Mental Health Care Facilities

High rate of suicide among men over 75 years of age is a major public health problem in Australia and in many parts of the world. According to the Australian Bureau of Statistics the highest number of suicides in 2013 were recorded for men over 85 years of age. The number was 36.7 per 100,000 in 2012 (“Elderly men three times more likely to die by suicide”, 2014). As the average life expectancy increases, the elderly population of Australia is also growing.  Several studies have tried to study the causes associated with the problem of suicide, however there are fewer studies that target the elderly population. Bringing about a deliberate end to one’s life has been defined as suicide (Nagaratnam, Nagaratnam, & Cheuk, 2011). Psychosocial and medical factors are the most likely reasons for suicide in men over 85 years. The principal reason for  ending life among the aged men is functional disability. Specific conditions may also trigger suicidal tendencies and these could include malignancy, liver disease, male genital diseases, neurological disorders, pain and arthritis. Strategies for prevention of causes that lead to suicide include treatment of mental health problems among the elderly. Social causes of suicide can be addressed by providing support to those elderly men who live alone in the community, or are residents of aged health care homes. Several interventions have been tried to solve the problem of social isolation of the elderly, but most have not been found to be effective (Findlay, 2003). Reduced mobility and chronic ailments make moving out  of the residence difficult for the aged.

In  a survey on Australian men who have contemplated suicide, 67% men said they wish they could have communicated with someone they could trust and respect. Participants were men above the age of 18 years and they did not take the extreme step because 67% of them feared the impact it would have on the lives of their families (Shand et al., 2015).

There was no correlation between smoking in men with mental health issues and their tendency to commit suicide in a survey conducted on 1812 Australian men who suffered from depression or psychosis (Sankaranarayanan, Mancuso and Castle, 2014).  Depression is a major cause of suicide in elderly men and they are less likely to share suicidal thoughts with others. Prevention of suicides by treating depression can be an effective strategy. Another study made a comparison between suicides in eight age bands between 60 and 99 years of age.

Families and social support from friends and younger members of the family, attitudes of younger people towards the elderly and whether they can take part in the day to day activities are factors that determine the overall quality of life of elderly people. Feelings of isolation from the family or society cause the elderly to neglect to eat, induces poor living, indulgence in substance abuse and even suicide. The issues that the elderly confront are complex. These are slowly being understood and experts recommend including suicide prevention programs as part of the care delivered in old age homes. The stress of moving from home setting to an aged care home induced by relocation should be taken care of while providing care to the aged. It is recommended to families that they continue to engage the elderly living alone or in care institutions so that they feel included in the family and feelings of isolation do not disturb them.

Bereavement causes depression in old age and could be due to loss of a friend or a spouse. Physical inabilities reduce mobility and this causes social isolation.  Others may face acute illness and may feel lonely and depressed. Dealing with a retired life is difficult and some men find it difficult to remain engaged in the community. About 10-20% people over the age of 65 years can suffer from depression. Mental health issues in old age stem either from depression or dementia. More access to age-appropriate mental health care facilities is required for the vulnerable among the elderly because many times treatment by general practitioners may not be enough. The understanding of how cognitive behaviour therapy and medications can be effective for this age group needs to be understood by the practitioners. Experts have recognized that the need of the hour in preventing suicides by the elderly is highly specialised old age psychiatric services.  (“Elderly men three times more likely to die by suicide”, 2014). Treatment of depression usually involves administration of serotonin-uptake inhibitors which could be either tricyclic antidepressants or monoamine oxidase inhibitors (Kokoung, Cavenett, McArthur, & Aromtaris, 2015).

Another aspect to think about is each individual’s ability to cope with the set of circumstances that old people find themselves in. There is a considerable difference in how the course of a person’s journey in earlier life impacts the risk of suicide in late life. Whether  the person has had a difficult childhood, an individual’s innate personality, trauma that may have been suffered in life, whether a person has had issues related to substance abuse have a bearing on how the challenges of old age are faced. It is important to understand that contrary to what some people believe, it is not right to think that it is alright for the aged to be depressed. Well adjusted aged people have a matured outlook towards life due to experience and they suffer a lesser impact of incidents that might the people younger in age quite perturbed. Their position as patriarchs and matriarchs in society is due to this age-related wisdom and attitude. Prevention of suicides in the elderly is of utmost importance. The thin line that divides euthanasia and suicide does not in any way mean that old people can take the route of suicide in countries where euthanasia is illegal. Work on prevention needs to tackle the triggers of suicidal thought, whether the reasons are psychological or social in nature. Countries that have legalised euthanasia still have a considerably high number of cases of suicides in men aged over 75 years (Draper, 2014).

Social and/or psychiatric causes of suicide in the elderly are problems that have solutions. To dismiss these problems as a natural course during old age is rather partisan. In the UK, the Campaign to end loneliness has worked and reduced the number of suicides among the elderly. They have been able to find a solution to the problem of loneliness that can drive a person to despair and adopt the drastic measure of suicide.

Old, hapless and widowed, men at an advanced age may have been cared for by their wives and may have relied on her for making social contacts and ties earlier (Horin, 2015). With no one by their side and lacking in social skills, the men folk  are left desolate. Development of a hobby that can help time to fly could make life that much more purposeful and drives away suicidal thoughts (Innamorati et al., 2014).

The rate at which the suicides have been reported have raised concerns over the manner in which suicides among the elderly have been the result of lacunae in framing policy, poor representation in the media and faults in the planning of service delivery that has failed to prevent at least some of the deaths. Depression should not be considered normal among the aged by clinicians and thus warning signs should not be missed when treating the elderly. Poor social support and unaddressed problems of anxiety and depression have also been the main reasons for an increase in the problem of suicides induced by depression (Magarey, 2015). 

Deprivation of social connect occurs because a person needs to be cared about by other people, when this need remains unmet, a person may begin to desire death. Some individuals perceive themselves as a burden on others because their care needs have increased and they begin to feel that it is alright for them to die. Taken together, unmet social needs and the feeling of having become a burden on the carers can trigger a desire for death (Fassberg et al., 2012).

Seeking help for problems related to mental distress is perceived by men as a sign of weakness and they tend to deal with their complex emotional needs on their own. More often elderly men do not have information about support services that they can access and at times they might doubt the usefulness of the support services (Beaton & Forster, 2012).

Several strategies for suicide prevention among the elderly may be employed. Improvement in resilience through counselling, introducing the concept of positive ageing, keeping the family members engaged in the well-being of the elderly and the use of telecom technology to keep in touch with the aged can play a significant role in prevention. If suicidal tendencies are identified by doctors, means restriction and education can be used to deter the aged from suicide (Lapierre et al., 2011). Prevention can be effective when society treats the elderly with respect, dignity and, compassion. In most cases, the person who is contemplating suicide gives out signals to people around them. Once such a communication is received, it should be reported to the general physician. Gaps in the training of personnel responsible for monitoring the mental health of the aged need to be removed. Management of mood disorders can be treated as the primary method of suicide prevention among older men (Podgorski, Langford, Pearson, & Conwell, 2010). For each case of suicide, it is likely that there have been 20 attempts at committing suicide (WHO, 2016).

Beaton, S., & P., F. (2012). Insights into Men’s Suicides. InPsych, 34(4). Retrieved from https://www.psychology.org.au/

Draper, B. (2014). Suicidal behaviour and suicide prevention in later life. Maturitas, 79(2), 179-183. https://dx.doi.org/10.1016/j.maturitas.2014.04.003

Elderly men three times more likely to die by suicide. (2014).  Retrieved 15 August 2016, from https://www.abc.net.au/news/2014-03-27/elderly-men-three-times-more-likely-to-die-by-suicide/5349116

Fässberg, M., Orden, K., Duberstein, P., Erlangsen, A., Lapierre, S., & Bodner, E. et al. (2012). A Systematic Review of Social Factors and Suicidal Behavior in Older Adulthood. International Journal Of Environmental Research And Public Health, 9(12), 722-745. https://dx.doi.org/10.3390/ijerph9030722

Findlay, R. (2003). Interventions to reduce social isolation amongst older people: where is the evidence?. Ageing And Society, 23(05), 647-658. https://dx.doi.org/10.1017/s0144686x03001296

Horin, A. (2015, September 6). Why are older men committing suicide? Retrieved from https://adelehorin.com.au/2015/09/06/why-are-older-men-committing-suicide/

Innamorati, M., Pompili, M., Di Vittorio, C., Baratta, S., Masotti, V., & Badaracco, A. et al. (2014). Suicide in the Old Elderly: Results from One Italian County. The American Journal Of Geriatric Psychiatry, 22(11), 1158-1167. https://dx.doi.org/10.1016/j.jagp.2013.03.003

KoKoAung, E., Cavenett, S., McArthur, A., & Aromataris, E. (2015). The association between suicidality and treatment with selective serotonin reuptake inhibitors in older people with major depression: a systematic review. JBI Database Of Systematic Reviews And Implementation Reports, 13(3), 174-205. https://dx.doi.org/10.11124/jbisrir-2015-2272

Lapierre, S., Erlangsen, A., Waern, M., De Leo, D., Oyama, H., & Scocco, P. et al. (2011). A Systematic Review of Elderly Suicide Prevention Programs. Crisis, 32(2), 88-98. https://dx.doi.org/10.1027/0227-5910/a000076

Magarey, J. (2015, August 24). /ageism-to-blame-for-elderly-mens-suicide-rate-experts-warn/news-story/. Retrieved from https://www.theaustralian.com.au: https://www.theaustralian.com.au/news/health-science/ageism-to-blame-for-elderly-mens-suicide-rate-experts-warn/news-story/613895e44dddc731a996ba29805895ab

Nagaratnam, N., Nagaratnam, K., & Cheuk, G. (2011). Diseases in the elderly. Springer.

Podgorski, C., Langford, L., Pearson, J., & Conwell, Y. (2010). Suicide Prevention for Older Adults in Residential Communities: Implications for Policy and Practice. PloS Med, 7(5), e1000254. https://dx.doi.org/10.1371/journal.pmed.1000254

Sankaranarayanan, A., Mancuso, S., & Castle, D. (2014). Smoking and suicidality in patients with a psychotic disorder. Psychiatry Research, 215(3), 634-640. https://dx.doi.org/10.1016/j.psychres.2013.12.032

Sankaranarayanan, A., Mancuso, S., Wilding, H., Ghuloum, S., & Castle, D. (2015). Smoking, Suicidality and Psychosis: A Systematic Meta-Analysis. PLOS ONE, 10(9), e0138147. https://dx.doi.org/10.1371/journal.pone.0138147

Shand, F., Proudfoot, J., Player, M., Fogarty, A., Whittle, E., & Wilhelm, K. et al. (2015). What might interrupt men’s suicide? Results from an online survey of men. BMJ Open, 5(10), e008172. https://dx.doi.org/10.1136/bmjopen-2015-008172

WHO. (2016). /suicide-prevention/attempts_surveillance_systems/en/. Retrieved from https://www.who.int: https://www.who.int/mental_health/suicide-prevention/attempts_surveillance_systems/en/