World Suicide Prevention Day Thursday 10th September

World Suicide Prevention Day is on 10th September. A key message from Suicide Prevention Scotland’s campaign is ‘What if asking about suicide could save a life?’

At SWAN, we have been thinking about what it means to approach that question through a neuro-affirming lens.

We need to talk about suicide

It’s vital that we aren’t afraid to talk about suicide, particularly within the autistic community: Research consistently shows that autistic people experience significantly higher levels of suicidal thoughts and behaviours and are at greater risk of dying by suicide than non-autistic people.

For some autistic people, suicidal thoughts may be recurring or long term rather than arising only during an identifiable crisis. This does not make those thoughts unimportant, nor does it mean that we should accept suicidality as an inevitable part of being autistic. It means that we need to listen carefully, understand the person’s individual experience and avoid relying on assumptions about what suicide risk is supposed to look like.

Being neuro-affirming means recognising that how we ask, the answer we get, and how we respond, will look differently depending on how someone’s neurology works.

What does neuro-affirming support mean?

Although every autistic person is unique, understanding common shared differences in how we communicate, experience our emotions and the world around us, and connect with our bodies, is vital for anyone supporting an autistic person experiencing suicidal thoughts. This includes professionals, friends, family members, partners and colleagues.

At SWAN we run a variety of trainings and workshops that are designed to support this understanding, Including our 'Understanding and Supporting Autistic people in Mental Health and Suicidal Crisis' and Autistic Wellbeing Courses

"Highly informative, constructive, autistic led and the training you wish any therapist, support worker or manager would undertake if working with anyone that is autistic." Impact Arts

"This has been really eye opening and thought provoking session, thank you for such an informative session" NHS Education for Scotland Masterclass Session

"The detailed and nuanced explanations were so easy to understand and gave so much insight into some of the sticking points I have been facing working with autistic individuals, Will highly recommend to all my colleagues thank you" NHS 24/Breathing Space 

A neuro-affirming conversation might involve:

• Using clear, direct and unambiguous questions rather than hints or euphemisms

• Allowing additional time for the person to process the question and formulate an answer

• Offering different ways to communicate, including speaking, writing, typing or using visual information

• Not assuming that a person’s facial expression, tone of voice or body language tells us how much distress they are experiencing

• Taking a person seriously even when their account sounds factual, detached or different from how we expect emotional distress to be expressed

• Recognising that shutdown, loss of speech, agitation, withdrawal or an increased need for routine may communicate distress

• Reducing sensory and communication demands wherever possible

• Asking what helps rather than assuming that conventional sources of comfort will feel supportive

• Developing plans collaboratively, with the person rather than simply for them

It is also important to understand the person’s usual experience. If suicidal thoughts are long term, asking what has changed may help us recognise increasing risk. However, recurring thoughts should never be dismissed as “just how they are.”

Neuro-affirming support does not mean minimising risk. It means responding to risk in a way that is more likely to help the person communicate, remain engaged and access meaningful support.

Suicide prevention must be intersectional

We know that how we experience and express our autistic identity will intersect with other aspects of our experience and identity – SWAN started because of the need for better understanding and support for autistic women, and we continue to focus on the intersection between autistic identity and gender. But intersectionality allows us to think about multiple intersections at the same time – recognising the importance of understanding along lines of gender and sexuality, race, class, age, amongst other things. This will shape how we might approach conversations around suicide, and thinking about suicide prevention within the autistic community.

There cannot be a single, standardised approach to suicide prevention within the autistic community. We need to remain curious about the whole person and the social and structural conditions surrounding their distress.

Time, space and compassion

The concept of time, space and compassion is central to Suicide Prevention Scotland’s work – a simple concept that describes what is important to those seeking help. Rather than a prescriptive guide to how to respond, the idea of time, space and compassion invites us to think about what individual people might need in a responsive way. What time, space and compassion might look like to an autistic person will be shaped by their individual neurology – we might think of it in terms of: needing time to process questions, the importance of sensory-safe spaces, and how the double empathy problem (from Damian Milton) frames differences in how we might experience and express empathy in terms of difference, rather than a deficit located in one person, and means we need to attend to gaps in how we might communicate compassion across neurotypes.

"I can without a doubt say without the work of SWAN I would not be here today. After being bumped around endless services that either judged me or missunderstood me. SWAN were the first people who stopped next to me and gave me the time, space and words to make sense of everything and I will never ever forget what they have done for me, literally a life saver. I now come to groups and things at SWAN which I would never have done and I actually have a life and friends, real friends at SWAN." 

These are all things we address in our trainings that looks specifically at what neuro-affirming support can look like for autistic people experiencing suicidal thoughts or feelings.

Suicide prevention is also about liveability

Preventing suicide is not enough. We also want to support lives that feel livable, a broad concept called ‘liveability’. The University of Edinburgh’s Discovering Liveability project describes liveability as a broad concept encompassing physical and mental health while also recognising how social, political, environmental and cultural contexts affect whether life feels liveable.

We want autistic people not just to survive, but to thrive. That means not just asking about suicide, and being able to respond when an autistic person is in crisis. It means understanding autistic experience as a whole, challenging and changing the systems and structures that can make life feel unliveable for autistic people, and creating spaces of autistic joy, connection and community.

At SWAN, as well as recognising the importance of peer support in suicide prevention, we also see the value of autistic peer support for creating community and connection. We also value autistic peer support as something more than a response to crisis: it can create community, shared understanding and spaces in which less explanation and masking are required.

If you need support

If you or someone else is in immediate danger, call 999 or go to your nearest Accident and Emergency department.

In Scotland, you can also contact:

• NHS 24: Call 111 for urgent mental health support.

• Samaritans: Call 116 123 free, at any time.

• Breathing Space: Call 0800 83 85 87 for confidential support if you are experiencing low mood, anxiety or distress.

If speaking by telephone is inaccessible, you could ask somebody you trust to help you make contact or accompany you while you seek support.