Dr. Richard McKeon is chief of the suicide prevention branch at the Center for Mental Health Services within the Substance Abuse and Mental Health Services Administration (SAMHSA). In this role, he oversees all branch suicide prevention activities, including the Garrett Lee Smith State/Tribal Youth Suicide Prevention and Campus Suicide Prevention grant programs, the National Suicide Prevention Lifeline and the Suicide Prevention Resource Center. Dr. McKeon spent the majority of his career in community mental health and has been appointed to suicide-prevention task forces in the Department of Veterans Affairs as well as the Department of Defense. He received his Ph.D. in clinical psychology from the University of Arizona, and a Master of Public Health in health administration from Columbia University.
Q: Can you talk about suicide risks in the senior population? What are some of the risk factors, vulnerabilities, statistics, trends or other issues that are unique to older adults?
There are a number of factors that come into play when it comes to mental health and suicide in older adults. Historically, older Americans have some of the highest suicide rates in the United States. There had been a historical, long-term downward trend, but that downward trend has stopped in recent years.
For the Medicare population, you have seniors as well as the disabled community [in dual eligibles]. For those with disabilities, there is also heightened risk for suicide. So, there is reason to be concerned about the potential for suicide in these populations.
The other thing about older Americans is they are more likely to die by suicide on their first attempt, so the possibility that non-fatal attempt may lead them to medical care might not happen. That makes it even more important to screen for risk among this population.
Q: How have you seen awareness evolve in recent years as it relates to suicide, depression and prevention?
We have seen a gradual increase in awareness of suicide as a public health challenge, even a public health crisis — in 2017, more than 47,100 Americans died by suicide, almost as many as the more than 47,700 who died by opioid overdose. Many of the recent efforts to reduce suicide have focused on youth and veterans; not many have focused on elderly people.
There are several efforts underway in terms of screening. One important thing is that initiatives to increase screening for depression also need to include screening for suicide. The [PHQ-9, or patient health questionnaire-9, administered in many different health care settings] includes a question around suicide, so as people are screening for depression, it’s critical that they also ask about suicidal thoughts.
SAMHSA helps oversee the Zero Suicide program, which is a comprehensive, multi-setting approach to suicide prevention in health systems. It’s also vital to have a protocol for care if some is identified as at-risk. A good option is collaborative safety planning — a brief intervention with an at-risk person discussing things they can do and ways they can keep themselves safe. Keeping in contact also helps: telephonic follow-up and staying in touch in high-risk times such as leaving the emergency department or a care transition. These are all essential interventions.
Q: What can someone do if they are concerned about suicide risks in their loved one(s)?
The most important thing is being willing to ask if your loved one is having thoughts about suicide if you have concerns. Sometimes people are worried about saying the wrong thing or putting an idea in someone’s head — research is clear that isn’t the case. What’s most important is to be willing to ask the question, and if the answer is yes, to encourage them to get help. Being older doesn’t mean that depression is inevitable, and there are still ways that it can be properly treated so older people with depression can have fuller lives despite the stresses of aging.
Q: How can the eldercare/Medicare community better approach suicide and mental illness?
Regardless of the kind of setting, we advise — and part of the Zero Suicide model — that there be a protocol established around suicide so staff doesn’t have to figure it out at the time the issue emerges.
That protocol, whether in a nursing care facility or primary care clinic or elsewhere, should include an approach toward screening for suicide risk that includes training people to do collaborative safety planning. There are resources SAMHSA has helped create regarding suicide prevention in senior living facilities, and one on suicide prevention in community aging programs.
SAMHSA also supports the National Suicide Prevention Lifeline, which can be reached by calling 1-800-273-TALK (8255). If someone is aware of a suicidal individual they can call any time, day or night.