Canada's elderly at high risk of suicide, can't afford mental health care: experts

TORONTO - Studies show that Canada's elderly are at a much higher risk of suicide than adolescents, and there is growing concern among mental health experts that psychological care may be out of reach for most seniors.

Dr. Marnin Heisel, a clinical psychologist and professor at the University of Western Ontario, says lack of public awareness of the issue is a key problem that affects not only the elderly, but their families and the public in general.

"One of the challenges that people face is thinking 'I'm unique in this, I'm alone, there's something wrong with me, no one can understand it,' and then they tend to back away from family, other supports, including professional supports," Heisel said in an interview.

Public awareness lets the people struggling with these issues know that they are not alone and their physical and mental health problems can be treated effectively, he said.

It may also cue their relatives into the fact that their older family members who are struggling with depression might be contemplating suicide, he said.

"They might, as a result, begin asking their family (member) 'How are you doing? Are you struggling with some of these things?' or even asking them if they've thought of suicide."

A 2009 report by Statistic Canada states that men aged 85 to 89 have the highest rate of suicide among any age group in Canada, at a rate of about 31 per 100,000, and usually do so through more violent means.

A report by the Chief Public Health Officer released the following year also showed that men over the age of 85 have on average higher suicide rates than all other age groups.

It is a difficult subject 82-year-old Gerry McGee knows all about.

Diagnosed with bipolar disorder at age 50, the Ottawa man has been struggling with severe depression for more than three decades — a struggle that he admits brought him at one point close to suicide.

"You never know when it's going to overwhelm you, I mean particularly with severe depression and suicidal ideation, which is not very pleasant," McGee said from the psychogeriatric ward at the Royal Ottawa Mental Health Centre.

He looks at that dark moment in his life as "the negative side", although he would much rather talk about "the good side" — three children who have grown to be successful professionals and a lifetime of service as an engineer, for which he was awarded the Queen's Diamond Jubilee Medal earlier this year.

For most Canadians, psychological services — which can easily run $100 or $200 an hour — are not covered by provincial and territorial health-care plans, but psychiatric services and medications generally are. Psychological care is covered only if it's hospital-based.

"But many if not most hospitals, at least in Ontario, typically don't have very much in the way of psychological services and typically not for older adults," said Heisel.

"One thing we do know is that unless somebody has extremely good third-party health coverage, or they are a child in the school system, or a veteran, or if they have access to psychological services as a result of a motor vehicle collision — most Canadians can't access psychological services unless they pay out of pocket."

Heisel said research has shown that 75 per cent of older adults who die by suicide had seen a primary care physician or provider within a month prior to ending their lives.

"That suggests that primary care is a key place where we should be assessing for screening for suicide risk factors and then try and implement aggressive, meaning very focused, interventions," Heisel said. "And we really don't see that happening. The literature shows it works extremely well, it just requires funding to do that."

There's also concern that many elderly suicides go undetected due to the way they are reported by coroners across Canada.

"I can envision a circumstance, for example, where an elderly male is found (deceased) in a bed alone ... maybe with no history of depression or suicidal thinking that he had expressed to anybody, and the coroner could determine that the death was due to natural causes and not even order an autopsy because of the age group," said Dr. William Lucas, Ontario Deputy Chief Coroner for Inquest.

"And if the person had used a relatively subtle means like an overdose of medications ... that wasn't obvious.... we wouldn't know," he said.

Heisel said research shows that when the means of death are more ambiguous, then suicide is more likely not to be detected.

"It's somewhat frustrating because we really don't know the full scope of the issue," he said.

What McGee finds frustrating is that many suicide prevention strategies are largely aimed at youth, but there is a distinct lack of initiatives aimed at the elderly. That's why he says he decided to speak publicly about the issue.

"Just telling my story, if it helps one person I would feel wonderful."

McGee says his family is what helps him the most in combating episodes of severe depression, in addition to staying active in his community through things such as the Kiwanis Club of Ottawa, an over-60 slow-pitch softball league and gardening.

"Those are the good things in my life when periods of depression start to creep in," he said.

"Well if the glass is half empty it must be half full... I try to forget about the half-empty side but what a wonderful half full my life is."