From this Anti-Oppression: Anti-Ableism Guide
"Ableism is prejudice plus power; anyone of any degree of physical or non-physical ability can have/exhibit ability-based prejudice, but in North America (and globally), societally enabled or nondisabled people have the institutional power, therefore Ableism is a systematized discrimination, antagonism, or exclusion directed against disabled people based on the belief that ‘normal ability’ is superior. Ableism involves both denying access to disabled people and exclusive attitudes of nondisabled persons.
Ableism and ableist societies restrict accessibility, either consciously or unconsciously, by designing physical locations/buildings, technology, transportation systems, communication systems, etc. that meet the needs of nondisabled people and dismiss the needs of disabled people. Disabled people, therefore, are primarily disadvantaged not by their difference or diagnoses, but by the society that disregards and marginalizes their needs and restricts accessibility."
It is imperative that any organization meant to prevent suicide understand disability as a social issue, and recognize the dignity and worth of the lives of all people, regardless of the disabilities they may experience. When considering the risk factors associated with suicide for disabled people, remember that systematic ableism underlies most of the factors, and plays a more substantial role than the condition itself.
Data on disability in relation to suicide is often lacking, and large scale studies of suicide often leave out disability as a variable of interest. Improvement is needed in data collection for suicide rates in people with disabilities across all ages. There are also unmet needs in the development of evidence-based programs to address suicidal thoughts and behaviors in people with specific disabilities.
Studies show that people with Autism are at higher risk for suicidal thoughts, plans, or actions than the general public, although how much higher varies widely among the studies. This could be because some of the risk factors for suicide in the general population may occur more frequently for those with Autism. For example (taken from this source):
- Children with autism are bullied at a much higher rate than their unaffected brothers and sisters.Research shows that both bullies and their victims have a higher risk of suicidal thoughts and attempts.
- People with autism have higher rates of underemployment or unemployment than the general population.
- Youth and adults with autism have higher rates of depression and social isolation than others.
Some recent studies have found that communication difficulties associated with Autism may mask the warning signs of suicide, especially in children and youth.
Crisis Supports for the Autism Community: This short guide assists crisis workers in identifying and supporting autistic callers/texters who are in crisis, even in cases where a person with autism may not disclose (or be aware of) their diagnosis. It explains the unique differences in communication, thought processes, sensory issues and misunderstandings a crisis worker may encounter while assisting a person on the autism spectrum in crisis.
Diagnosing Depression in Autism: This article reviews several studies examining depression in children and adults with Autism, and provides recommendations for understanding, recognizing, and diagnosing depression in this population.
Deaf & Hard of Hearing
Studies have found that deaf individuals have higher rates of psychiatric disorder than those who are hearing, while at the same time encountering difficulties in accessing mental health services. These factors might increase the risk of suicide. However, the burden of suicidal behavior in deaf people is currently unknown. Data collection needs improvement to capture the experience of suicide in deaf and hard of hearing people (and people with disabilities broadly). Specialist mental health services are crucial to meet the needs of deaf and hard of hearing people.
Suicide Prevention Lifeline Resources for the Deaf/Hard of Hearing: Includes option for Online Chat, Video Relay Service, and Voice/Caption. TTY: Dial 800-799-4889.
DeafLEAD Crisis Line: VP: 321-800-3323 DeafLEAD also provides free 24hour crisis interpreting to deaf victims of crime. Anytime, 24 hours a day, contact 573-445-5005 to schedule an interpreter. Or, text “HAND” to 839863 to request an interpreter.
Deaf Community and Mental Health Care: Common problems related to mental health care access for deaf/hard of hearing people include communication and linguistic barriers and lack of experience and understanding in the provider.
The National Association of the Deaf notes that deaf people have the right to push for referrals to mental health professionals who have experience working with those who are deaf or are hard of hearing. The organization also says that deaf people have the right to communicate "in the language and mode of communication that is effective for you," and to clearly understand the diagnosis and recommendations for their treatment.
The suicide rate among people with epilepsy is about 22% higher than that of the general population, according to the CDC (2016). Important findings from this report include:
- Compared with the non-epilepsy population, those with epilepsy were more likely to have died from suicide in houses, apartments, or residential institutions (81% vs 76%)
- People with epilepsy were more than twice as likely to poison themselves compared to the non-epilepsy population (38% vs 17%)
- More people with epilepsy ages 40 to 49 died from suicide than persons without epilepsy in the same age group (29% vs 22%).
This could point to a need for lethal means reduction to prevent suicide in people with epilepsy.
From the Epilepsy Foundation: What Causes Someone with Epilepsy to Have Suicidal Thoughts?
Researchers have found that
- Some of the brain areas responsible for certain types of seizures also affect mood and can lead to depression.
- Living with the challenges of epilepsy (such as misunderstanding, discrimination, fear of disclosure, unpredictability of seizures, bullying, financial troubles, and changes in relationships, work, or school) can also lead to depressive thoughts or feelings.
- Seizure medications may contribute to changes in mood. Some medicines may help mood, while others may worsen mood. In 2008, the U.S. Food and Drug Administration issued a general warning that antiepileptic drugs may increase the risk of suicide or suicidal thoughts. A 2009 review found that many other factors were not addressed, including the risk of depression in people with epilepsy. People taking any seizure medication should be advised of possible changes in mood, suicidal feelings, or other changes.
Epilepsy & Seizures 24/7 Helpline: English: 1-800-332-1000 / Spanish: 1-866-748-8008. Please note that this is an information and referral line, and is not staffed by clinical professionals. The Epilepsy & Seizures Helpline provides support related to epilepsy treatment and alternative therapies, medication questions, support groups, seizure first aid and safety devices, employment and discrimination, emotional support, and more.
Tourette Syndrome (TS)
Data from the CDC:
Mental Health Concerns associated with Tourette Syndrome:
- 86% of children who had been diagnosed with TS also had been diagnosed with at least one additional mental health, behavioral, or developmental condition based on parent report
- 63% had ADHD.
- 26% had behavioral problems, such as oppositional defiant disorder (ODD) or conduct disorder (CD).
- 49% had anxiety problems.
- 25% had depression.
- 35% had autism spectrum disorder.
- 47% had learning disabilities
- 29% had speech or language problems.
- 30% had developmental delays.
- 12% had intellectual disabilities
Higher Suicide Risk in People with TS
There is an under-recognized mental health need in people with TS/CTD. From the Tourettes Action Center:
- People with Tourette Syndrome or Chronic Tic Disorder may feel sad or depressed
- Result of tic disorder or response to difficulties experienced living with condition?
- Anxiety about the future
- Career/academic pressures
- Coping with symptoms
- Patients with TD/CTD were four times more likely to have died by suicide
- 8% with TD/CTD had attempted suicide at least once compared to 2% of the general population
- Main predictor of suicide was persistence of tics beyond young adulthood (19+); other predictors were a previous suicide attempt and the additional diagnosis of a personality disorder
This case study based on suicide and attempts in people with TS (Davila et al., 2010) found suicidal behavior was associated with moderate-to-severe tics, self-injurious behavior, bipolar mood swings, obsessive-compulsive disorder, and impulsive-aggressive behaviors.
Self Harm Behaviors in People with TS (Source)
Self-harm behavior (SHB) appears mostly in children and adolescents and rarely begins in adulthood. Self-harm behavior is associated mainly with tic severity, obsessive-compulsive disorder, and attention-deficit/hyperactivity disorder.
Clinical correlates of SHB are age related and differ at different points of life. Tic severity is the main factor associated with SHB in children. In the adult group, anxiety disorder and other psychiatric comorbidities may play the most important role.
Children with TS/Chronic Tick Syndrome: (Source)
- More prone to suicidal thoughts or behaviors than peers without
- Biggest indicator: rage (anger, frustration)
- TS and chronic tic disorders often co-occur with OCD or anxiety; however, aggression played a bigger role in the risk of suicidal behaviors
- 1 in 10 will experience suicidal thoughts or behavior; however, no data on how many children with chronic tic disorders die by suicide
Dealing with Rage
Some people with TS have anger that is out of control, or episodes of “rage.” Rage that happens repeatedly and is disproportionate to the situation that triggers it may be diagnosed as a mood disorder, like intermittent explosive disorder. Symptoms might include extreme verbal or physical aggression. Examples of verbal aggression include extreme yelling, screaming, and cursing. Examples of physical aggression include extreme shoving, kicking, hitting, biting, and throwing objects. Rage symptoms are more likely to occur among those with other behavioral disorders such as ADHD, ODD, or CD.
- Treatment: behavior therapy, Coping skills, learning how to relax, social skills training
- Some of these methods will help individuals and families better understand what can cause the symptoms of rage, how to avoid encouraging these behaviors, and how to use appropriate discipline for these behaviors.
- In addition, treating other behavioral disorders that the person might have, such as ADHD, ODD, or CD can help to reduce symptoms of rage.