Telephone Counseling and Suicidal Older Adults

An Australian research team studying how crisis call counselors perceive callers over the age of 65 who are in suicidal crisis concluded that“an explicit focus on risk factors alone may preclude counselors from gaining a deeper understanding of suicidal crisis in an older person’s life.” The crisis line in the study was a mental health triage service based in the South Australian Ambulance Service.

The authors recommend that (1) counselors focus on the reactions of the callers to risk factors (rather than the risk factors themselves); (2) counselors be educated about the ambivalence of older adult callers toward death, in order to counteract counselors’ perception that older adults are near the end of their lives and may have less reason to live than younger people; and (3) counselors be taught that the most helpful interactions with older adults in suicidal crisis may be collaborative conversations that explore the “immediate capacity for change.”

The authors identified three themes that led to recommendations they feel may enhance the effectiveness of crisis call services for people over the age of 65 who are experiencing suicidal crises.

First, although counselors accurately identified the physical, mental, and social challenges faced by suicidal older people (such as depression and social isolation), the callers did not focus on these risk factors but rather on their “intense feelings of sadness, hopelessness, and loneliness.” The authors suggest that while it is important for crisis counselors to identify and understand risk factors,  it is more important during the crisis call to understand and help alleviate the immediate psychological effects of these risk factors on callers than to focus on the risk factors themselves.

Second, the common belief held by counselors that older callers were already near or at the end of their lives, and thus had less to live for than younger callers, may affect their ability to offer support to older callers that would help alleviate the suicidal crisis. In contrast to the feelings of the counselors that older callers had “little to hope for,” the callers themselves were ambivalent about death. Educating counselors to understand that older people can have fulfilling lives, and training them in how to help older callers find hope and reasons for living, might enhance their effectiveness with this age group.

Finally, the researchers observed that when counselors focused on “what was acutely different in the older person’s life at that very moment that had led to the older person calling,” they “became more outcome oriented” and “were able to explore and determine the older person’s capabilities and possibilities for change.”With this approach, phone counselors may be better able to establish the caring rapport that, according to other research, callers need in order to find crisis support helpful.

The authors note that these recommendations are based upon a study with a very small sample size which included a wide age range among older callers, and that often the calls were initiated by significant others or health professionals on behalf of the callers themselves. The study focused on behavior during the call, and did not explore whether the callers ultimately died by suicide.

This summary from: Deuter, K., Procter, N., Rogers, J. (2013). The emergency telephone conversation in the context of the older person in suicidal crisis. Crisis 34(4), 262-272.