Ms. McKay is a 78-year-old African American woman living in Dorchester. She is single, with significant hypertension, diabetes, and arthritis. Although she has a prosthetic leg, she is mobile. She has been active in her church but is recently spending more and more time alone in her apartment and not even collecting her mail. Her apartment is getting increasingly cluttered, bordering on hoarding.
The resident services coordinator (RSC) of her senior building noticed that Ms. McKay seemed depressed and offered several suggestions. First, he recommended that she see her primary care physician. She said that she had one, two weeks prior, and was told that she looked okay, and to return in six months. The RSC then suggested the local hospital’s outpatient psychiatric clinic for mental health treatment, but Ms. McKay did not feel she had the ability to handle that. Finally, Ms. McKay agreed to see a licensed mental health counselor.
After several home and office visits the therapist talked about how her only close relative—her niece—moved away. She spoke about the loss of her leg in an accident that also precipitated the break-up of her engagement in her 20s. She never married and had never talked about her sadness from this. She then talked extensively about how she felt that no one really cared whether she showed up or not. This lack of belonging, the fact that she felt no one cared or maybe would not even know if she disappeared, is a significant risk factor for suicide.
Through regular weekly visits, always being on time, addressing her suicidality, and acknowledging her losses and grief, Ms. McKay began to feel better. Over time, she agreed to come to see her counselor at the clinic. She became able to resume going to church and the women in her quilting class took a real interest in her. Her counselor continues to see her monthly.