Exclusion by Design (January in the Rearview)
January headlines show how systemic failure is the pattern, not the exception
Some of the more unsettling neurodiversity related news last month did not arrive as a surprise. It arrived as confirmation.
From the death of neurodivergent children in Hamilton and the UK, to collapsing urban mental-health systems, to international warnings from experts, January’s reporting traces a single throughline: institutions built without autistic people in mind eventually become dangerous to them.
What follows is a summary of recent media coverage and the broader research that explains why these outcomes were not only predictable, but structurally produced.
Systemic failure is not an anomaly. It’s a predictable outcome.
This post uses media coverage from last month and the broader research that explains why these outcomes keep repeating, across jurisdictions and political systems.
“This is unprecedented.”
Urban mental health system collapse
CTV reports on a new “report card” showing sharp deterioration in Toronto’s mental-health infrastructure, including service shortages, emergency backlogs, and increasing crisis acuity. Mental health systems designed for short-term crisis intervention fail people who require lifelong, non-linear support. While the reporting is broad, the implications for neurodivergent people are severe.
Neurodivergent adults are consistently overrepresented in emergency mental-health settings due to lack of community-based services. System collapse does not create vulnerability, it exposes it. Neurodivergent patients have been using the emergency services for years due to system gaps.
Research consistently shows that when community-based supports erode, neurodivergent people are pushed into crisis-driven systems that are ill-equipped to support them. Emergency rooms are not substitutes for continuity of care, but they become default entry points when prevention fails.
Read more:
Mental health in decline: Toronto’s first report card on mental wellness in the city Not everyone is equally affected and concerning patterns are emerging.
Addressing Stigma-Related Health Disparities for Autistic Individuals Disproportionate stigma across the life course in interpersonal, healthcare, and educational contexts.
“He should still be here with us.”
Hamilton bus crash: disability, exclusion, and preventable death
The death of an autistic boy in a school-related bus incident in Hamilton was not framed by family advocates as a tragic fluke, but as the result of missing, inadequate, or ignored school supports. Transportation planning, supervision, individualized safety protocols: all were named as gaps.
This story echoes well-established research finding autistic children face higher injury and fatality risk when systems rely on standardized procedures rather than individualized accommodations. When safety is treated as optional, or contingent on staffing levels, disabled children absorb the risk. Family advocates are calling for urgent reform after this tragic school bus incident. The reporting focuses not only on the tragedy itself, but on the absence of appropriate school supports: transportation planning, supervision, and individualized accommodations.
Read more:
World Health Organization (WHO) — World Report on Disability Documents elevated injury and mortality risks for disabled children in poorly adapted systems.
UN Committee on the Rights of Persons with Disabilities (CRPD) — Canada reviews Repeatedly flags systemic safety failures where accommodations are treated as discretionary.
Canadian Human Rights Commission — Disability discrimination in education Documents systemic discrimination against students with disabilities.
“Joshua’s death wasn’t an isolated incident...”
More UK reporting on disability system breakdown
A coroner raised concerns after another child’s death. They concluded that critical opportunities for appropriate care were missed, noting that the child had not been assessed by dietitians knowledgeable about autism and had never received a formal autism diagnosis prior to his death.
This case is not an isolated failure but a reflection of deeper structural pressures within public health and disability support systems in the UK and beyond.
The BBC article is another example systemic strain within the UK’s disability or mental-health support systems, highlighting delayed services, unmet needs, and policy gaps that leave disabled people without adequate care. Even in countries with universal healthcare, bureaucratic fragmentation and austerity measures disproportionately harm disabled and neurodivergent populations.
Comparative policy research shows that autism outcomes correlate less with national wealth and more with service coordination and rights-based frameworks. Even within universal systems, autistic people are disproportionately affected when coordination breaks down. Universal coverage does not guarantee universal access.
Read more:
Learning from deaths: Children with a learning disability and autistic children aged 4 – 17 years Draws on data from the National Child Mortality Database (NCMD).
Care Quality Commission (UK) — Autism & learning disability reviews Repeatedly documents systemic neglect tied to coordination failures.
“An inclusive future for autistic adults cannot be optional.”
Global Autism Convention: adults left behind
Autistic adults are expected to age out of support without aging into rights.
This article reports on experts at a global autism convention calling attention to a familiar gap: supports drop off sharply in adulthood. The focus shifts from awareness to employment, housing, autonomy, and dignity, underscoring how people and systems worldwide still frame autism as a childhood issue.
Research across regions shows adult outcomes are driven not by autistic traits, but by policy neglect, a failure to plan beyond childhood and schooling.
Global studies consistently show that adult outcomes for autistic people are driven by policy neglect rather than individual capacity. At a global autism convention in Bengaluru, experts issued a familiar warning: supports still disappear in adulthood. Employment, housing, autonomy, and dignity remain underdeveloped policy areas worldwide, despite growing awareness of autism.
Read more:
UN Special Rapporteur on the Rights of Persons with Disabilities Identifies service fragmentation as a major rights violation.
Autism-Europe’s analysis of EU’s implementation of the UNCRPD Examines CRBD recommendations , specifically those relevant for autistic people.
National Autism Indicators Report: The Intersection of Autism, Health, Poverty and Racial Inequity Adult outcomes correlate more with support access rather than individual traits.
January reporting points to a pattern that is by now unmistakable. Institutions respond after harm occurs rather than anticipating it. Supports are offered conditionally, dependent on funding cycles, staffing levels, or crisis thresholds, rather than guaranteed as a matter of rights. Neurodivergence, meanwhile, continues to be treated as a disruption to systems designed for a narrow norm, not as a core design consideration. What January’s coverage exposes is not a lack of evidence or understanding, but a persistent failure to act on what is already known.
The evidence base is remarkably consistent. Inclusion is less costly than exclusion when measured over a full lifespan. Early and sustained supports reduce later crises across education, health, and justice systems. Outcomes improve when disabled and autistic people are involved in designing the policies and services meant to support them. Yet these findings rarely translate into durable implementation. As a result, governments and institutions revisit the same tragedies, commissions, and reviews, often framing them as unprecedented despite their familiarity.