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This discussion paper identifies and examines several tensions inherent in traditional approaches to understanding older people's suicide. Predicted future increases in the absolute number of elderly suicides are subject to careful interpretation due to the underreporting of suicides in older age groups. Furthermore, a significant number of studies of older people's death by suicide examine risk factors or a combination of risk factors in retrospect only, while current approaches to suicide prevention in the elderly place disproportionate emphasis on the identification and treatment of depression. Taken together, such tensions give rise to a monologic view of research and practice, ultimately limiting our potential for understanding older people's experience of suicide and suicidal behaviour. New approaches are necessary if we are to move beyond the current narrow focus that prevails. Fresh thinking, which draws on older people's experience of attempting to die by suicide, might offer critical insight into socially-constructed meanings attributed to suicide and suicidal behaviour by older people. Specifically, identification through research into the protective mechanisms that are relevant and available to older people who have been suicidal is urgently needed to effectively guide mental health nurses and health-care professionals in therapeutic engagement and intervention. [ABSTRACT FROM AUTHOR]

The study of the disorders of the mind at the turn of the twentieth century offered useful knowledge about the psyche and the First World War (FWW) provided an avalanche of case studies. Prior to the war the mentally ill were treated with disdain and the social distrust of individuals who did not present as ‘normal’ was high. The level of diagnostic expertise of psychiatric illness by doctors and nurses was low and as a consequence medicine and nursing was ill-equipped to deal with the phenomenon initially referred to as ‘shell shock’. However, the soldiers of the FWW who endured the varied and seemingly unrelated symptoms of shell-shock were respected men – occasional heroes – who were reduced to the status of ‘mentals’. There is evidence that civilian trained health professionals altered their views about mental illness during the FWW but initially, the military imperatives inherent in a global conflict perpetuated the notion that mental illness was linked with defective morality. This paper provides an historical account of changes in attitude toward the mentally ill as a consequence of the FWW. The interregnum (1918–39) was a period of advancement in the field of mental health within the civilian sector. However, the imperatives of war negated these developments and there is evidence that the management of soldiers suffering from post-traumatic stress disorders in the Second World War did not benefit from the lessons learnt in the FWW. [ABSTRACT FROM AUTHOR]