The unedited version provided below of The ASHA Leader column (which is available online at Internet: Clients Who Threaten Suicide -- and Our Responsibilities by Judith Maginnis Kuster, November 20, 2012) contains additional information.


Clients Who Threaten Suicide -- and Our Responsibilities

There are historical references to suicide or suicidal ideation in persons with communicative disorders - Beethoven who was 28 and living with a severe hearing loss contemplated suicide and Freud who was suffering with repeated and extensive surgeries associated with oral cancer, begged for physician assisted suicide. He died of a morphine overdose, which may have been an attempt to relieve pain or may have been an assisted suicide. Even in our field, Charles Van Riper thought of suicide "and tried it once" (Charles Van Riper: On the End of His Life - http://www.mnsu.edu/comdis/kuster/vanriper/goodbye.html).

I have had 10 different individuals with communicative disorders report suicide ideation to me - one as young as 6, another 11, 6 in their teens and early twenties, and two who were adults. Fortunately none followed through on suicide, but some do. Recently there was a suicide of a 17 year old who stuttered (Uncle Brett Hart's "James Campbell Stuttering Memorial" - http://www.stutteringhelp.org/Default.aspx?tabid=932). Not long ago, another young man who stuttered committed suicide. He was in a graduate program to become an SLP, (Steven Kaufman's blog - Thanks for the Memories - http://stevenonstuttering.blogspot.com/2010_11_01_archive.html).

"In Orange County, California a young teen killed two neighbors before committing suicide. . . . An update on the young man who committed the crimes. . . stated that he suffered from Asperger's Syndrome." (Bonnie Sayer's "Suicide among Asperger Teens" - http://www.bellaonline.com/articles/art37003.asp)

My area of expertise is stuttering, and all but two of the people referred to above were persons who stuttered (PWS). But it is not only PWS in our caseloads who express suicide ideation. The purpose of this column is to create awareness of potential suicide ideation in some of the clients seen in our caseloads and to provide information about what to do. Courses in counseling are also highly recommended.

Some examples of suicide ideation in a variety of clients are embedded in several online resources. Below are quoted specific references to suicide ideation, but reading the entire resource provides additional insight.

Last summer, a post appeared on Facebook: "Am I the only one here who wants to kill himself because of how stuttering can f*** a person's life?" Anticipating these kinds of threats, Facebook has developed a form, "Report Suicidal Content" (http://www.facebook.com/help/contact/?id=305410456169423) and states, "IMPORTANT: If you have encountered a direct threat of suicide on Facebook, please immediately contact law enforcement or a suicide hotline."

In October 2011, I hosted an online conference on stuttering. A consumer posted, "I just had it today, wanted to end my life because of my stuttering. Didn't want to be embarrassed anymore about my speech problem. I am 23 years old & I am a person who stutters. Stuttering has changed my life drastically. . .. I feel hopeless." (I was able to locate her through an IP address, connected her to a local NSA chapter, helped connect her with 2 friends her age who stutter and are also SLPs. She's been referred for counseling as well as speech therapy).

After seeing her post, I asked the following question to a panel on the "Prof is In": "Do any of your training programs have a required course where suicide ideation, threats or attempts in clients is discussed? The silence was deafening. One of the 25 professionals on the panel responded. Another posted at the end of the conference saying she had signed up for a workshop on suicide. After the conference concluded, two more wrote privately and said they had added a section to their courses on counseling and CDis, one by scheduling a counselor to come and talk to her class.

Of course counseling persons who are suicidal is not part of the scope of practice for a speech-language pathologist or audiologist. Yet professionals should know the basics of what to do in many emergency life and death situations. While someone is dialing 911 to summon help, everyone should be know what to do if someone is choking, bleeding severely, having a seizure, having an apparent heart attack or stroke, or not breathing. Basic first aid courses are required in many work settings.

As professionals we should also have some basic knowledge of what to do when someone expresses suicidal ideation to us. Below are several helpful resources:

Prevention resources

Crisis Hotlines and online support resources