2015

PROMOTING EMOTIONAL HEALTH

AND PREVENTING SUICIDE

A Toolkit for Senior Centers

Acknowledgments

This toolkit was prepared for the Substance Abuse and Mental Health Services Administration 

(SAMHSA) by Synergy Enterprises, Inc., in collaboration with Education Development 

Center, Inc. under contract number HHSS28320140003C. Michele LaTour Monroe served 

as Contracting Officer Representative and Rosalyn Blogier, LCSW-C served as Task Order 

Manager.

Disclaimer

The views, opinions, and content of this publication are those of the authors and do not 

necessarily reflect the policies or opinions of SAMHSA or HHS. The listing of non-federal 

resources in this document is not comprehensive, and inclusion does not constitute 

endorsement by SAMHSA or HHS.

Public Domain Notice

All material appearing in this report is in the public domain and may be reproduced or copied 

without permission from SAMHSA. Citation of the source materials in the public domain is 

appreciated. However, this publication may not be reproduced or distributed for a fee without 

the specific, written authorization of the Office of Communications, SAMHSA, HHS.

Electronic Access and Copies of Publication

This publication may be downloaded or ordered at http://store.samhsa.gov. You may also 

order it by calling SAMHSA at 1-877-SAMHSA-7 (1-877-726-4727) (English).

Recommended Citation

Substance Abuse and Mental Health Services Administration. (2015). Promoting 

Emotional Health and Preventing Suicide: A Toolkit for Senior Centers. HHS Publication 

No. SMA-15-4416. Rockville, MD: Center for Mental Health Services, Substance Abuse 

and Mental Health Services Administration, 2015.

Originating Office

Suicide Prevention Branch, Center for Mental Health Services, Substance Abuse and 

Mental Health Services Administration, 1 Choke Cherry Road, Rockville, MD 20857. 

HHS Publication No. SMA-15-4416. 

2015
Promoting Emotional Health 

and Preventing Suicide:

A Toolkit for Senior Centers

U.S. Department of Health and Human Services

Substance Abuse and Mental Health Services Administration

Center for Mental Health Services

Division of Prevention, Traumatic Stress, and Special Programs

Suicide Prevention Branch
A Toolkit for Senior Centers | 5

TABLE OF CONTENTS

About This Toolkit................................................................. 6

Questions You May Have .........................................................................................................6

Contents of the Toolkit............................................................................................................. 7

Toolkit Sections, Steps, and Tools........................................................................................... 8

Getting Started .................................................................... 10

Strategy 1: Promote Emotional Health............................... 13

Provide Activities and Programs that Increase Protective Factors................................... 13

Support the Development of Social Connections............................................................... 16

Strategy 2: Recognize and Respond to Suicide Risk ............18

Recognize the Warning Signs of Suicide .............................................................................. 18

Recognize and Respond to Depression ................................................................................ 21

Recognize and Respond to Medication and Alcohol Misuse ............................................ 22

Increase Access to Care .......................................................................................................... 23

Strategy 3: Respond to a Suicide Attempt or Death............26

References ............................................................................ 28

Tools..................................................................................... 29

Tool 1: Suicide among Older Adults..................................................................................... 30

Tool 2: Assessment Checklist................................................................................................. 33

Tool 3: Connecting to Behavioral Health Resources in the Community ........................ 34

Tool 4: Activities to Promote Health and Wellness............................................................. 37

Tool 5: Strategies for Establishing Social Networks............................................................ 39

Tool 6: Recognizing and Responding to Depression.......................................................... 40

Tool 7: Recognizing and Responding to Medication and Alcohol Misuse.............

Tool 8: Community Support Meeting................................................................................... 44

Tool 9: Resources List ............................................................................................................. 46

Fact Sheets for Older Adults ............................................... 49

Fact Sheet 1: Looking Out for the Well-Being of Yourself and Others ............................ 50

Fact Sheet 2: Know the Warning Signs of Suicide............................................................... 52

Fact Sheet 3: After a Suicide: What to Expect and How to Help....................................... 54

Appendix–Additional Acknowledgments........................... 56
6 | PROMOTING EMOTIONAL HEALTH AND PREVENTING SUICIDE

About This Toolkit

This toolkit is a resource for senior center staff and volunteers. As a focus 

point for the community, senior centers connect older adults with a range 

of critical services and programs, including meals and nutrition 

programs, transportation services, health and wellness programs, and 

social and recreational activities. Therefore, these centers can play an 

important role in promoting emotional health among older adults and 

increasing the factors that may protect them from suicide. This toolkit 

will give you many ideas, examples, tools, and resources for integrating 

suicide prevention into the work you already do to support the well-being 

of older adults. 

Questions You May Have

Promoting emotional health and preventing suicide might be new topics 

to you—and if so, you may have a few questions.

How can my senior center address suicide and other sensitive topics?

Suicide, depression, and problems with alcohol and medications are issues 

you may feel uncomfortable talking about or not qualified to address. But 

there are many individuals and organizations in your community who 

can help you talk about these issues and connect older adults to the help 

they need. These individuals include mental health providers who have 

been trained to lead educational sessions addressing these issues and to 

screen and counsel older adults and link them to sources of help.

Do older adults want to talk about emotional health?

You may be concerned that the older adults who come to your center 

will not want to talk about suicide and related mental health problems. 

It’s true—if you were to schedule a workshop on “suicide prevention” or 

“depression,” very few people would likely show up. But mental health 

educators and others who conduct these sessions at senior centers have 

found that older adults will indeed attend when these topics are framed 

in a more positive and engaging way (e.g., “Promoting Emotional WellBeing”). Older adults want to learn about these issues—both to improve 

their own health and wellness and to serve as a resource to their friends, 

family members, and others who may be experiencing problems.

Will older adults be willing to seek help?

You may be wondering, “What’s the point of raising these issues? Older 

adults will not want to seek help because they don’t want to be labeled 

as having a mental health problem.” Many older adults may indeed be 

reluctant to do so—and that is why it’s so important to let them know 

that depression, problems with alcohol and medications, and thoughts 

of suicide are not a normal part of aging and that effective treatment is 

available. If you notice signs that an older adult may have a problem, 

you can promote help-seeking by encouraging the person to talk with a 

counselor, a social worker, or his or her doctor. This can be a critical first 

step that can make a tremendous difference in that person’s life.
A Toolkit for Senior Centers | 7

Contents of the Toolkit

Promoting Emotional Health and Preventing Suicide: A Toolkit for 

Senior Centers (2015) is based on a similar resource for senior living 

communities published in 2011 by the Substance Abuse and Mental 

Health Services Administration (SAMHSA). This toolkit, which is 

tailored to the needs of senior centers, was developed for SAMHSA by 

the Education Development Center, Inc., with input from other federal 

agencies, senior center staff, and individuals and organizations who work 

with senior centers to provide services and support to older adults.

This toolkit includes the following:

■ A Getting Started section that provides an overview of suicide among

older adults and how senior centers can help address this important

problem.

■ A section on each of the three key strategies that senior centers can

use to promote emotional well-being and prevent suicide among

older adults. Each section describes recommended steps for carrying

out the strategy and indicates relevant tools and resources.

■ Nine tools for carrying out the three strategies.

■ Three fact sheets that senior centers can share with older adults and

their families as part of an educational session or other event.

The table that follows provides an at-a-glance look at the contents of 

this toolkit, showing how all the parts fit together. For each section and 

subsection of the toolkit, the table lists the steps that your senior center 

can take and the related tools and fact sheets.

Please feel free to adapt the information in this toolkit to best fit 

your needs and to share it with others who serve older adults in your 

community.
Toolkit Sections, Steps, and Tools

Section and Steps Tools and Fact Sheets

Getting Started

• Educate staff, volunteers, and participants about suicide among 

adults.

older Tool 1: Suicide among Older

Adults Tool 2: Assessment

• Assess needs and develop a plan. Checklist

• Identify and partner with behavioral health providers in your

community.

Tool 3: Connecting to

Behavioral Health Resources in

• Identify others who can help you carry out each strategy. the Community

Strategy 1: Promote Emotional Health

Provide Activities andPrograms thatIncreaseProtective Factors

• Offer activities and programs that foster a sense of purpose, resilience,

and other protective factors.

Tool 4: Activities to

Promote Health and

Wellness

• Provide activities and programs that integrate mental and physical

health.

• Invite a mental health educator to lead wellness sessions at your senior

center.

• Align programs and activities with the values, preferences, and cultural

and linguistic needs of the older adults you serve.

Support the Development of Social Connections

• Establish a buddy system to welcome new participants.

• Provide activities that help men, in particular, develop social

connections.

• Develop a policy for addressing bullying.

Tool 5: Strategies for

Establishing SocialNetworks

Fact Sheet 1: Looking Out for

Well-Being of Yourself and 

Others

the

Strategy 2: Recognize and Respond to Suicide Risk

Recognize the Warning Signs of Suicide

• Designate someone at your senior center to serve as the point person

for addressing concerns related to suicide risk.

Fact Sheet 2: Know the

Warning Signs of Suicide

• Identify a mental health professional in the community who will be

your contact for advice and referrals.

• Develop a written protocol for recognizing and immediately responding

to the warning signs of suicide.

• Provide training to staff, volunteers, and participants.

• If someone shows any signs of immediate risk, alert the designated

person at your senior center.

• Refer individuals who may be at serious, but not immediate risk of

suicide to a mental health professional for further assessment and

treatment.

8 | PROMOTING EMOTIONAL HEALTH AND PREVENTING SUICIDE
A Toolkit for Senior Centers | 9

Strategy 2: Recognize and Respond to Suicide Risk cont’d

Recognize and Respond to Depression

• Increase awareness of the symptoms of depression.

• Identify community partners who can conduct educational sessions at

your senior center to educate staff, volunteers, and older adults about

depression.

Tool 6: Recognizing and 

Responding to Depression

Recognize and Respond to Medication and Alcohol Misuse

• Increase awareness of the recommended drinking limit for older adults.

• Invite a behavioral health professional to make a presentation about

alcohol and/or medication misuse for your staff and volunteers.

• Invite a pharmacist to conduct a session on appropriate and

inappropriate use of medications.

Tool 7: Recognizing and 

Responding to Medication and 

Alcohol Misuse

Increase Access to Care

• Encourage older adults to seek care for behavioral health problems by

using words that are neutral and nonthreatening.

• Suggest that older adults talk with their doctors about issues related to

mental health and/or use of alcohol or medications.

• Invite a local behavioral health care professional to come to your senior

center to encourage help-seeking and describe available services.

• Facilitate access to screening and treatment.

Tool 3: Connecting to Behavioral 

Health Resources in the 

Community

Strategy 3: Respond to a Suicide Attempt or Death

•

•

•

Develop one or more postvention protocols for responding to a suicide

attempt or death.*

Provide training to senior center staff and volunteers.

Contact an organization that provides postvention support to obtain its

help in the event of a suicide death or attempt.

Tool 8: Community Support 

Meetings

Fact Sheet 3: After a Suicide: What 

to Expect and How to Help

* The term postvention refers to “response to and care for individuals affected in the aftermath of a suicide attempt or suicide death” (HHS Office of the 

Surgeon General and National Action Alliance for Suicide Prevention, 2012, p. 141).
10 | PROMOTING EMOTIONAL HEALTH AND PREVENTING SUICIDE

Getting Started

Senior centers vary tremendously in size, location, number of people 

served, funding sources, staffing, services, and activities—as well as in 

their approaches to mental health promotion and suicide prevention. 

This section provides an overview of suicide among older adults, presents 

three key strategies that senior centers can use to address this problem, 

and suggests steps for getting started.

Suicide among Older Adults. In 2013, more than 7,000 people age 65 

or older died by suicide (CDC, 2013). Suicide rates are higher among 

older adults than in the general population (CDC, 2013). In addition to 

the thousands of older adults who die by suicide, many more have made 

suicide attempts and suffer from the emotional pain of suicidal thoughts. 

Suicide rates are particularly high among older men—higher than 

among any other group in the United States (CDC, 2013). Although 

suicide attempts are more common among older women than older 

men (SAMHSA, 2013b), attempts are more likely to be fatal among men 

because men are more likely than women to use firearms (CDC, 2013).

Although older adults (both men and women) are less likely than 

younger adults to report serious thoughts of suicide or a suicide attempt 

(SAMHSA, 2013b), attempts are more likely to result in death among 

older adults than among younger people (Conwell, 1997; Fassberg et al., 

2012).

Risk and Protective Factors. In most cases, suicide results from a 

combination of factors rather than a single cause. Studies suggest that 

some of the key risk factors for suicide among older adults include the 

following (Conwell, Van Orden, & Caine, 2011): 

■ Mental disorders, particularly depression

■ Substance use problems (including abuse of prescription

medications)

■ Physical illness, disability, and pain

■ Social isolation

■ Stressful life events and losses

■ Access to lethal means

Suicide is preventable. Several factors may help protect older adults from 

suicide and related behavioral health problems. Protective factors for 

suicide among older adults include the following (Conwell, et al., 2011): 

■ Receiving care for mental and physical health problems

■ Social connectedness

■ A sense of purpose or meaning

■ Skills in coping and adapting to change

■ Cultural or religious beliefs that discourage suicide

There is help and hope when individuals, families, and organizations such 

as senior centers join forces to prevent suicide. 
A Toolkit for Senior Centers | 11

Three Key Strategies. Senior center staff and volunteers can promote emotional health and prevent suicide 

among older adults by implementing three key strategies: 

■ Strategy 1: Promote emotional health. This strategy focuses on all older adults—regardless of individual risk

for suicide. It includes providing a range of programs, services, and activities that support emotional health

and helping older adults develop positive social connections.

■ Strategy 2: Recognize and respond to suicide risk. This strategy focuses on identifying older adults who may

be at risk for suicide, as well as related mental health or substance use problems, and linking them to sources

of help. As senior center staff and volunteers work with older adults on a daily basis, they are in a unique

position to notice signs of a problem and encourage help-seeking.

■ Strategy 3: Respond to a suicide attempt or death. A suicide attempt or death can have a profound emotional

impact on older adults and their families and other caregivers, as well as on senior center staff and volunteers.

This section of the toolkit offers information on how to support your staff, volunteers, and participants after a

crisis.

What you can do

Educate staff, volunteers, and participants about 

suicide among older adults. Help increase awareness 

of the issue of suicide and educate senior center staff, 

volunteers, and participants by sharing copies of 

Tool 1: Suicide among Older Adults. It provides key 

facts, a detailed list of risk and protective factors, and 

suggestions for what you can do.

Assess needs and develop a plan. Assess how well 

your senior center is already addressing the three key 

strategies (see Tool 2: Assessment Checklist), and 

develop a plan for closing any existing gaps and making 

improvements. Consider scheduling a meeting with 

your board members, staff, and volunteers to review 

the checklist and identify the strategies and steps that 

are feasible for and important to your center. You can 

then follow the guidance in each relevant section of this

toolkit to help you take those steps.

Identify and partner with behavioral health 

providers†

 in your community. These include mental 

health centers and specialists, programs aimed at 

preventing and/or treating substance use disorders, 

pastoral counseling resources, support groups, and 

hospitals, all of whom can support the work of your 

center in many ways. This toolkit provides many 

examples of how these partnerships can be a win-win 

situation for all involved. 

†

 Behavioral health providers are individuals and organizations who provide support for a wide range of mental and/or substance use problems, including 

alcohol and drug addiction, misuse of substances, mental illness, serious psychological distress, co-occurring mental and substance use disorders, and suicide 

(SAMHSA, 2011). 

A Win-Win Situation

Partnerships between senior centers and behavioral 

health providers can benefit both parties in many 

ways.

Behavioral health providers can help senior centers by:

• Serving as valuable sources of consultation and

referrals

• Providing trained specialists to lead workshops and

sessions that educate older adults and/or senior center

staff and volunteers on topics related to behavioral

health

• Screening older adults for depression, substance use

disorders, and/or suicide risk and connecting them to

sources of care

Senior centers can support the work of behavioral health 

providers by:

• Helping them reach older adults in the community

who may be unwilling to go to a specialist for help

with a behavioral health problem

• Providing space for screenings and consultations at a

trusted location that is easily accessible to older adults

via transportation services

• Connecting providers to individuals and

organizations serving older adults (e.g., meals and

transportation services, home health aides) who can

identify older adults in other settings (e.g., at home)

who may need help.
12 | PROMOTING EMOTIONAL HEALTH AND PREVENTING SUICIDE

Identify others who can help you carry out each strategy. Potential partners include health educators, who can 

lead sessions on health and wellness; primary care providers, who can offer preventive services and care for chronic 

health problems, thereby also reducing suicide risk; and others in the community who provide services for older 

adults, such as Meals on Wheels programs and home health aides.

All of these connections—among providers of services for older adults, behavioral health services, and other health 

care services—can promote better coordination of services and improved health and quality of life for the older 

adults you serve.

Tools you can use

■ Tool 1: Suicide among Older Adults can help you increase awareness of the risk and protective factors for

suicide among older adults. Distribute copies to staff and volunteers.

■ Tool 2: Assessment Checklist will help you assess how well your senior center is addressing the three

strategies and identify areas for improvement.

■ Tool 3: Connecting to Behavioral Health Resources in the Community will help you develop a list of

potential partners.

Other resources

Get Connected! Linking Older Adults with Medication, Alcohol, and Mental Health Resources is a toolkit that 

provides step-by-step information and resources, including fact sheets and screening tools, on how to establish 

a program to link older adults with medication, alcohol, and mental health treatment and support resources. 

Available at http://store.samhsa.gov/product/Linking-Older-Adults-With-Medication-Alcohol-and-MentalHealth-Resources/SMA03-3824.

Two Issue Briefs from the Administration for Community Living offer information about partnering with 

behavioral health providers and preventing suicide among older adults: 

■ Issue Brief 1: Aging and Behavioral Health Partnerships in the Changing Health Care Environment

■ Issue Brief 4: Preventing Suicide in Older Adults

Available at http://www.aoa.acl.gov/AoA_Programs/HPW/Behavioral/index.aspx.
A Toolkit for Senior Centers | 13

Strategy 1: Promote Emotional 

Health

Senior centers offer many activities and services that help older adults 

stay healthy and independent as they age—but centers can do even more. 

The factors that may help protect older adults from suicide and other 

behavioral health problems include personal characteristics and skills 

and positive and caring social connections. This section describes ways 

to promote emotional well-being and to strengthen protective factors 

among all senior center participants, regardless of their individual risk for 

suicide. 

Provide Activities and Programs that Increase 

Protective Factors

Studies suggest that the characteristics and skills that may help protect 

older adults from suicide include having a sense of purpose or meaning, 

self-esteem, social skills, flexibility, and skills in coping and adapting to 

change (Conwell, et al., 2011). Cultural or religious beliefs that discourage 

suicide and support self-preservation may also be protective.

Senior centers can increase these protective factors by offering activities 

and programs that older adults find interesting and enjoyable, build on 

their strengths, and help them develop new skills. Given that medical 

problems, disability, and pain may increase suicide risk, it is also 

important to provide activities and programs that help older adults 

manage chronic health conditions and adapt to changes in physical 

function. Whenever possible, these programs should convey the message 

that physical and mental health are strongly linked and that both are 

important to healthy aging.

What you can do

Offer activities and programs that foster a sense of purpose, resilience, 

and other protective factors. Consider activities that do the following: 

■ Help older adults prevent and manage health problems (e.g., sessions

on topics such as diabetes self-management and injury prevention)

■ Develop coping skills (e.g., workshops on issues such as loss and

bereavement or caring for a spouse or partner)

■ Provide a sense of purpose and opportunities to develop meaningful

connections with others (e.g., volunteering and mentoring activities,

intergenerational activities)

■ Provide a sense of accomplishment and pleasure (e.g., word and

number games, writing poetry or stories, cooking, using computers,

woodworking, financial management)

A brief survey can be a great way to identify topics and activities of 

interest to your participants. Create a list of potential offerings and ask 

participants to rank order them and/or suggest their own ideas.

Provide activities and programs that integrate mental and physical 

health. Consider adding mind-body activities, such as mindfulness, 
14 | PROMOTING EMOTIONAL HEALTH AND PREVENTING SUICIDE

meditative breathing, and yoga to your exercise and activity programs. When planning an educational session 

on a health problem, such as heart disease or diabetes, make sure that the session also addresses the relationship 

between mental and physical health (e.g., the link between heart disease and depression). You might offer chronic 

disease self-management workshops that include topics such as decision making, stress reduction, coping with 

pain, and the appropriate use of medications. Consider inviting behavioral health providers from your community 

to participate in health fairs and other events hosted by your senior center. 

Invite a mental health educator to lead wellness sessions at your senior center. See the box for examples of 

wellness classes offered by senior centers in Colorado and Utah.

Wellness Classes: Ideas from Colorado and Utah

Senior Reach (http://www.seniorreach.org), a program in Colorado that partners with others in the community to 

support the well-being of older adults, sends wellness coordinators to lead classes at senior centers. Sample topics include:

• NO MORE REGRETS! Focusing on past regrets robs us of any happiness we can have right now.

• Taking In the Good. Savoring the good in our lives can help promote healing and a deep sense of inner

contentment.

• Into the Stillness. During the holidays, take some time to just be still, through meditation, journaling, and ritual.

• Awakening to Joy. Focus on how to live our daily lives more mindfully.

• Calm in the Chaos. Typical holiday scenarios are followed by discussion and information on various coping

techniques.

• The Journey of a Caregiver. Consider the passages involved in being a caregiver and ways to take care of 

oneself. 

Valley Behavioral Health (http://www.valleycare.com), in Utah, has a Vital Aging Project that provides wellness classes at 

19 senior centers. Class topics are selected via a needs assessment questionnaire completed by senior center participants. 

More than 15 wellness topics are offered, and participants are encouraged to make suggestions. Examples include: 

• How I View Myself (Self-Esteem)

• Achieving a Healthy Mind, Body, and Soul

• Building Resilience

• Creative Problem Solving

• Mindfulness and Relaxation Techniques

• Adjusting to Transitions in Your Living Environment
A Toolkit for Senior Centers | 15

Align programs and activities with the values, preferences, and 

cultural and linguistic needs of the older adults you serve. For 

example, if your senior center serves Spanish-speaking older adults, 

invite a Spanish-speaking mental health professional to lead a session 

on wellness. Be aware that some terms (e.g., depression) may not 

translate well into other languages. Choose culturally competent 

presenters, particularly individuals who come from the same culture as 

session attendees. (See sidebar for an example of a prevention program 

designed specifically for Native American older adults.) In addition to 

considering race/ethnicity and language, also take into account the 

needs and interests of other groups, such as people with disabilities 

and those who are lesbian, gay, bisexual, or transgender. Connect with 

organizations representing various groups in your community to find 

out more about the types of programs that different older adults may 

find appealing. 

Tools you can use

Tool 4: Activities to Promote Health and Wellness provides

additional examples of activities and programs your senior center 

may consider incorporating. 

Other resources

Issue Brief 11: Reaching Diverse Older Adult Populations and 

Engaging Them in Prevention Services and Early Interventions

provides information and examples on how to deliver culturally 

appropriate services. Available at http://www.aoa.acl.gov/AoA_

Programs/HPW/Behavioral/index.aspx. 

A Toolkit for Serving Diverse Communities, from the 

Administration on Aging, offers easy-to-use methods for providing 

respectful, inclusive, and sensitive services. Available at http://

www.aoa.acl.gov/AoA_Programs/Tools_Resources/DOCS/AoA_

DiversityToolkit_Full.pdf. 

Wise Elders Living Longer 

(WELL-Balanced): A 

Group Program for Native 

Americans

WELL-Balanced is a program developed 

by the National Resource Center 

on Native American Aging and the 

University of North Dakota Wellness 

Center specifically for Native American 

elders. The program uses exercise, 

information, and social interaction 

to help elders remain active and 

independent. It helps elders:

• Prevent falls

• Manage diabetes, arthritis, and

hypertension

• Engage in social activity

• Increase their level of physical

activity

• Develop strategies for independent

living

• Have fun

WELL-Balanced program materials are 

available online at https://www.nrcnaa.

org/well-balanced. 
16 | PROMOTING EMOTIONAL HEALTH AND PREVENTING SUICIDE

Support the Development of Social Connections

Being connected to others at the personal, family, and community 

levels has been identified as a key protective factor for older adults 

(CDC, 2006; Conwell, et al., 2011). Studies suggest that suicide may 

be less likely among older adults who have close friends and family 

members, participate in community activities, and/or are active 

in organizations than among those who have fewer connections. 

Belonging to a faith community and attending services also may 

help protect older adults from suicide by connecting them to 

sources of social support in the community. To be protective, these 

connections should “create positive interactions and feelings of 

being cared about” (Conwell, et al., 2011, p. 6). 

Senior centers can provide older adults with a variety of 

opportunities to develop positive connections with their peers, 

staff, volunteers, and other service providers. These social networks 

may be particularly important to older adults who lack day-to-day 

contact with family and close friends. 

What you can do

Establish a buddy system to welcome new participants. Ask 

current participants if they would like to volunteer to serve as 

buddies. When new participants come to your senior center, they 

can be connected with a buddy who will introduce them to the 

facilities, services, personnel, and other participants. Organizing 

“friendship tables” in dining locations is another way to welcome 

new members and help them develop positive connections.

Provide activities that help men, in particular, develop social 

connections. As noted in the Getting Started section, suicide rates 

are particularly high among older men. However, men are less likely 

than women to reach out socially. It is estimated that men make up 

only about 30 percent of senior center participants, or less than one 

in three (NCOA, 2012). This makes it especially important to attract 

men to your senior center by providing activities that they will find 

engaging. Consider conducting a community survey to identify 

activities and topics of interest to older men who live in your area. 

For example:

■ Games such as pool, poker, and bridge

■ Opportunities for men to work on meaningful projects of their

choice (e.g., carpentry, restoring bicycles for a local school,

gardening, mentoring on how to start a new business), at their

own pace, while interacting with other older men

■ Breakfast or lunch speakers who can address an issue of

particular interest to the men in your community (e.g., local

news and events, sports)

■ Workshops or discussions on topics of interest to men in your

community (e.g., a men’s health issue)
A Toolkit for Senior Centers | 17

Develop a policy for addressing bullying. Bullying is a social problem 

that affects people of all ages, including older adults. Bullying can happen 

in any place where older adults spend a lot of time together, such as 

dining areas and other shared facilities. Consider adopting a formal 

protocol for preventing, recognizing, and stopping bullying at your senior 

center. The protocol should define bullying, give examples, indicate 

how and to whom one should report this type of behavior, and state the 

center’s disciplinary policy (e.g., verbal warning, followed by written 

warning, followed by a suspension of senior center privileges). 

Tools you can use

■ Tool 5: Strategies for Establishing Social Networks offers

more ideas on how to help older adults establish positive social 

connections. 

■ Distribute Fact Sheet 1: Looking Out for the Well-Being of Yourself

and Others to senior center participants as part of a session or 

presentation on health promotion and wellness.

Other resources

For more on senior bullying, see a series of blog posts by two experts on 

the topic, Dr. Robin Bonifas and Marsha Frankel. Available at http://www.

mybetternursinghome.com/senior-bullying-guest-post-by-robin-bonifasphd-msw-and-marsha-frankel-licsw/.

Recognizing and 

Stopping Bullying

Signs of bullying may include:

• Name calling, teasing, taunting,

or threatening

• Pushing, hitting, destroying

property, or stealing

• Shunning, excluding or

ignoring, gossiping, spreading

rumors, or mimicking

• Laying claim to certain spaces

or areas in the building and

leaving others out

Bullying can cause long-term harm 

to its victims. For bystanders, it 

creates a toxic environment of fear 

and distrust. 

Ignoring bullying won’t make it go 

away. Strategies for preventing and 

stopping bullying include: 

• Creating a culture of equality

and respect

• Increasing awareness of bullying

via educational sessions and

awareness materials

• Adopting a policy on bullying

and posting it at your facility
18 | PROMOTING EMOTIONAL HEALTH AND PREVENTING SUICIDE

Strategy 2: Recognize and Respond 

to Suicide Risk 

Senior centers can play an important role in preventing suicide by 

identifying older adults who may be at immediate risk, taking appropriate 

follow-up actions to keep them safe, and connecting them to help 

they need. This section describes how to recognize and respond to 

the warning signs of suicide. Since suicidal behavior is closely linked 

to mental disorders and substance misuse, this section also addresses 

how to recognize and respond to depression and misuse of alcohol and 

medications among older adults. 

Recognize the Warning Signs of Suicide 

Senior center staff and volunteers should be able to recognize the warning 

signs of suicide and know how to respond immediately if someone 

displays any of them. This information may also be useful to the older 

adults at your center, as they may have friends, neighbors, or family 

members who are experiencing suicide risk.

What you can do

Designate someone at your senior center to serve as the point person 

for addressing concerns related to suicide risk. For example, you could 

designate the senior center director, a social worker, or other appropriate 

staff member to serve in this capacity.

Identify a mental health professional in the community who will be 

your contact for advice and referrals. Contact local behavioral health 

providers to identify one or more mental health professionals who can 

provide this assistance to your senior center and its participants. (See 

Tool 3: Connecting to Behavioral Health Resources in the Community

for more information on how to identify and contact behavioral health 

providers.)

Develop a written protocol for recognizing and immediately 

responding to the warning signs of suicide. The protocol should include 

information on how to recognize warning signs and behaviors. It should 

also indicate the senior center point person to notify and the community 

mental health provider to contact for assistance. Develop and disseminate 

a resource sheet that provides this information (e.g., Fact Sheet 2: Know 

the Warning Signs of Suicide).
A Toolkit for Senior Centers | 19

Provide training to staff, volunteers, and participants. Consider 

partnering with a mental health provider who can provide training on 

how to identify and help individuals who may be showing these signs. 

When offering this training to senior center participants, also invite 

family members and other caregivers to attend. These individuals may be 

in a good position to notice changes in behavior that could indicate a 

problem. 

If someone shows any signs of immediate risk, alert the designated 

person at your senior center. The following three behaviors may indicate 

that a person is at immediate risk of suicide (SPRC, 2014): 

■ Talking about wanting to die or to kill oneself

■ Looking for a way to kill oneself, such as searching online or

obtaining a gun

■ Talking about feeling hopeless or having no reason to live

If you see any of these signs, alert the point person at your senior center. 

He or she should immediately call your senior center’s mental health 

contact in the community or the National Suicide Prevention Lifeline 

(1-800-273-8255). The goal is to connect the person to a mental health 

professional who can quickly assess for suicide risk. If you think the 

person is in immediate danger of attempting suicide, call 911. Stay with 

the person until help arrives, talking with him or her in a supportive tone.

Refer individuals who may be at serious, but less immediate risk of 

suicide to a mental health professional for further assessment and 

treatment. The following behaviors may indicate a serious risk, especially 

if the behavior is new, has increased, and/or seems related to a painful 

event, loss, or change: 

■ Talking about feeling trapped or being in unbearable pain

■ Talking about being a burden to others

■ Increasing the use of alcohol or drugs

■ Acting anxious or agitated; behaving recklessly

■ Sleeping too little or too much

■ Withdrawing or feeling isolated

■ Showing rage or talking about seeking revenge

■ Displaying extreme mood swings

If you see any of these signs, alert the point person at your senior center. 

He or she should connect the person to your senior center’s mental health 

contact in the community who can screen the person, determine whether 

a referral for treatment is appropriate, and facilitate treatment.

Tools you can use

■ Distribute Fact Sheet 2: Know the Warning Signs of Suicide to

your staff and volunteers and to older adults who visit your senior 

center as part of an educational session. Consider sharing it with 

other service providers (e.g., home health aides, personnel from 

transportation and meal programs) as well.

Partnering with 

Behavioral Health 

Providers to Educate 

Older Adults

Older adults can play an important 

role in recognizing and addressing 

suicide risk among their family 

members, friends, neighbors, 

and other older adults in the 

community. Partnering with local 

mental health providers can be a 

great way to educate older adults 

who come to your senior center 

about this important issue.

Valley Behavioral Health (http://

www.valleycares.com) in Utah and 

Oakland Family Services (http://

www.oaklandfamilyservices.org/

programs/oacs/oacs.html) in 

Michigan work in partnership with 

their local senior centers to educate 

older adults about behavioral health 

topics, including the warning signs 

for suicide. The two organizations 

lead educational workshops to do 

the following:

• Discuss the signs that a family

member or friend may be at risk

• Offer guidance on how to

respond

• Provide information about

sources of mental health care in

the community

These workshops use information 

adapted from Promoting Emotional 

Health and Preventing Suicide: 

A Toolkit for Senior Living 

Communities. Available at http://

store.samhsa.gov/product/

Promoting-Emotional-Health-andPreventing-Suicide/SMA10-4515.
20 | PROMOTING EMOTIONAL HEALTH AND PREVENTING SUICIDE

■ Encourage or provide training on managing suicide risk for appropriate professional staff and volunteers.

Consider setting up a time to view online webinars addressing suicide and other behavioral health issues 

among older adults. See links to available webinars in Tool 9: Resources List.

Other resources

The National Suicide Prevention Lifeline (1-800-273-TALK/8255) is a 24-hour, toll-free, confidential suicide 

prevention hotline that provides crisis counseling and mental health referrals to anyone in suicidal crisis or 

emotional distress. Visit http://www.suicidepreventionlifeline.org. 

The Friendship Line (1-800-971-0016) is the nation’s only 24-hour toll-free hotline specifically for older and 

disabled adults. Trained staff and volunteers make and receive calls to and from individuals who are either in crisis 

or just in need of a friend. Visit http://www.ioaging.org/services-for-elders-and-caregivers/friendship-line.

Promoting Emotional Health and Preventing Suicide: A Toolkit for Senior Living Communities includes a trainer’s 

manual that senior centers have adapted to provide training to senior center staff, volunteers, and participants. Available 

at http://store.samhsa.gov/product/Promoting-Emotional-Health-and-Preventing-Suicide/SMA10-4515.

Question, Persuade, Refer (QPR) Gatekeeper Training for Suicide Prevention is a one- to two-hour training, delivered 

by QPR-certified instructors or online, for staff, volunteers, and others who interact with older adults. It covers the 

warning signs of suicide and what to do, as well as what not to do. Although not specifically designed for older adults, 

QPR has been used successfully with staff in nursing homes. For more about this training, including associated costs, visit 

http://qprinstitute.com. 

safeTALK is a half-day training, delivered by registered LivingWorks trainers who are assisted by a community resource 

person who can recommend local resources. It can be used to train senior center staff, volunteers, and others who 

interact with older adults, although it is not designed specifically for this audience. safeTALK helps participants identify 

people who are at risk for suicide and connect them with intervention resources. For more about this training, including 

associated costs, visit https://www.livingworks.net/programs/safetalk.
A Toolkit for Senior Centers | 21

Recognize and Respond to Depression

Depression is a serious mental health problem that affects many older adults. Although depression is more 

common among women than among men, it is also a serious concern for men. Depression is not a normal part 

of aging—it is a mental health problem that can significantly diminish one’s quality of life. Effective treatment, 

including medication and counseling, is available.

Senior centers can play an important role in increasing awareness of depression among staff, volunteers, and others 

who provide services to older adults, as well as to older adults themselves. All of these individuals can help identify 

others who may be experiencing problems and can encourage help-seeking.

What you can do

Increase awareness of the symptoms of depression. Key symptoms include (APA, 2013): 

■ Depressed mood (e.g., feeling sad, empty) most of the time‡

■ Loss of interest or pleasure in activities

■ Weight loss or gain (changes in appetite)

■ Disturbed sleep (sleeping too much or too little)

■ Noticeable restlessness (agitation) or slow movement

■ Fatigue or lack of energy

■ Feelings of worthlessness or extreme guilt

■ Difficulties with concentration or decision making

■ Frequent thoughts of death or suicide, or a suicide attempt

Share this information with your staff and volunteers, but also let them know that these symptoms are similar to 

those of other medical conditions and may also vary among different groups (e.g., by age, sex, race/ethnicity). Only 

a mental health care provider can make a full evaluation and diagnosis.

‡

 Among older adults, a depressed mood is not always a symptom of depression as it usually is among younger adults. Therefore, it is important to look out for 

the other listed symptoms.
22 | PROMOTING EMOTIONAL HEALTH AND PREVENTING SUICIDE

Identify community partners who can conduct educational sessions at 

your senior center to educate staff, volunteers, and older adults about 

depression. These sessions can provide information on risk factors, the 

signs and symptoms of depression, self-help techniques, treatment, 

sources of professional help, and ways to take care of oneself to support 

one’s emotional health and well-being. See the sidebar for an example of 

this type of partnership.

Tools you can use

■ Share copies of Tool 6: Recognizing and Responding to Depression

with your staff and volunteers.

Other resources

See Get Connected! Linking Older Adults with Medication, Alcohol, 

and Mental Health Resources for information, tools, and resources 

addressing depression, anxiety, and other mental health problems 

affecting older adults. Available at http://store.samhsa.gov/product/

Linking-Older-Adults-With-Medication-Alcohol-and-Mental-HealthResources/SMA03-3824.

Issue Brief 6: Depression and Anxiety: Screening and Intervention

discusses how to help older adults who have mental health issues. 

Available at http://www.aoa.acl.gov/AoA_Programs/HPW/Behavioral/

index.aspx.

Recognize and Respond to Medication and Alcohol 

Misuse

The misuse of alcohol and/or medications may increase the risk for 

many health problems among older adults. As people get older, their 

metabolism slows, so the effects of alcohol are greater. Alcohol use may 

speed up normal declines in functioning due to aging; increase the risk 

of falls, injuries, and disability; and trigger or complicate many medical 

and mental conditions (SAMHSA, 2013a). Alcohol may also displace 

important nutrients in older people’s diets, interfere with the intended 

effects of medications, and interrupt sleep at night. 

Many older adults have chronic health conditions that require them to 

take several medications per day. Misusing medications, or combining 

alcohol with certain medications, can lead to serious side effects and 

medication interactions.

What you can do

Increase awareness of the recommended drinking limit for older 

adults. The National Institute on Alcohol Abuse and Alcoholism 

recommends that adults age 65 or older who are healthy and take no 

medications should drink no more than three alcoholic drinks on a given 

day, not to exceed seven drinks per week (NIAAA, n.d.). Women are 

advised to drink less than this because their bodies react differently to 

alcohol than men’s bodies do. People with certain health conditions may 

need to drink less or not at all. 

Screening Older Adults 

for Depression and 

Connecting Them to 

Sources of Care 

The Mental Health Association of 

New York City (MHA-NYC, http://

www.mhaofnyc.org) conducts 

workshops at local senior centers 

that educate older adults about 

depression. At least two educators 

lead each emotional wellness 

workshop, which comprises an 

interactive discussion addressing 

emotional well-being, symptoms 

of depression, risk factors, and 

treatment. 

At the start of each session, 

workshop leaders distribute 

information packets, including a 

depression knowledge survey and a 

screening tool (the PHQ-9). Before 

and after the discussion, leaders 

walk around the room, reviewing 

answers and encouraging helpseeking in a nonthreatening way. 

Lisa Furst, MHA-NYC Director of 

Education for the Geriatric Mental 

Health Alliance of New York, gives 

an example of what she might 

say: “Mary, you took the time to 

fill this out. I’d love to talk to you 

about it. This number suggests that 

depression could be getting in the 

way of your emotional wellness. 

I can’t tell you based only on this 

piece of paper what is making you 

feel this way. But it would beneficial 

for you to talk to someone to know 

for sure if it is depression that is 

causing you to feel this way.” 

Workshop leaders encourage 

participants who may be showing 

signs of depression to talk with 

a health care provider. They also 

connect them to LIFENET, New 

York City’s free and confidential 

mental health hotline service, 

which offers counselors and 

referrals. 
A Toolkit for Senior Centers | 23

Invite a behavioral health professional to make a presentation about alcohol and/or medication misuse for 

your staff nd volunteers. The presenter might discuss myths and facts about substance misuse among older 

adults, signs and symptoms of misuse, treatment, and sources of help in the community.

Invite a pharmacist to conduct a session on appropriate and inappropriate use of medications. He or she can 

explain how medications should be taken, possible side effects, and interactions with alcohol, other medications, 

and supplements. The pharmacist can also review medications, answer questions, and provide tools, such as 

medication tracking charts.

Tools you can use

■ Distribute copies of Tool 7: Recognizing and Responding to Medication and Alcohol Misuse to your staff

and volunteers.

Other resources 

Get Connected! Linking Older Adults with Medication, Alcohol, and Mental Health Resources offers 

information, tools, and resources addressing medication and alcohol misuse among older adults. Available at 

http://store.samhsa.gov/product/Linking-Older-Adults-With-Medication-Alcohol-and-Mental-Health-Resources/

SMA03-3824.

The following Issue Briefs provide information and resources on substance use problems and older adults: 

■ Issue Brief 2: Alcohol Misuse and Abuse Prevention

■ Issue Brief 3: Screening and Preventive Brief Interventions for Alcohol and Psychoactive Medication Misuse/

Abuse

■ Issue Brief 5: Prescription Medication Misuse and Abuse Among Older Adults

Available at http://www.aoa.acl.gov/AoA_Programs/HPW/Behavioral/index.aspx.

Increase Access to Care

Although proven interventions for mental health and substance use 

problems are available, many older adults with these behavioral health 

issues do not receive the treatment they need (Karlin, Duffy, & Gleaves, 

2008). Studies show that most adults who die by suicide saw a primary care 

provider within one year before their death, but only a small minority had 

contact with mental health services (Luoma, Martin, & Pearson, 2002). 

Many people of all ages may not feel comfortable seeking treatment for 

behavioral health problems. But help-seeking can be particularly difficult 

for older adults, who grew up at a time when attitudes about mental 

illness were very negative. Some may not realize that the symptoms they 

are experiencing could be caused by a mental illness (Karlin, et al., 2008). 

Others may recognize that they need mental health care but may not 

know where to go for treatment. Transportation can also be a barrier, 

particularly for older adults who live in rural areas. In addition, feelings of 

hopelessness and helplessness linked to suicidal thoughts and depression 

may prevent help-seeking.

Culture and Help-Seeking

Cultural issues can affect helpseeking among older adults. Studies 

suggest that Chinese older adults, 

for example, may not want to admit 

to having thoughts of suicide for 

fear of disrupting family honor 

or “losing face” (Dong, Chen, 

Wong, & Simon, 2014). In another 

recent study, Korean older adults 

living in California reported not 

feeling comfortable seeking help 

for suicidal ideation from mental 

health care providers (Kim & Ahn, 

2014). Poor English language skills 

are also a barrier to accessing care.
24 | PROMOTING EMOTIONAL HEALTH AND PREVENTING SUICIDE

What you can do

Encourage older adults to seek care for behavioral health problems by using words that are neutral and 

nonthreatening. Keep in mind that some older adults may not react well to words such as counseling, mental 

illness, or alcoholic. Focus instead on health and wellness and improving quality of life. Use language such as 

“removing things that may be standing in the way of your physical and mental well-being,” or “talking with 

someone who can help.” Connect them with sources of help in your community.

Suggest that older adults talk with their doctors about issues related to mental health and/or use of alcohol 

or medications. Some older adults may be more comfortable talking with their primary care provider about such 

issues than going to a mental health provider. If an older adult chooses to seek help from a primary care provider, 

suggest that he or she write down the reason for the visit and any symptoms he or she may be experiencing and to 

present this information to the provider during the visit. 

Invite a local behavioral health care professional to come to your senior center to encourage help-seeking and 

describe available services. Having an outside professional lead a group session may help participants feel more 

comfortable talking about these issues. Ask the presenter to describe how useful it can be to talk with a specialist 

about life issues that make people, particularly older adults, feel sad, depressed, or anxious. He or she should also 

explain that clinicians are bound by rules of confidentiality that they may break only in cases when the client or 

someone else is in danger. 

Facilitate access to screening and 

treatment. Consider different ways 

of partnering with local providers to 

connect older adults with behavioral 

health services. Models that are being 

used by senior centers in different parts 

of the country include the following:

■ A behavioral health specialist

provides screening services at the 

senior center and refers older adults 

to counseling services if needed. 

These services may be offered at 

home or at the provider’s facility.

■ A local mental health agency

sends a trained counselor to the 

senior center. The center provides 

a space where the counselor offers 

drop-in office hours or scheduled 

appointments on a regular basis 

(e.g., one day per week).

■ A behavioral health professional

offers group counseling sessions at 

the senior center. 

Increasing Access to Care: Ideas from Michigan and 

Pennsylvania

Oakland Family Services (http://www.oaklandfamilyservices.org/

programs/oacs/oacs.html), a behavioral health provider in Michigan, 

describes a partnership with local senior centers that was successful in 

increasing access to behavioral health care. Through a SAMHSA grant, 

the partners worked together to train Meals on Wheels drivers serving 

13 communities to look for signs of depression in older adults—simple 

things, such as not having changed clothes from one day to the next or 

not recognizing the driver. When a driver identified someone who might 

need help, the senior center outreach supervisor followed up by calling 

the person and asking, “How are you feeling today? We are offering a new 

program. We can send someone to talk with you about any concerns you 

may have, at no cost. Would you like us to send someone to talk with 

you?” The behavioral health provider then called the person to set up an 

appointment, and sent a therapist to the person’s home. The number of 

contacts increased from 72 in the first year to 200 the following year and 

400 in the third year. 

Another idea for increasing access to care comes from Get Busy Get 

Better: Helping Older Adults Beat the Blues, a program that was found 

to be effective in reducing depressive symptoms and improving quality 

of life among African Americans ages 55 years and older in Philadelphia 

(Gitlin et al., 2013). Conducted jointly by a senior center and a university 

research center, the tailored program randomly assigned participants to a 

home-based intervention or a wait-listed group. As part of the program, 

the research center trained care managers at the senior center and other 

agencies on how to screen for depression using a standardized tool. The 

training helped care managers effectively integrate depression assessment 

into the services they were providing to older adults in the community. 

As this program demonstrates, providing mental health training to care 

managers can be a great way to increase access to behavioral health care.
A Toolkit for Senior Centers | 25

Tools you can use

■ Use Tool 3: Connecting to Behavioral Health Resources in the Community to adapt the information you

have gathered about community resources, and then share it with participants and their families. Ensuring that

all participants know where they can go for help can decrease one key barrier to help-seeking.

Other resources

Issue Brief 11: Reaching Diverse Older Adult Populations and Engaging Them in Prevention Services and 

Early Interventions, from SAMHSA and the Administration on Aging, provides information and resources on 

how to reach and engage adults from different cultural backgrounds. Available at http://www.aoa.acl.gov/AoA_

Programs/HPW/Behavioral/index.aspx. 

The SAMHSA Resource Center to Promote Acceptance, Dignity, and Social Inclusion Associated with Mental 

Health offers information, resources, and programs for providing a caring, welcoming, and supportive community 

that will help promote recovery and wellness for people with mental health problems and substance use disorders 

and for those who have experienced trauma. To learn more, visit http://www.promoteacceptance.samhsa.gov/

audience/adults/default.aspx. 
26 | PROMOTING EMOTIONAL HEALTH AND PREVENTING SUICIDE

Strategy 3: Respond to a Suicide 

Attempt or Death

Senior center staff and volunteers can play an important role in helping 

participants cope with a suicide attempt or death. These events can have a 

profound emotional impact on survivors—family members, friends, and 

others who knew the person involved. 

People who are affected by a suicide attempt or death may experience 

feelings of grief, guilt, anger, shame, and embarrassment. In addition, 

exposure to a suicide death can also increase suicide risk among 

vulnerable individuals. Responding to suicide deaths and attempts in an 

appropriate way can help alleviate the pain caused by these incidents, 

promote healing, and help prevent similar attempts by others.

What you can do

Develop one or more postvention protocols for responding 

appropriately to a suicide attempt or death. The term postvention refers 

to “response to and care for individuals affected in the aftermath of a 

suicide attempt or suicide death” (HHS Office of the Surgeon General 

and National Action Alliance for Suicide Prevention, 2012, p. 141). 

Developing postvention protocols and sharing them with your staff and 

volunteers will help your senior center to respond promptly to these 

traumatic events. 

A protocol for responding to a suicide death should indicate the 

following: 

■ The lead person for postvention support

■ How to identify participants and others who may be affected by the

event, including senior center staff and volunteers

■ If, when, and how to offer a community support meeting

■ How to provide individualized support to those who may need more

help

Provide training to senior center staff nd volunteers. The training 

should cover why the protocol was developed and how it should be used. 

It should also explain that exposure to a suicide attempt or death can 

increase suicide risk among people who are vulnerable. As part of the 

training, share copies of Fact Sheet 3: After a Suicide: What to Expect 

and How to Help, and note that this is a good resource to share with all 

who may be affected by a suicide death.

Contact an organization that provides postvention support to obtain 

its help in the event of a suicide death or attempt. Behavioral health 

providers and suicide prevention organizations are good starting places.
A Toolkit for Senior Centers | 27

Tools you can use

■ Tool 8: Community Support Meeting provides a facilitator guide for holding a community support meeting

after a crisis.

■ Share Fact Sheet 3: After a Suicide: What to Expect and How to Help with older adults at your senior center.

Other resources

The Suicide Prevention Resource Center Survivor Resource Sheet lists a number of organizations, websites, and 

materials that can help people who have lost someone to suicide. Available at http://www.sprc.org/sites/sprc.org/

files/Survivors.pdf. 
28 | PROMOTING EMOTIONAL HEALTH AND PREVENTING SUICIDE

References

American Psychiatric Association (APA). (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). 

Washington, DC: Author.

Centers for Disease Control and Prevention (CDC). (2006). Strategic direction for the prevention of suicidal behavior: 

Promoting individual, family, and community connectedness to prevent suicidal behavior. Retrieved from http://www.cdc.

gov/ViolencePrevention/pdf/Suicide_Strategic_Direction_Full_Version-a.pdf

Centers for Disease Control and Prevention (CDC). (2013). Fatal injury reports, national and regional, 1999-2013. Web-based 

Injury Statistics Query and Reporting System (WISQARS). Retrieved from http://webappa.cdc.gov/sasweb/ncipc/mortrate10_

us.html

Conwell, Y. (1997). Management of suicidal behavior in the elderly. The Psychiatric Clinics of North America, 20(3), 667–683.

Conwell, Y., Van Orden, K., & Caine, E. D. (2011). Suicide in older adults. The Psychiatric Clinics of North America, 34(2), 

451–468.

Dong, X., Chen, R., Wong, E., & Simon, M. A. (2014). Suicidal ideation in an older U.S. Chinese population. Journal of Aging 

and Health, 26(7), 1189–1208.

Fassberg, M. M., van Orden, K. A., Duberstein, P., Erlangsen, A., Lapierre, S., Bodner, E., . . . Waern, M. (2012). A systematic 

review of social factors and suicidal behavior in older adulthood. International Journal of Environmental Research and Public 

Health, 9(3), 722–745.

Gitlin, L. N., Harris, L. F., McCoy, M. C., Chernett, N. L., Pizzi, L. T., Jutkowitz, E., . . . Hauck, W. W. (2013). A home-based 

intervention to reduce depressive symptoms and improve quality of life in older African Americans: A randomized trial. 

Annals of Internal Medicine, 159(4), 243–252.

HHS Office of the Surgeon General and National Action Alliance for Suicide Prevention. (2012). 2012 National Strategy for 

Suicide Prevention: Goals and objectives for action. Washington, DC: HHS.

Karlin, B., Duffy, M., & Gleaves, D. H. (2008). Patterns and predictors of mental health service use and mental illness among 

older and younger adults in the United States. Psychological Services, 5(3), 275–294.

Kim, B. J., & Ahn, J. (2014). Factors that influence suicidal ideation among elderly Korean immigrants: Focus on diatheses and 

stressors. Aging and Mental Health, 18(5), 619–627.

Luoma, J. B., Martin, C. E., & Pearson, J. L. (2002). Contact with mental health and primary care providers before suicide: A 

review of the evidence. The American Journal of Psychiatry, 159(6), 909–916.

National Council on Aging (NCOA). (2012). Senior centers: Fact sheet. Retrieved from http://www.ncoa.org/press-room/factsheets/senior-centers-fact-sheet.html

National Institute on Alcohol Abuse and Alcoholism (NIAAA). (n.d.). Older Adults. Retrieved from http://www.niaaa.nih.

gov/alcohol-health/special-populations-co-occurring-disorders/older-adults

Substance Abuse and Mental Health Services Administration (SAMHSA) (2013a). Get connected! Linking older adults with 

medication, alcohol, and mental health resources. Retrieved from http://store.samhsa.gov/product/Linking-Older-Adults-WithMedication-Alcohol-and-Mental-Health-Resources/SMA03-3824

Substance Abuse and Mental Health Services Administration (SAMHSA) (2013b). Internal analysis based on data from the 

National Survey on Drug Use and Health.

Substance Abuse and Mental Health Services Administration (SAMHSA). (2011). Leading change: A plan for SAMHSA’s roles 

and actions 2011-2014. Retrieved from http://store.samhsa.gov/product/Leading-Change-A-Plan-for-SAMHSA-s-Roles-andActions-2011-2014/SMA11-4629

Suicide Prevention Resource Center (SPRC). (2014). Warning signs of suicide. Retrieved from http://www.sprc.org/sites/sprc.

org/files/library/RS_warningsigns.pdf
A Toolkit for Senior Centers | 29

TOOLS AND FACT SHEETS

Tool 1: Suicide among Older Adults............................................................................... 30

Tool 2: Assessment Checklist........................................................................................... 33

Tool 3: Connecting to Behavioral Health Resources in the Community ....................... 34

Tool 4: Activities to Promote Health and Wellness ........................................................ 37

Tool 5: Strategies for Establishing Social Networks........................................................ 39

Tool 6: Recognizing and Responding to Depression....................................................... 40

Tool 7: Recognizing and Responding to Medication and Alcohol Misuse..................... 42

Tool 8: Community Support Meetings............................................................................ 44

Tool 9: Resources List ...................................................................................................... 46

Fact Sheet 1: Looking Out for the Well-Being of Yourself and Others........................... 50

Fact Sheet 2: Know the Warning Signs of Suicide.......................................................... 52

Fact Sheet 3: After a Suicide: What to Expect and How to Help................................... 54
30 | PROMOTING EMOTIONAL HEALTH AND PREVENTING SUICIDE

Tool 1: Suicide among Older Adults 

Key facts

Older adults are the fastest-growing segment of the U.S. population (Ortman, Velkoff, & Hogan, 2014). Babyboomers began to turn 65 in 2011. By 2030, the U.S. Census projects that more than 20 percent of the U.S. 

population—almost 73 million adults—will be 65 or older (Ortman et al., 2014).

Suicide is an important problem affecting older adults. In 2013, 7,215 people ages 65 or older (16.1 per 100,000) 

died by suicide in the United States, compared to 12.6 per 100,000 among all age groups (CDC, 2013).

Suicide rates are particularly high among older men. While suicidal 

thoughts and attempts are more common among older women than older 

men (SAMHSA, 2013), men’s attempts are more likely to be fatal. In 2013, 

the suicide rate among men ages 65 or older was 30.9 per 100,000—more 

than six times the rate among women of the same age (4.6 per 100,000) 

(CDC, 2013). The highest suicide rates in the country are among men ages 

85 or older. 

A key reason that men’s suicide attempts are more likely to be fatal is that 

men are more likely to use firearms. In 2013, the vast majority (5,113 of 

7,215, or 71 percent) of suicide deaths among older adults were linked to 

firearms—and men accounted for more than 91 percent (4,666 of 5,113) of 

such deaths (CDC, 2013). Other lethal means of suicide among older adults 

include poisoning and suffocation (e.g., hanging). 

Older adults are less likely than younger adults to report serious thoughts 

of suicide or a suicide attempt (SAMHSA, 2013). And yet, suicide attempts 

are much more likely to result in death among all older adults than among 

those who are younger. Reasons that a suicide attempt may be more likely 

to be fatal in this population include the following (Conwell, 1997; Fassberg 

et al., 2012):

■ Older adults plan carefully and use more deadly methods—particularly

firearms. 

■ Suicide attempts by younger people are more impulsive, and they are less likely to use firearms.

■ Older adults are more likely to live alone than other age groups and are less likely to be discovered and rescued

than younger people.

■ Many older adults are physically frail. They are less likely to recover from a suicide attempt than younger

people.

Key Terms

Suicide. Death caused by selfdirected injurious behavior with 

any intent to die as a result of the 

behavior 

Suicide attempt. A nonfatal, 

self-directed, potentially injurious 

behavior with any intent to die as a 

result of the behavior

Suicidal ideation. Thoughts 

of engaging in suicide-related 

behavior 

(Adapted from HHS Office of the 

Surgeon General and National 

Action Alliance for Suicide 

Prevention [NAASP], 2012.) 
Risk and protective factors for suicide among older adults

In most cases, suicide results from a combination of factors rather than a single cause. Studies suggest that the

following factors may be particularly important among older adults (Conwell, Van Orden, & Caine, 2011).

Risk Factors Protective Factors

Risk factors are “characteristics that make it more likely

that a person will think about suicide or engage in suicidal

behaviors” (HHS Office of Surgeon General & NAASP,

2012, p. 13). Some factors may be long lasting—such as a

chronic health condition—while others may be short-lived

(e.g., a stressful event or a brief illness). Risk factors in

older adults include the following:

Mental and/or substance use disorders

• Major depression and othermood disorders

• Substance use problems, particularly involving alcohol

and medications

Physical illness, disability, and pain

• Medical conditions that are painful and/or affect one’s

function and autonomy

• Having several health problems at the same time

Social factors

• Socialisolation

• Important losses (e.g., of a loved one, job due to

retirement, driver’s license)

• Relationship problems or conflicts

• The feeling that one is a burden to others

Individual factors

• Being timid or hostile

• Finding it difficult to adjust to change

• Having serious financial problems

Other risk factors

• A previous suicide attempt and/or having a family

member who died by suicide

• Accessto lethal means, such as firearms

Protective factors are characteristics

of individuals and the environment

that “strengthen, support, and protect

individuals from suicide” (HHS Office of

Surgeon General & NAASP, 2012, p. 13).

Protective factors in older adults include

the following:

Behavioral health and health care

• Assessment and care for mental and

substance use disorders

• Care for medical conditions and

physical health problems

Social connectedness

• Connections to others at the personal,

family, and community levels

• Friends and family members in whom

to confide

• Participation in community activities

• Relationships that create positive

interactions and feelings of being cared

about

Personal characteristics and skills

• Sense of purpose or meaning

• Self-esteem

• Social skills

• Flexibility

• Skills in coping and adapting to change

• Cultural or religious beliefs that

discourage suicide and support selfpreservation

A Toolkit for Senior Centers | 31
32 | PROMOTING EMOTIONAL HEALTH AND PREVENTING SUICIDE

What you can do

Working with partners to recognize and reduce risk factors and increase protective factors for suicide is at the 

heart of this toolkit’s approach to suicide prevention. 

If someone you know may be experiencing risk factors for suicide:

■ Talk with the person in a caring, nonjudgmental way

■ Encourage the person to attend wellness sessions or classes offered by your senior center

■ Connect the person to supportive services available from the senior center (e.g., Meals on Wheels programs,

assistance with financial planning)

■ Connect the person to sources of counseling or other forms of help

References

Centers for Disease Control and Prevention (CDC). (2013). Fatal injury reports, national and regional, 1999–2013. Web-based 

Injury Statistics Query and Reporting System (WISQARS). Retrieved from http://webappa.cdc.gov/sasweb/ncipc/mortrate10_

us.html

Conwell, Y. (1997). Management of suicidal behavior in the elderly. The Psychiatric Clinics of North America, 20(3), 667–683.

Conwell, Y., Van Orden, K., & Caine, E. D. (2011). Suicide in older adults. The Psychiatric Clinics of North America, 34(2), 

451–468.

Fassberg, M. M., van Orden, K. A., Duberstein, P., Erlangsen, A., Lapierre, S., Bodner, E., . . . Waern, M. (2012). A systematic 

review of social factors and suicidal behavior in older adulthood. International Journal of Environmental Research and Public 

Health, 9(3), 722–745.

HHS Office of the Surgeon General and National Action Alliance for Suicide Prevention (NAASP). (2012). 2012 National 

Strategy for Suicide Prevention: Goals and objectives for action. Washington, DC: HHS.

Ortman, J. M., Velkoff, V. A., & Hogan, H. (2014). An aging nation: The older population in the United States. Retrieved from 

http://www.census.gov/prod/2014pubs/p25-1140.pdf

Substance Abuse and Mental Health Services Administration (SAMHSA). (2013). Internal analysis based on data from the 

2013 National Survey on Drug Use and Health. 
Tool 2: Assessment Checklist

Promoting EmotionalHealth and Preventing Suicide among OlderAdults

Questions Review This Section of the Toolkit

For each question,

current situation.

circle the answer that best matches your If you answered “No” or “Don’t Know,” 

consider taking the steps and using the tools

and resources in the toolkit section listed

below.

Getting Started

Do your staff members

know what factors may

of suicide among older

and volunteers

increase the risk

adults?

Yes No Don’t

Know

Getting Started section

Do you have a list of the behavioral

contacts in your community?

health Yes No Don’t

Know

Getting Started section

Promote Emotional Health

Do you offer a variety of activities that

promote intellectual, creative, spiritual,

and physicalwell-being?

Yes No Don’t

Know

Strategy 1: Provide Activities and

That Increase Protective Factors

Programs

Do you offer programs designed to

promote social networks and community

building?

Yes No Don’t

Know

Strategy 1: Support

Connections

the Development of Social

Recognize and Respond to Suicide Risk

Have your staff and volunteers been

trained on how to recognize the warning

signs ofsuicide?

Yes No Don’t

Know

Strategy

Suicide

2: Recognize the WarningSigns of

Do your staff and volunteers know

identify symptoms of depression?

how to Yes No Don’t

Know

Strategy 2: Recognize

Depression

and Respond to

Do your staff and volunteers know how

to identify problems with alcohol and/or

medications?

Yes No Don’t

Know

Strategy 2: Recognize and Respond

Medication and Alcohol Misuse

to

Do you provide older adults with

information and resources on depression,

substance abuse, and suicide?

Yes No Don’t

Know

Strategy 2: Increase Accessto Care

Respond to a Suicide Attempt or Death

Do you have a plan and

individuals bereaved by

resources to help

a suicide death?

Yes No Don’t

Know

Strategy

Death

3: Respond to a Suicide Attempt or

A Toolkit for Senior Centers | 33
34 | PROMOTING EMOTIONAL HEALTH AND PREVENTING SUICIDE

Tool 3: Connecting to Behavioral Health Resources in 

the Community

You can develop a list of contacts in behavioral health organizations and programs in your local area where you can 

refer participants for treatment and from whom you can obtain services and educational programs for your senior 

center. Consider the following steps:

1. Contact some or all of the following types of organizations and programs:

■ Mental health centers, including evaluation and crisis intervention teams

■ Hospitals, including emergency departments and psychiatric units

■ Psychiatric hospitals

■ Individual mental health providers, including psychiatrists, psychologists, and social workers

■ Pastoral counseling resources

■ Substance misuse treatment programs

■ Telephone hotlines for suicide, depression, and substance misuse

■ Support groups for different types of mental health, health, and substance misuse problems and for dealing

with losses, such as of a spouse

The following national organizations and tools can provide you with local contacts:

SAMHSA Behavioral Health Treatment Services Locator 

http://findtreatment.samhsa.gov/

National Suicide Prevention Lifeline—Crisis Center Locator 

http://www.suicidepreventionlifeline.org/GetInvolved/Locator

American Psychological Association—Psychologist Locator 

http://locator.apa.org

National Association of Social Workers 

http://www.helppro.com/nasw/BasicSearch.aspx

National Alliance on Mental Illness—State Organizations and Local Affiliates 

http://www.nami.org/Find-Your-Local-NAMI

American Foundation for Suicide Prevention—Local Chapters 

http://www.afsp.org/local-chapters/find-your-local-chapter

As you connect with each organization or program, fill in a copy of the following form: Information Form 

for Behavioral Health Resources.

2. Fill in a copy of the Behavioral Health Resources Chart so that all of your contacts are in one place.

3. Make the chart available to all of your center staff.
A Toolkit for Senior Centers | 35

Information Form for Behavioral Health Resources

Name of Organization/Program:_________________________________________________________________

Contact Person:_______________________________ Phone Number:________________________________

E-Mail:_____________________________________________________________________________________

1. Do you currently provide services for older adults (ages 65+) with:

Mental health issues ____ Yes ____ No

Substance use problems ____ Yes ____ No

2. Are you able to take new clients that we would refer to you? ____ Yes ____ No

3. Do you accept health insurance? ____ Yes ____ No

If yes, check all that apply: ____Medicare ____ Medicaid ____ Private insurance ____ Other

4. What counseling and/or treatment programs do you provide?

5. What support groups do you provide?

6. Would you be available for consultation with our senior center staff about behavioral health issues?

7. What services could you provide at our senior center, for example:

____ Screening

____ Counseling

____ Support groups

____ Speakers/trainings/classes for: ____ Staff ____ Participants

____ Other (please describe):
Behavioral Health Resources Chart

In the first column,list the contact informationfor each organizationor program.Thenplace an “X” in the box for eachservice thattheorganizationor

program provides.

Name of

Organization

or Program

Contact Person

Phone Number

E-Mail Address

Mental

Health

Treatment

Substance

Misuse

Treatment

Support

Groups

Consultation Training for

Staff

Education

Programs

for Older

Adults

and Their

Families

N/A N/A N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A N/A N/A

36 | PROMOTING EMOTIONAL HEALTH AND PREVENTING SUICIDE
A Toolkit for Senior Centers | 37

Tool 4: Activities to Promote Health 

and Wellness

Social activities

Social activities fill many functions, including providing pleasure, helping 

older adults prevent and cope with loneliness, enhancing emotional 

support, and fostering relationships. Some examples are group trips 

to social, sporting, and cultural events; parties to celebrate holidays, 

birthdays, and other special occasions; and a hospitality room where 

coffee is served every morning or tea every afternoon. Many of the 

following ideas also involve social contact.

Health and wellness activities and programs

Group exercise classes and interactive games increase physical activity, 

balance, circulation, and flexibility. Walking and gardening provide 

physical activity and opportunities to get outdoors. Classes in relaxation, 

breathing techniques, yoga, Qigong, or Tai Chi may help with stress 

reduction and overall wellness. Group games, such as health education 

bingo, and presentations that include a discussion component are 

interactive ways to convey health information. 

Arts activities, such as creative writing, poetry readings, arts and 

crafts, photography, music, drama, and dance, can promote creativity, 

imagination, and self-expression.

Classes on health-related topics, such as nutrition, preventing falls, 

or managing chronic diseases (e.g., heart disease, diabetes), can help 

residents take better care of their own health. 

Classes or groups on coping skills can help residents better deal with 

personal issues, such as loss and bereavement, aging, living with specific 

health conditions, sexuality, caring for a spouse or partner, stress, 

interpersonal communication, problem solving, financial issues, and 

organizing paperwork.

Spiritual and religious activities, such as religious services, celebration 

of religious holidays, prayer groups, meditation classes, and taking 

personal time for contemplation, may help participants find meaning, 

purpose, and value in life.

Positive life review. Also called reminiscence, this activity involves going 

back through one’s life and putting together scrapbooks, journaling, and/

or writing life stories. It can be very helpful in the process of putting one’s 

life in perspective and finding meaning, and it is also a form of creative 

expression. It can be done in groups, alone, or with another person as a 

guide, such as a student, a professional, or a friend.
38 | PROMOTING EMOTIONAL HEALTH AND PREVENTING SUICIDE

Educational and skill-building activities

Classes that build knowledge and skills in such topics as computers, carpentry, cooking, sewing, gardening, 

financial management, and grandparenting may increase a sense of competence and self-esteem.

Intellectual activities, such as book groups, current events discussions, presentations, seminars, workshops, 

learning a new language, and interactive gaming may stimulate cognitive functioning and enhance self-esteem.

Mastery activities, such as crossword puzzles, word and number games, jigsaw puzzles, woodworking, writing 

poetry or stories, and painting, are pleasurable for many older adults, provide a sense of accomplishment, and are 

important for maintaining a positive mood.

Volunteering and mentoring

Helping others may provide older adults with a sense of purpose or meaning. For example:

■ Participants can identify ways to welcome new members and engage other participants in contributing their

own skills, either within the senior center or in other settings.

■ Within the senior center, participants can help organize and run events; develop and manage a newsletter; help

other participants with household tasks, shopping, getting to appointments, and taking walks outside; or plant 

and maintain a community garden. Participants can also organize and run fundraisers or volunteer their time 

to the center as grant writers. 

■ Participants can teach or tutor children, teens, young adults, and other older adults, as well as tutor senior

center staff and volunteers who are learning English as a second language.

■ Outside the senior center, participants can volunteer for community organizations, such as ethnic and

religious groups and the Service Corps of Retired Executives. Other volunteering opportunities may be 

available from Senior Corps Programs sponsored by the Corporation for National and Community Service, 

such as RSVP, a volunteer network for adults ages 55 and older (http://www.nationalservice.gov/programs/

senior-corps/rsvp). 

■ Intergenerational activities can be effective in bringing young energy to older adults and enabling them to

contribute to young people’s lives. These activities can range from caring for preschool children to tutoring 

or mentoring school-age children. For ideas, visit the website of Generations United (http://www.gu.org), 

a national membership organization that advocates for the mutual well-being of children, youth, and older 

adults, and builds bridges between generations.

Behavioral health

■ Invite a behavioral health provider to encourage help-seeking and describe available services. Ask the

provider to describe how useful it can be to talk with a mental health professional about life issues that make 

people feel sad, depressed, or anxious. The provider should also explain that clinicians are bound by rules of 

confidentiality that they may break only in cases when the client or someone else is in danger. 
A Toolkit for Senior Centers | 39

Tool 5: Strategies for Establishing Social Networks

Welcoming new participants

■ Hold events specifically to welcome new visitors to the senior center, where they can meet other participants

and senior center staff and volunteers.

■ Provide information to new participants on all the types of social connection and support available at the

senior center.

■ Coordinate buddy systems that match the new participant with someone who has been using the center for a

longer time, or designate greeters who are available to welcome anyone new who comes to the center.

Maintaining connections

■ Implement a telephone outreach program, in which participants make calls to other participants to check

how they are doing and offer support. Predetermined times can be set for the calls. If an individual does not 

respond to daily calls made at set times, the caller alerts a designated emergency contact.

■ Provide opportunities for participants to volunteer to do things to help others, such as taking a new member

to dinner, providing support if a spouse dies, or making hospital visits.

■ Provide training on the warning signs of suicide and listening skills.

■ Encourage involvement in decision making that affects the senior center and helps build social networks for

both individuals and the community as a whole. You can involve participants in the senior center’s decisionmaking processes by asking them to participate in or contribute to the center’s advisory, governing, or 

planning bodies. 

■ Offer small-group activities, such as knitting and quilting, that allow participants to share information and

develop relationships.

■ Encourage connections among older men who may come to the center for lunch by adding post-lunch

activities, such as playing pool, cards, or Ping-Pong. Consider adding a “Fix-It” room, where community 

members can bring in items that need to be fixed, and senior center participants work together on the repairs. 

Offer educational sessions on topics related to men’s health.
40 | PROMOTING EMOTIONAL HEALTH AND PREVENTING SUICIDE

Tool 6: Recognizing and Responding to Depression

Many people mistakenly think that symptoms of mental illness, such as sadness, depression, and anxiety, are a 

natural part of the aging process or a grief response to the loss of a spouse or other stressful live event. Depression 

is a serious but treatable illness that needs immediate attention.

Key symptoms of depression include the following (APA, 2013):

■ Depressed mood (e.g., feeling sad, empty) most of the time§

■ Loss of interest or pleasure in activities

■ Weight loss or gain (changes in appetite)

■ Disturbed sleep (sleeping too much or too little)

■ Noticeable restlessness (agitation) or slow movement

■ Fatigue or lack of energy

■ Feelings of worthlessness or extreme guilt

■ Difficulties with concentration or decision making

■ Frequent thoughts of death or suicide, or a suicide attempt

Identifying late-life depression can be challenging. Many older 

adults may have symptoms that do not meet the full criteria 

for depression, but they may still be experiencing significant 

problems. In addition, symptoms of depression can be similar 

to those of other medical conditions, making depression more 

difficult to diagnose. 

Older adults who have depression may be more likely than 

younger adults to report physical symptoms (e.g., nervousness, 

loss of appetite) than psychological ones (SAMHSA, 2013). 

Symptoms may also vary among different groups of older adults. A recent review found that among older 

Hispanics, symptoms of depression included “weakness, multiple aches and pains, dizziness, palpitations, and sleep 

disturbances” (Sadule-Rios, 2012, p. 466).

Assessment, diagnosis, and treatment

A number of screening tools can be used to screen older adults for depression. The tools will not give a definite 

diagnosis, but they can indicate that a problem may exist. 

Depression screening is one of the free preventive services that an older adult’s primary care provider may offer. All 

health plans that comply with the Patient Protection and Affordable Care Act (ACA), including Medicare Part B, 

cover this screening when delivered by a primary care provider from the health plan’s network. Doctors who offer 

depression screening must be prepared to facilitate referrals to mental health treatment if needed. 

Individuals who screen positive for depression should receive a full diagnostic evaluation from a mental health 

care provider. Treatment of depression often combines psychotherapy (talk therapy) and medication. However, 

many older adults fail to seek treatment because of the fear of being labeled as having a mental illness. They may 

feel embarrassed or reluctant to seek help.

Men and Women May Show 

Different Symptoms

Women with depression are more likely to 

have feelings of sadness, worthlessness, and 

excessive guilt.

Men with depression are more likely to:

• Be very tired

• Be irritable

• Lose interest in once-pleasurable activities

• Have difficulty sleeping

Men may be more likely than women to turn 

to alcohol or drugs when they are depressed. 

They also may become frustrated, discouraged, 

angry, and sometimes abusive. Some men may 

behave recklessly. 

(Adapted from National Institute of Mental 

Health [n.d.].)

§ Among older adults, a depressed mood is not always a symptom of depression as it usually is among younger adults. Therefore, it is important to look out 

for the other listed symptoms.
A Toolkit for Senior Centers | 41

What you can do

Promote acceptance of mental health issues by sharing the following messages (SAMHSA, 2013):

■ You are not alone. Depression, anxiety, and other mental health issues are more common than you think.

■ These feelings are not your fault. Mental health issues are real health concerns.

■ You may feel better if you talk to someone who can help. Treatment does work.

■ The earlier you see a doctor or other health professional and get help, the better you will feel.

If you think that someone you know may be showing signs of depression, talk with a nurse, doctor, social worker, 

mental health professional, or member of the clergy. Your goal is to find someone who can speak to the person and 

help him or her find out if there is a problem and how to get help.

If you think that you or someone else may have depression:

In this facility, contact: ________________________________________________________________________

Or contact:__________________________________________________________________________________

In the local community, contact:_________________________________________________________________

References

American Psychiatric Association (APA). (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). 

Washington, DC: Author.

National Institute of Mental Health. (n.d.). What is depression? Retrieved from http://www.nimh.nih.gov/health/topics/

depression/index.shtml

Sadule-Rios, N. (2012). A review of the literature about depression in late life among Hispanics in the United States. Issues in 

Mental Health Nursing, 33(7), 458–468.

Substance Abuse and Mental Health Services Administration (SAMHSA). (2013). Get connected! Linking older adults with 

medication, alcohol, and mental health resources. Retrieved from http://store.samhsa.gov/product/Linking-Older-Adults-WithMedication-Alcohol-and-Mental-Health-Resources/SMA03-3824
42 | PROMOTING EMOTIONAL HEALTH AND PREVENTING SUICIDE

Tool 7: Recognizing and Responding to Medication and 

Alcohol Misuse

Recognizing medication and alcohol misuse among older adults can be difficult. Sometimes it may be hard to tell 

if a problem exists. People may mistake alcohol and drug problems for a bad mood, dementia, or delirium. But 

knowing what to look for can help.

Symptoms of alcohol or medication problems in older adults include the following:

■ Blackouts

■ Forgetfulness or trouble concentrating

■ Frequent falls and unexplained bruising

■ Shakes or tremors

■ Constant irritability and altered mood

■ Depression or anxiety

■ Poor hygiene and self-neglect

■ Sleep problems or daytime drowsiness

■ Slurred speech

■ Tremor, clumsiness, and trouble walking

Alcohol and medications can interact with each other to cause these symptoms. Also, drugs can interact with each 

other. Thus, it is crucial to make sure older adults take their medications properly.

Problems with alcohol

An alcohol problem is defined as drinking above the limits recommended by the National Institute on Alcohol 

Abuse and Alcoholism (NIAAA), using alcohol while taking prescription medications, and/or using alcohol in any 

other way that is harmful. 

How much alcohol is too much? Although everyone is different, NIAAA (n.d.) recommends that adults ages 65 

or older who are healthy and take no medications drink no more than three alcoholic drinks on a given day, not to 

exceed seven drinks per week. 

One drink is equal to one of the following:

■ One 12-ounce can or bottle of regular beer or ale

■ One 5-ounce glass of red or white wine

■ One 1.5-ounce shot glass of hard liquor (spirits), such as gin, vodka, or whiskey. The label on the bottle will

read 80 proof or less.

Women are advised to drink less than this because their bodies react differently to alcohol than men’s bodies 

do. Older adults should not drink alcohol if they (1) take prescription pain medications, sleeping pills, over-thecounter sleep aids, or medication for anxiety or depression; (2) have memory problems; and/or (3) have a history 

of falls or unsteady walking. 

It is crucial to address alcohol problems among older adults because these problems can be harmful and even fatal. 

However, these problems are often hard to recognize and address. Many older adults disapprove of and feel shame 

about alcohol misuse. Many do not want to seek professional help for what they consider a private matter. Relatives 

of older people with alcohol problems, particularly their adult children, may also be ashamed of the problem and 

choose not to address it.

A range of services are available for older adults who have alcohol problems or who are at risk. Types of treatment 

include individual counseling, group-based approaches, and approaches that combine medication with counseling.
A Toolkit for Senior Centers | 43

Problems with prescription and over-the-counter medications

Medications of concern among older adults include those used to treat anxiety, depression, insomnia, and 

other mood disorders. Older adults also use over-the-counter medications, such as pain relievers and herbal 

supplements. Taking multiple medications and herbal supplements can lead to serious side effects and drug 

interactions. 

Factors that can increase the risk of medication misuse include the following:

■ Multiple physicians prescribing multiple drugs

■ Inappropriate prescribing (e.g., prescribing the wrong medication or an inappropriate dose)

■ Instructions and package inserts written in small print or confusing language

■ Failure to tell the doctor about over-the-counter medications, vitamins, and herbal supplements

■ Memory problems that make it difficult to keep track of medication schedules

■ Problems taking medicine correctly because of alcohol use, depression, or self-neglect

■ Missing instructions as a result of hearing or vision problems, memory problems, language barriers, and so

forth

What you can do

If you think someone you know may be showing signs of medication or alcohol misuse, talk with a nurse, doctor, 

social worker, behavioral health professional, or member of the clergy. Your goal is to find someone who can speak 

to the person and help him or her find out if there is a problem and how to get help. 

If you or someone you know may have a problem with alcohol or medications:

In this facility, contact: ________________________________________________________________________

Or contact:__________________________________________________________________________________

In the local community, contact:_________________________________________________________________

References

National Institute on Alcohol Abuse and Alcoholism. (n.d.). Older adults. Retrieved from http://www.niaaa.nih.gov/alcoholhealth/special-populations-co-occurring-disorders/older-adults

SOURCE: Adapted from Substance Abuse and Mental Health Services Administration. (2013). Get connected! Linking older 

adults with medication, alcohol, and mental health resources. HHS Publication No. (SMA) 03-3824. Rockville, MD: Author. 

Retrieved from http://store.samhsa.gov/product/Linking-Older-Adults-With-Medication-Alcohol-and-Mental-HealthResources/SMA03-3824
44 | PROMOTING EMOTIONAL HEALTH AND PREVENTING SUICIDE

Tool 8: Community Support Meeting

A death by suicide can have a huge impact on family members, friends, and other survivors. A community support 

meeting is one way to bring those affected by a suicide together, to share their stories and to reaffirm that they are 

not alone in their grief.

This brief guide for facilitating such a meeting was adapted from a program developed by college health 

professionals to help the larger university community come together in the aftermath of tragic events. Meilman & 

Hall (2006) note that administrators are bolstered by having a plan in place when adverse circumstances arise, and 

program participants feel taken care of when administrators have such a plan in place.

Facilitating a community support meeting

1. Opening

The facilitator introduces attending staff members and makes a few comments regarding the confidentiality and 

duration of the meeting (1 hour). The facilitator requests that any members of the media identify themselves and 

leave unless they are willing to participate as affected individuals rather than as members of the press.

2. Brief description of the death or event

_______________________________ [insert your designee] gives an official explanation of what is known about 

how the death occurred so that all who are present are working from the same basic set of facts. This also offsets 

any potential adverse impact of the rumor mill.

3. Purpose of the meeting

The facilitator acknowledges that this is a difficult time, that participants are courageous for attending, and that it is 

important that the meeting be a helpful and healing gathering for the community. The facilitator reiterates the need 

for confidentiality, stating, “We want to ask that this session and the things we discuss be considered confidential 

within the confines of this room. Does everyone feel okay with that?” 

4. Opening question

The facilitator opens the conversation by posing a question to the group: “We feel sad about what has happened, 

but we did not know ____________________________ [name of the deceased] as well as you did, and we’d 

like to understand what [he or she] was like in order to be helpful. Can you tell us something about [name of 

the deceased] so that we can all share a common understanding? You can share your reflections as you feel 

comfortable. You may also choose not to share, although we hope you will be comfortable enough to speak.”

5. Sharing stories

This begins the heart of the process. In telling the story of the deceased, in reminiscing, in laughing, and in crying 

together, the grieving process is facilitated, and the community reconnects with itself. Simply put, the storytelling 

is the work. In a sense, talking can be viewed as the psychological equivalent of chewing—it breaks down an 

overwhelming experience into manageable, more easily digestible pieces.

6. Grieving process

The facilitator makes a few very brief comments about grieving as a process that takes time, and he or she includes 

such words and phrases as shock, disbelief, feeling disorganized, feeling despair, sadness, anger (at the situation, at the 

person who died, at God), guilt, anxiety about oneself, and eventually acceptance. The facilitator emphasizes that 

there is no right or wrong way to go through the situation and that, for a while, the grieving person may experience 

an emotional roller coaster.

7. The “what ifs . . . ”

Participants hold a discussion of the inevitable “what ifs” and “if onlys” that people often privately consider in 

the aftermath of a suicide. It is helpful when we ask residents to identify their own “what ifs” and to speculate 

out loud about the kinds of statements that others in the room may be considering, such as, “If only I had done, 

_______________________________ [name of the deceased] would still be alive.” Through this discussion, we 
A Toolkit for Senior Centers | 45

attempt to put perceived guilt on the table, identify it as being an impediment to grieving, and demonstrate to 

participants that they are not alone with their self-recriminations—that many people are wondering what more 

they could have done. 

It is also important to explain that suicide is complex and that there are many reasons for it, including relationships 

or failure at relationships, family issues, internal psychological conflicts, personal value systems, biology, logical 

and illogical thinking processes, tunnel vision (black-and-white thinking), conscious and unconscious processes, 

bottled-up anger directed at oneself, and religious beliefs. The facilitator explains that changing any of the “if onlys” 

would not have been likely to create a different outcome. 

8. Wrap-up

The facilitator makes parting comments along these lines: “This gathering is important. It helps enhance a sense of 

community now when it’s needed. You’re in the fortunate position of having a community and being able to care 

for one another. Please look out for one another. If someone is isolated or having a hard time, invite him or her to 

talk about it.” 

9. Community resources

The facilitator identifies helpful resources within the senior center and in the broader community, 

including ________________________________ [insert local resources]. This may be a good time to distribute 

Fact Sheet 3: After a Suicide: What to Expect and How to Help.

10. Staff Availability

The facilitator announces that staff will stay for a few minutes afterward in case anyone wants to talk individually.

11. Reviewing the meeting 

At the next monthly staff meeting, the staff (and perhaps others who were involved in the community support 

meeting) assess their work and conduct a review of the meeting. This process helps the staff continually refine their 

approach and allows staff members who were not participants in the particular postvention to learn from it.

SOURCE: Meilman, P. W., & Hall, T. M. (2006). Aftermath of tragic events: The development and use of community support 

meetings on a university campus. Journal of American College Health, 54(6), 382–384. The format presented here for a 

Community Support Meeting was created by Philip W. Meilman, PhD, Director of Counseling and Psychiatric Services at 

Georgetown University, and Tanni M. Hall, MEd, associate dean of students at Cornell University. Some of their language has 

been adapted for use with older adults. 
46 | PROMOTING EMOTIONAL HEALTH AND PREVENTING SUICIDE

Tool 9: Resources List

For senior center staff and volunteers

Basic Information on Suicide Prevention

Older Americans Behavioral Health: Issue Brief Series

http://www.aoa.acl.gov/AoA_Programs/HPW/Behavioral/index.aspx#issue

Older Americans Behavioral Health: Webinar Series

http://www.aoa.acl.gov/AoA_Programs/HPW/Behavioral/index.aspx#webinars

Substance Abuse and Mental Health Services Administration (SAMHSA), Administration on Aging (AoA), 

and National Council on Aging (NCOA). (2011–2013)

These resources cover key behavioral health issues that affect older adults, including suicide, depression, 

anxiety, and alcohol and prescription medication misuse, as well as prevention and treatment programs to 

address these problems. Note especially the items on preventing suicide and reaching diverse populations.

Toolkits with Guidance and Resources on Suicide Prevention and Behavioral Health Promotion

Promoting Emotional Health and Preventing Suicide: A Toolkit for Senior Living Communities

http://store.samhsa.gov/product/SMA10-4515

Substance Abuse and Mental Health Services Administration. (2011)

This toolkit contains resources to help staff in senior living communities promote emotional health and 

prevent suicide among their residents and to help residents become active participants in mental health 

promotion and suicide prevention efforts. It includes information on recognizing and responding to people 

who are suicidal and/or have depression or substance misuse problems; responding to a suicide death; 

conducting one-hour trainings for staff, residents, and their families; and implementing a comprehensive 

suicide prevention program.

Get Connected! Linking Older Adults with Medication, Alcohol, and Mental Health Resources 

Substance Abuse and Mental Health Services Administration (SAMHSA), Administration on Aging (AoA), 

and National Council on Aging (NCOA). (revised 2013)

http://store.samhsa.gov/product/Linking-Older-Adults-With-Medication-Alcohol-and-Mental-HealthResources/SMA03-3824

This toolkit provides step-by-step information and resources on how to establish a program to link older 

adults with resources on alcohol and medication misuse and mental health problems. Tools provided include 

a program coordinator’s guide, fact sheets, screening tools, sample forms, and suggested curricula for 

program staff and for older adults.

A Toolkit for Serving Diverse Communities

Administration on Aging (AoA)

http://www.aoa.acl.gov/AoA_Programs/Tools_Resources/DOCS/AoA_DiversityToolkit_Full.pdf

This toolkit offers easy-to-use methods for providing respectful, inclusive, and sensitive services. It covers 

assessing the needs of a community, identifying resources, designing services, and evaluating programs.

Telephone Lines for Older Adults in Crisis

National Suicide Prevention Lifeline

1-800-273-TALK (8255)

http://www.suicidepreventionlifeline.org/

This 24-hour, toll-free suicide prevention hotline is available to anyone in suicidal crisis or emotional 

distress. Calls are routed to the nearest crisis center in a national network of more than 160 crisis centers, 

where trained counselors provide crisis counseling and mental health referrals. To connect online through 

the Crisis Chat service, go to http://www.suicidepreventionlifeline.org/GetHelp/LifelineChat.aspx.
A Toolkit for Senior Centers | 47

Friendship Line

1-800-971-0016

http://www.ioaging.org/services-for-elders-and-caregivers/friendship-line

This phone line at the Institute on Aging is the nation’s only 24-hour, toll-free hotline specifically for older 

and disabled adults. Trained staff and volunteers make and receive calls to and from individuals who are 

either in crisis or just in need of a friend. 

Organizations and Programs with Additional Resources on Behavioral Health and Older Adults

National Council on Aging (NCOA)

http://www.ncoa.org

This nonprofit service and advocacy organization works with organizations across the country to help 

seniors improve their health, find jobs and benefits, live independently, and remain active in their 

communities. 

NCOA’s Center for Healthy Aging 

http://www.ncoa.org/improve-health/center-for-healthy-aging/?

This center offers a number of resources on behavioral health.

National Institute of Senior Centers (NISC)

http://www.ncoa.org/national-institute-of-senior-centers/

Part of NCOA, this institute supports a national network of more than 2,000 senior center professionals. 

It promotes research, promising practices, professional development, and advocacy. It also offers the only 

national accreditation program for senior centers.

Administration on Aging (AoA)

http://www.aoa.acl.gov/AoA_Programs/HPW/Behavioral/index.aspx

The Administration on Aging is part of the Administration for Community Living, the federal agency on 

aging and disability. The Behavioral Health section offers a variety of resources on behavioral health in older 

adults.

Positive Aging Resource Center (PARC)

http://positiveaging.org

Brigham and Women’s Hospital and the Harvard Medical School Division on Aging provides information 

and resources for older adults, caregivers, health and social service professionals, and policymakers.

Suicide Prevention Resource Center (SPRC)

http://www.sprc.org

SPRC provides information, resources, training, and technical assistance related to suicide and suicide 

prevention. 

SPRC Online Library 

http://www.sprc.org/search/library/Older%20Adults%20%2855%252B%29?filters=type%3Alibrary_

resource%20tid%3A243

This online library contains a large number of materials related to older adults. 

SPRC State Pages

http://www.sprc.org/states

Use the State Pages to find your state suicide prevention contact person and to learn about suicide prevention 

coalitions, programs, and activities in your area. 

American Foundation for Suicide Prevention (AFSP)

http://www.afsp.org

AFSP offers educational programs and provides support to those affected by suicide. Find Your Local 

Chapter: http://www.afsp.org/local-chapters/find-your-local-chapter. Contact your local AFSP chapter to 

find out about local resources, including support groups.
48 | PROMOTING EMOTIONAL HEALTH AND PREVENTING SUICIDE

SAMHSA Resource Center to Promote Acceptance, Dignity and Social Inclusion Associated with Mental 

Health

http://www.promoteacceptance.samhsa.gov/audience/adults/default.aspx

This center provides information, resources, and programs for providing a caring, welcoming, and 

supportive community that will help promote recovery and wellness for people with mental health problems 

and substance use disorders and for those who have experienced trauma. 

For older adults and their families

Suicide Prevention

Suicide Warning Signs (wallet card)

National Suicide Prevention Lifeline

http://www.suicidepreventionlifeline.org/getinvolved/materials.aspx

Suicide Prevention for Seniors (brochure)

SAVE (Suicide Awareness Voices of Education)

http://www.save.org/index.cfm?fuseaction=shop.productDetails&product_id=78EE6EC5-E947-7D63-

23CC0B169CB38D7C

Suicide Prevention Resources for Survivors of Suicide Loss (resources list)

Suicide Prevention Resource Center (SPRC). (2013)

http://www.sprc.org/sites/sprc.org/files/Survivors.pdf

Depression

AgePage: Depression

National Institute on Aging. (updated 2015) 

http://www.nia.nih.gov/health/publication/depression

AgePage is also available in Spanish.

Older Adults and Depression

National Institute of Mental Health 

http://www.nimh.nih.gov/health/publications/older-adults-and-depression/index.shtml

Alcohol Misuse

AgePage: Alcohol Use in Older People and Older Adults and Alcohol: You Can Get Help (booklet) 

National Institute on Aging. (updated 2015)

http://www.nia.nih.gov/health/publication/alcohol-use-older-people

AgePage is also available in Spanish.
A Toolkit for Senior Centers | 49

Fact Sheets for Older Adults

These fact sheets are meant for senior center users, and you may also share them with staff and 

volunteers. Because they cover emotionally sensitive topics, the fact sheets should only be handed out 

in settings where they can be discussed. A social worker, a trained staff person, or a behavioral health 

specialist should be present to help explain the information, answer questions, and help older adults 

deal with any feelings that may come up.

Suggested settings in which the fact sheets can be distributed and discussed follow:

Fact Sheet 1: Looking Out for the Well-Being of Yourself and Others

■ Workshops or presentations

■ Health promotion or wellness programs

Fact Sheet 2: Know the Warning Signs of Suicide

■ Workshops or presentations

■ Support group run by a social worker or other mental health professional

■ Individual sessions with a social worker or other mental health professional

Fact Sheet 3: After a Suicide: What to Expect and How to Help

■ Community meetings, as described in Tool 8: Community Support Meeting

■ Support group run by a social worker or other mental health professional

■ Individual sessions with a social worker or other mental health professional

At the end of each fact sheet is space for you to fill in the names of relevant contact people at local 

agencies, such as community mental health centers or behavioral health providers, from whom 

participants or staff can seek help. Be sure to add this information before giving out the fact sheets.

SOURCE: These fact sheets were adapted from Promoting Emotional Health and Preventing Suicide: A Toolkit for Senior 

Living Communities (SAMHSA, 2011). Available at http://store.samhsa.gov/product/Promoting-Emotional-Health-andPreventing-Suicide/SMA10-4515.
50 | PROMOTING EMOTIONAL HEALTH AND PREVENTING SUICIDE

Fact Sheet 1: Looking Out for the 

Well-Being of Yourself and Others

No matter what age you are, it is important to look out for your 

own emotional well-being. This is especially true for older adults 

because of the special challenges at this stage of life. Taking 

charge of your emotional well-being can make a big difference.

• Are you in pain?

• Do you feel depressed?

• Are you lonely?

• Have you experienced a loss?

• Can you think of someone else who may be experiencing

these challenges, such as a spouse, friend, or acquaintance?

If you or someone you know may be going through a difficult 

time, know that help is available. Read on . . . 

Take care of yourself

Your emotional well-being is affected by your health. If you need 

help or support, staff at your senior center can help you see a 

medical or mental health provider. They can also recommend 

health and wellness activities.

Here are some suggestions for taking care of your health:

■ Make an appointment with a medical provider if you are in

pain or have a physical illness.

■ Seek treatment or talk to a counselor if you have depression

or another mental health issue, or if you drink too much or 

are misusing medications.

■ Join a support group to help you cope with the loss of family

and friends, financial problems, or other personal issues.

■ Stay active and exercise regularly. Try taking a group exercise

class or going on walks.

■ Eat a healthy diet. Avoid too much sugar, salt, fat, and

caffeine.

Taking care of your physical and mental health will help you feel 

better and reduce your feelings of helplessness.

Get involved

Getting involved in intellectual and creative activities is a 

valuable way to build your skills and give you a sense of purpose. 

If an activity that interests you is not offered at your facility, 
A Toolkit for Senior Centers | 51

find out how you can help get it started. Here are some possible 

activities:

■ Attend a discussion group or presentation on a topic of interest

to you

■ Do arts and crafts activities

■ Go to a poetry, music, or theater event at the facility

■ Join or start a book club

■ Take a class in sewing, computer, carpentry, or financial

management

You can build skills or start a new hobby at any age. You just need 

to be willing to try.

Reach out

The well-being of older adults is affected by strong relationships 

with family, friends, and others. Here are some ways to help you 

build relationships in your senior center, share emotional support, 

and have fun:

■ Go on group trips to social, sporting, and cultural events

■ Attend parties to celebrate holidays, birthdays, and other special occasions

■ Play bingo, bridge, or poker

■ Join the committee to welcome new residents

■ Mentor or be a buddy for new residents

■ Join a committee involved in facility decision making

■ Volunteer to help others in your local area

Reaching out to other senior center staff and participants will also help you look out for the 

emotional well-being of others.

If you or someone else needs help:

In this facility, contact: _____________________________________________________________

In the local community, contact:______________________________________________________

Helping Others

Look out for the emotional 

well-being of other older 

adults. Someone might be 

helped by your friendship 

and encouragement to get 

involved in activities or to see 

a mental health professional. 

Remember to be respectful. 

If you are concerned about 

someone, decide if it would 

be more helpful to talk with 

a staff member or a social 

worker about the person or to 

talk with the person directly.
52 | PROMOTING EMOTIONAL HEALTH AND PREVENTING SUICIDE

Fact Sheet 2: Know the Warning 

Signs of Suicide

Have you ever heard someone make these statements? Have 

you thought them yourself?

• “They’d be better off without me.”

• “Don’t worry—I won’t be here to bother you much longer.”

• “I can’t deal with it any more. Life is too hard.”

• “I no longer want to live.”

• “Death seems like the only way out.”

Do either of the following descriptions sound like your 

neighbor, a friend, or yourself?

The person has been drinking more than usual. He or 

she doesn’t think life has any purpose now that his or her 

spouse is gone. He or she yells at food servers or other 

senior center staff for taking too long.

The person has stopped coming to exercise class. He or she 

paces around at night, unable to sleep. He or she reports 

feeling hopeless and that nothing in life will ever improve.

Know the warning signs of suicide.

The following three warning signs suggest that a person could be 

at immediate risk of suicide:

■ Talking about wanting to die or to kill oneself

■ Looking for a way to kill oneself, such as searching online or

obtaining a gun

■ Talking about feeling hopeless or having no reason to live

Other behaviors that may also indicate a serious risk—especially 

if the behavior is new, has increased, and/or seems related to a 

painful event, loss, or change: 

■ Talking about feeling trapped or in unbearable pain

■ Talking about being a burden to others

■ Increasing the use of alcohol or drugs

■ Acting anxious or agitated, behaving recklessly

■ Sleeping too little or too much

■ Withdrawing or feeling isolated

■ Showing rage or talking about seeking revenge

■ Displaying extreme mood swings
A Toolkit for Senior Centers | 53

These signs may suggest that someone is considering suicide. Get help if you notice any of these 

behaviors and moods in yourself or someone else. See the next page for information on what you can do.

What you can do

If someone you know is showing any of the warning signs of suicide, your goal is to encourage that 

person to seek help—but while that’s easy to say, it’s not always easy to do. People are sometimes 

uncomfortable seeking help for mental health problems. If they’ve never done it before, they may not 

know what to expect. The belief that we should be able to cope on our own can also prevent many of 

us from getting much-needed treatment.

If you or someone else shows one or more warning signs of suicide:

■ In this senior center, contact: _____________________________________________________

■ In the community, contact the following mental health provider(s):

_______________________________________________________________________________________

_______________________________________________________________________________________

■ If you are unable to reach a mental health provider, call the National Suicide Prevention Lifeline

(1-800-273-8255). 

■ The goal is to connect the person to a mental health professional who can quickly assess for

suicide risk. If you think the person is in immediate danger of attempting suicide, call 911. Stay 

with the person until help arrives, talking with him or her in a supportive tone. 

Taking care of your mental health is just as important as taking care of your physical health.

If you had diabetes, you would get help. Do the same with a mental health concern.

SUICIDE CAN BE PREVENTED!
54 | PROMOTING EMOTIONAL HEALTH AND PREVENTING SUICIDE

Fact Sheet 3: After a Suicide: What 

to Expect and How to Help

A death by suicide can have 

a huge impact on family 

members, friends, senior 

center volunteers, staff, and 

other survivors of suicide 

loss. Whether you have lost 

someone by suicide or want 

to help another person who 

has, it is useful to know what 

to expect and how to best help 

someone else.

How to help yourself

Coping with a suicide can 

cause many emotions. Strong 

feelings are normal. No one 

has the same reaction, and 

emotions can change. Take 

time to figure out how you feel. You may be feeling any of the 

following:

■ Disbelief

■ Denial

■ Grief

■ Guilt

■ Anger

■ Shame

An attempted suicide often brings up some of these same emotions.

Here are some tips for coping:

■ Give yourself time to deal with the loss and accept whatever

emotions you feel. Remember that everyone grieves 

differently.

■ The suicide of a family member or friend can affect your

emotional health. Get help if you feel emotionally vulnerable 

yourself.

■ Talk about the person who died with someone you trust—a

family member, friend, member of the clergy, or senior 

center staff person.

■ Honor the memory of the person who died—place pictures of

the person in your room or write something about him or her.

Why Did It Happen?

It’s common to try to figure 

out why someone took his or 

her life—yet, the answers may 

not be known. The causes of 

suicide are complicated and 

different for each person. The 

person who died may be the 

only one able to answer your 

questions. At some point, 

most people accept that clear 

reasons may not exist and 

that knowing why will not 

change what happened. This 

acceptance is a key step in 

healing.
A Toolkit for Senior Centers | 55

■ Express your feelings with a counselor or in a support group with others who are likely to

understand what you are going through.

■ Stay with your daily routine and take care of your basic needs—eat, sleep, and attend your regular activities.

■ Be prepared for holidays and anniversaries, since they can be difficult emotionally. Consider

doing something special in memory of the person who died.

How to help others

How you feel about suicide will affect how you respond to 

others. Take the time to get clear about your feelings before you 

try to help someone else.

People who lose a friend or relative by suicide need a lot of 

support and understanding. The loss and shock of suicide can 

make a person more sensitive, so be extra careful not to say or do 

something that could make the person feel worse.

If you feel uncomfortable about suicide, it can be especially hard to 

know how to respond to someone who has experienced a loss like 

this. It is helpful to avoid judgment and blame related to the cause 

of death.

What to say

Express empathy, and acknowledge their pain and sadness.

■ “I am so sorry for your loss.”

■ “I can see that you are hurting.”

Ask if they want to talk about the person, and then just listen.

■ “Do you want to talk about _______________________?”

Let them know that you care about their well-being.

■ “I am here to support you in any way.”

What to do

■ Be kind and reach out—send a card, have tea or lunch together, watch a television show or movie together

■ Call and visit regularly

■ Listen when they talk about their feelings and don’t try to make them feel better

■ Offer to help with their responsibilities, but don’t take over unless they ask

Resources to help cope with a suicide

In this facility, contact: _____________________________________________________________

In the local community, contact:______________________________________________________

The ational Suicide Prevention Lifeline (1-800-273-TALK [8255]) is available 24 hours a day, 7 

days a week.

SOS: A Handbook for Survivors of Suicide by Jeffrey Jackson (2003) can be downloaded from 

http://www.sprc.org/library/SOS_handbook.pdf.

How Do You Feel?

Your attitude and feelings 

can make a big difference 

to someone who has lost a 

friend or loved one by suicide. 

Acceptance is key to helping 

them deal with the loss:

• Accept all their feelings.

• Accept that you will not be

able to ease their pain.

• Accept that their loss can’t

be compared to anyone

else’s.

• Accept that the suicide was

not an accident.

• Accept that healing will take

a long time. Be patient and

understanding.

Your understanding and 

support are what the person 

needs most.
56 | PROMOTING EMOTIONAL HEALTH AND PREVENTING SUICIDE

Appendix–Additional Acknowledgments 

Input and review were provided by:

• Federal agencies: Administration on Aging/Administration for Community Living, Centers for Disease Control and

Prevention, National Institute of Mental Health

• National organizations: National Council on Aging, National Institute of Senior Centers

• Community-based agencies and organizations: Beat the Blues, Johns Hopkins School of Nursing; Belmont Council on

Aging, MA; Expand Your Horizons: 50+ Consulting, PA; Mental Health America of New York City, NY; Oakland Family

Services, MI; Senior Reach, CO; ValleyCare Health System, UT

SMA-15-4416 

First printed 2015