The Zero Suicide Framework requires adaptation to include older adults

To the Editor

The Zero Suicide Framework for suicide prevention has been widely implemented internationally for people of all ages. Turner et al. (2020) describe the first published implementation of the Zero Suicide Framework in Australia. While we laud their efforts, we are troubled by the near absence of older adults from this intervention. The authors note that the Gold Coast Hospital and Health Service provides mental health services to all aged 18 years and over. However, only 3% (142/4774) of consumers on the Suicide Prevention Pathway were aged 65+ (Turner et al., 2020). This concerning finding was not highlighted or explained. There are several possibilities to consider including staff training, access to the service, perceived relevance of the programme to older adults and the limitations of not conceptualising primary care as part of mental health.

Even clinicians working in dedicated aged care services have reported lacking knowledge, confidence and skills managing suicide and self-harm in older adults (Wand et al., 2020). The training course developed as part of the Zero Suicide Framework implementation in Queensland included reference to older people, but detail was not provided about the content or any adaptations of the Framework for older adults. We have argued that the presentation, engagement and needs of older adults are different to younger adults, requiring the Zero Suicide model be adapted accordingly and based on evidence specifically derived from older adult populations.

Could ageist bias have hindered entry to the pathway through suicide attempts in older adults being conceptualised as accidental harm, understandable or acceptable acts; influencing assessments and care offered? Self-harm regardless of intent is an important risk factor for suicide in older adults, who have a low self-harm to suicide ratio (Troya et al., 2019). Furthermore, suicidal and at-risk older adults often consult their general practitioner (GP) rather than a mental health service, yet GPs were only mentioned in the transition of care step of the pathway (Turner et al., 2020). Finally, perhaps older adults were offered the programme but rejected it. Were there barriers to participation such as poor engagement with the service or difficulties with age-related aspects of access to the intervention (e.g. cognitive impairment, transport, means of follow-up communication)? Qualitative data would be informative.

The study of Turner et al. (2020) highlights the limitations of ageless mental health services and suicide prevention interventions not adapted for older adults.