We read with interest the paper by De Leo et al (Reference De Leo, Buono and Dwyer2002), which implied that needs assessment telephone calls and 24-hour emergency services had proved effective for elderly females, with a reported significant reduction in suicide rate.

In our study of 216 elderly suicides in Cheshire and Birmingham over a 5-year period (1994-1998; Reference Salib, Tadros and CawleySalib et al, 2001), 30% of suicide victims were not known to psychiatric services. Surprisingly, 38% of the men and 16% of the women among those elderly suicide victims unknown to services were found to have had some defined, albeit untreated, psychiatric morbidity.

Evidence of psychiatric morbidity was extracted from coroner's records of statements provided by families and friends of the deceased. Men were less likely to be known to local services but more likely to be living alone and to harbour undetected psychiatric morbidity, hence the high risk of succeeding in their first suicide attempt.

Elderly male suicide victims do not tend to ask for help, whether face to face or over the telephone, so we must find a way to take the help to them, particularly at their moment of despair.

The findings of De Leo et al are hardly surprising. However, there is an obvious risk that we may evaluate our services based on ‘total’ decline in numbers of suicides, in which women may be over-represented, thus giving a false impression of the actual reduction in suicide rate.