The Emergency Telephone Conversation in the Context of the Older Person in Suicidal Crisis:
A Qualitative Study
Abstract
Background: Suicide in older people is a significant public health issue with a predicted future increase. Contemporary research directs considerable attention toward physical, mental, and social risk factors that contribute to suicidality in older people; still, little is understood about the fundamental meanings that older people in suicidal crisis attribute to these factors. Aims: The aim of this qualitative study was to describe, analyze, and compare counselors’ and older peoples’ perceptions of the suicidal crisis during an emergency telephone conversation. Methods: Data collection consisted of individual interviews with telephone counselors (N = 7) working within an emergency mental health triage service, and listening to telephone calls (N = 14) received by the service responding to people aged 65 years and over in suicidal crisis. Triangulation of the two data sets resulted in the emergence of three key themes. Results: We found (1) congruence in the way risk factors were perceived by counselors and communicated during telephone conversations, (2) dissension between counselors’ perceptions of end-of-life issues and older people’s feelings of ambivalence about wanting to die and not knowing what to do and (3) the need for working side-by-side with the older person, exploring acute changes and immediate capacity for change. Conclusions: An explicit focus on risk factors alone may preclude counselors from gaining a deeper understanding of suicidal crisis in an older person’s life. This research has begun to capture and illuminate how telephone counselors can deliver effective crisis intervention as older people struggle and make meaning through their suffering.
References
2002). Would older medical patients use psychological services? The Gerontologist, 42, 392–398.
(1971). The Samaritans and the elderly: Some problems in communication between a suicide prevention scheme and a group with a high suicide rate. Sociology, Science and Medicine, 5, 483–490.
(2007). National Statement on Ethical Conduct in Human Research. Canberra: Australian Government.
(2001). Research corner critical incident technique as a qualitative research method. Association of Perioperative Registered Nurses Journal, 74, 536.
(1988). Elderly suicide in London: An analysis of coroners’ inquests. International Journal of Geriatric Psychiatry, 3, 251–261.
(1994). Suicide in elderly patients. In , Diagnosis and treatment of depression in late life. (pp. 397–418)Washington, DC: American Psychiatric Press.
(1998). Research design: Qualitative and quantitative approaches. Thousand Oaks, CA: Sage Publications.
(2010). Turning points. An extraordinary journey into the suicidal mind. Bowen Hills, Australia: Australian Academic Press.
(2011). DSM-V and the future of suicidology. Crisis, 32, 233–239.
(1991). Suicide in the elderly: General characteristics. Crisis, 12, 3–17.
(1995). Lower suicide rates associated with a tele-help/tele-check service for the elderly at home. American Journal of Psychiatry, 152, 632–634.
(2002) Suicide among the elderly: The long term impact of a telephone support and assessment intervention in northern Italy. British Journal of Psychiatry, 181, 226–229.
(2009). Suicidal behaviours on all the continents among the elderly. In , Oxford textbook of suicidology and suicide prevention: A global perspective. (pp. 693–701). New York, NY: Oxford University Press.
(2011). Suicide of elderly persons: Towards a framework for prevention. Geriatrics and Gerontology International, 11, 107–113.
(1978). The research act: A theoretical introduction to sociological methods (2nd ed.) New York, NY: McGraw-Hill.
(1987). A quantitative literature review of the effectiveness of suicide prevention centers. Journal of Consulting Clinical Psychology, 55, 239–244.
(2004). Suicide at 50 years of age and older: Perceived physical illness, family discord and financial strain. Psychological Medicine, 34, 137–146.
(2011). Key considerations for preventing suicide in older adults: consensus opinions of an expert panel. Crisis, 32, 106–109.
(2010). Using the right type of evidence to answer clinical questions. In , Using evidence to guide nursing practice (pp. 27–41). Sydney, Australia: Elsevier.
(1954). The critical incident technique. Psychological Bulletin, 51, 327–358.
(2011). A systematic review of suicidal behaviour in old age: A gender perspective. Journal of Clinical Nursing, 20, 2109–2124.
(1992). Community and home care for mentally ill older adults. In , Handbook of mental health and aging (pp. 793–813). San Diego, CA: Academic Press.
(2009). When the solution is part of the problem: Problem solving in elderly suicide attempters. International Journal of Geriatric Psychiatry, 24, 1396–1404.
(1992). Becoming qualitative researchers: An introduction. White Plains, NY: Longman.
(2007). An evaluation of crisis hotline outcomes part 2: Suicidal callers. Suicide and Life Threatening Behavior, 37, 338–352.
(2011). The annual report of the chief psychiatrist of South Australia 2010-11. Adelaide, Australia: Office of the Chief Psychiatrist.
(2001). Psychiatric disorder and personality factors associated with suicide in older people: A descriptive and case-control study. International Journal of Geriatric Psychiatry, 16, 155–165.
(2010). Why we need qualitative research in suicidology. Suicide and Life-Threatening Behavior, 40, 74–80.
(1997). Active interviewing. In , Qualitative research: Theory, method and practice (pp. 113–129). London, UK: Sage.
(2008 ). Suicide among older people: Gerontological social worker attitudes (Unpublished doctoral dissertation ). Yeshiva University, New York, USA.2005). The prevention of suicide in later life: A task for GPs? British Journal of General Practice, 55(513), 262–262.
(2007). Establishing standards for the assessment of suicide risk among callers to the national Suicide Prevention Lifeline. Suicide and Life Threatening Behavior, 37, 353–365.
(2009). Why do they become vulnerable when faced with the challenges of old age? Elderly people who committed suicide, described by those who knew them. International Psychogeriatrics, 21, 903–912.
(2010). Why suicide? Elderly people who committed suicide and their experience of life in the period before their death. International Psychogeriatrics, 22, 209–218.
(2007). Telecommunications and suicide prevention: Hopes and challenges for the new century. Omega, 55, 237–253.
(2009). Interviews. Learning the craft of qualitative research interviewing (2nd ed.). Thousand Oaks, CA: SAGE Publications.
(2011). A systematic review of elderly suicide prevention programs. Crisis, 32, 88–98.
(2006). Elderly suicide attempters: Characteristics and outcome. International Journal of Geriatric Psychiatry, 21, 1052–1059.
(1965). Suicide-prevention telephone service. Journal of the American Medical Association, 192, 107–111.
(2002) Contact with mental health and primary care providers before suicide: A review of the evidence. American Journal of Psychiatry, 159, 909–916.
(2005). Suicide prevention strategies: A systematic review. The Journal of the American Medical Association, 294, 2064–2074.
(2006). Suicide among older people. Nursing Older People, 17, 24–29.
(2010). Suicide in later life: Public health practitioner perspectives. International Journal of Geriatric Psychiatry, 25, 1230–1238.
(1999). Synthesis of research and evidence on factors affecting the desire of terminally ill or seriously chronically ill persons to hasten death. Omega, 39, 1–70.
(1997). Effects of different telephone intervention styles with suicidal callers at two suicide prevention centres: An empirical investigation. American Journal of Community Psychology, 25, 861–895.
(2007). Which helper behaviors and intervention styles are related to better short-term outcomes in telephone crisis intervention? Results from a silent monitoring study of calls to the U.S 1-1800-SUICIDE Network. Suicide and Life-Threatening Behavior, 37, 308–321.
(2010). Resolving ethical dilemmas in suicide prevention: The case of telephone helpline rescue policies. Suicide and Life-Threatening Behavior, 40, 159–169.
(1998). Evaluating an intervention for the elderly at increased risk of suicide. Research on Social Work Practice, 8, 28–46.
(1969). Who calls the suicide prevention center: A study of 55 persons calling on their own behalf. American Journal of Psychiatry, 126, 314–324.
(1984). Suicide: Issues of prevention, intervention, and facilitation. Journal of Clinical Psychology, 40, 1328–1333.
(2004). Recent developments: Suicide in older people. British Medical Journal, 329, 895–899.
(2003). The depression care manager and mental health specialist as collaborators within primary care. The American Journal of Geriatric Psychiatry, 11, 507–516.
(2002) Qualitative research and evaluation methods (3rd ed.). Thousand Oaks, CA: SAGE Publications.
(2005). Detecting suicidal ideation in older patients: Identifying risk factors within the general practice setting. British Journal of General Practice, 55, 269–273.
(2010). Exploring the phenomenology of suicide. Suicide and Life-Threatening Behavior, 40, 234–244.
(2005). Physical health and mental disorder in elderly suicide: A case-control study. Aging and Mental Health, 9, 576–584.
(2007). Avoiding death: The ultimate challenge in the provision of contemporary healthcare? Health Sociology Review, 16, 397–404.
(2007). Mental health emergencies. In , Emergency and trauma nursing (pp. 625–639). Sydney, Australia: Elsevier.
(2002). Association between physical illness and suicide among the elderly. Social Psychiatry and Psychiatric Epidemiology, 37, 190–197.
(1997). Use of the critical incident technique in primary care in the audit of deaths by suicide. Quality in Health Care, 6, 25–28.
(2001). Life events and psychosocial factors in elderly suicide – a case control study. Psychiatric Medicine, 31, 1193–1202.
(2011). Understanding why older people develop a wish to die: A qualitative interview study. Crisis, 32, 204–216.
(2007). Critical incident technique: A user’s guide for nurse researchers. Journal of Advanced Nursing, 61, 107–114.
(2010). The hidden toll: Suicide in Australia. Canberra, Australia: Author.
(2007). The relationship between suicide rates and age: An analysis of multinational data from the World Health Organization. International Psychogeriatrics, 19, 1141–1152.
(1996). The suicidal mind. New York, NY: Oxford University Press.
(2001). Suicide in late life. Reviews in Clinical Geriatrics, 11, 253–360.
(2005). Attempted suicide in elderly Chinese persons. The American Journal of Geriatric Psychiatry, 12, 562–571.
(2002) Risk factors for late-life suicide: A prospective community-based study. American Journal of Geriatric Psychiatry, 10, 398–406.
(2007). The risks of risk assessment. Advances in Psychiatric Treatment, 13, 291–297.
(1990). Researching lived experience: Human science for an action sensitive pedagogy. London, UK: Althouse Press.
(2010). Statewide mental health triage scale: Guidelines. Melbourne: Author.
(2002) Illness burden in elderly suicides: A controlled study. British Medical Journal, 324, 1355–1358.
(2003). Alcohol dependence and misuse in elderly suicides. Alcohol and Alcoholism, 38, 249–254.
(2011). Risk factors for suicide in the elderly: What do we know? What do we need to find out? Suicidologi, 16, 3–8.
(2012). Existentialist-informed hermeneutic phenomenology. In , Qualitative research methods in mental health and psychotherapy (pp. 117–130). Chichester, UK: John Wiley & Sons.
(