The Executive Order and OT Implications: The Rising Suicide Rate in Baby Boomers and the Role of Occupational Therapy

The Executive Order and OT Implications: The Rising Suicide Rate in Baby Boomers and the Role of Occupational Therapy

Anjali K. Parti, OTD, OTR/L Gerontology Co-Chair Annette Bullard, COTA, Gerontology Co-Chair

At the Florida Occupational Therapy Association (FOTA) conference in 2018, Anjali Parti and Annette Bullard hosted a Conversations that Matter that was very well attended, many OT practitioners voiced an interest in doing more for mental health in the VA setting. We have decided to re-visit this important topic due to President Trump’s recent Executive Order signed March 5, 2019. Here is some information on the order and what the order entails:

“As the largest integrated health care provider in the nation and a leader in developing innovative mental health and suicide prevention strategies, the Department of Veterans Affairs (VA) is uniquely positioned to co-chair this effort with the White House,” said VA Secretary Robert Wilkie. “Veterans suicide is a national public health issue that affects communities everywhere, and this executive order is a national call to action. We are committed to saving Veteran lives, but just as there is no single cause of suicide, no single organization can end Veteran suicide alone,” Wilkie said. “We must work side by side with our partners at all levels of government — and in the private sector — to provide our Veterans with the mental health and suicide prevention services they need. This executive order advances the public health approach to suicide prevention further by identifying key integrations and connections across the federal government and communities that can be used to save Veterans’ lives.”- VA Secretary Robert Wilkie

Executive Order Task Force Agenda

Within 365 days of the date of the order and working with a variety of representatives from across both the public and private sectors, the task force shall:

  1.  Develop a comprehensive national public health roadmap outlining the specific strategies needed to lower effectively the rate of Veteran suicide, with a focus on community engagement
  2. Design and propose to Congress a program for making grants to local communities, which will increase their ability to collaborate with each other, integrate service delivery and coordinate resources to Veterans, and
  3. Develop a national research strategy to improve the coordination, monitoring, benchmarking and execution of research in the field of Veteran suicide prevention.

The Issue at Hand:

A growing baby boomer suicide rate! ‘Suicide at any age is a tragedy for the individual, his or her family and friends, and the communities of which they are a part. At a population level suicide is also a major public health problem, accounting for over 34,500 deaths each year in the United States and an estimated one million or more worldwide (Yeates, Van Orden, & Caines, 2011). According to the National Institute of Mental Health Suicide is the 8th most frequent cause of death of Americans ages 55-64. The World Health Organization calls for a coordinated action to reduce suicides worldwide. “This report is a call for action to address a large public health problem which has been shrouded in taboo for far too long” (World Health Organization, 2014). The first WHO report on suicide prevention reports that suicide rates are highest in people 70+ and women are twice as likely to die by suicide as men. In 2016, the highest suicide rate (19.72) was among adults between 45 and 54 years of age. The second highest rate (18.98) occurred in those 85 years or older. (American Foundation for Suicide Prevention, 2018)

What Does this Mean for Occupational Therapy?

With this new governmental support, maybe our implementation of more mental health approaches to our veteran....

  1. Use the ‘Interest Checklist’ and the Meaningful Activity Participation Assessment to assess what is valuable to a client, compared to how physically or mentally they can engage in those activities can assist OT’s in prioritizing, grading and/or adapting valued occupations. Information revealed by use of the checklist may also assist OT’s in reviving once utilized activities to replace activities that engagement in is no longer possible. By ensuring engagement in valuable occupations we ensure engagement and value of life and thereby contribute to suicide prevention.
  2. Utilize the COPM and Beck Depression Inventory in your evaluations.
  3. Refer your client to a list of resources for mental health counseling in his/her area and be a true advocate for this and not just a messenger.
  4. Continue to identify preferred tasks which bring fulfillment and collaborate with caregivers and family and friends.
  5. Collaborate with nursing homes, assisted living facilities, hospitals, and local Council on Aging and local support groups to brainstorm on potential funding or easy ways to identify signs/ symptoms of suicidal ideation that come along with depression.
  6. Look for local ‘Mental Health First Aid’ courses to better identify signs/symptoms of mental distress and how to properly assist in case of an emergency.
  7. Review your workplace’s policies and procedures on what to do should someone report suicidal intent.
  8. Speak with your therapy manager and team to see what the department can/should do should a patient express suicidal intent or ideation in a treatment session.
  9. Identify a treatment goal that can consistently target preferred tasks and occupations and focus on this as much as possible in your sessions.
  10. Finally, focus on your client’s social isolation and what that means for the client’s functionality with ADL/IADL and help identify ways to incorporate community re-integration into your treatment planning
















patients in the VA or in other settings will receive additional support. Many Occupational Therapy professionals see first-hand the effects of aging in the baby boomers in the state of Florida. Florida being the sunshine state is one of the states where many baby boomers wish to retire. Many OT practitioners often practice in the geriatric setting because of prevalent job opportunities and a rising need of the community for OT services. The Occupational Therapy profession is unique in many ways one of which sets our profession apart is that, the whole person is considered during treatment. This fact makes us uniquely qualified to assist with suicide prevention with our patient/clients. In their article ‘Suicide in Older Adults’ Conwell, writes that ‘suicide needs to be understood as a developmental process to which risk and protective factors contribute in defining a trajectory to suicide over time.’ His article sets a perfect stage for Occupational Therapy professionals to intercept what Conwell describes as a trajectory toward suicide. Consistent use of the training OT’s receive in mental health can begin to change the course, from tragedy to successful redefining purposeful life engagement, despite challenges. In conclusion, it is very important for those of us treating the geriatric population to be mindful of the most important item in our treatment planning and processes; the mental health of the client. It would be prudent to advocate for our skill set and discuss scheduling and reimbursement matters with our workplace administrators for support. Support to spend more time on focusing on signs and symptoms of depression, consulting with mental health providers, and taking an interdisciplinary approach with our nursing, physical, and speech 9 focus • Spring 2019 therapy peers would be a step in the right direction. The strength of Occupational Therapy is focusing on the psychosocial well-being of all clients and ultimately their ability to safely participate in functional and preferred activities. We must be mindful of ensuring our clients feel the quality in their quality of life in order to feel fulfilled and prevent risk for suicide.

American Foundation for Suicide Prevention. (2017) Suicide Statistics. Retrieved March 01, 2018 
Eakman, A., Carlson, M., Clark, F. (2010). The Meaningful Activity Participation Assessment: A Measure of Engagement in Personally Valued Activities. * Model of Human Occupational Theory and Application. (2018). Modified Interest Checklist. 
National Institute of Mental Health. (May 2017) Suicide.
Office of Public and Intergovernmental Affairs. (2016, September 01). Office of Public and Intergovernmental Affairs.
World Health Organization (Sept 4, 2014). First WHO report on suicide prevention.
Yeates, C., Van Orden, K., & Eric, C. (June 2011) Suicide in Older Adults.
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