She Wasn't 'Not Engaging' ... She Just Needed Time and a Keyboard

I met her on the ward as part of a routine review. The handover was straightforward: young autistic woman, admitted following an overdose, discharged from mental health services way too early, parents felt she wasn't ready, now she's stuck as a "social admission" while we figure out longer-term accommodation.

The MDT consensus was clear. She wasn't engaging. Withdrawn. Difficult to assess. There was even talk of selective mutism. The plan was to keep her in hospital until a suitable care placement could be arranged. But something didn't sit right with me.

When silence gets mistaken for not caring

I sat with her properly. Not rushed. Not surrounded by five people in a huddle. Just time, space, and the offer: would she be more comfortable typing on her phone than talking?

Her responses came straight away. Clear. Thoughtful. Articulate.

Within ten minutes, I knew more about what she actually wanted than the entire admission had uncovered. She didn't want to stay in hospital. She didn't want a care placement. She wanted to go home to her parents. But she felt like a burden. She was terrified of being a problem. And she needed proper support at home to make that work.

That wasn't selective mutism. That wasn't "not engaging". That was an autistic person communicating in a way that worked for her brain, not the way the system expected her to.

The anxiety trap

Here's what was actually happening. When staff asked her questions directly, especially in groups or with pressure to answer quickly, her brain went into overdrive. She'd start overthinking every word. Am I saying this right? Will they think I'm weird? What if I get it wrong? The anxiety would spiral so badly that the easiest, safest thing was to shut down completely. Say nothing. Withdraw.

From the outside, that looked like selective mutism. Like she couldn't speak, or wouldn't speak, on purpose. Like it was a symptom to manage.

But what was really happening was the opposite. She was so desperate to get it right, so afraid of making a mistake or being judged, that the pressure itself was what made her go completely silent. Her anxiety was so high that speaking felt impossible, not because she physically couldn't, but because the fear of getting it wrong was paralyzing.

Put her in front of a keyboard, give her time, take away the pressure and the audience, and suddenly all that overthinking gets channelled into clarity. She could think. She could type. She could change what she'd written if she wasn't happy with it. She could control the pace. She could do it in her own time, without someone staring at her waiting for an answer.. That's not a disorder to label and medicate around. That's how her autistic brain works when it's in a high-anxiety environment.

The parents knew all along

Her parents had tried to tell us. When she was being discharged from mental health services, they'd said: we don't think she's ready, we can't support her alone, please help us. And they'd been politely heard, and then completely ignored. Twenty years of living with her, supporting her, understanding her inside out, knowing exactly how her anxiety works and when she'll completely shut down, knowing that "selective mutism" is just what happens when she's terrified and pressured, none of that seemed to count against a discharge checklist.

When she was readmitted after the overdose, they tried again. But now they're seen as anxious, overprotective maybe. Parents who can't let go. Not as the actual experts they are.

This is where so much goes wrong. Not out of cruelty, but out of a system that's forgotten to listen to the people who know the person best.

The shift that changes everything

The moment we involved the parents properly, not as worried relatives to manage but as essential members of the care team, everything shifted. They could tell us about her communication preferences. They could explain what actually happens when she's put under pressure to speak. They could help us understand that her silence wasn't refusal, it wasn't a psychiatric symptom, it was fear. Pure, simple, treatable fear. They could be part of building a discharge plan that had a real chance of actually working.

And crucially: when we fed back to them what their daughter had said, that she wanted to be with them, that she felt like a burden, that she was scared, they could address that. They could reassure her. They could problem-solve with us about what structured support might look like at home, and how to communicate with her in ways that wouldn't trigger that shutdown response.

The "social admission" became a proper care plan. One that was autism-friendly, family-centred, and actually based on what she wanted, not what we assumed she needed.

Why this matters

Autistic people and people with learning disabilities don't communicate in one way. Some need time. Some need written word instead of speech. Some need a quiet room. Some need a trusted person there. Some need all of the above. Some, like her, experience massive anxiety around getting things "right" and need the pressure completely removed.

But too often, if someone doesn't communicate the way staff expect them to, the conclusion is that they've got a label like "selective mutism" or they're "not engaging", rather than asking the obvious question: have we tried a different approach? What's actually making them go quiet? Is this anxiety, or is this them genuinely refusing?

And parents, carers, family members, they're not obstacles to bypass. They're the people who've spent years learning how this person works, what triggers their anxiety, what helps them feel safe. Their knowledge is clinical gold. Not listening to them isn't compassionate; it's wasteful and dangerous.

At Dr MJ's Harmony Haven

This is why, at Dr MJ's Harmony Haven, we don't have a one-size-fits-all approach to communication. We ask. We observe. We try different methods. We take time. And we listen to families, not as an afterthought but as part of the core team from day one.

Because someone being quiet doesn't mean they have nothing to say. It usually just means we haven't yet found the way they need to say it, or we haven't removed the pressure that's making them shut down.

And when we do find it, when we actually hear what someone is telling us, and when we take their parents seriously as partners in care, that's when real change happens. That's when people can go home. That's when overdoses become preventable. That's when young autistic women stop feeling like burdens and start feeling like they belong.

It starts with listening. Properly. To them, and to the people who love them.

#Supported by Skill, Surrounded by Heart