Am I Being Unreasonable About Text-Only Communication with CMHT? (Seeking Advice!)

Hey everyone, thanks again for the lovely welcomes! As I hinted in my intro, I've hit a bit of a wall with the Community Mental Health Team (CMHT) and could really use some collective wisdom.

To recap: I was referred to the CMHT for mental health support. My autism and selective mutism mean I really struggle with face-to-face appointments (especially in busy city environments) and having strangers in my safe home space. I explained this, and they offered a few options, but none that truly accommodate my communication needs.

My preference, as highlighted in my autism diagnosis report, is to communicate via text/email. It's the only way I can really process and express myself without becoming overwhelmed and non-verbal.

Their latest response, however, was pretty disheartening. They said they couldn't offer an initial assessment with "written communication only." They reiterated their standard options (F2F, video call, phone) and basically said if I can't commit to those, they can't proceed. They did mention discussing whether a "service specific to ASD support" would be better placed for me.

Honestly, I feel quite upset and like I'm being pushed away from mainstream mental health support, despite my genuine need for help. It feels like they're trying to shunt me to a specialist service, which might not even offer the crisis support or other interventions I might need, rather than making reasonable adjustments themselves.

I've just sent them a detailed email, referencing my autism diagnosis report (which explicitly recommends text/email communication) and even the NHS England guidance (B1800) that states mainstream services should be accessible to autistic adults and offer text/email options for contact. I also copied PALS.

Now I'm left wondering: Am I being unreasonable here? Should I just try to force myself into one of their standard options, even though I know it will be incredibly distressing and likely unproductive? Or should I continue pushing for text-only communication, given that it's clearly stated as a necessary accommodation in my diagnosis and in NHS guidance?

Has anyone else faced this kind of pushback from mainstream mental health services? Any advice on how to navigate this, or what to expect next? I'm trying not to give up, but this is really draining.

Thanks for listening!

Oh and please feel free to tell me if I am being unreasonable here, I value your opinion on this, all love and respect!

TheQuietOak

  • Thanks for your reply, sometimes people just assume everyone is tech savvy and has access to modern phones etc. I wish I could easily go back to my GP, for me it's something that is very difficult. I think it's really hard for people to understand selective mutism, most people just don't get it they think I'm choosing not to speak or I'm shy or maybe just stupid. Thanks again for your reply.

  • Honestly if they would have given me a chance to email them and chat via text I think we could have come up with something like that, I would find it hard to chat 'live' and I wouldn't be able to express my feelings or to answer many questions but I could have given them some information prior to the meeting and explained what was going on. They just seem uncooperative. I had to go to PALs to even get them to give me an email because there was only a phone number and I can't talk on the phone. Thanks for your input, I am very aware that I need to be careful that I'm not just seeing my side so thanks again!

  • That's kind of how I feel! In some situations I really can't talk at all. When I can it's usually something I've pre-rehearsed and memorised, but any questions and I'm stuck. Sometimes I can go for years without speaking to anyone outside my family. Weirdly with some people in some situations I can just chat away no problem. It's something caused by anxiety and past traumas I think, I don't feel like it's who I am. I'm autistic through and through and I'm happy with that it's who I am but I feel selective mutism is the result of how I've been treated in the past and I would love to be rid of it. Thanks for your reply!

  • I wonder how they'd cope if you or anyone turned and couldn't speak, would they say you were uncooperative or something.

  • You said:

    'They said they couldn't offer an initial assessment with "written communication only." '

    Does this mean they just want to have first session this way but subsequent ones could be by email?

    Perhaps they have to see you the first time. Without it they can't see you to understand how they can help.

    Could you compromise and have a video call so you don't need to travel, they can see you and talk to you, but you can respond by typing in the chat box. Video calls can also allow you to type.

  • I'd go back to your GP and explain it to them and see if they can refer you to ASC specific support, but in my experience don't be surprised if they don't listen either, I spent 20 mins explaining to one of our local ones how I struggle with tech, don't have a smart phone and can only do really basic stuff, I was told that I could join a video dicussion which is their standard introduction and were amazed when I told them I couldn't do it as I lacked the equipment and the the knowlege of how to do so.

    Is there someway you could make a room in your home OK for an outsder to come into? Like putting blankets or throws on the sofa and chairs, so as when the visitor has lef they can immediatley be taken off and washed?

    If these written options were in your report then I think you do have a case for insisting on it, maybe writing to your MP or someone could help? 

  • Thanks for the reply. Honestly I think they could offer me what I need if they choose to, I think they just don't want to make any changes to how they normally operate. It would be great if there was a specialist service which could help me but I think what they mean by that is a service designed for people who need social care or telling me to look at particular websites, as far as I am aware none of these services offer crisis care and I do feel that the CMHT should be supporting everyone including autistic people and people with communication difficulties. They haven't suggested any alternatives yet, just an ultimatum to fit in or be refused help. I do appreciate your reply and comments thank you. I need some time to have a think about this.

  • I can share my experiences.

    At work I am often encouraged to communicate in person, usually by Teams with my managers. If I am trying to explain my difficulties I prefer to put it in writing as it gives me time to work out what I want to say as in person I tend to stall for the right words.

    In respect of NHS services. When I had a period of burnout I spoke to a lovely lady at our surgery who is a mental health nurse. She did a referral for assessment for autism but did say she couldn't advise on this as she is not trained in this area.

    I had a similar experience when speaking to a nurse from Occupational Health who said she could not advise on reasonable adjustments for autism as my employer did not subscribe to the service provided for this.

    From my experience, if they can't offer what you need would it be helpful to ask about the specialist service with autism experience?

  • Thanks, sometimes I need some processing time so chatting in a video call would be hard but they won't even accept that. I also think I might be out of luck here too, even if they do back down I'm not convinced that they will be able to help me, in fact I think there a good chance that they will make things worse. Thanks for the input thought, I appreciate it.

  • It doesn’t sound like you’re being unreasonable, but I’m curious how that email will be received. My thought is that while you might be reasonable in fighting for a text/email solution, you might be out of luck with this provider.

    If you do end up conceding and taking up their services in person, I’d recommend via video call. Some video call services have chat options, so you might be able to conduct that meeting with mostly text responses. Kind of just depends on what service they use.