Suicide among disabled people is an important issue because people with a disability are more likely to think about, plan, and attempt suicide. It can be difficult for disabled people to get medical help for substance use disorder because treatment is sometimes inaccessible, providers may lack awareness of the needs and experiences of disabled people, and the treatment may not be effective. This exploratory study begins with a synthesis of evidence on facilitators and barriers to treatment for suicidality among disabled adults. We then describe what is known about the effectiveness of treatments and describe research gaps.

WHY THIS MATTERS

Despite the increased risk for suicide among people with a disability, the suicide-related needs of this diverse population often remain unmet within existing health care frameworks, making access to effective treatment for suicidality among disabled people a pressing public health concern. Policy changes that impact barriers and facilitators to the take up of effective treatment can lower suicide rates. Strategic research in collaboration with disabled people with diverse experiences could identify effective treatments by type of disability and identify policies that minimize barriers and maximize facilitators.

WHAT WE FOUND

Barriers include accessibility issues, provider lack of awareness about the experiences and needs of individuals with disabilities, and fears of involuntary commitment among patients.

Facilitators include the provision of disability-inclusive health care services, boosting the share of providers with a nuanced awareness of the experiences and needs of disabled individuals (including by recruiting providers with a disability), and integrating assistive technologies and communication tools. Peer support groups and 12-step and other community-based programs could also play a role in supporting disabled people and helping them find services and recover.

Several treatments and therapies have been adapted for intellectual and sensory disabilities, including cognitive behavioral therapy, dialectical behavior therapy, and mentalization-based techniques. However, among the few studies focused on people with disabilities, the effectiveness of these treatments varies. These limited studies point to the need for comparative effectiveness research and research on adaptations to people with other disabilities or disability-related needs. Interview participants emphasized the importance of holistic care.

Research gaps include (1) the dearth of empirical information about suicide risk mechanisms among disabled people overall and by their type of disability, including a lack of evidence about the appropriateness of specific assessment tools and therapies for people with specific types of disabilities; (2) the lack of tools and therapies adapted for people with specific disabilities; and (3) the limited representation of people with diverse disabilities in existing studies. There is also a pressing need for research on the role of support networks in recovery.

Results point to the importance of scaling up provider training and recruiting for disability competency and helping health care systems implement practices to improve suicide care, such as a Zero Suicide framework informed by where and with whom disabled people seek health and social services.

HOW WE DID IT

We conducted a rapid review of the literature and interviews of technical experts and individuals with lived expertise.