Citation

Kennedy GJ. Am. J. Geriatr. Psychiatry 2021; ePub(ePub): ePub.

Copyright

(Copyright © 2021, American Association for Geriatric Psychiatry, Publisher Elsevier Publishing)

DOI

10.1016/j.jagp.2021.09.004

PMID

34629223

Abstract

In this issue of the journal, Schmutte et al.1 used large-scale claims-based data to show that the majority of older adults admitted for a suicide attempt, ideation, or deliberate self-harm, were not seen within 7 days of discharge be it a general or psychiatric hospital. Granted the data is from 2015, but with hospitals and mental health centers overwhelmed by the COVID-19 pandemic, the current reality is likely much worse. Patients discharged from psychiatric hospitals fared somewhat better but the current shortage of psychiatric beds and extended boarding times spent in emergency rooms awaiting a psychiatric admission provide scant comfort. The stigmatization of the mentally ill, mental health providers, and old age is often cited as the patient-based cause of inadequate follow-up. Yet there is a growing awareness that lack of access not stigma is the major obstacle to behavioral health care. But ack of access is not the only complicating factor.

In a previous publication2 Schmutte et al. using data from 2003 to 2016 in the National Violent Death Reporting System found that most older men and women who died by suicide did not have a known psychiatric disorder and the most common precipitating factor was a physical health problem. Among these decedents the most common means of death was a firearm totaling 80% of men and nearly 45% of women. Among those with a known psychiatric disorder, 70% of men and 30% of women used a firearm. These decedents had either a history of a prior attempt, had disclosed suicidal intent, were depressed, or had a substance use disorder. However, in both groups three quarters had not disclosed suicidal intent...

Language: en