By Jim Spencer
SpencerSpeaks.com

October 23, 2007

When the group updating Colorado’s statewide suicide prevention plan held an information-gathering session in Cortez recently, participants had plenty to talk about.

“A couple in their late eighties had just committed suicide,” said Susie Street.

Street’s organization, Mental Health America of Colorado, has the job of modernizing a decade-old program to keep people from killing themselves. She can’t yet say how – or if - the new program will deal specifically with the elderly. But Streets readily admits to an ugly statistical fact:

“The highest rates for suicide are among elderly white men.”

In Colorado and most of the West, those rates are much higher than the national average. With Baby Boomers on the verge of reaching senior citizen status, the body count from self-inflicted killings stands to rise significantly, even if the rate stays the same.

In rural areas such as Cortez, the problem of elderly suicide is a once-dark secret that is finally being discussed, said Diana Buza, program director of the Piñón Project, a family resource center.

“We’ve had three (elderly) suicides in the past several months,” Buza said.

Cortez is in Montezuma County in southwestern Colorado. With a population of just 25,000, three suicides in a few months projects to an annual suicide rate multiples higher than the national average for all ages - 11 per 100,000 population.

“Rural communities are more at risk for elderly suicide,” Buza said. “There are not as many services in remote areas. People are isolated. There is still a stigma on mental health problems.”

Based on post-mortem background checks, experts agree that roughly 90 percent of people who take their own lives suffer from some sort of mental health issue. Alcohol lowers the inhibitions and isolation warps the thinking, said Buza, citing two more big risk factors. And of course, the easy access to firearms makes it easier to kill yourself.

Easier, sometimes, than getting folks to recognize the problem of elderly suicide.

With the rural elderly, said Buza, coroners and police “don’t as accurately report suicide” because they often want to “spare the family of the elderly person embarrassment, especially if the coroner is a friend of the family.”

Even if authorities were more honest about elderly suicide, they would still be reacting to it, not preventing it.

In northeastern Colorado, a group called Rural Solutions hopes to teach people who interact regularly with older citizens how to recognize the beginnings of suicidal behavior and to intervene. The program that Maranda Miller carries to doctors, nursing homes and even the post office is called QPR, - as in question, persuade and refer.

It focuses on myths and facts about suicide, risk factors and warning signs, said Miller, who grew up on a farm in rural Colorado.

“The elderly don’t want to seek mental health treatment,” Miller said. “So I focus on primary care physicians.”

In rural communities, if your doctor says to do something, you usually do it.

The fear that talking to older people about suicide could push them to kill themselves may be the biggest myth of all, said Miller and Mental Health America’s Street.

“If you ask the question,” said Street, “they get to talk about it. They don’t have to carry the secret around.”

The elderly who take their lives tend to think about it for a long time. Statistics show that while roughly one in 20 adolescent suicide attempts results in death, one in four elderly suicide attempts is fatal.

Older people are more serious about suicide and the rural elderly live in a culture that creates a deadly double whammy.

“There is a finality of life on the farm or the ranch,” said Miller. “When an animal is of no more use, you put it down.”

At the same time, mental illness and the medications used to treat it are seen as a sign of weakness.

“Families will fight not to get suicide put on a death certificate,” Miller said. “The Morgan County coroner told me he doesn’t want to put that down because it hurts the family.”

With better intervention, Miller hopes the decision will not have to be made.

She tells hospice employees to carefully watch the spouses of those who are about to die. She tells doctors to look for people who stop taking medications or who ask how long they will live if they stop. She tells nursing home staff members and social workers that the loss of a spouse or an unwanted move or an inability to drive and be independent can result in suicidal thinking.

You usually see warning signs before an older person acts on that thinking.

“We had one man who gave his pocket knife to a good friend,” said Miller. “We had a farmer give away his dog.”

The knife was a family heirloom, the dog an essential part of living on a farm. Parting with each was a statement that demanded intervention. The guy with the dog got intervention and lived, Miller said. The guy with the pocket knife did not and killed himself.

You have to question, no matter how uncomfortable it feels, Miller stressed. You have to persuade. You have to refer people to treatment, tell them you’d like them to get help, perhaps even offer to take them to the doctor or counselor, Street emphasized.

“It’s hard to ask,” Miller added, “but you need to ask to save someone’s life.”

Finally, though, all the people working in the field of suicide prevention, particularly elderly suicide prevention, realize that the life and death decision ultimately rests with the individual.

“Quality of life issues for an elderly person are very different from a young person,” Street noted. “Some of these people are suffering immensely.”

The first task is to do everything you can to ease that suffering.

The second may be to understand this:

While people can physically survive, there are circumstances under which no reasonable person would want to live.

This is the second in an occasional series on America’s high rates of elderly suicide. Here is Part 1. Still to come: Undiagnosed Depression in Older Americans and The Right to Die.Copyright 2007 by Jim Spencer. All rights reserved. This material may not be published, broadcast, rewritten or redistributed without permission.