Mental health in aged care is often the elephant in the room—big, obvious, and not talked about nearly enough. When you are working in health or aged care, you come face to face with a wide range of emotions every single day. Some are light and joyful. Others are dark and heavy. Among the toughest to talk about are self-harm risk and suicidal behaviour.

Let us take a breath and walk through this topic together. No jargon. No sugar-coating. Just real talk, because this is too important to get wrong.

Why Mental Health in Aged Care Needs Attention

You might think older people are meant to be at peace with life. Rocking chairs, warm tea, and stories of the good old days. But that is not always the case. Mental health in aged care is a serious concern. Many residents live with long-term illnesses, grief, loneliness, and feelings of being forgotten. It is no surprise that these emotions can snowball.

Older people are not immune to self-harm or suicidal behaviour. In fact, it can be harder to spot in this group. That is because the signs do not always look the way we expect them to. One person might talk about death often. Another might stop eating. Someone else might withdraw completely or start giving away their things.

You have a front-row seat to these changes. That makes your role in spotting and responding more important than ever.

Understanding Self-Harm Risk

Self-harm risk is not always about wanting to die. Sometimes it is a way to deal with emotional pain. That pain can come from feeling useless, unloved, or stuck. For someone in aged care, that might look like refusing food, neglecting personal hygiene, or skipping medication.

Here is the thing—self-harm in older people does not always involve physical injury. It can be slow and hidden. A resident might say they are just tired, or that they do not want to be a burden. You need to read between the lines. Pay attention to what they say, but also what they stop saying.

Common Warning Signs to Watch For

You do not need to be a mind reader. But you do need to be observant. Here are some common signs of suicidal behaviour or self-harm risk:

• Talking about death or wanting life to end
  
• Refusing food, water, or medication
  
• Withdrawing from social activities
  
• Sudden mood swings or personality changes
  
• Giving away personal items
  
• Expressing feelings of hopelessness or being a burden
  
• A sudden calmness after a period of depression
  

If something feels off, trust your gut. It is better to check in than to stay silent.

What To Do If You Notice a Risk

Let us say you see something that raises a red flag. What now? First, stay calm. Panic helps no one.

Talk with the resident. Keep it gentle. You are not trying to fix everything in one chat. You are simply opening a door.

Try saying something like:

"You seem a bit down lately. Do you want to talk about it?"
or
"I have noticed some changes. I care about you and want to help."

It may feel awkward, but awkward beats silence every time.

Listen without judging. Let the person speak. Let the pauses hang. They might be hard to sit through, but they often lead to truth. Avoid saying things like “You should be grateful” or “It is not that bad.” That can shut the conversation down.

Know Your Incident Management Steps

When you suspect a self-harm risk, follow your organisation’s incident management steps. These steps are not just paperwork. They guide you in protecting the resident, your team, and yourself.

Most places will have a plan that includes:

• Reporting to a supervisor or nurse immediately
  
• Recording the signs or statements made
  
• Contacting mental health professionals if needed
  
• Monitoring the person closely and offering support
  
• Making sure the environment is safe (removing sharp objects, for example)
  

You are not alone in this. Share what you notice, even if you are not one hundred percent sure. It is always better to be cautious.

Responding with Compassion

Kindness goes a long way. Even if you are busy, a few simple actions can help someone feel seen:

• Sit with them for a moment
  
• Ask if they want a cup of tea
  
• Offer to help them make a phone call
  
• Encourage gentle movement, like a short walk or hand massage
  

You do not have to be a trained counsellor. But your presence, your voice, and your time can create a ripple effect.

Looking After Your Own Mental Health

Let us be honest—this work can take a toll on you too. Seeing pain up close, especially the kind that cannot be patched with a bandage, is heavy. Do not bottle it up.

Talk with someone you trust. That might be a co-worker, a manager, or a support service. Get rest. Eat well. Take short breaks when you can. And if it all feels like too much, reach out for help.

Remember, you cannot pour from an empty cup. Taking care of yourself is not selfish. It is necessary.

Breaking the Stigma

There is still a lot of shame tied to mental health and suicidal behaviour—especially among older generations. Many were raised in times when asking for help was seen as weak. That means they may keep their struggles hidden.

Your job is not to judge. Your job is to keep showing up, asking questions, and making space for honesty.

By treating every concern seriously and every person with respect, you help break the silence.

Creating a Safe Culture in Aged Care

The best defence against self-harm is a strong, caring culture. That means:

• Regular staff training on mental health in aged care
  
• Clear communication between team members
  
• Encouraging residents to talk and share
  
• Watching out for social isolation
  
• Supporting activities that give people a sense of purpose
  

Even something small like inviting someone to a puzzle or asking them to help water the garden can help them feel needed.

Little things matter. Small actions stack up.

When It Is an Emergency

Sometimes, a situation moves from concerning to critical. If someone is at immediate risk—say they are threatening to harm themselves or others—you must act fast.

• Do not leave them alone
  
• Call emergency services
  
• Keep others safe, including yourself
  
• Stay calm and speak gently
  

Every second counts. Stay focused and follow your service’s emergency procedures.

You Are Part of the Solution

You might think, “I am just one person. What difference can I make?” The answer is—a big one.

You are the eyes, ears, and heart of aged care. You see things others miss. You notice the sighs, the silences, the shifts in behaviour. You offer warmth and support in moments that feel dark and lonely.

By taking self-harm risk seriously, responding with care, and following clear incident management steps, you help protect lives.

That is no small thing.

Final Thoughts

This is not easy work. But it matters. When you talk about mental health, when you check in on a resident, when you share your concerns—you are doing something powerful.

So next time your gut tells you something is not quite right, listen to it. Speak up. Reach out. And remember, you are never alone in this.

Even the smallest gesture can light up the dark.