Supporting the Adult Population as a Board-Certified Behavior Analyst (BCBA)
Tip #112: Best Practices for Addressing Suicidal Ideation in Behavior Analytic Services
One afternoon, I arrived at a residential site to complete a routine visit. Before I even met the individual I was scheduled to see, staff pulled me aside.
They warned me that the person had recently threatened to take their own life—and had actually attempted to do so.
On another occasion, I inherited a case and discovered documentation indicating a long history of suicidal ideation. Yet there was little evidence that the behavior had been formally addressed.
In another situation, staff reported that an individual frequently made statements about wanting to die, but the team had stopped responding because the behavior was believed to be “attention-seeking.”
If you have worked with adults with intellectual or developmental disabilities long enough, these scenarios may sound familiar.
And they raise an important question for our field:
What is our responsibility when suicidal ideation occurs in the populations we serve?
A Risk That Cannot Be Ignored
Suicidal ideation must always be taken seriously—regardless of the context in which it occurs.
Individuals with intellectual disabilities and co-occurring mental health conditions often express distress in ways that are misunderstood, dismissed, or minimized. When suicidal statements are interpreted solely through a behavioral lens without considering broader mental health risk, opportunities for intervention may be missed.
Research suggests that suicide risk is present in the intellectual disability population and may be underrecognized in service systems.
One study examining adults with intellectual disabilities in crisis found that 23% reported overt thoughts of suicide and 11% had attempted suicide (Lunsky & Benson, 2001).
More broadly, suicide remains a significant public health concern in the United States. In 2023, more than 49,000 individuals died by suicide, making it one of the leading causes of death nationwide (Centers for Disease Control and Prevention, 2024).
These statistics highlight a critical truth:
When individuals communicate suicidal thoughts—even if the behavior appears to be maintained by attention—it must still be treated as a potential safety risk.
A Call to Behavior Analysts: Responding Within Our Scope
As behavior analysts, our role is not to replace mental health professionals or crisis clinicians. However, we do have ethical responsibilities to respond appropriately when safety concerns arise.
The BACB Ethics Code for Behavior Analysts provides clear guidance for situations like these.
Relevant ethical standards include:
Ethics Code 2.01 – Providing Effective Treatment
Behavior analysts design and implement interventions that prioritize the client’s well-being.
Ethics Code 1.04 – Practicing Within Scope of Competence
When situations exceed our training or expertise, we seek consultation or refer to qualified professionals.
Ethics Code 2.15 – Referrals When Needs Exceed Scope
Behavior analysts must recommend additional services when client needs extend beyond behavior analytic treatment.
These responsibilities also align with several competencies in the BCBA 6th Edition Task List, including:
• Conducting functional behavior assessments to identify antecedents and consequences
• Developing and monitoring behavior support plans
• Implementing risk management and safety procedures
• Collaborating with interdisciplinary teams to support client well-being
Together, these standards reinforce that ignoring suicidal ideation—or dismissing it as “attention-seeking”—is inconsistent with ethical and professional practice.
What Behavior Analysts Can Do
When suicidal ideation or attempts occur, behavior analysts can play an important role in coordinating safe and appropriate responses.
1. Follow the Behavior Support Plan
Staff should immediately implement procedures outlined in the individual’s Behavior Support Plan. These plans often include crisis protocols designed to guide safe responses during behavioral or emotional escalation.
2. Conduct Follow-Up Assessment
Behavior analysts can help identify potential triggers by examining antecedents, setting events, and consequences associated with suicidal statements or behaviors.
Understanding environmental variables may help reveal conditions contributing to emotional distress.
3. Advocate for Environmental and Supportive Changes
When risk factors are identified, environmental modifications or additional supports may be necessary to reduce distress and improve quality of life.
Research has shown that environmental stressors, social isolation, and limited support systems can increase suicide risk in individuals with disabilities (Hughes et al., 2017).
4. Utilize Crisis Resources
Encourage caregivers or the individual to contact the 988 Suicide & Crisis Lifeline, which provides immediate guidance from trained crisis professionals.
5. Respond to Immediate Safety Risks
If suicidal ideation occurs alongside self-injury, threats of harm to others, or imminent danger, emergency services should be contacted by calling 911.
6. Convene a Care Team Meeting
A care team meeting allows interdisciplinary providers to collaboratively review the situation, identify contributing variables, and develop coordinated support strategies.
Interdisciplinary collaboration is widely recognized as a best practice when addressing complex behavioral and mental health needs (Horner et al., 2020).
7. Seek Supervision and Consultation
Every case is different. Consulting with supervisors or experienced colleagues helps ensure decisions are aligned with ethical standards and best practices.
Seeking guidance also models an important professional skill: knowing when to involve your village.
Moving the Field Forward
As behavior analysts, we are trained to analyze observable behavior, identify functional relationships, and implement effective interventions.
But when suicidal ideation occurs, our responsibility extends beyond behavior reduction.
We must respond with urgency, collaboration, and compassion.
Even when a behavior appears to serve an attention function, the expression of suicidal thoughts should never be dismissed. Instead, it should prompt careful assessment, interdisciplinary coordination, and immediate safety planning.
The individuals we support rely on us not only for technical expertise—but also for advocacy, awareness, and ethical leadership.
From the one and only... Shanda J Your BCBA
Author Credit: Meme and article modified and enhanced with support from my AI tool ChatGpt aka Gem.
Final References (APA 7th Edition)
Behavior Analyst Certification Board. (2022). Ethics code for behavior analysts. https://www.bacb.com/ethics
Behavior Analyst Certification Board. (2023). BCBA/BCaBA test content outline (6th ed.). Behavior Analyst Certification Board.
Centers for Disease Control and Prevention. (2024). Suicide data and statistics. U.S. Department of Health and Human Services. https://www.cdc.gov/suicide/facts/data.html
Horner, R. H., Sugai, G., & Anderson, C. M. (2020). Examining the evidence base for school-wide positive behavior support. Focus on Exceptional Children, 42(8), 1–14.
Hughes, R. B., Robinson-Whelen, S., Raymaker, D., Lund, E. M., Oschwald, M., Katz, M., & Powers, L. (2017). The relation of abuse to suicide ideation and behavior in adults with disabilities. Disability and Health Journal, 10(3), 392–398.
Lunsky, Y., & Benson, B. A. (2001). Association between perceived social support and strain, and positive and negative outcome for adults with mild intellectual disability. Journal of Intellectual Disability Research, 45(2), 106–114.
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