Understanding Harm to Self and Suicidal Ideation as Behaviours of Concern

Suicidal ideation and self-harm demand immediate attention and care, particularly if the individual has reached a crisis point. However, before such a crisis occurs, suicidal ideation often emerges as a response to underlying behaviours of concern. By identifying and addressing these behaviours early, it is possible to implement appropriate positive behaviour support mechanisms to help prevent escalation.

If there is an immediate risk to health or life, please seek urgent assistance without delay by contacting emergency services.

In this article, we will explore self-harm and suicidal ideation within the context of behaviours of concern. We’ll also outline practical strategies for addressing these behaviours using the positive behaviour support framework, providing a pathway to understanding and proactive intervention.

First, let's define these terms.

What is Suicidal Ideation?

Suicidal ideation refers to thoughts about suicide or taking one’s own life. Often described as “suicidal thoughts,” these can vary in intensity and frequency and are not always linked to a diagnosed mental health condition. At this level, this is considered passive suicidal ideation.

For some, suicidal ideation may manifest as fleeting thoughts, such as wondering what it would be like not to wake up in the morning. For others, it might involve more vivid or recurring scenarios, like imagining jumping in front of a fast-moving vehicle. These thoughts can deeply affect an individual’s mental health, potentially leading to self-harming behaviours or actions that escalate the risk of suicide.

It’s important to note that suicidal ideation can occur for a variety of reasons. It is a symptom of certain mental health disorders, such as depression or anxiety, and may also arise from the use of certain psychoactive drugs. Additionally, it can emerge in response to adverse life circumstances—such as grief, trauma, or significant stress—even in the absence of a diagnosable mental health condition.

Understanding suicidal ideation as a behaviour of concern allows for early identification and intervention, which can help individuals navigate these thoughts in a safe and supportive way.

Active Suicidal Ideation

Active suicidal ideation goes beyond having thoughts about suicide—it involves an intent to die by suicide and may include a specific plan to carry it out. This level of ideation signals a significant escalation from passive thoughts of self-harm or suicide to an active desire and preparation to end one’s life.

Examples of active suicidal ideation include:

• Thinking about methods to end one’s life.

• Creating a detailed plan or timeline for suicide.

• Taking steps to prepare, such as writing a note or acquiring means to carry out the plan.

Attempting suicide is one of the most serious outcomes of active suicidal ideation. A prior suicide attempt is a key risk factor for future attempts or completed suicide, highlighting the importance of early intervention and ongoing support.

Active suicidal ideation requires immediate attention from mental health professionals and may also necessitate emergency medical care. Ensuring safety and providing compassionate support during this time is critical to prevent escalation and promote recovery.

Active and passive suicidal ideation sit on the Suicidal Ideation Scale. This is a psychological assessment tool used to measure the severity, frequency, and intensity of suicidal thoughts in an individual.

Suicidal Thoughts and Behaviour of Concern

Suicidal ideation, while alarming and deeply distressing, is often more than an isolated experience. It can be considered a behaviour of concern in its own right because of the potential risks it poses to an individual’s safety and well-being. However, suicidal thoughts frequently present alongside or as a result of other behavioural conditions, making it essential to understand the broader context in which they arise.

Is Suicidal Ideation a Behaviour of Concern?

In the Positive Behaviour Support (PBS) framework, behaviours of concern are defined as actions that pose a risk to the individual or others, restrict the individual’s ability to participate in their community, or impact their quality of life. Suicidal ideation fits this definition when it leads to behaviours such as self-harm or suicide attempts, affects relationships, or limits the person’s ability to engage in meaningful activities.

However, suicidal ideation is also a symptom, often signalling deeper challenges that require attention. Addressing suicidal thoughts effectively often involves identifying and managing the underlying behavioural or mental health conditions that contribute to them.

Suicidal Ideation in the Context of Other Behavioural Conditions

Suicidal ideation frequently co-occurs with or results from other behavioural and psychological conditions, including:

Depression

Feelings of hopelessness and worthlessness can lead to persistent suicidal behaviour.

Anxiety Disorders

High levels of distress and worry can overwhelm coping mechanisms, leading to thoughts of escape through suicide.

Post Traumatic Stress Disorder

Trauma survivors often experience intrusive thoughts and emotional pain can lead someone to experience suicidal ideation.

Autism Spectrum Disorder

Difficulty with emotional regulation, sensory overwhelm, or social isolation can increase the risk of suicidal thoughts, especially in adolescence or adulthood.

Attention Deficit Hyperactivity Disorder (ADHD)

Impulsivity combined with feelings of frustration or rejection sensitivity can heighten the risk of self-harm or suicide attempts.

Oppositional Defiant Disorder (ODD)

Persistent struggles with authority, emotional dysregulation, and social rejection may contribute to suicidal ideation in some individuals.

Personality Disorders

Conditions like borderline personality disorder often involve chronic suicidal ideation due to challenges with emotional regulation and interpersonal relationships.

Bipolar Disorder

Suicidal ideation can arise during depressive episodes, or as a result of impulsivity and emotional dysregulation during manic or mixed episodes.

Why Does Suicidal Ideation Present Alongside These Conditions?

Suicidal ideation often arises as a response to overwhelming emotional pain, unmet needs, or feelings of isolation. When someone struggles with a behavioural condition or a mental health problem, they may face compounding challenges, such as:

• Difficulty coping with stress or emotional distress.

• Limited access to appropriate communication or emotional regulation strategies.

• Experiences of social rejection, bullying, or misunderstanding.

• Lack of support systems or feelings of being misunderstood by caregivers or professionals.

These factors, combined with the individual’s unique life circumstances, can create a heightened vulnerability to suicidal ideation. This is referred to as an individual's 'suicide risk'.

Suicide Prevention in the Context of Behavioural Conditions

Suicidal thoughts can arise in young adults navigating behavioural conditions such as ADHD, Autism, and Anxiety, particularly during stressful life events. These experiences can amplify emotional challenges, making it essential for caregivers, educators, and professionals to be vigilant about warning signs and risk factors.

Why Stressful Life Events Are Critical Triggers

Stressful life events—such as transitions in education, relationships, or family dynamics—can overwhelm a young person’s ability to cope, especially if they already struggle with emotional regulation or social skills. Examples of triggering events include:

• Academic pressure, such as exams or unmet expectations.

• Changes in friendships, bullying, or social rejection.

• Family instability, such as divorce or conflict.

• Loss of a loved one or pet.

• Moving to a new school, home, or community.

For young people with anxiety or other behavioural conditions, these situations can heighten feelings of hopelessness, fear, or being out of control, which may lead to the development of suicidal thoughts.

Warning Signs of Suicidal Thoughts in Young Adults

Recognising early warning signs is key to prevention. Look for changes in behaviour, mood, and communication, such as:

• Withdrawal from friends, family, or activities they once enjoyed.

• Expressing feelings of hopelessness, worthlessness, or being a burden.

• Sudden changes in sleep patterns (sleeping too much or too little).

• Increased irritability, anger, or emotional outbursts.

• Decline in academic performance or motivation.

• Risk-taking behaviours, including substance use.

• Talking about death or expressing a desire to “disappear.”

• Making preparations, such as giving away personal belongings or writing notes.

Risk Factors for Suicidal Thoughts in Young People

Several factors can increase the likelihood of someone feeling suicidal, particularly when combined with stressful life events or pre-existing behavioural conditions:

• Behavioural and Mental Health Conditions: Anxiety, ADHD, autism, depression, and mood disorders are linked to higher rates of suicidal ideation.

• Social Isolation: Difficulty forming or maintaining friendships due to behavioural challenges.

• Rejection Sensitivity: A heightened emotional response to criticism, common in anxiety and ADHD, can increase feelings of despair.

• Impulsivity: Individuals with ADHD or similar conditions may act on suicidal thoughts without fully considering the consequences.

• Bullying or Peer Pressure: Young people with autism or anxiety may be more vulnerable to bullying, leading to increased stress and suicidal ideation.

• Family History: A family history of mental health conditions or suicide can elevate risk.

• Substance Use: Experimentation with drugs or alcohol can exacerbate emotional distress or lower inhibitions.

Prevention Strategies

For caregivers and professionals supporting young people with behavioural conditions, proactive steps can make a significant difference:

• Foster Open Communication: Encourage conversations about emotions and normalise seeking help for distress.

• Build Coping Skills: Teach young people strategies for managing anxiety and navigating stressful situations.

• Monitor Behaviour Closely: Stay alert to changes in behaviour, especially during times of transition or stress.

• Provide Supportive Environments: Create safe spaces at home, school, or community settings where young people feel valued and understood.

• Engage Professional Help: Partner with mental health professionals for therapy or intervention if suicidal thoughts are suspected.

Understanding the interplay between suicidal thoughts, stressful life events, and behavioural conditions is crucial for early intervention and prevention. By staying attuned to warning signs and risk factors, we can provide the support young people need to navigate life’s challenges safely.

Links Between Sexual Orientation, Gender Identity and Suicidal ideation

Research consistently shows that individuals who identify as part of the LGBTQ+ community, including those with diverse sexual orientations and gender identities, are at an increased risk of experiencing suicidal ideation compared to their heterosexual and cisgender peers. This heightened risk is often linked to unique stressors and challenges faced by LGBTQ+ individuals, particularly during adolescence and young adulthood.

Why LGBTQ+ Individuals Are at Greater Risk

The elevated rates of suicidal ideation in LGBTQ+ individuals are not inherent to their identity but rather a response to external factors such as discrimination, stigma, and lack of support. Key contributing factors include:

• Minority Stress: The chronic stress of living in a society that may be unaccepting or hostile to LGBTQ+ identities increases feelings of isolation and distress.

• Bullying and Rejection: Many LGBTQ+ individuals face bullying, social rejection, or even estrangement from their families due to their sexual orientation or gender identity.

• Internalised Stigma: Negative societal messages can lead to internalised feelings of shame, guilt, or worthlessness.

• Barriers to Support: A lack of affirming mental health services or supportive community networks can make it difficult for LGBTQ+ individuals to access the help they need.

The Role of Stressful Life Events

Stressful life events such as coming out, experiencing discrimination, or navigating family rejection can exacerbate feelings of hopelessness and lead to suicidal ideation. For transgender and non-binary individuals, the challenges of gender dysphoria and difficulties accessing gender-affirming care add additional layers of stress.

Warning Signs in LGBTQ+ Individuals

Many of the warning signs of suicidal ideation are similar across populations but may present differently in LGBTQ+ individuals due to the unique challenges they face. These include:

• Withdrawal from social interactions or LGBTQ+ support networks.

• Reluctance to share their identity due to fear of rejection or harm.

• Increased substance use as a coping mechanism.

• Expressing feelings of being a burden or not belonging.

Protective Factors

Despite the challenges, there are several protective factors that can reduce the risk of suicide ideation in LGBTQ+ individuals:

• Supportive Relationships: Acceptance from family, friends, or peers can significantly improve mental health outcomes.

• Affirming Spaces: LGBTQ+-friendly schools, workplaces, and community organisations foster a sense of belonging and reduce isolation.

• Access to Mental Health Resources: Gender-affirming and LGBTQ+-inclusive therapy and support can help individuals navigate their experiences.

Using Positive Behaviour Support (PBS) and Functional Behaviour Assessments (FBA) to Manage Behaviours of Concern

Positive Behaviour Support (PBS) and Functional Behaviour Assessments (FBA) are effective tools for managing behaviours of concern, particularly when they occur alongside behavioural conditions such as ADHD, autism, or anxiety. These approaches focus on prevention rather than treatment, aiming to create supportive environments and equip individuals with strategies to manage their challenges before they escalate into more concerning behaviours or suicidal ideation.

Why Prevention Matters

Behaviours of concern can arise as a response to unmet needs, emotional distress, or environmental stressors. If these behaviours are not managed effectively, they can create stressful living conditions that exacerbate mental health struggles and increase the risk of suicidal ideation. PBS and FBA focus on prevention rather than reactive intervention, helping to create environments where concerning behaviours are less likely to occur in the first place.

Prevention is always more effective and less distressing than treatment after a crisis has occurred. By focusing on early intervention and building supportive environments, PBS and FBA help individuals thrive, reducing the risk of escalation into harmful or life-threatening behaviours. This proactive approach is essential for fostering long-term well-being and empowering individuals to lead fulfilling lives.

Conclusion

Suicidal ideation is a complex and deeply concerning issue, particularly when it arises in the context of behavioural conditions such as ADHD, autism, and anxiety, or as a result of external stressors like discrimination and stressful life events. Understanding suicidal thoughts as behaviours of concern allows caregivers, educators, and professionals to adopt a proactive and compassionate approach to prevention.

By recognising warning signs, addressing risk factors, and creating supportive, affirming environments, we can help individuals navigate their challenges safely. Whether through positive behaviour support frameworks, open communication, or the involvement of mental health professionals, early intervention can make a profound difference in reducing risk and improving overall well-being. Everyone has a role to play in supporting vulnerable individuals and fostering hope for a brighter future.

Further Support

If this article on suicidal ideation has brought up any issues for you, please remember that support is available.

If you are in distress or need someone to talk to, consider reaching out to support services in your country. Below are some commonly available resources:

• Lifeline (Australia): 13 11 14
• QLife (Australia): 1800 184 527 or chat online for LGBTQ
• Samaritans (UK): 116 123, LGBTQI+ friendly.
• Switchboard Victoria (Australia): 1800 184 527 or chat online.
• National Suicide Prevention Lifeline (USA): 988
• Crisis Text Line (USA/UK/Canada): Text HOME to 741741
• Kids Helpline (Australia): 1800 55 1800
• Trevor Project (USA): 1-866-488-7386 or
• Rainbow Youth (New Zealand): Support for LGBTQI+ youth.
• Crisis Text Line (USA/UK/Canada): Text HOME to 741741 for crisis support.

For global resources, visit https://befrienders.org.

Your identity is valid, your concerns are important, and you are valued.

You are not alone, and help is always available.