Understanding suicidality in adults with learning disabilities: a qualitative exploration of the experiences and perceptions of professionals in NHS Community Learning Disability Services

Background: Experiences of suicidality within the learning disability population remain largely unknown. Despite suicide prevention strategies being a standard part of clinical practice in all healthcare settings in the United Kingdom (UK), no research has been conducted exploring professionals' understanding of suicidality as it presents in clinical practice. Difficulties with communication and comprehending death make navigating suicidality in this population more complicated. Little is known about clinicians' experience of engaging with individuals with learning disability who presents with suicidality. Aim: The current research aimed to explore professionals' experiences and perceptions of suicidality as it presents for individuals with a learning disability in clinical practice. Method: A qualitative methodological approach was applied using Reflexive Thematic Analysis. Semi-structured interviews were conducted with 14 professionals working in an NHS Community Learning Disability Service. Findings: Two overarching themes, five main themes, and four sub-themes were generated. The findings highlight that although suicidality was not seen as the most frequent presentation, it was consistently described as one of the most complex and challenging to navigate. Professionals understood suicidality to be grounded in the multitude of adversities, particularly trauma, social exclusion and unmet relational needs. It was predominantly viewed as a form of communication and learned relational strategy, which professionals interpreted as a desire for connection rather than a direct intention to die by suicide. Professionals highlighted the challenges of determining risk and needing to navigate uncertainty around the comprehension of death and suicide within this population. Emotional and professional burdens were evident, with professionals describing the weight of caring, concerns about responsibility, and the strain of working within current system limitations. Conclusion: The findings are considered in the context of existing research and psychological theory, with an overview of the study's strengths and limitations provided. Clinical implications and future research are also considered.