and perceived knowledge of autism and mental health.
Table 4. Perceptions of school policy on mental health, coproduction with stakeholders, and knowledge of autism and mental health.
Analysis
We used Reflexive Thematic Analysis (RTA) for its systematic yet flexible approach to identifying patterns of barriers and needs (Braun and Clarke, 2019). In line with RTA, our analytical focus was on generating latent themes that interpret underlying ideas and shared meanings, rather than providing a descriptive, topic-by-topic summary of the data (Braun and Clarke, 2019). GP and SC adopted an inductive approach to explore recurring themes around mental health support in education. Each author independently developed themes and sub-themes, followed by iterative refinement through discussion. Our primary focus was not on establishing reliability but on exploring how our diverse experiences and knowledge shaped how we interpreted participants’ narratives and identified key elements.
Reflexivity
We acknowledge how our lived experiences and interests may have influenced our approach and interpretation. We have academic and professional experience from our work within the fields of health, psychology, and special educational needs and disability (SEND) provision, as well as personal and/ or family experience. The team is made up of neurodivergent and neurotypical individuals. In line with a reflexive approach, we did not aim for ‘accurate’ or ‘reliable’ coding (Byrne, 2022) or the use of rigid coding frameworks when analyzing the qualitative data. When discussing findings, the team reflected on the assumptions and expectations they brought to the work, as well as how their own experiences may have influenced their interpretations of the data.
Results
Four themes were found, with several sub-themes within these (see Table 5). Additional quotes for codes are available in the Supplementary material 2.
Table 5. Synopsis of the themes and sub-themes found by interviews with participants.
Theme 1: SLTs’ views and beliefs about autism and autistic students
Sub-theme 1.1: A view of autism as a within-the-person deficit
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.
They may see the world in a different light, but the world is not going to change for them. They're still going to have to adapt to the world. […] There’s a number of parents who use it [autism] as an excuse or use it as the rationale as to why that child is not going to either behave or conform. (SLT-4)
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.
We’ll see significant mental health challenges for them [meaning autistic girls] and that generally leads us into the road of exploring if they’re neurodiverse. (SLT-17)
Most participants thought that autistic students struggle to attend therapy due to autistic traits.
I think the hardest part, when it comes to autistic young people is getting them to take perhaps up offers of help because of the quite often social aspects of that goes alongside autism, of not being able to articulate yourself very well and talk about how you're feeling…the lack of understanding of those emotions and what you're feeling. (SLT-21)
Sub-theme 1.2: A neurodiversity lens on strengths, struggles, and needs
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.
They seek out support, they want to be recognized for who they are. They would like support and understanding how they fit in the normal world, so that, you know, I am helping them to identify what their differences and embrace those. (SLT-6)
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.
I think it’s [mental health support] all a very individual thing, and there might be adaptations for an individual, but not necessarily for a blanket type of person. (SLT-21)
Theme 2: The use of one-size-fits-all approaches in mental health policy and provision
Sub-theme 2.1: Lack of neurodiversity-informed mental health policy
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.
We don't specifically have a mental health policy in isolation. […] It's within subsections of our safeguarding and child protection policy. It's not an isolated alone. There are lots of sort of crossovers with our sort of SEND policies as well. (SLT-7)
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).
When we're creating the policy, we're trying to make one policy that encompasses everyone […] So we try to make the whole policy inclusive, and so, regardless of who is in that school at that time. It would, it would be for them [autistic students] as well. So that's how we try and make a really holistic kind of the policy. (SLT-16)
These umbrella policies broadly mention SEND students, without any specification on different types of neurodivergences and/or autism.
There actually isn't enough in-depth with the breakdown of different pupils, “what about children with ASD, what about children with ADHD?” There's nothing there really that kind of links it into that SEND provision. What I've realized is that this makes it a bit disjointed. (SLT-8)
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.
So whenever we are looking at anything, I need to say, “well, actually, how would that work affect or impact on neurodiverse students” […] Would it happen if I wasn't being the kind of almost the devil's advocate, I think it would, but maybe not to the same extent. (SLT-2)
Sub-theme 2.2: Blanket approaches in increasing mental health awareness
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.
If a [an autistic] student is struggling with an assembly, they would come out and they come and work with the teaching assistance, and we will then work our best to get them in the back, so they're just listening or they don't have to see them, they'll just sit and listen to it. (SLT-14)
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.
Sometimes in PSHE, there is requirement like, “let's discuss this or like can you talk about a time when this happened to you” and that can be difficult for autistic students. Some of them will come out […] they might access it sort of more individually […] would try and plug the gap. (SLT-20)
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).
We talked PSHE in the past, when we've talked about suicide, we had a year 10 lesson, and then we had some parents contact and say, “The documentary that you showed was really, really impactful, but my child is really struggling now with kind of like what they saw and the people talking”. (SLT-11)
I've just finished running a course with boys regarding healthy relationships. […] They [autistic students] may benefit for more of a much smaller group, or 1:1, because I actually might make them feel more of anxious or, or cause potentially more harm because they're put in an environment that makes them feel really really uncomfortable. (SLT-4)
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).
All pupils have what we call a pupil profile, so that is like a one-page information for teachers on that child. So, it might include information things like where they like to sit most in the room, so then teachers doing their seating plans […] So, it's like personal information on the child that the teachers should be aware of and it would include strategies as well. So, we use a lot in school. (SLT-10)
Autism training was considered important but was rare to be available.
Our staff probably haven't really had any up-to-date training in terms of autism for quite some time. And I think that's something that was also very key that we needed to change. (SLT-18)
Sub-theme 2.3: Blanket approaches in identification and targeted mental health support
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).
So, we would hope that like their tutors who they see every day would be the first person spotting that […] the idea is that the people that see them all the time notice the difference and then do something about it. (SLT-15)
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.
As a school, you know, I'm not aware of any more appropriate wellbeing resources or screeners, or whatever for our ASD young people. And I would be really keen to hear of them, but we they end up using what the standardized screener. (SLT-17)
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).
It [mental health difficulty] can be disguised that it's not clear or masked. I think I think it's harder sometimes to be able to identify whether this is a mental health issue, or whether it is just part of their characteristics you know their autism, isn’t that? (SLT-12)
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.
There isn't anything different. There isn't any unique pathways at the moment that that we would pursue. We're only in a position to move the pathways that we would for all of the non-neurodiverse young people. (SLT-17)
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.
If it was a child that it was less about autism and it was just purely mental health, they might be just going through the mental health kind of provision side of things. Whereas with an autistic child, we'd be focused on the social communication aspect of it as well. […] we work with professionals that have worked with a lot of autistic kids to basically sort of talk to them. You know, things like zones of regulation and stuff like that. (SLT-19)
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.
What we generally tend to do is to quite light touch mental health support alongside the specific autism intervention […] we will focus the intervention on the autism with a light touch on the anxiety or the mental health with the belief that if we work on the autism, the anxiety should be reduced overtime. (SLT-9)
Theme 3: The difficulty of overcoming and deepening systemic barriers in organizing mental health provision
Sub-theme 3.1: Competing priorities
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.
We are expected to be their [students’] parents, their teachers, you know, the guidance counselor, we're expected to do all of that and that's what's really difficult. Because while mental health is absolutely one of our priorities, so is everything else on the list. (SLT-15)
All of SLT know what's happening with our really at-risk students. I will be honest and say, I don't think there is enough support from the Government, which is a little bit controversial, but that is how we feel as a school. (SLT-22)
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).
Everyone talk about individuality and embracing different, yet we squeeze every child at the age of 16 through the same education system and it doesn't fit for some children, ASD is there as well. And schools are really under pressure to follow expectations because they feel they've got to justify themselves to Ofsted and then they made decisions. […] We're expecting autistic learners that are going for a real difficult time to just forget about all of their needs and “you just need to do GCSE”, because that's what you got to do as a school. (SLT-16)
I think, because with autistic students, they're in a minority, doesn't make an excuse, but I think they are minorities […] Unfortunately in education, there's always something else that comes along that's more important, and that's the problem that you can have a focus on autism and mental health. And it's who's screaming loudest it sometimes feels, you know, who is making the most fuss. (SLT-12)
Sub-theme 3.2: Knowledge gaps, resource constraints, and professional coordination
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.
That would be every school that you speak to, there is not enough resources for what we. You know, we have waiting lists for sort of students needing counseling and some sort of support. […] we are all operating on restricted budgets basically. Then we can be more creative with it, but what we are able to do is constrained by resources which are constrained by funding for schools. (SLT-13)
So, we might identify a need, we might do the referral. But some children wait a year to see anyone […] And it’s, you know, of course there's going to be significant deterioration over that year, even with the best will in the work. (SLT-10)
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).
I think they still feel like they're misunderstood, or they're not heard, or they can’t connect with the person that we've placed them with. The person that being placed with to speak to doesn't have a lot of ASD specific knowledge, might not approach it in the right way. (SLT-17)
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).
So, it's about, “How can we provide that understanding autism? How their autism affects their mental health?” We don't have that level of support. Our counselors have a certain remit, so it's this kind of this pinch point. (SLT-6)
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.
Often, we make referrals into CAMHs, I mean this maybe I don't know what it's like across the rest of the country, but we just get told “but they had ASD, so it's not mental health problem”. (SLT-20)
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 therapy itself and the service [meaning CAMHs service] almost doesn't recognize that it's almost the one-size-fits all, you're a child psychotherapist delivering one-to-one therapy. You do it the same if it's an autistic child or not an autistic child. (SLT-19)
In the 6 weeks time, they've got to build a relationship enough with something. Cause you know, I'm thinking of them, that's a new person and it's very difficult for them to have that connection in enough time that they get sessions with them. I think of a couple of students, who's in the MHST program and it, you know, it's not been easy. (SLT-8)
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.
I'm not saying that there is specialist support out there. I think that is the problem […] because it isn't. (SLT-12)
Theme 4: The need to deepen participation with stakeholders and services
Sub-theme 4.1: The importance of parent and student voice
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.
If there needed to be a specific focus on a one-to-one basis, because it's more likely that parents of children with autism are more likely to have much more contact with the school than our parents, then we'll be more likely to have more regular meetings. If those students are on EHCPs, they have a guaranteed annual review and mental health would come up as part of that. (SLT-13)
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.
They are fighting with the system […] And it's a shame. And breaking down that barrier, saying actually, that's my job in school, you know, or it's the form tutor, is their advocate in school, so it's relationships. (SLT-14)
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.
…We're just signposting parents to things that are available. So it's signposting them to access information and stuff. […] It might be specific for SEND students, but not autistic students. (SLT-21)
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.
I think there's an indirect element to that [meaning student input to mental health policy and provision] through things like we have um… the Student Council, and we have opportunities for the students to get involved. (SLT-3)
I think that, I'm coming at this without having asked anyone who is a young person who is autistic, whether they feel like it. And I think that they're the best people to know whoever they feel like they need something that is different, and I've never asked them. (SLT-21)
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.
You know, I've worked in a lot of schools where it's very much a tick box thing “Oh, yeah, we'll ask the students what they think, and then we'll kind of ignore it, because we're not really interested in the first place”, you know, it's that kind of approach. Whereas I think it really has to be driven by autistic students, because they're the only ones that have the understanding and the knowledge of what it's like to be autistic and what they actually need. (SLT-19)
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.
I think there's a degree of like, other students don’t necessarily perceive or know how their minds differ and when. Well, they do to an extent, but it'd be much better from like a lived experience. (SLT-7)
I think some of the real anxieties are around behavior and about what goes on in social times. And again, if we can promote autism awareness to our non-autistic students, that would help relieve the anxiety within that community. I've got a young girl who's not long had her diagnosis. She is receiving support about understanding autism. She would be brilliant to talk to some of our other students about “this is how I have navigated my school life” rather than it coming from us that don't understand. (SLT-6)
Sub-theme 4.2: Call for national networks, audience, and training
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.
A policy that is robust, but achievable and useful. So it's got to have kind of step-by-step, it has to have, you know, it is like a guidance almost for us. When we go back to policy, “Okay, we've got this situation, what does the policy say about it?” because then it reassures everyone […] but how autism is so broad that you can't just have a one-size-fits-all approach. (SLT-11)
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.
I think we need more autism training looking at specifically at mental health. It needs another focus, you know, regular training really, keeping it to the top of the pile to keep it dripping through that it's important. (SLT-12)
Targeted training in that very area. There isn't enough training for education staff to understand how mental health issues would affect an autistic young person in comparison to someone that isn't neurodivergent. (SLT-17)
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.
We have very little community participation. So yeah, none of this autism specific. (SLT-10)
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.
I think it's just one thing, I think it's actually collaborating with people who do this on a day-to-day basis, which is like you're doing to make sure that you've picked upon areas that might not work or areas where it needs to at least be trailed. (SLT-22)
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.
Discussion
Conceptualizing autism and mental health
Senior leadership teams members’ understandings of autism revealed persistent tension between deficit-based and neurodiversity-oriented perspectives. While participants expressed inclusive intentions and empathy toward autistic students, many descriptions still framed autism through a lens of vulnerability or deficit. This conceptual ambiguity shaped how mental health support was designed and delivered. The coexistence of contradictory narratives mirrors wider discourse, where autism is alternately positioned as a disorder to be managed or a difference to be understood (Den Houting et al., 2021; Milton, 2019). Such inconsistencies indicate that inclusive policy commitments are not yet matched by deep, coherent understanding at leadership level.
The limits of generic mental health provision
Although schools implemented a range of universal mental health programs, these initiatives were rarely adapted to the needs of autistic students. Awareness sessions, counseling, and whole-class wellbeing lessons often relied on emotion-focused discussions or group participation, which many autistic students found overwhelming or inaccessible. In some cases, universal programs, particularly those covering sensitive topics such as suicide prevention, appeared to heighten anxiety among autistic learners. These findings align with research warning that undifferentiated mental health initiatives may inadvertently disadvantage neurodivergent students (Deighton et al., 2025b; Stapley et al., 2025). Tailored, sensory-aware, and co-designed approaches are urgently needed to make whole-school provision genuinely inclusive.
Systemic barriers to inclusive support
Senior leadership teams’ capacity to provide effective support was constrained by systemic barriers, including limited resources, competing priorities, and fragmented external provision. Participants described taking on extensive pastoral responsibilities due to the scarcity or inaccessibility of specialist mental health services. The rigidity of referral pathways, particularly CAMHs’ frequent rejection of autism-related cases, left schools managing complex needs without adequate support (Ashworth et al., 2025). These constraints reflect long-standing structural challenges within SEND and mental health systems (Castro-Kemp et al., 2019; Van Herwegen et al., 2019). As a result, provision often depended on individual commitment rather than coordinated systemic capacity.
Building capacity: What SLTs need
Senior leadership teams members consistently called for targeted autism-specific mental health training and greater access to specialist expertise. Many felt confident in general wellbeing promotion but lacked the knowledge to adapt strategies for autistic students. Evidence suggests that autism-focused professional learning can significantly enhance staff confidence and understanding (Cooper et al., 2018; Johnson et al., 2021). Strengthening inter-agency collaboration and embedding practical guidance within national policy frameworks would further support schools to deliver effective, context-sensitive provision.
From policy to practice: Toward autism-inclusive systems
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.
Strengths and limitations
A key methodological strength of this study is the co-creation of interview questions with leaders in school settings, ensuring that the questions asked are relevant and reflective of real-world school contexts. This collaborative approach aligns with best practices in qualitative research, enhancing the study’s validity and the transferability of knowledge (Van Dijk-de Vries et al., 2020). Another strength is its focus on perspectives of school leaders, whose voices are underrepresented in school mental health research despite prior research that has demonstrated a clear pattern between leadership support/priorities, school culture, and policies and the sustainability of school-based mental health and wellbeing programs (Herlitz et al., 2020; March et al., 2022). By engaging those with decision-making power in the education system (March et al., 2024), this study holds the potential to facilitate impactful school partnerships, which are crucial for bridging the research-practice gap in autism support (Parsons et al., 2013).
Self-reported data risk social desirability bias, a known issue in mental health research, particularly in interviews (Henderson et al., 2012), wherein participants may overstate good practices or underreport gaps to align with perceived institutional or societal expectations. In educational contexts, school leaders may overstate inclusive practices or underreport implementation gaps to align with institutional priorities, such as Ofsted frameworks (Perryman et al., 2018). Finally, while the sample size aligns with suggested benchmarks for thematic depth (Guest et al., 2006; Hennink et al., 2017), the regional variability in resource allocation for SEN students may limit the generalizability of findings, particularly for schools in underfunded areas.
Implications for research and practice
The findings of this study reveal a multifaceted picture of how SLTs understand and respond to the mental health needs of autistic students in mainstream secondary schools. These insights highlight several key implications for both educational practice and future research, especially in light of the systemic and cultural challenges SLTs face.
Embedding neurodiversity-informed approaches across the system
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.
Rejecting one-size-fits-all in favor of contextualized, individualized support
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).
Strengthening systemic capacity and cross-professional collaboration
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.
Cultivating meaningful participation and stakeholder engagement
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.
Exploring autistic students’ lived experiences of mental health support
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.
Mapping leadership practices that enable sustainable, inclusive mental health provision
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.
Conclusion
This study provides critical insights into how SLTs in mainstream secondary schools in England approach the mental health needs of autistic students. While SLTs express a clear commitment to supporting student wellbeing, their strategies are often shaped by limited autism-specific knowledge and constrained by systemic barriers such as funding shortages, service gaps, and competing school priorities. The coexistence of deficit-based and neurodiversity-affirming narratives reveals a lack of consistency in understanding autism, leading to the use of generic mental health interventions that may not adequately meet the unique needs of autistic learners.
Despite these challenges, the study highlights promising directions for change, including SLTs’ expressed interest in targeted autism training, calling for greater cross-sector collaboration, and recognizing of the value of participatory practices that engage autistic students and their families. To truly advance inclusive mental health provision, schools must adopt nuanced, evidence-informed, and student-centered approaches supported by systemic investment, national policy alignment, and further research—particularly into the roles of EMHPs and the lived experiences of autistic students. By bridging knowledge, practice, and policy, SLTs can play a pivotal role in creating mentally healthy, inclusive environments for all learners.
Data availability statement
The datasets presented in this article are not readily available because the dataset contains sensitive information as participants often refer to colleagues and students and will only be shared in anonymized form upon reasonable request. Data access is subject to ethical approval and may require a data use agreement to ensure compliance with participant confidentiality and institutional data protection policies. Requests to access the datasets should be directed to c2V5ZGEuY2V0aW50YXMuMjFAdWNsLmFjLnVr.
Ethics statement
The studies involving humans were approved by Institute of Education, Doctoral School ethics committee board, UCL. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable data included in this article.
Author contributions
SC: Methodology, Investigation, Conceptualization, Writing – review & editing, Project administration, Formal analysis, Writing – original draft, Data curation. JVH: Supervision, Writing – review & editing, Conceptualization, Project administration. HA-J: Methodology, Validation, Writing – review & editing. RM: Writing – review & editing, Methodology. JH: Writing – review & editing. GP: Conceptualization, Supervision, Methodology, Writing – review & editing, Writing – original draft, Formal analysis, Project administration.
Funding
The author(s) declare that no financial support was received for the research and/or publication of this article.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Generative AI statement
The authors declare that no Gen AI was used in the creation of this manuscript.
Any alternative text (alt text) provided alongside figures in this article has been generated by Frontiers with the support of artificial intelligence and reasonable efforts have been made to ensure accuracy, including review by the authors wherever possible. If you identify any issues, please contact us.
Publisher’s note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
Supplementary material
The Supplementary material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/feduc.2025.1662602/full#supplementary-material
References
Adams, D., Lok Tan, K., Sandmeier, A., and Skedsmo, G. (2023). School leadership that supports health promotion in schools: a systematic literature review. Health Educ. J. 82, 693–707. doi: 10.1177/00178969231180472
Ashworth, E., Bray, L., Hanlon, C., Moore, D., Pavlopoulou, G., Firth, E., et al. (2025). Accumulating harm and waiting for crisis: parents’ perspectives of accessing child and adolescent mental health services for their autistic child experiencing mental health difficulties. Autism 29, 2111–2122. doi: 10.1177/13623613251335715,
Autistica. (2019). Building happier healthier longer lives. Briefings to improve autism policy and research. Available online at: https://www.autistica.org.uk/downloads/files/Building-Happier-Healthier-Longer-Lives-The-Autistica-Action-Briefings-2019.pdf
Benevides, T. W., Shore, S. M., Palmer, K., Duncan, P., Plank, A., Andresen, M. L., et al. (2020). Listening to the autistic voice: mental health priorities to guide research and practice in autism from a stakeholder-driven project. Autism 24, 822–833. doi: 10.1177/1362361320908410,
Braun, V., and Clarke, V. (2019). Reflecting on reflexive thematic analysis. Qual. Res. Sport Exerc. Health 11, 589–597. doi: 10.1080/2159676X.2019.1628806
Byrne, D. (2022). A worked example of Braun and Clarke’s approach to reflexive thematic analysis. Qual. Quant. 56, 1391–1412. doi: 10.1007/s11135-021-01182-y
Cargo, M., and Mercer, S. L. (2008). The value and challenges of participatory research: strengthening its practice. Annu. Rev. Public Health 29, 325–350. doi: 10.1146/annurev.publhealth.29.091307.083824,
Carroll, C., and Hurry, J. (2018). Supporting pupils in school with social, emotional and mental health needs: a scoping review of the literature. Emot. Behav. Difficulties 23, 310–325. doi: 10.1080/13632752.2018.1452590
Castro-Kemp, S., Palikara, O., and Grande, C. (2019). Status quo and inequalities of the statutory provision for young children in England, 40 years on from Warnock. Front. Educ. 4:76. doi: 10.3389/feduc.2019.00076
Chou, W. J., Wang, P. W., Hsiao, R. C., Hu, H. F., and Yen, C. F. (2020). Role of school bullying involvement in depression, anxiety, suicidality, and low self-esteem among adolescents with high-functioning autism spectrum disorder. Front. Psych. 11:9. doi: 10.3389/fpsyt.2020.00009,
Cooper, K., Loades, M. E., and Russell, A. (2018). Adapting psychological therapies for autism. Res. Autism Spectr. Disord. 45, 43–50. doi: 10.1016/j.rasd.2017.11.002,
Crane, L., Adams, F., Harper, G., Welch, J., and Pellicano, E. (2019). ‘Something needs to change’: mental health experiences of young autistic adults in England. Autism 23, 477–493. doi: 10.1177/1362361318757048,
Cumming, T. M., Strnadová, I., Lee, H. M., and Lonergan, R. (2022). Education-centred formal wraparound services in support of school-aged students with complex support needs: a systematic review. Australas. J. Spec. Incl. Educ. 46, 47–60. doi: 10.1017/jsi.2022.1
Daly, B. P., Resnikoff, A., and Litke, S. (2025). Effective school leadership for supporting students’ mental health: findings from a narrative literature review. Behav. Sci. 15:36. doi: 10.3390/bs15010036,
Deighton, J., Thompson, A., Humphrey, N., Thornton, E., Knowles, C., Patalay, P., et al. (2025a). Effectiveness of school mental health awareness interventions: Universal approaches in English secondary schools. Department for Education. Available online at: https://assets.publishing.service.gov.uk/media/680f52ef5072e9b7db83cce9/Effectiveness_of_school_mental_health_awareness_interventions.pdf (Accessed April 13, 2025).
Deighton, J., Thompson, A., Humphrey, N., Thornton, E., Knowles, C., Patalay, P., et al. (2025b). Effectiveness of school mental health and wellbeing promotion: Universal approaches in English primary and secondary schools. Department for Education. Available online at: https://assets.publishing.service.gov.uk/media/680f531f11d566056bcae925/Effectiveness_of_school_mental_health_and_wellbeing_promotion.pdf (Accessed April 13, 2025).
Den Houting, J., Botha, M., Cage, E., Jones, D. R., and Kim, S. Y. (2021). Shifting stigma about autistic young people. Lancet Child Adolesc. Health 5, 839–841. doi: 10.1016/S2352-4642(21)00309-6,
Department for Education. (2024). Academic year 2023/2024. Special educational needs in England. Available online at: https://explore-education-statistics.service.gov.uk/find-statistics/special-educational-needs-in-england (Accessed August 20, 2024).
Department for Education. (2025). School and college voice: Omnibus surveys for 2024 to 2025. Available online at: https://www.gov.uk/government/publications/school-and-college-voice-omnibus-surveys-for-2024-to-2025 (Accessed May 22, 2025).
Department of Health and Department for Education. (2017). Transforming children and young people’s mental health provision: a green paper. Available online at: https://assets.publishing.service.gov.uk/media/5a823518e5274a2e87dc1b56/Transforming_children_and_young_people_s_mental_health_provision.pdf (Accessed January 10, 2024).
Department of Health and Social Care and Department for Education. (2021). Policy paper. National strategy for autistic children, young people and adults: 2021 to 2026. Available online at: https://assets.publishing.service.gov.uk/media/60d2e20fe90e0743a210e00f/national-strategy-for-autistic-children-young-people-and-adults-easy-read.pdf (Accessed January 10, 2024).
Ellins, J., Hocking, L., Al-Haboubi, M., Newbould, J., Fenton, S. J., Daniel, K., et al. (2024). Implementing mental health support teams in schools and colleges: the perspectives of programme implementers and service providers. J. Ment. Health 33, 714–720. doi: 10.1080/09638237.2023.2278101,
Fazel, M., and Hoagwood, K. (2021). School mental health: integrating young people's voices to shift the paradigm. Lancet Child Adolesc Health 5, 156–157. doi: 10.1016/S2352-4642(20)30388-6,
Fletcher-Watson, S., Adams, J., Brook, K., Charman, T., Crane, L., Cusack, J., et al. (2019). Making the future together: shaping autism research through meaningful participation. Autism 23, 943–953. doi: 10.1177/1362361318786721,
Foulkes, L., and Stapley, E. (2022). Want to improve school mental health interventions? Ask young people what they actually think. J. Philos. Educ. 56, 41–50. doi: 10.1111/1467-9752.12649
Foulkes, L., and Stringaris, A. (2023). Do no harm: can school mental health interventions cause iatrogenic harm? BJPsych Bull. 47, 267–269. doi: 10.1192/bjb.2023.9,
Garratt, K., Kirk-Wade, E., and Long, R. (2024). Children and young people's mental health: Policy and services (England). Commons Library Research Briefing (CBP-7196). Available online at: https://researchbriefings.files.parliament.uk/documents/CBP-7196/CBP-7196.pdf (Accessed March 25, 2024).
Garside, M., Wright, B., Nekooi, R., and Allgar, V. (2021). Mental health provision in UK secondary schools. Int. J. Environ. Res. Public Health 18:12222. doi: 10.3390/ijerph182212222,
Gee, B., Wilson, J., Clarke, T., Farthing, S., Carroll, B., Jackson, C., et al. (2021). Delivering mental health support within schools and colleges–a thematic synthesis of barriers and facilitators to implementation of indicated psychological interventions for adolescents. Child Adolesc. Ment. Health 26, 34–46. doi: 10.1111/camh.12381
Guest, G., Bunce, A., and Johnson, L. (2006). How many interviews are enough? An experiment with data saturation and variability. Field Methods 18, 59–82. doi: 10.1177/1525822X05279903
Hedley, D., Uljarević, M., Foley, K. R., Richdale, A., and Trollor, J. (2018). Risk and protective factors underlying depression and suicidal ideation in autism spectrum disorder. Depress. Anxiety 35, 648–657. doi: 10.1002/da.22759,
Henderson, C., Evans-Lacko, S., Flach, C., and Thornicroft, G. (2012). Responses to mental health stigma questions: the importance of social desirability and data collection method. Can. J. Psychiatry 57, 152–160. doi: 10.1177/070674371205700304,
Hennink, M. M., Kaiser, B. N., and Marconi, V. C. (2017). Code saturation versus meaning saturation: how many interviews are enough? Qual. Health Res. 27, 591–608. doi: 10.1177/1049732316665344,
Herlitz, L., MacIntyre, H., Osborn, T., and Bonell, C. (2020). The sustainability of public health interventions in schools: a systematic review. Implement. Sci. 15, 1–28. doi: 10.1186/s13012-019-0961-8
Hoover, S., and Bostic, J. (2021). Schools as a vital component of the child and adolescent mental health system. Psychiatr. Serv. 72, 37–48. doi: 10.1176/appi.ps.201900575,
Horgan, F., Kenny, N., and Flynn, P. (2023). A systematic review of the experiences of autistic young people enrolled in mainstream second-level (post-primary) schools. Autism 27, 526–538. doi: 10.1177/13623613221105089,
Hugh, M. L., Ahlers, K., Joshi, M., and Locke, J. (2021). School-implemented interventions for preschool to high school students with autism: an update on recent research. Curr. Psychiatry Rep. 23, 1–11. doi: 10.1007/s11920-021-01266-4
Hull, L., Levy, L., Lai, M. C., Petrides, K. V., Baron-Cohen, S., Allison, C., et al. (2021). Is social camouflaging associated with anxiety and depression in autistic adults? Mol. Autism. 12, 1–13. doi: 10.1186/s13229-021-00421-1
Iachini, A. L., Anderson-Butcher, D., and Mellin, E. A. (2013). Exploring best practice teaming strategies among school-based teams: implications for school mental health practice and research. Adv. Sch. Ment. Health Promot. 6, 139–154. doi: 10.1080/1754730X.2013.784618
Johnson, A., Soares, L., and Gutierrez de Blume, A. P. (2021). Professional development for working with students with autism spectrum disorders and teacher self-efficacy. Georgia Educ. Res. 18, 1–25. doi: 10.20429/ger.2021.180101,
Kern, L., Mathur, S. R., Albrecht, S. F., Poland, S., Rozalski, M., and Skiba, R. J. (2017). The need for school-based mental health services and recommendations for implementation. Sch. Ment. Health 9, 205–217. doi: 10.1007/s12310-017-9216-5
Koh, G. A., Askell-Williams, H., and Barr, S. (2023). Sustaining school improvement initiatives: advice from educational leaders. Sch. Eff. Sch. Improv. 34, 298–330. doi: 10.1080/09243453.2023.2190130
Leksy, K., Gawron, G., Rosário, R., Sormunen, M., Velasco, V., Sandmeier, A., et al. (2024). The importance of school leaders in school health promotion. A European call for systematic integration of health in professional development. Front. Public Health 11:1297970. doi: 10.3389/fpubh.2023.1297970,
Lukito, S., Chandler, S., Kakoulidou, M., Griffiths, K., Wyatt, A., Funnell, E., et al. (2025). Emotional burden in school as a source of mental health problems associated with ADHD and/or autism: Development and validation of a new co‐produced self‐report measure. J. Child Psychol. Psychiatry. 66, 1577–1592. doi: 10.1111/jcpp.70003
Lupton, R. (2023). School leadership in current times: As school leaders see it National Education Union https://neu.org.uk/sites/default/files/2023-11/Research%20document%20on%20school%20leadership%20in%20UK.pdf (Accessed April 20, 2024).
Ma, K. K. Y., Anderson, J. K., and Burn, A. M. (2023). School-based interventions to improve mental health literacy and reduce mental health stigma–a systematic review. Child Adolesc. Ment. Health 28, 230–240. doi: 10.1111/camh.12543
Maiano, C., Normand, C. L., Salvas, M. C., Moullec, G., and Aime, A. (2016). Prevalence of school bullying among youth with autism spectrum disorders: a systematic review and meta-analysis. Autism Res. 9, 601–615. doi: 10.1002/aur.1568,
Makin, C., Hill, V., and Pellicano, E. (2017). The primary-to-secondary school transition for children on the autism spectrum: a multi-informant mixed-methods study. Autism Develop. Lang. Impair. 2, 1–17. doi: 10.1177/2396941516684834
March, A., Stapley, E., Hayes, D., Moore, D., and Deighton, J. (2024). Sustaining mental health and wellbeing programmes in schools: recommendations from an online roundtable. Front. Educ. 9:1397994. doi: 10.3389/feduc.2024.1397994
March, A., Stapley, E., Hayes, D., Town, R., and Deighton, J. (2022). Barriers and facilitators to sustaining school-based mental health and wellbeing interventions: a systematic review. Int. J. Environ. Res. Public Health 19:3587. doi: 10.3390/ijerph19063587,
Marshall, L., Wishart, R., Dunatchik, A., and Smith, N. (2017). Supporting mental health in schools and colleges: Quantitative survey report. Department for Education. Available online at: https://assets.publishing.service.gov.uk/media/5a82e5bb40f0b6230269d46c/Supporting_Mental-Health_survey_report.pdf (Accessed February 15, 2024).
Mason, B. K., Leaf, J. B., and Gerhardt, P. F. (2024). A research review of the zones of regulation program. J. Spec. Educ. 57, 219–229. doi: 10.1177/00224669231170202
Mayes, S. D., Gorman, A. A., Hillwig-Garcia, J., and Syed, E. (2013). Suicide ideation and attempts in children with autism. Res. Autism Spectr. Disord. 7, 109–119. doi: 10.1016/j.rasd.2012.07.009
Mesa, S., and Hamilton, L. G. (2022). We are different, that’s fact, but they treat us like we’re different-er: understandings of autism and adolescent identity development. Adv. Autism 8, 217–231. doi: 10.1108/AIA-12-2020-0071
Milin, R., Kutcher, S., Lewis, S. P., Walker, S., Wei, Y., Ferrill, N., et al. (2016). Impact of a mental health curriculum on knowledge and stigma among high school students: a randomized controlled trial. J. Am. Acad. Child Adolesc. Psychiatry 55, 383–391.e1. doi: 10.1016/j.jaac.2016.02.018,
Milton, D. (2019). “Difference versus disability: implications of characterisation of autism for education and support” in The SAGE handbook of autism and education. eds. R. Jordan, J. M. Roberts, and K. Hume (London, UK: Sage), 3–11.
Moore, S. A., Sridhar, A., Taormina, I., Rajadhyaksha, M., and Azad, G. (2024). The perspective of school leaders on the implementation of evidence-based practices: a mixed methods study. Implement. Res. Pract. 5, 1–14. doi: 10.1177/26334895231220279,
Mugabekazi, J. C., and Mukanziza, J. (2025). Educational leadership, mental health, and equity: a review of effective interventions in schools. Eur. J. Educ. Manage. 8, 49–62. doi: 10.12973/eujem.8.1.49
National Autistic Society. (2023). Education Report 2023. Available online at: https://dy55nndrxke1w.cloudfront.net/file/24/asDKIN9asAvgMtEas6gIatOcB5H/NAS_Education%20Report%202023.pdf (Accessed December 25, 2023).
National Institute for Health and Care Excellence. (2022). Social, emotional and mental wellbeing in primary and secondary education. Available online at: https://www.nice.org.uk/guidance/ng223/resources/social-emotional-and-mental-wellbeing-in-primary-and-secondary-education-pdf-66143833987525 (Accessed January 10, 2024).
Pantazakos, T. (2025). Neurodiversity and psychotherapy—connections and ways forward. Couns. Psychother. Res. 25:e12675. doi: 10.1002/capr.12675
Pantazakos, T., and Vanaken, G. J. (2023). Addressing the autism mental health crisis: the potential of phenomenology in neurodiversity-affirming clinical practices. Front. Psychol. 14:1225152. doi: 10.3389/fpsyg.2023.1225152,
Papa, D. P. (2018). School leader preparedness for addressing student mental health. J. Educ. Leadersh. Policy Stud., 60–76. Available online at: https://files.eric.ed.gov/fulltext/EJ1227157.pdf (Accessed April 8, 2024).
Parsons, S., Charman, T., Faulkner, R., Ragan, J., Wallace, S., and Wittemeyer, K. (2013). Commentary–bridging the research and practice gap in autism: the importance of creating research partnerships with schools. Autism 17, 268–280. doi: 10.1177/1362361312472068,
Pavlopoulou, G., Chandler, S., Lukito, S., Kakoulidou, M., Jackson, I., Ly, E., et al. (2025). Upsetting experiences in the lives of neurodivergent young people: a qualitative analysis of accounts of adolescents diagnosed with ADHD and/or autism. Child Adolesc. Psychiatry. doi: 10.1002/jcv2.70038
Perihan, C., Bicer, A., and Bocanegra, J. (2022). Assessment and treatment of anxiety in children with autism spectrum disorder in school settings: a systematic review and meta-analysis. Sch. Ment. Heal. 14, 153–164. doi: 10.1007/s12310-021-09461-7,
Perryman, J., Maguire, M., Braun, A., and Ball, S. (2018). Surveillance, governmentality and moving the goalposts: the influence of Ofsted on the work of schools in a post-panoptic era. Br. J. Educ. Stud. 66, 145–163. doi: 10.1080/00071005.2017.1372560
Pickard, K., Maddox, B., Boles, R., and Reaven, J. (2024). A cluster randomized controlled trial comparing the effectiveness of two school-based interventions for autistic youth with anxiety. BMC Psychiatry 24:6. doi: 10.1186/s12888-023-05441-0,
Pollock, K., and Briscoe, P. (2019). School principals’ understandings of student difference and diversity and how these understandings influence their work. Int. J. Educ. Manag. 34, 518–534. doi: 10.1108/IJEM-07-2019-0243
Public Health England. (2021). Promoting children and young people’s mental health and wellbeing a whole school or college approach. London: Public Health England. Available online at: https://assets.publishing.service.gov.uk/media/614cc965d3bf7f718518029c/Promoting_children_and_young_people_s_mental_health_and_wellbeing.pdf (Accessed April 15, 2022).
Roberts, J., and Webster, A. (2022). Including students with autism in schools: a whole school approach to improve outcomes for students with autism. Int. J. Incl. Educ. 26, 701–718. doi: 10.1080/13603116.2020.1712622
Scanlan, D., and Savill-Smith, C. (2021). Education Support. Teacher wellbeing index 2021. Available online at: https://www.educationsupport.org.uk/media/qzna4gxb/twix-2021.pdf (Accessed February 14, 2024).
Sharpe, H., Ford, T., Lereya, S. T., Owen, C., Viner, R. M., and Wolpert, M. (2016). Survey of schools’ work with child and adolescent mental health across England: a system in need of support. Child Adolesc. Mental Health 21, 148–153. doi: 10.1111/camh.12166,
Silvester, S. J. E., and Rankine, R. (2024). Neurodiversity-affirming school counselling: supporting neurodivergent student wellbeing with person-centred therapy. J. Psychol. Couns. Sch. 34, 266–284. doi: 10.1177/20556365241267050
Smith, R., Sharp, C., Sims, D., Millar, S., Nossiter, J., Menys, R., et al. (2018). Teacher voice omnibus: Research report. Department for Education. Available online at: https://assets.publishing.service.gov.uk/media/5aa25807ed915d4f563b6d47/Teacher_Voice_report_Summer_2017.pdf (Accessed December 7, 2023).
Stapley, E., Knowles, C., March, A., Mansfield, R., Ashworth, E., Burrell, K., et al. (2025). School staff perspectives on approaches to mental health promotion: Experiences of delivering universal approaches in English primary and secondary schools. Department for Education. Available online at: https://assets.publishing.service.gov.uk/media/680f535656bc2cfe7f7f5bfb/School_staff_perspectives_on_approaches_to_mental_health_promotion.pdf (Accessed April 13, 2025).
Stroul, B., Blau, G., and Friedman, R. (2010). Updating the system of care concept and philosophy [Issue Brief]. Washington, DC: Georgetown University Center for Child and Human Development, National Technical Assistance Center for Children’s Mental Health. Available online at: https://www.isbe.net/Documents/soc-brief-2010.pdf (Accessed December 3, 2023).
Suhrheinrich, J., Melgarejo, M., Root, B., Aarons, G. A., and Brookman-Frazee, L. (2021). Implementation of school-based services for students with autism: barriers and facilitators across urban and rural districts and phases of implementation. Autism 25, 2291–2304. doi: 10.1177/13623613211016729,
Tomé, G., Almeida, A., Ramiro, L., Gaspar, T., and de Matos, M. G. (2021). Intervention in schools promoting mental health and well-being: a systematic review. Glob. J. Community Psychol. Pract. 12, 1–23. doi: 10.17161/gjcpp.v12i1.20659
Tucker, V., and Schwartz, I. (2013). Parents’ perspectives of collaboration with school professionals: barriers and facilitators to successful partnerships in planning for students with ASD. Sch. Ment. Health 5, 3–14. doi: 10.1007/s12310-012-9102-0
Van Dijk-de Vries, A., Stevens, A., van der Weijden, T., and Beurskens, A. J. (2020). How to support a co-creative research approach in order to foster impact. The development of a co-creation impact compass for healthcare researchers. PLoS One 15:e0240543. doi: 10.1371/journal.pone.0240543,
Van Herwegen, J., Ashworth, M., and Palikara, O. (2019). Views of professionals about the educational needs of children with neurodevelopmental disorders. Res. Dev. Disabil. 91:103422. doi: 10.1016/j.ridd.2019.05.001,
Vincent, C., Oliver, C., and Pavlopoulou, G. (2023). Lessons from lockdown: autistic students, parents and mainstream schools. Br. Educ. Res. J. 49, 522–537. doi: 10.1002/berj.3854
White, C., Lea, J., Gibb, J., and Street, C. (2017). Supporting mental health in schools and colleges: Qualitative case studies. Department for Education. Available online at: https://assets.publishing.service.gov.uk/media/5a82001e40f0b62305b91f21/Supporting_Mental-health_Case_study_report.pdf (Accessed February 15, 2024).
White, J., McGarry, S., Falkmer, M., Scott, M., Williams, P. J., and Black, M. H. (2023). Creating inclusive schools for autistic students: a scoping review on elements contributing to strengths-based approaches. Educ. Sci. 13:709. doi: 10.3390/educsci13070709
Keywords: autism, school mental health, student wellbeing, school leadership, neurodiversity affirming practice
Citation: Cetintas S, Van Herwegen J, Al-Jayoosi H, McEvoy R, Hurry J and Pavlopoulou G (2026) A qualitative examination of the role of school leadership teams in secondary school mental health policy and practice for autistic students. Front. Educ. 10:1662602. doi: 10.3389/feduc.2025.1662602
Edited by:
Darren Moore, University of Exeter, United KingdomReviewed by:
Ben Morris, Leeds Trinity University, United KingdomWing Chee So, The Chinese University of Hong Kong, China
Copyright © 2026 Cetintas, Van Herwegen, Al-Jayoosi, McEvoy, Hurry and Pavlopoulou. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Georgia Pavlopoulou, Z2VvcmdpYS5wYXZsb3BvdWxvdUB1Y2wuYWMudWs=