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Background: The White Paper The Health of the Nation targets a reduction in suicide rates. Preventive strategies must be guided by an understanding of the demography and antecedents of suicide. These issues are examined in relation to suicide by old people in Manchester.Method: One hundred consecutive coroners' inquisitions on people aged over 65 occurring between 1980 and 1991 in which the verdict was suicide were scrutinised and related to Health Service notes.Results: Suicides were rare, numbers ranging from 0 to seven per annum per Health District. Rates did not vary between district but did within smaller sub-populations. Most individuals died at home; 65% were physically ill, of whom 23% had been hospitalised within the previous year. At least 60% were clinically depressed, with 25% being prescribed antidepressants. A total of 43% had seen their general practitioner in the previous month but only 14% were in contact with psychiatric services.Conclusions: Many elderly people who commit suicide are not in close contact with primary care services; those who are may not be prescribed appropriate treatment, and few are referred for specialist care. Specialist services will fail to reduce suicide rates unless they embark upon programmes to increase public awareness of therapeutic possibilities and work more closely with primary care agencies to realise these possibilities. [ABSTRACT FROM AUTHOR]

The initial features and progress of depressive symptomatology over 42 to 104 months are presented for 100 elderly patients admitted with severe, non-neurotic depressive states; none had experienced a previous hypomanic episode. Sixty per cent either remained well throughout or had further episodes followed by full recovery; only 7% suffered continuous depressive symptoms. Of potential prognostic factors, only male sex and poor physical health, both at presentation and developing subsequently, were associated with poorer outcomes. The view is supported that treatment with well established methods achieves worthwhile and sustained improvement for most patients. [ABSTRACT FROM AUTHOR]

The article discusses the services for old people with mental disorders in Great Britain. The nature of services depends on the historically available equipment and buildings, the personality and interests of a single consultant, and the structure and needs of the population. Some services are geared to respond to all cases of mental illness above a certain age while others deal only with demented patients. Patients who are under the joint care of psychiatrist and geriatrician have formed an important part of most services.

Reported here is a cohort study of five years' bed usage in the Goodmayes Psychiatric Unit for Old People. Patients first admitted in 1970 continued to use beds, by readmission or by continuing stay, over the next four years; subsequent cohorts of admissions made correspondingly extended use of beds. Bed-usage by men appears now to have stabilized, whilst for women it is still rising. Over the first six years the bed complement was reduced by 40%, despite an increase in referrals of over 40%; this is because the Unit's style of work prevented newly admitted patients from accumulating in beds made available by deaths. It looks as if in future not only will patients who die by replaced by new female admissions but more beds will be needed for these admissions. The present bed-usage is just within the Government's recommended guidelines, and the local issues are considered in the context of national policy. [ABSTRACT FROM AUTHOR]