Solutions to the problem of suicide for older adults should draw from all conceptual levels – individual, social network, community/environment, and societal – in order to create an integrated framework for research, treatment, and prevention. We can only meet the needs of a widely diverse populations when we respond to the foundational and multifactorial causes of this complex social problem. We must work to build a rich assortment of comprehensive interventions that simultaneously:
- Identify individual risk factors and risk behaviors
- Provide widespread suicide prevention education
- Promote early detection in the form of universal depression screening
- Increase access to mental health resources
- Educate and train healthcare professionals
- Build Age-Friendly Communities that reframe the experiences of aging
- Create county-wide standards and uniform approaches to statistical tracking and analysis
The County can pursue research and support solutions by collaborating with public health, academic, and other partners to:
- Conduct comprehensive epidemiologic analyses of risk factors, early warning signs, detection, and treatment for suicidality among older adult populations
- Initiate additional research in areas of psychopharmacology
- Establish shared and consistent definitions, interventions, and evaluation tools
- Implement best-practice, evidence-based screening tools for suicidality
- Study intervention models with potential for population-wide expansion
Healthcare entities and the County can advance treatment solutions by taking the following steps:
- Train healthcare and social service providers to identify warning signs and refer older adults who are at-risk for depression or suicide to services (e.g., “gatekeeper” training).
- Train healthcare providers to optimize treatment of pain, sleep problems, or other physical symptoms that can decrease an older adult’s quality of life and increase suicidal thoughts.
- Train community members and service providers to combat ageism and aging stigma while promoting respect and dignity in aging.
- Introduce depression and suicide screening in the course of non-clinical activity (e.g., senior center staff, senior transportation, senior companions).
- Increase the number of Social Model Adult Day Programs in the county that provide support for functional impairments and complex medical conditions while reducing social isolation.
- Expand access to peer support programs and community services that increase connectedness and reduce social isolation (“mental health first aid”).
- Expand access to culturally responsive programs and services particularly for at-risk older adults such as LGBTQ persons, recent immigrants, communities of color, women, and persons with limited English proficiency
- Increase supports for effective “role transitions” (i.e. retirement from work, stepping down from being head of household, facing new functional limitations and medical conditions) to retain and enhance life meaning and purpose
The County can take the lead on implementing prevention solutions by pursuing the following recommendations:[1]
- Implement improved statistical tracking of suicide deaths in Alameda County to include information on methodology and differentiate between age groups above 65+ years old.
- Fund and implement a variety of interventions at all conceptual levels that treat the holistic mental health needs of older adults in the County.
- Establish county-wide standards of care for integrated multidisciplinary treatment based on national best-practice methods for suicide prevention.
- Because community-based and in-home services providers are in a unique position to identify older adults at risk for depression or suicide, advance funding solutions to ensure these programs have capacity to meet their communities’ needs.
- Incentivize and encourage the implementation of routine standard screening for depression and suicidal ideation in all clinical settings, along with the use of collaborative depression care management interventions to optimize diagnosis and treatment of late-life depression.
- Provide systematic outreach to assess and support high-risk older adults (e.g., recently widowed, socially isolated older men) in improving life situations and addressing issues and needs that can reduce stress.
- Support policy that strengthens economic supports, financial security, housing stabilization, and health insurance coverage of and access to mental health services.
- Advance public health initiatives that promote connectedness through peer support programs and community services, and that teach coping and problem-solving skills.
- Launch a public awareness campaign that includes the warning signs and safe reporting and messaging about suicide, in concert with a campaign to address stigma and ageism.
- Support a robust network of caregiver support programs, both to ensure that caregivers know how to identify and act on risk signs, and to reduce stress and alleviate both caregivers’ and older adults’ feelings of “burden.”
- Strengthen health insurance coverage of, access to, and delivery of mental health services.
- Prevent future risk by following nationally recognized Reporting on Suicide Guidelines.
[1] Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. (2017) Preventing Suicide: A Technical Package of Policy, Programs, and Practices. Retrieved from https://www.cdc.gov/violenceprevention/pdf/suicideTechnicalPackage.pdf
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National Suicide Prevention Lifeline: Provides 24/7, free and confidential support for people in distress, prevention and crisis resources for you or your loved ones, and best practices for professionals.
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American Association of Suicidology: Promotes the understanding and prevention of suicide and support those who have been affected by it.
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SAMHSA Substance Abuse Treatment Referral Helpline: Federal organization that provides a 24-hour toll-free hotline for people seeking information about substance abuse services. Services are available in English and Spanish. The service provides referrals to local treatment facilities, support groups, and community-based organizations. Callers can also order free publications on substance abuse and mental health issues.
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American Foundation for Suicide Prevention: Voluntary health organization that gives those affected by suicide a nationwide community empowered by research, education and advocacy to take action against this leading cause of death.
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National Institute on Mental Health: The lead federal agency for research on mental disorders.
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Mental Health First Aid: Mental Health First Aid is a training program that teaches members of the public how to help a person developing a mental health problem, experiencing a worsening of an existing mental health problem or in a mental health crisis. Like traditional first aid, Mental Health First Aid does not teach people to treat or diagnose mental health or substance use conditions. Instead, the training teaches people how to offer initial support until appropriate professional help is received or until the crisis resolves. While first aid for physical health crises is a familiar notion in developed countries, conventional first aid training has not generally incorporated mental health problems.
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Trauma Informed Care: Trauma Informed Care promotes understanding the impact of trauma on overall wellness is essential when providing trauma informed care. This section begins to explain this relationship between trauma and its impact on wellness as well as discusses the shift to trauma informed care; changing the question from “What is wrong with you?” to “What has happened to you?”
