Last Christmas Eve, at a dementia care facility in suburban Sydney, Steve Atkins’ 93-year-old mother decided her time had come. Her son had recently told her he would not be spending Christmas Day with her. It was not her first attempt, nor was it without forewarning.
“When she was told she was going into care, and her GP told her that, she immediately said ‘I will kill myself’,” Mr Atkins said recently at a cafe in central Sydney.
Mona Atkins has two different kinds of dementia and also suffers from bipolar, undiagnosed for much of her life. She spent about two weeks in hospital after that suicide attempt.
In the mid-20th century, as pensions became commonplace and living standards improved, the rate of suicide among older people began a gradual decline. However in the past 15 years that trend has bottomed out, worrying groups that advocate for the aged.
“It seems that the suicide stream is running again towards an increase in rates,” Professor Diego De Leo, from Griffith University, says.
In 2013, men aged 85 and over had the highest rate of suicide of any age group in Australia, according to ABS data. In the same year, if you brought the age range down to 65 and over, the number of deaths was 396 — 16 per cent of all suicides. (While an ageing Australia may affect the rate, the statistics do compensate for population.)
Suicide is the leading cause of death for men aged 15-19, and affects those aged 18-44 most profoundly. But what’s behind a phenomenon the Council on the Ageing (CoTA) has labelled “the suicides we choose to ignore”?
‘A life with too many difficulties’
It was a Wednesday in August in the Jubilee Room of the NSW State Parliament. Mr Atkins, 67, was telling his story for a room full of medical professionals, politicians and other stakeholders, because how could he not?
For Mr Atkins, suicide has reared its head with an almost unfathomable regularity. His first experience was in 1969, when his mother tried to kill herself in front of him. In 1987 it was his son, who even before his high school graduation had decided he was a failure in life.
“He spent three-and-a-half days in intensive care being told he’d die or be a vegetable,” Mr Atkins says.
A few years later it was Mr Atkins’ friend, Martin — a poet, novelist and son of two famous Australian writers, one of whom also happened to take her own life.
More years passed and the same story played out. Mr Atkins lost colleagues at the CSIRO where he worked and eventually, after a combination of chronic fatigue and some bad medication he took to treat his depression, he began to think that perhaps he, too, was not fit for this world.
“There are a number of factors that have been identified,” Lifeline Research Foundation executive director Alan Woodward says. “It would seem one of the key things around quality of life and happiness for older people is their perceptions around how they fit socially and with their families, how society regards them — the attitudes towards older people — and their real ability to participate in life.”
Our society treats older people differently to other cultures, Mr Woodward says. The Australian experience, unlike in many parts of Asia and the Middle East, is not one of inviting your ageing parents to live with you.
A recent Australian study, Suicide in Older Adults, found living alone was “a significant independent predictor of suicide”.
Mr Atkins tells the story of his 85-year-old uncle. “He went into a nursing home. [He and his wife] had lived together for 49-and-a-half years — they’d only been apart twice in their life, when their two sons were born. I go to visit my uncle and the first thing he says to me is ‘Steve, can you help me kill myself, please? I cannot live apart from Margaret’.”
While dementia afflicts Mona Atkins, it is less prevalent, according to some research, among older people who have taken their lives than those that died in accidents or from heart attacks. That study, published in the Journal of Psychiatric Research in 2013, also found a lower prevalence of psychiatric problems among a group of elder suicides as compared to a group of middle aged people who also died by their own hand. The study’s main conclusion: mental illness is not the whole story.
“I don’t think it is very much the mental disorder but [it’s] the loneliness, the impediments you have in doing many things, the difficulties in feeding yourself — the difficulties in accepting a life with too many difficulties — that may play a role,” Professor De Leo says.
“So we need to embrace a holistic approach to suicide, not to narrow all attentions to mental disorders, because there is quite a number of people that don’t have a mental disorder when they decide to die, particularly in old age.”
Mr Atkins also points to social exclusion as a key factor, particularly for people who had put a lot emphasis on their careers and therefore, in retirement, feel adrift. And if the stigma of men talking about their feelings remains strong anywhere, it is surely among our oldest generation.
“[They have] the feeling of incapacity to contribute to the family anymore,” David Helmers, executive director of The Australian Men’s Sheds Associations (AMSA), says.
He finds the high rate of suicides among men aged over 85 alarming, but not surprising. “It’s a very complex problem. It’s tragic. They feel worthless. If they are not seeing their families anymore, they just think, ‘Why am I doing this?'”
The idea of the Men’s Sheds, which operate not just around Australia but in New Zealand and the UK, is to give older men space where they can work on their own building projects and feel comfortable talking with other men about their lives.
“What we prevent is social isolation,” Mr Helmers says. “Social isolation is the tipping point. It creates poor eating, poor living, substance abuse, suicide. Lots of the key killers of men can be linked to social isolation.”
‘Casting out the darkness’
One day in October, 2004, Noel Braun’s wife Maris told him she was meeting up with a friend to exchange some books. Noel is pretty sure that was the only time, in 42 years of marriage, that she ever lied to him. “I sort of knew, when my wife went off,” Noel, 82, says from his home in Jindabyne, at the foot of the Snowy Mountains. “I had this dreadful apprehension.”
Noel and Maris had spoken of her depression, which developed 20 years earlier and seemed to get worse with age. He worked on the phones for Lifeline, so he knew the signs, and the couple were open about the topic of suicide.
Two of Maris’s sisters had taken their own lives, and she had long assured Noel it would never be her fate. But in her final year, her thoughts changed.
“I knew exactly what her plan was, because I asked her,” Noel says. “That was my background with Lifeline. I often told people who were completely devastated, they didn’t know [about her suicidal tendencies], I said, ‘Well, I did’. But I still couldn’t stop her.”
Maris and Noel Braun in the 1970s. Maris took her own life in 2004, at the age of 66.(Supplied: Noel Braun)
Maris’s darkness overwhelmed her the day of her son’s bucks party. She was 66. The funeral was held on the Thursday, the wedding on the Saturday. In the months afterwards, some family members invited Noel on a skiing trip to the US, and he accepted. It turned out to be a bad decision.
“When I came back it was all waiting for me, all the grief,” he says. “It was sort of like a real vacuum, a real hole.”
The feeling of worthlessness became oppressive, he says. He thought he had done wrong by Maris. He felt immense guilt, that he was “bad”. “I reckon I was at risk myself,” he says. “I was wanting to join my wife.”
It was a comment from a colleague at Lifeline that turned things around, he says. “I was dwelling on all the things that I didn’t do for my wife. And this lady said, ‘Well, think of all the things that you did do’, and that thought really grabbed me. I did do a lot of things — it was just in those last hours, in that last day, she just slipped away. That really saved me.”
He decided he wasn’t going to be the strong, silent type, but would be open about the “insidious” disease of depression and his own experience with it.
Eleven years later, Noel stays active. He likes to walk. “In a way that is something that gave structure to my life, it gave me a sense of purpose,” he says. “If people have a sense of purpose, it sort of makes their life meaningful.”
He recently walked the Camino de Santiago pilgrimage in Spain — one month, one backpack, 700 kilometres — and he was conscious of Maris walking with him. And if the opportunity arose at the little chapels or churches he passed, he lit a candle for her. The candle has great symbolic meaning, he says: “It’s casting out the darkness.”
‘It’s an epidemic’
As for what can be done to decrease the number of older people taking their lives, many experts say the problem is complex.
But Mr Woodward says Australia could do better in having suicide prevention techniques integrated into the aged care system.
He points to the US where he says guides on suicide prevention are distributed in aged care homes, with the stress of relocation noted as a factor in suicidal tendencies.
Family support can also be a very significant “protective factor”, he says. “Families [can] directly address the issue of isolation, so that an older person, perhaps living alone, can still participate in family visits and activities and have a sense of meaning and purpose within that family.”
Meanwhile, Mr Helmers says that changes to access to unemployment benefits for older Australians may have a positive effect.
He uses the example of a man who spent his life installing right-side car doors at a Ford factory but was laid off at 55.
“From a commercial sense, his prospects are quite minimal,” he says. And yet he must fulfil the same job search and training requirements as someone applying for the dole at 18. A relaxing of those standards, Mr Helmers says, might make entry back into the workforce easier, something that is particularly important given the retirement age will rise to 67 by 2023.
Of course, while groups such as CoTA and AMSA advocate for greater awareness of the suicides among older Australians — and therefore greater resourcing — it is important to put the issue into perspective. In 2013, men aged 85 and over had the highest suicide rate — 38 deaths per 100,000 people — but as a proportion of total male deaths among this age group, suicide accounted for less than 1 per cent. In contrast, for men aged 40-44 — the group with the second-highest suicide death rate — 17 per cent of deaths were the result of suicide. For men aged 15 to 19 — the age group at which so much suicide prevention work is directed — the figures are even worse. One in three deaths are the result of suicide.
Mr Helmers argues there does need to be a reallocation of resources, citing unpublished Victorian Coroners Court data he says shows the majority of the state’s 2,200 suicides in a recent year were of men aged over 45.
“It’s logical, isn’t it? If that’s where the numbers are, that’s where the money should be going,” he says. “Youth suicides are tragic, but with older people it’s an epidemic.”
Mr Woodward points to a similar issue: that as a society we don’t look at the older life as any less valuable than the younger when it comes to suicide prevention.
“Certainly, we need to put much more money and efforts into suicide [prevention] in a coordinated manner,” Professor De Leo says. “We need to invest much more in research. We need to create many tailored — by age and gender — programs and evaluate them carefully, which is something that we weren’t too good in doing so far.
“However, I believe we are doing still too little to have a significant government impact on suicides, and we are doing even less for the elderly because we continue to consider the elderly as less important than young people.”