'Accommodations for neurodivergent people exclude no one and include everyone' – psychiatrist Dr Catherine Dakin

Dr Catherine Dakin is a child and adolescent psychiatrist, specialist neurodivergence advisor at Essex Partnership University Trust, and one of the psychiatry leads for Autistic Doctors International. She is also late-diagnosed autistic and ADHD, a parent of neurodivergent children and someone who has navigated the NHS both as a clinician and supporting a person in crisis. She speaks to Neurodivergent Works about what organisations most consistently get wrong, what genuine support actually looks like and why the person is always the starting point – not the problem.

Dr Dakin did not follow the usual path. She graduated from medical school at 40, already a mother, already someone with a career behind her. She did not know she was autistic or ADHD at the time. What she did have was a way of looking at people: not at their symptoms, not at their diagnosis, but at who they actually were.

That instinct is now the foundation of her work. As specialist neurodivergence advisor at Essex Partnership University Trust (EPUT), she bridges the gap between ward and board, working with colleagues at every level to understand what is actually happening for neurodivergent staff and patients, and to make the case for change. It is a role she proposed herself, after auditing the referrals she was receiving in a one-day-a-week autism advisory post she held and realising that the cases she had to decline were beginning to outnumber the ones she could take on.

'I approached senior colleagues and was invited to present my reports to the Quality Committee of the Board,' she says. 'I identified the themes of need, and one of my proposals was that this becomes a full-time, substantive role. But more broadly neurodivergence, not just autism, because we are missing so many neurodivergent conditions where there are mental health and risk issues that are not being identified or supported.'

The Trust agreed. She interviewed for the role she had designed. She was appointed.

Before taking any credit, though, she is quick to name Julia Hopper: a person with lived experience of EPUT's services, and who is now her co-production partner. Dr Dakin describes Hopper as 'a very powerful, passionate and intelligent voice that has proactively led the way for change in our neurodivergence work.' 

The role, Dr Dakin says, came about because people with lived experience demanded it first.

What organisations get wrong

When Neurodivergent Works asks what HR professionals and managers most consistently get wrong about supporting neurodivergent employees, Dr Dakin does not reach for blame. She reaches for context.

'The information, the education, the training hasn't been there,' she says. 'It's only just starting to be there.' She cites the Oliver McGowan mandatory training and the National Autism Trainer Programme from the Anna Freud Centre as genuinely good developments. But she is also clear that the gap remains vast.

The deeper problem is structural. Every system that neurodivergent employees are asked to navigate — recruitment, interview, induction, office environments — was designed with neurotypical people in mind, because that was simply all anyone knew.

'Neurodivergent people are, by definition and by default, excluded from that space,' she says. 'The amount of effort for a neurodivergent person just to show up at work is extraordinary: the journey in, the application process, the interview, which is unbearable for many, the new environment, people. They've done a day's work, a week's work, before they even get there. And then to not have reasonable adjustments in place means that bringing your whole self to work is impossible. You can't, because your sensory processing, your information processing, your wellness in that space is fundamentally challenged.'

On reasonable adjustments specifically, she identifies a widespread misunderstanding of the Equality Act 2010. Many managers do not realise that an employee does not need a formal diagnosis to be entitled to adjustments. There only has to be an identified need arising from a long-term condition (at least 12 months) that has a substantial impact on their ability to do their work. 'There are multiple layers of understanding missing: of neurodivergence, of the law, of employer responsibility.'

Her vision of what good looks like is disarmingly simple. A manager who, when a new starter joins, says: 'Thinking about the practicalities of you in this workspace: how do you thrive? What has worked well for you in the past? What hasn't? Tell me what you think.' Not a form or a policy, but a conversation. Before the person has had to ask.

'That opens a conversation where the burden of responsibility isn't on the person needing support,' she says. 'But as we know at the moment, the person who needs support is having to do all the heavy lifting.'

Lived and living experience

Dr Dakin uses a phrase that she has thought carefully about: lived and living experience. Not just lived, because neurodivergence is not just something that happened in the past. It is present tense, every day, all of the time.

Her own experience of it is woven through everything she does clinically. She describes the moment of her own diagnosis as one where the same lens she had always used to look at the world came into focus. 'Everything suddenly made more sense. I could feel it in my core. It was so empowering but at the same time, deeply painful as I tried to navigate and accept this new identity, and make peace with all the years before when I hadn’t known or understood myself'. She now brings that experience into her work with patients.

'I don't observe a person when they're telling me their story,' she says. 'I sort of instinctively mentally insert myself into that journey and walk with them in the same direction. I didn't know that wasn't the way most people hear other people talk. That was a discovery. It sits within my experience of how I'm autistic.'

She has cried with patients. She is not ashamed of it. When someone receives a diagnosis after years of unexplained difficulty and pain, the relief they feel is something she recognises at a physical level. 

The complication is that the same connection that makes her effective can also make the work painful. When she sees a neurodivergent person being misunderstood, or described through their diagnosis rather than who they are, she feels it. 

'That hurts. I really have to check in with myself, take a moment to process what I've heard, and then work out: how do I go back to that situation and try to educate, compassionately, without making it about me?'

The NHS as employer

Dr Dakin is clear that significant work is being done in EPUT, and the creation of her role – the first of its kind – demonstrates the seriousness of their intention to turn learning into meaningful action to support not only their patients but also their workforce. But does the NHS, regarded as one of the biggest employers in the UK, understand what neurodivergent parents go through when their children are struggling? Dr Dakin feels that they possibly do not.

She speaks from experience. When her autistic son was very unwell, she did not know how to step back from work. She did not want to lose the career she had only recently begun. What made the difference was a single workplace relationship: a supervising consultant who knew her, kept her at the centre of every decision and proactively supported her. She suggested Dr Dakin work from home when she could – a reasonable adjustment that was supported by the Trust.

'I was struggling to access work,' Dr Dakin says. 'She said: “How about you work from home when you can?” That made a huge difference, because I could be present for my son.' 

When even that became unsustainable, she took six months of sick leave. When she returned, as a reasonable adjustment arising from some creative and collaborative thinking, she moved into a non-clinical quality governance role for a year, one she was qualified for through a previous career. Within six months, she was leading the team.

'No one could have predicted that,' she says. 'But that's how it all played out, to everyone's benefit.' She is clear-eyed about how unusual her situation was. 'I'm going to suggest that is not a usual solution that people have access to. It was a very unique one that I will be forever grateful for.  But my experience as a neurodivergent parent trying to support a neurodivergent child in need is not unique’.

The experience has shaped how she thinks about what genuine employer support looks like: not reactive, not transactional, but built on a relationship in which the employee feels safe enough to be honest. 

'Because I felt safe in my relationship with my boss, I could have these very honest conversations,' she says. 'That's what made everything else possible.'

What improvement looks like

Dr Dakin is optimistic about where the NHS is heading on neurodivergence. She sees Trusts trialling new ways of working, commissioners beginning to think seriously about the issue and a cultural shift beginning to take hold. But she is equally clear that the gap between policy and practice remains wide, and that financial constraints are making it harder to turn workplace needs assessment recommendations into reality.

At EPUT, she points to the Neuroinclusive Café, which is a regular Microsoft Teams space open to all staff, neurodivergent or not, to connect, share experience and feed themes into the Trust's neurodivergence steering group. It is an example of what inclusive infrastructure looks like. She points to the reasonable adjustments passport for managers, which now includes a neurodivergence chapter, as another.

But the headline, she says, is not just a policy or a programme. It is a culture.

'Genuine improvement means that neurodivergent people are supported because all people are supported, because all people are seen as individuals with their own unique experience of being. Not: “Here are the reasonable adjustments for the autistic people.” Every person has a unique experience of the world around them, a unique experience of what's happened to them, and a unique experience of what they're trying to achieve and what matters to them.'

She closes on the line she arrived at during the conversation: 'Accommodations and acceptance of neurodivergence exclude no one and include everyone.'

Everyone has a sensory profile. Everyone benefits from predictability. No one likes slamming doors. 'So yeah: accommodations, acceptance of neurodivergence, exclude no one and include everyone.'

Neuroinclusion is not a specialist concern. It is just good practice for everyone, everywhere.

'See the person,' she says. 'Care about the person. Help them be safe to share. With acceptance.'

Dr Catherine Dakin is a psychiatrist and specialist neurodivergence advisor at Essex Partnership University Trust and one of the psychiatry leads for Autistic Doctors International.

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