A failure to recognize and address the large number of suicides among
elderly Americans has allowed thousands of Americans to die every year. To
curb rates of suicide among older people—older white men in particular
have the highest suicide rate among major U.S. demographic
groups—advocates have launched an effort to force the issue onto the
federal legislative agenda.
During a June briefing before congressional staff, mental health advocates,
led by the Suicide Prevention Action Network (SPAN USA), discussed the scope
of the problem and urged support for legislation that would bolster senior
The legislation that could help reduce these suicides include companion
House and Senate bills (HR 4897 and S 1854, both known as the Stop Senior
Suicide Act) that would coordinate the efforts of federal agencies on the
issue. The bills also would lower Medicare's out-of-pocket coinsurance rate
for outpatient mental health services from 50 percent to 20 percent, a change
long advocated by APA. Some of these bills' provisions also have been included
in must-pass Medicare overhaul legislation (S 1715).
The high rate of suicide among senior citizens "is an issue that
frequently flies under the radar," said Yeats Conwell, M.D., a
psychiatrist who has researched suicide among seniors.
Its low profile masks the extent of the problem. There were 6,860 suicides
by people older than 60 in 2004—the highest rate of suicide for any age
group—according to a 2007 report by the Centers for Disease Control and
Prevention. People over age 60 make up 12 percent of the U.S. population, but
they complete 16 percent of suicides.
The high rate of suicide among seniors, said Jerry Reed, executive director
of SPAN USA, is driven by the high rate of untreated mental illness in that
population. As many as 90 percent of suicides by seniors, he and other
advocates noted, are likely related to untreated mental illness. "It's a
very real problem," he said.
The most recent effort to get Congress to take steps that could reduce
suicide by the elderly was led, in part, by Senate Majority Leader Harry Reid
(D-Nev.), who lost his father to suicide years ago.
"Clinical depression and suicidal feelings are not a normal part of
aging, yet these treatable conditions are often misdiagnosed, untreated, or
ignored in far too many seniors," said Reid in a Senate floor speech
when he introduced S 1854 in July 2007. "Out-of-pocket expenses under
Medicare, the health insurance program for 37 million Americans aged 65 years
and older, is a key reason."
Reid and mental health advocates said the copayment difference discourages
Medicare beneficiaries, especially low-income and fixed-income individuals,
from seeking mental health treatment. This financial disincentive exacerbates
the stigma that also keeps many seniors from seeking needed mental health
care. The Medicare copay policy dates back to the inception of the program in
The Reid bill and its House version also would establish the Federal
Interagency Geriatric Mental Health Planning Council. This council would
coordinate suicide-prevention efforts by federal agencies that interact with
In addition, the legislation would provide small grants to state and local
governments to develop suicide-prevention strategies aimed at seniors.
Mel Kohn, M.D., Oregon's state epidemiologist, helped coordinate that
state's first-in-the-nation senior suicide-prevention initiative.
"We had a youth suicide-prevention program for years in Oregon, but
the data showed that we were really missing the boat on where the problems
lay," said Kohn, about the high rates of senior suicide.
The Oregon plan funded a data collection effort to understand the scope of
the problem and research to find the most effective prevention approaches. As
others have done, the Oregon planners found that one of the biggest missed
opportunities to address suicide by seniors involved primary care physicians.
Seniors have the highest rate of primary care contact of any age group, with
58 percent of seniors who commit suicide having visited their doctor within a
month of their death, according to SPAN USA. Part of the effort to reduce
suicide among seniors has to include education for general practitioners about
the high rates of untreated mental illness among seniors and the increased
risk of suicide when this population remains untreated, according to the
Outreach and treatment especially are needed for the 1.4 million seniors
who have attempted suicide and who are likely to try again, Reed said.
One-on-one intervention efforts between physicians and their patients can
be supplemented by state and local governments' use of education and risk
reduction plans, according to advocates. Suicide-prevention strategies among
older people in other countries that have shown some promise, Conwell said,
include making senior-focused telephone assistance available and reducing the
availability of the most common means of suicide. For example, the most common
means of suicide in Great Britain was carbon monoxide poisoning through
residential gas appliances before the government mandated that domestic gas
suppliers cut the carbon monoxide content in gas for household use.
Supporters said they are confident that state and local prevention
strategies can be inexpensive but effective at reducing suicide rates among
the older population, although research on the effectiveness of risk reduction
and education plans for seniors has not yet been conducted.
The legislative outlook for the senior suicide-prevention bills is poor
during the current Congress, according to congressional staff. However, some
of the bills' provisions may pass as part of a Medicare overhaul, which has
stalled over Republican opposition to spending increases for domestic
The need for federal action on the issue will grow in the coming years,
mental health advocates said, as the number of seniors is expected to grow
from about 35 million now to 70 million by 2030. They plan to continue pushing
Congress to act until the problem of suicide by seniors receives the federal
attention it deserves.
The senior suicide prevention and Medicare overhaul bills can be
by searching on the bill numbers, S 1854, HR 4897, and S 1715.▪