A new British study has shed more light on the elevated risk of death by suicide among people on the autism spectrum.

The study, first published in the British Journal of Psychiatry, found that 10% of people who died by suicide in the United Kingdom had evidence of likely undiagnosed autism. That is 11 times higher than the rate of autism in the UK.

The results of the British study are in line with previous research on the link between autism and suicide. Last year, a Danish study found that individuals with diagnosed autism spectrum disorder (ASD) had more than three times the risk of suicide attempts and suicide completion compared to the general population. And a meta-analysis conducted by Columbia University and University of Colorado researchers concluded that children and adults with ASD had more than three times the risk of self-harm and a substantially increased risk for suicidality.

“The findings from our systematic review and meta-analysis underscore the need for targeted interventions to reduce the risk of self-harm in people with autism,” said a co-author of the latter study, Dr. Ashley Blanchard, assistant professor of emergency medicine at Columbia College of Physicians and Surgeons.

Within the autistic population, a Swedish study found that death by suicide is more common among individuals with mild autism than severe autism. The same study also found that autistic women are at greater risk than autistic men – notably, this is the reverse of the gender breakdown of suicides in the general population.

Why are people on the autism spectrum at elevated risk of suicide?

Among the heaviest emotional burdens carried by many people on the spectrum, especially women, is “camouflaging;” that is, making constant and elaborate effort to hide the signs of autism. A 2021 study found that camouflaging comes with a significant cost: physical exhaustion, anxiety, depression, and erosion of the sense of identity.

People on the autism spectrum may grow up being bullied or isolated socially, and the pain of those experiences can build up over time. Studies have also shown a connection between unmet support needs and suicidality in autistic people. This is a widespread problem: according to the National Institutes of Health, the majority of autistic adults have unmet needs for functional skills services, employment or vocation services, and mental and behavioral health services.

One of the key warning signs of suicide risk is feeling “trapped,” like there is no way out of an overwhelming situation. As the American Association of Suicidology notes, autistic people often have some cognitive inflexibility, meaning they can easily get stuck in a negative thought pattern and have difficulty considering alternatives.

Recognizing suicide warning signs in people on the autism spectrum can be difficult

Autism spectrum disorder affects perception, social interaction, communication, and patterns of behavior. One consequence of ASD is that the warning signs of suicidality may present differently in someone with ASD compared to a neurotypical person.

Much more research is needed to identify the warning signs of suicidality in people on the autism spectrum and develop screening methods and interventions that meet the unique needs of autistic people. For instance, people on the spectrum may not answer standard suicide screening questions as readily as others, or their answers may require more interpretation to assess the true risk of suicide. As an important step forward, the American Association of Suicidology recently released resources on its website for autistic people in crisis.

It’s also clear that the people who know an autistic person best – parents, siblings, partners, and close friends – are best-positioned to recognize that something may be wrong. Medical and mental health professionals need to listen to those voices and take suicide warning signs seriously. We know that people on the autism spectrum carry a high degree of suicide risk, and the healthcare system needs to respond accordingly to mitigate that risk.

Victims’ families may have legal recourse

Additional research and suicide prevention resources for people on the autism spectrum are sorely needed because far too many autistic lives are cut short by suicide. The Law Offices of Skip Simpson has the experience and knowledge to investigate the circumstances of suicide and advise families on how to proceed during an extraordinarily difficult time. Our law firm is based in Texas, but we serve clients nationwide. If you have lost a loved one to suicide completion, contact attorney Skip Simpson today.

One of an attorney’s most serious responsibilities is respecting client confidentiality. However, a still greater responsibility is protecting the client’s life.

Last year, the State Bar of Texas rightly voted to amend the Texas Disciplinary Rules of Professional Conduct to allow lawyers to disclose confidential information “when the lawyer has reason to believe it is necessary to do so in order to prevent the client from dying by suicide.” (Rule 1.05. Confidentiality of Information)

The amended rule went into effect this year, allowing Texas attorneys to help their clients get the assistance they need to prevent suicide.

Here’s what attorney Skip Simpson said in support of the rule change:

“It may be one of the most dangerous situations—a client who is considering killing himself or herself. Should the lawyer reach out for assistance to prevent a suicide attempt? The answer is yes—and the lawyer needs a confidentiality of information exception to permit disclosure to prevent client death by suicide.

Lawyers may be confronted with clients who are so despondent about their circumstances that they state they are considering “leaving this earth,” “just disappearing,” or something else that worries the lawyer.

In those cases it is appropriate to ask the client, “Are you suicidal?”

Once the lawyer has started screening for suicidal thinking, the lawyer cannot be hampered by the notion of confidentiality. Even for mental health specialists, where there are concerns that the patient may be at risk for suicide, confidentiality is trumped by the need to save a life. Information from family, for instance, may be lifesaving; at such times, confidentiality must be broken.

The U.S. surgeon general and the National Action Alliance for Suicide Prevention issued the National Strategy for Suicide Prevention. Goal 7 of the report includes lawyers as professionals whose work brings them into contact with clients with suicide risk. The goal is to train lawyers on how to address suicidal ideations and on how to respond to those affected.

Part of responding to clients affected by suicidal thinking is reaching out for assistance.”

Originally published in the Texas Bar Journal, February 2021.