Recognizing depression in a relative or friend is one thing.
Talking with them about getting treatment is another – especially, suicide prevention advocates say, when the person with depression belongs to a generation less likely to place faith in mental health services, or “mental health” as a concept.
“This older generation actually went through the Depression,” said AJ Sanders, who runs the suicide-prevention program at the Spokane Regional Health District. “This is nothing to them. ‘We’ve been through worse, we can get through this,’ ” the thinking goes, she said. “They don’t even want to ask for meals to come to their home. They’re not going to ask for mental health (help).”
Meanwhile, seniors have the highest suicide rates in the nation. And depression that often contributes to suicide among the elderly is highly treatable, said Catherine Perusse, a mental health counselor in Sandpoint who leads the North Idaho chapter of the Suicide Prevention Action Network.
“But you have to get people to accept that it’s not a weakness,” Perusse said. “And most seniors view depression as a weakness: ‘I’m being weak. I should just get my act together and move on.’ ”
It’s a pull-yourself-up-by-the-bootstraps outlook prevalent among older populations, she said.
“If you’ve got a chemical imbalance, which is what causes depression – whether it’s situational or physiological – you can pull your bootstraps all you want, it ain’t gonna help,” Perusse said.
Suicide rates are especially high among nursing home residents and widows and widowers, said Pamela Sloan, elder services director at Frontier Behavioral Health. Other factors that contribute to depression among seniors: the loss of a driver’s license, the loss of physical mobility, the death of an elder’s own child.
Older men commit suicide far more often than older women. Sloan said their higher rate can often be linked to a sense of purpose, a sense of self built on physical accomplishment, that erodes along with physical abilities.
Meanwhile, it’s become impractical or impossible for extended families to live together, leaving older people isolated at home or in care facilities. Whereas one stay-at-home parent used to be able to care for aging relatives as well as children, all under the same roof, now both adults work. The grandchildren who used to be around to hear stories about the old days now live states away.
And people are living longer, Perusse noted. Retirements expected to last 10 years may last 30. Adults who’ve worked their entire lives – at occupations and at home – are at a loss.
Those who seek out volunteer roles or other outlets that make them feel connected to communities are people who “really dig in and look,” Perusse said. “If you’re not that kind of person, because it’s always been work, work, work, work, work, you’re not even aware that those opportunities exist, or that they could be fulfilling.”
• First Call for Help crisis hotline:
• National Suicide Lifeline: (800) 273-8255.
• Elder services: (509) 458-7450
you know is depressed or considering suicide
• Ask, then listen. If you suspect someone is thinking about suicide, they probably are, AJ Sanders said. Ask them if they’re contemplating taking their life. Ninety percent of people considering suicide say “yes” when questioned, she said.
“What they’re going to do right then is unload,” Sanders said. “They just need to talk. All you have to do is sit there and listen.”
Listen for two things in particular, she advised: their reasons to die and their reasons to live. Latch on to a reason to live and build on it in your conversation.
• Frame the discussion. Relatives or friends who suspect a senior has depression should start with the positive, Pamela Sloan advised: “ ‘I love you very much, and I know that you might not recognize that you’ve changed, but you’ve been changing.’ … Talk in a way that doesn’t make the person feel that they have to defend themselves, but in a way that says, ‘This person loves me so much they’ve actually tried to look at what’s happening with me.’ ”
Frame the discussion in a way that pits you and the elder on one side, tackling the problem of depression together. If person refuses to talk about it, don’t give up. Try again later.
• Call someone to help. Don’t feel equipped for the discussion that follows your questioning? Call someone at a suicide hotline or agency that serves seniors.
Frontier Behavioral Health’s elder services workers can go to the senior’s home, do an assessment, and connect them with health services. Private psychiatrists, counselors, faith-based organizations or support groups also can help, Sloan said.
Identifying and assisting seniors with depression is among her agency’s key services, she said – but that process very rarely starts with the senior him- or herself.
“We never get calls from old people saying they’re depressed. Never,” Sloan said. “They are out there saying, ‘I’m not calling anybody.’ So people call on their behalf.”
• Heed warning signs. It’s no myth that people planning suicide give away important belongings, Sanders said: “They’re kind of backward asking you, ‘Talk to me about this.’ ”
• Talk to the senior’s doctor. While patient-privacy laws prevent a physician from giving information to a relative, for example, they don’t prevent the relative from giving information to the physician.
• Restrict access to means of suicide. Put away the guns, Catherine Perusse advises. Restrict access to drugs that could be used improperly. Make sure other caregivers know about your concerns.