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There are historical references to suicide or suicidal ideation in persons with communicative disorders - Beethoven who was 28 and living with a severe hearing loss contemplated suicide and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."
- "I thought of suicide often (mainly when alone in bed at night). I never had enough courage then to go through with it. Even if I wanted to do it now I couldn't -- it's physically impossible." (from Nick Chisholm's "The patient's journey: Living with locked-in syndrome" - http://www.bmj.com/content/331/7508/94.full)
- "One night I literally had to choose right or left. Walk right to the bridge, or left to continue walking and thinking about what my laryngectomy had changed in my life. Every time I reached the corner, I had to choose again." (from Elizabther Finchem's "Grieving Whispers on the Web" - http://www.webwhispers.org/news/dec2006.asp)
- "i feel that if i could take a pill and be out of the game without suffering then i would take one now as this living in hiding is no way to live-hiding so that nobody sees me eating. i hate myself right now and this depression is all as a result of the swallowing problems" (from Stuart, "Dysphagia root cause of depression/suicide" - http://www.nomorepanic.co.uk/showthread.php?t=99334)
- "For me, like many others, aphasia was devastating . . . . Lack of communication often leaves people feeling isolated, depressed and angry. Aphasia erodes the social bonds that give life meaning. Everyday interactions with family, friends, and coworkers take tremendous energy. Many persons with aphasia succumb to depression or consider suicide when they find their condition unbearable." (from John Liechty and Justin Heinz "John's Story" - http://www.mayfieldclinic.com/MC_hope/Story_John_aphasia.htm)
- "Felt worthless, contemplated suicide. Had very low self-esteem, frustrated in not being able to do such a simple thing as to speak. . . . I hate imperfection, so find SD hard to accept. If Botox had not come along for us, I feel suicide would have become an option." (Don Edgar's "Spasmodic Dysphonia: What's Wrong with your Voice" -
- "When I was 21, all the difficulties associated with my deafness came to a head, and I decided to kill myself." (from Kate Locke, "Looking back: The isolation of deafness and considering suicide" - http://katelocke.wordpress.com/2010/01/07/the-isolation-of-deafness-and-considering-suicide/)
- An article by Grahame Simpson and Robyn Tate in the Medical Journal of Australia (2007) reports "People with traumatic brain injury (TBI) have an increased risk of suicide, suicide attempts and suicide ideation compared with the general population." (https://www.mja.com.au/journal/2007/187/4/preventing-suicide-after-traumatic-brain-injury-implications-general-practice). This is recognized as so prevalent among veterans that the Veterans Integrated Service Network has produced a 33-page manual Traumatic Injury and Suicide: Information and resources for clinicians (http://www.sprc.org/library/TBI_Suicide.pdf)
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:
Crisis Hotlines and online support resources
- Preventing Suicide: A Toolkit for High Schools a 229 page PDF from the U.S. Department of Health and Human Services (http://store.samhsa.gov/shin/content//SMA12-4669/SMA12-4669.pdf)
- Preventing Suicide (http://www.cdc.gov/features/preventingsuicide/) from the Centers for Disease Control and Prevention
- The Yellow Ribbon Campaign (http://www.yellowribbon.org/) - a suicide prevention training program "dedicated to preventing youth suicide and attempts."
- Paul Quinette's Suicide: the Forever Decision: For those thinking about suicide and for those who know, love and counsel them (http://www.qprinstitute.com/pdfs/Forever_Decision.pdf) free PDF book that describes QPR (question, persuade, refer), Quinette's helpful information of what to do when someone expresses suicide ideation, directly or indirectly.
- Stop a Suicide Today (http://www.stopasuicide.org/index.aspx) provides good information about suicide and describes another short acronym, ACT (Acknowledge, Care, Get Treatment) http://www.stopasuicide.org/actdecision.aspx
- Suicide Prevention Resource Center (http://www.sprc.org/) is dedicated to "promoting a public health approach to suicide prevention" with good information about prevention basics, freely-available online training and webinars, and a phenominal library of resources.
- American Foundation for Suicide Prevention (http://www.afsp.org/) has education resources including PowerPoint presentations and excellent information about suicide including what to do "When You Fear Someone May Take Their Life"
- Suicide from TeensHealth (http://kidshealth.org/teen/your_mind/mental_health/suicide.html) has good information for teens, also available in Spanish.
- Youth Suicide Prevention Curriculum from the Wisconsin Department of Public Instruction includes two free downloads Suicide Prevention Grades 6-8 and Suicide Prevention Grades 8-10 and a free Middle/High School Suicide Prevention Curriculum Webinar (http://dpi.wi.gov/sspw/suicideprevcurriculum.html)
- Befriender's International Network in Arabic, Chinese, German, Spanish, French, Japanese, Dutch, Russian, Suomi, Portuguese, Danish. This site also provides Helpline Information from countries around the world. (http://www.befrienders.org)
- Samaritans provides "confidential support for suicide, suicidal thoughts, feelings of despair or distress" in the UK and Ireland and has good inforomation on how to initiate a conversation with someone you suspect is suicidal. (http://www.samaritans.org/)
- San Francisco Suicide Prevention - America's oldest community crisis hotline (http://www.sfsuicide.org/index2.html)
- Suicide Forum - a support forum for people in crisis (http://www.suicideforum.com/). Quick links show how to contact the forum leaders.
- National Suicide Prevention Helpline (http://www.suicidepreventionlifeline.org/) 1-800-273-TALK (8255) (CALL FOR HELP for yourself or a loved one)