Elderly suicide is an index of more widespread disorder and discontent among the elderly, and furthermore is a potentially preventable cause of death. This study used coroner's inquest records of 200 elderly in Cheshire who killed themselves, and in which their unexpected deaths attracted a verdict of suicide. Sociodemographic characteristics, clinical aspects of the suicidal process and health care contact before death are reviewed. Unlike most available studies, cases of unexpected death in which an open verdict was given were not included in this study, which covered a 13 year period. The findings are interpreted and compared to the currently available literature on suicide in the elderly. Late life suicide is characterised by less warning, higher lethality and greater prevalence of depression and physical illness. However, suicide risk often remains undetected. All suicidal behaviour in the elderly should be taken seriously by psychiatric and primary care services, in order to reduce suicide rates in the elderly.

Child bearing has been reported to be protective for women in terms of suicide risk. However, it is not clear whether the protective effect of having children diminishes in old age. A literature search has not found studies which examined childlessness as a possible risk factor in elderly suicide. In this study we attempt to explore whether childlessness has any significant association with elderly suicide and whether this differs between women and men. Data was extracted from the records of coroners' inquests into all unexpected deaths of persons aged 60 and over, in Cheshire, over a period of 13 years from 1989-2001. The study found no significant gender difference in childlessness in elderly suicide victims (P>.05). Significantly fewer widowed men who committed suicide were childless (OR 0.1, 95% CI 0.02-0.3 P<.001). A history of deliberate self-harm (DSH) and being previously known to services were found to be significantly lower in childless female victims compared to elderly mothers (OR 0.4, 95% CI 0.1-0.9 P<.05). Leaving suicide notes and the method of suicide did not appear to be significantly influenced by a childless status in either of the sexes (P>.05). The protective effect of having children appears to diminish in old age. Childless females appear to be at a higher risk of succeeding in their first suicide attempt and more importantly, can easily escape the attention of services.

AimsThe trust policy dictates that all urgent GP referrals should be contacted within 48 hours by the duty team. The duty team carries out a telephone screening assessment and offers the patients who are deemed to be urgent, a face-to-face assessment. Those who are not assessed to be urgent are signposted to the right service.MethodsAll the urgent GP referrals of the month of July 2021 were followed up retrospectively and the outcome was recorded to assess the influx and outcome of urgent referrals from primary care. The urgent referrals from all other routes such as Psychiatric Liaison, and Social Services, Police etc were not included in the data.ResultsA total of 124 urgent referrals were received in the month of July 2021. Only 13 out the 124 were deemed urgent following the telephone assessment and they were offered a face-to-face assessment. Fifty three patients were referred to primary care mental health team, 24 were referred to the secondary community mental health, 20 were referred to the older adults team and 10 were discharged back to the GP following. Out of the 13 who were assessed by the duty team, 6 patients were referred to primary care mental health team and 6 were referred to the secondary community mental health team. The urgent referrals came from 20 GP surgeries that cover a wide area of the rural and urban communities and the surgeries with most urgent referrals were highlightedConclusionTrying to work on improving the quality of urgent referrals, the team tried to analyse the results, which proved to be complicated. The efforts to standardise the referral process has depended mainly on the degree of awareness of the GPs about the way the mental health service operates considering there is a percentage of locum GPs who might not be fully aware of how mental health service works.The recommendation of the audit is to arrange visits to the GP surgeries to work on raising awareness among GPs about the referral system to the Mental Health team. It is also recommended that the GPs should be able to complete a brief risk assessment to justify why the referred patient needs to be reviewed urgently instead of on routine basis.