Suicidal Behavior and Community Support of Adults with Intellectual Disability: Two Case Illustrations
Luiselli, James K., MaGee, Christine M., Graham, Michelle J., Sperry, James M., Hauser, Mark J., Mental Health Aspects of Developmental Disabilities
Some adults with intellectual disability perform self-harming behaviors of potential lethality and in some cases, these appear to be intentional acts of suicide. Suicidal behavior, non-suicidal self-injury, and parasuicide among people who have intellectual disability are complex clinical concerns confronting mental health professionals. We present two case illustrations of adults with mild to moderate intellectual disability, psychiatric disorders, and multiple suicide attempts. Each adult was treated at a community-based residential setting with therapeutic support focused on their life-threatening behavior. The case illustrations detail treatment formulation, report outcome data, and describe long-term results.
Keywords: suicide, community support, SIB, depression, intellectual disability, mental retardation, psychiatric disorder
Suicide among adults with intellectual disability has not been studied extensively. (12) Yet, published incidence data reveal that negative thoughts about living, intent to kill oneself, and potentially lethal suicide attempts occur in 6-34% of community living adults who have intellectual disability. (9,11) Although completed suicides have been reported, (3,4,13) most of the extant literature describes adults who made suicide gestures and unsuccessful suicide attempts by medication overdose, (2,3) self-immolation, (1) ingesting toxic substances, (2,8,10) jumping from high places, (15) hanging, (6) running in front of a motor vehicle, (7) and cutting or stabbing. (8,16)
Not much is known about the risk factors for attempted suicide by adults with intellectual disability. The strongest association appears to be persons with mild to moderate cognitive impairment who have a diagnosed mood disorder such as major depressive episode. (9,11) Hurley (8) noted the potential for suicide in an adult with mild to moderate intellectual disability if the person has "feelings of social rejection and hopelessness" and lives in a community setting with reduced caregiver supervision. Psychiatric comorbidity and crisis events (e.g., death of a parent, loss of a friend) also have been identified as precipitating influences. (11)
In addition to the clinical profiles of adults who have intellectual disability and attempted suicide, mental health professionals need more information about community-based treatment options. Some adults are able to access available services successfully through outpatient counseling and pharmacotherapy while living semi-independently or with family members. (8) However, some high-risk individuals require services in more specialized settings in order to protect their safety and provide habilitation programming.
The present paper describes two adults with intellectual disability who received intensive residential treatment due to repeated self-harming behavior of potential lethality. Our presentation addresses each person's suicide history, diagnostic formulation, the various interventions tried with them, and the long-term sequelae of community support. We conclude by discussing the unique features of each case and suggesting therapeutic recommendations.
Mr. A was a 42-year-old man diagnosed as having mild intellectual disability, major depression (recurrent with psychotic features), and borderline personality disorder. He had been adopted as a young child and lived at home with his family for many years. While at home, he received special education services, culminating in his first hospitalization at 18 years of age. Subsequently, and as the result of persistent problem behavior, he had two state hospital admissions and one private psychiatric hospital admission during an approximately 3-year period.
Sixteen years ago, Mr. A enrolled in a residential school. At that time, he displayed serious aggression, pica, and sexualized behavior towards peers and staff. He also had incidents of jumping from windows and elopement from the school. …