James Donaldson on Mental Health - Why Older Men Are at Higher Risk for Suicide

Prevention as Restoration of Livability First, primary care is central.

Older men may see physicians more readily than psychotherapists.

Routine assessment should therefore include depression, pain, sleep, alcohol use, bereavement, loneliness , functional decline, perceived burdensomeness, and access to highly lethal means.

The conversation should be collaborative rather than paternalistic.

Second, prevention should protect autonomy.

Instead of saying, “You need help,” clinicians and relatives can ask, “What would make daily life feel more manageable again?” Shared decision-making , concrete problem-solving, and small domains of choice can reduce the experience of being controlled.

Third, belonging should be rebuilt before crisis.

Peer groups, bereavement groups, volunteering, intergenerational programs, and social prescribing—in which clinicians connect patients with community activities or supportive groups—can function as need-based interventions.

The evidence base for social prescribing is promising but heterogeneous; it should be used thoughtfully, not as a substitute for clinical care.

Fourth, prevention should restore competence.