Suicide in later life

The interesting and timely analysis from Pearson and colleagues in the November 2009 issue¹ confirms the richness of the data in the National Confidential Inquiry into homicide and suicide by people with mental illness. The troubling suggestion that people considering suicide may attend their GP for a consultation but still continue to take their own life is not new. This teams' finding that many GPs (following the suicide of a patient) thought that the death had probably been unavoidable is new, and challenges those who think that the recent decline in suicide rates is attributable to greater primary care skills and confidence. It was not surprising to read that risk assessment needs to be refined and that communication between primary and secondary mental health services could be improved.

We suggest that these are not the only tasks. Pearson et al's findings are that 65 of the 247 patients whose cases they reviewed in the northwest of England were aged 57 years and over, that confirms the importance of investigating suicide in later life (60 were aged under 30 years). There remain few studies of suicide prevention for older people, yet they attend primary care more often than other age groups and so offer more opportunities to identify concerns. Most studies of communication between primary care and mental health services relate to services for adults of working age. Current targets in dementia services may further reduce interest in services for older people with depression, a higher risk group for suicide than the general population of older adults.

This is an age group where communication with social care services is important because they are more likely than specialist mental health teams to know the older person well, through their provision of services related to disability or long-term conditions. GPs have much to contribute to social care assessments, support plans, and risk assessments because of their knowledge of individual patients and their risk factors. Care management by social workers or nurse-led case management can benefit from clinical input to interpret any deterioration in mental health and decide on thresholds for action.

Finally, we sensed some concerns among the GPs interviewed that the unexpectedness of the suicide of a patient may not be acknowledged by others, and that they will be blamed for their failure to prevent it. Support should be available to practitioners working with people who are at risk of suicide, and to those whose patient has taken their own life. This is good for the individual clinician and it can also assist them practically because they are likely to be the people to whom families turn at this time. Death by suicide is often deeply disturbing for those left behind and one contribution a GP can make is to offer personal support and to put the bereaved in touch with suicide bereavement networks.