Autistic students’ mental health and wellbeing in UK higher education: A systematic review of support, barriers, and dropout

Abstract

Background. More autistic students are entering UK higher education (HE) each year. Their mental health, social experience, and academic progression remain worse than those of their non-disabled peers. The autism-in-HE literature has grown, but the evidence on mental health and wellbeing (MHWB) provision has not been pulled together in one place. As a result, no clear answer exists to the practical question institutions actually ask: which kinds of support help, for which students, in which conditions.

Aim. This review brings the evidence together. It maps existing MHWB provision for autistic students, examines the barriers they face in using it, and assesses how strongly autism is linked to HE dropout.

Methods. A systematic search of seven academic databases (Education Research Complete, ProQuest, Psychology and Behavioural Sciences Collection, APA PsycINFO, Scopus, SocINDEX, Web of Science) was conducted in January–April 2025 for studies published 2015–2025. Eligibility criteria, search strategy, and data extraction were pre-specified. Critical appraisal used CASP (qualitative) and JBI (mixed-methods) checklists. Synthesis followed a qualitative narrative approach with reflexive thematic analysis (Braun & Clarke, 2006; 2022). Reporting follows PRISMA 2020 (Page et al., 2021).

Results. Twenty studies were included. Three themes were generated through reflexive thematic analysis. Theme 1 covers the barriers autistic students reported: mental-health difficulties, academic structures that worked against them, social and sensory environments, weak staff awareness, and the cost of disclosure. Theme 2 sets out the relationship between autism and dropout, where attrition is disproportionately high and the drivers are both individual and institutional. Theme 3 covers MHWB support: peer mentoring and adapted CBT looked promising, but autism-specific provision was thin almost everywhere.

Conclusions. UK universities are not yet meeting the MHWB needs of autistic students. The Equality Act 2010 imposes the duties; the Abrahart judgment has tightened them; institutional practice has not caught up. The case for shifting from reactive accommodation to proactive, autism-informed design is clear, as is the case for staff training, co-produced support frameworks, and rethinking how assessment is structured. The evidence base remains small for the size of the population it concerns, and the studies are too varied in method to be meta-analysed. Longitudinal and participatory research, designed with autistic students rather than about them, is the priority.