Suicide Prevention is Everyone’s Work

Teal W. Benevides

Brenna B. Maddox

Rachel L. Moseley-Braund

Mirabel Pelton

Lisa Morgan


Additional Crisis Resources:
988 National Suicide and Crisis Lifeline:

Warning: This article discusses the topic of suicide and suicide prevention.

Suicide prevention in the autism community is an important topic because suicidal thoughts and behaviors are significantly more common among Autistic people than non-Autistic people.1,2  This doesn’t mean that suicidal thoughts and behaviors are inevitable—quite the opposite. We believe that Autistic people can get to a place where suicide is not common and envision a time when Autistic people have the tools and resources to live lives worth living. This can be accomplished through understanding the lived experience of Autistic people in our society. 

Suicide prevention is generally discussed in relation to risk factors,3,4 theories,5 and interventions6,7 aiming to reduce suicidal thoughts and behaviors, but it cannot stop there. Suicide prevention is much larger. Suicide prevention requires an understanding of individual protective factors and strengths, opportunities for building meaningful lives, and ideal neuro-affirming^ educational,8 clinical,9,10 and community spaces for care and support.11 Put simply, what do Autistic people need to live fulfilling lives? Beyond what makes people want to die, what makes lives worth living? And how do we create conditions in which Autistic people want to live?12 Suicide prevention certainly means that we work together to identify risk,13-15 that we understand specific warning signs of suicide,16 and that we have appropriate support to offer when people experience suicidal thoughts and behavior.17 Suicide prevention also means that we need to re-frame how autism is perceived and talked about in society, so that we recognize the inherent value in every human life. We need to advocate for a society where people feel valued and their strengths are recognized, and their lives have meaning and purpose. We cannot address suicidal thoughts and behaviors if we don’t address the context in which people are living and experiencing repeated stigma, discrimination, and misunderstanding.12,18-20

This important work to build evidence in suicide prevention has been growing, with an increase in the number of research teams that are working to expand our knowledge, including teams led by Autistic researchers and community members. Verifiable increases in the number of published studies, funding support, and interest in suicide prevention are exciting and promising, yielding important growth in what we know and do. However, we still have a long way to go.

We are only just beginning to establish valid ways to assess suicide risk21-24 or evaluate approaches to support Autistic people in crisis.25,26 We need to better understand ‘warning signs’ of imminent suicidal behavior in Autistic people,16 and about ‘reasons for living’ that might help Autistic people resist intrusive suicidal thoughts. We know very little about the neuro-biology or genetics of suicidality in autism,27 or about how prescribed medications for depression or anxiety may be metabolized or experienced differently in Autistic people. While many ‘black box’ warnings exist for the general population related to specific psychotropic medications creating potential for suicidal thoughts or behaviors, these studies have not been done in Autistic people in a rigorous way despite Autistic people being over-prescribed psychotropic medications.

We also lack concrete evidence about how creating inclusive, neuro-affirming healthcare settings can support help-seeking among Autistic people in crisis. We are also only just starting to explore protective factors against suicide risk28 or ways that organizations can collectively prevent suicide or improve care delivery in collaboration with the Autistic community.29,30 We need to work to identify protective factors specific to suicide, including understanding people’s reasons for living and Autistic people’s strengths. This is also reflected in our knowledge base. A recent review described few articles discussing character strengths in autism.31 

We need research and practice to focus more on strengths and move away from interventions that remediate autism, that is to reduce Autistic characteristics. As Stephen Shore often says, “No one builds a life off of remediated weaknesses.” We need approaches that build on a person’s interests and passions and link them to future opportunities. In sum, suicide prevention isn’t solely about specific interventions when someone is in crisis. Suicide prevention starts in early intervention, in schools, at home, and in outpatient therapy clinics, aided by timely autism diagnosis and provision of support. Suicide prevention is the work of everyone, recognizing each Autistic person for the gifts they bring and creating accessible, welcoming societies where neurodivergent people are accepted and celebrated for who they are. Suicide prevention includes connecting people to the right support, at the right time. Suicide prevention is creating community opportunities and pathways, helping people know that they matter. Suicide prevention is elevating the most marginalized voices and working in partnership with them to create knowledge and shape practice – and ultimately save lives.  

Importantly, among the people writing this article, we represent people who are both neurodivergent and have attempted suicide or family members of people who have these lived experiences; we are also researchers, psychologists, social workers, and occupational therapists. In our roles it is difficult to separate the many ‘hats’ and this article is written as a reflection on where we are as a community. Ensuring Autistic leadership to catalyze change is essential, not optional. Our respective collaborations and Autistic leadership has spurred resources created by and with Autistic people, including a new warning signs resource and other tools such as a Reasons for Living guide.32 There is real concern– if it takes more than 7 years for research to influence policy and practice, the challenge ahead is to accelerate translation of what we know into meaningful action while continuing to expand research into community priorities for suicide prevention.33 Implementation is not a future aspiration; it is an urgent necessity.


^Neuroaffirming approaches validate Autistic ways of thinking, communicating, and experiencing the world, while providing support for difficulties and distress without framing autism as something that requires normalization or cure.


References

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