Real-world evidence in digital mental health: the case of Autism Chat

14 January 2026

There are many good digital mental health practices in Belgium, but they are often only limitedly and insufficiently represented in academic literature. That’s in part why it was such a pleasure to read this study by Chloè Bontinck on Autism Chat, a Belgian chat service by Liga Autisme Vlaanderen that has been running for over six years.

Naturalistic studies like this one might lack methodological rigour — they’re miles away from gold standard RCTs — but, similar to Fien Buelens’ work on depressiehulp.be, they offer valuable insights into how services actually behave in the wild. In times where there are increasing calls for evidence of impact, these approaches lead the way for services to gain better insights into their own functioning while at the same time strengthening the visibility of the real-world impact they offer.

Key takeaways

For the substantial subgroup of autistic individuals who already seek digital support, chat functions as a first-choice access channel for many users rather than a marginal alternative.

The data indicate that chat produces meaningful short-term improvements in well-being when used for emotional support or problem-solving. Purely informational conversations result in little or no immediate improvement. Chat sessions in times of crisis were relatively rare.

The primary added value of the medium lies in its autism-specific affordances, such as control over communication pace and reduced social pressure, which directly address barriers common in face-to-face care.

Recognising and systematically learning from this kind of real-world evidence is one of the most promising ways to strengthen and scale the digital services that are already helping people today. Hopefully more Belgian services will follow suit.