T he people of Spokane County have come to another crossroads. This one is at once moral, ethical, financial and fixable. How we resolve this problem will speak ill or well of our ability to define the true meaning of compassion or, perhaps, demonstrate our capacity for collective common sense.

The recent announcement of severe and program-ending cuts in mental health services for our oldest citizens spells potential disaster to some of our most vulnerable citizens. Unless people step forward to solve this problem, people will die.

I did not say might die; I said will die. Some of our at-risk elders will quietly freeze to death in their unheated homes with their dignity intact because, at least, they didn’t have to ask for help. Others will stop costly life-sustaining medications because no one will be there to assist them in finding generics or cheaper sources. Others will stop seeing their doctors or attending Adult Day Health programs for the simple fact that they have no transportation. Others will slowly starve, develop chronic medical conditions and infirmities requiring hospitalization or nursing home care, and not a few will take an active hand in the remedy of their problems by ending their own lives violently. People over 65 make up 13 percent of America’s population, but they account for 25 percent of its suicides.

Setting aside the issue of ageism and its impact on social and health policy in this country for the moment, at least in Spokane for the past 26 years, our older citizens have enjoyed a sort of Camelot. If you are in trouble with clinical depression, early-onset dementia or some other brain disorder, and having trouble with eating, sleeping, paying power bills, picking up your mail or fixing a screen door, some good volunteer soldier, a community “gatekeeper,” will make a call to Elder Services on your behalf and a friendly, competent social worker and nurse will come to visit.

Without fee, without prejudice and without asking for anything, these professionals provide a small miracle: offer to help you to solve the problems of living to a ripe, if sometimes challenging, old age.

In my travels around the United States and internationally, I often say to my audiences, “If you are on the margin financially, and are finding growing old much less fun than you ever imagined, come to Spokane, Washington, and we will look after you.” I don’t say we will love you, but does it not come to the same thing?

A community-based elder-outreach service program for our most at-risk, home-dwelling frail older adults was created by Spokane Mental Health and the Area Agency on Aging, with county support, under the visionary guidance of Ray Raschko and Mary Higgins. In the beginning the goal was to reduce inappropriate psychiatric hospitalizations and premature nursing home placements of our older citizens, but in the end the suicide rate for persons over 65 dropped for 10 straight years.

Why? Because if you solve the problems people feel they must die to solve, they don’t have to kill themselves.

Unknown to most who read this paper, this program won the prestigious $100,000 Ford Foundation Award for Innovations in Psychiatry, enjoys a national and international reputation as a “best practices” model for how older at-risk citizens should be served in their communities and is the only functional elderly suicide prevention in the United States.

I invite my fellow citizens to act now, to take the high ethical and moral road and to “manage upward” through our bureaucracies to see to it that this program does not end. Except by a collective demonstration of our compassion for those at the sunset of life, how else can we be proud of our community?