Almost 150 Australian nursing home residents took their own lives while in care between 2000 and 2013, a confronting new study has revealed.

Nursing home residents who took their own lives most commonly died from hanging (31.9%), falls from height (17%) and plastic bag asphyxia (14.2%).

The majority of these residents were male (68.8%) and had a diagnosed mental illness, primarily depression (66.6%). Suicides in nursing homes were three times more likely to occur over a holiday period. Undertaken by a team of researchers from Monash University, the study analysed national records generated by coroners’ investigations into the deaths in order to determine an individual’s health status, personal circumstances and care history.

It pinpointed major life stressors including health deterioration (79.4%), isolation and loneliness (42.6%) and maladjustment to nursing home life (29.8%) as leading contributors to the rate of suicide in residential care. The study’s co-leader, Professor Joseph Ibrahim from the Department of Forensic Medicine, said researchers focused on suicide in residential care in a bid to form a better understanding of the management of depression and mental health.

“Our question was does this [suicide] ever happen and if it does, how could it? You don’t expect a suicide in a hospital or a school or in an environment where you have a large number of people and professional staff to monitor your behaviour.”

Professor Ibrahim labelled the number of suicides “distressing” regardless of the total figure spanning a decade. He said the findings reflected significant gaps in services across Australia and widespread acceptance about the shortcomings of aged care.

“One of the things people make assumptions about is if you’re old, have a disability and live in aged care that it’s natural to be sad and depressed,” Professor Ibrahim said.

“While we agree there’s going to be some type of bereavement response when you move in, no one should be clinically depressed and miserable in a supervised setting.” Professor Ibrahim said the current delivery of aged care was ineffective when it comes to preventing suicides. Change requires improving the nursing home environment and providing greater access to mental health services and specialist teams, he added.

“[It’s about] better attention to social inclusion and making residential care a place that people actually want to live rather than a last resort.”

Currently, 170,000 Australians live in nursing homes and the country invests less than 1% on aged care services, ranking it 17th out of 96 globally. Professor Ibrahim believes lifting the overall quality of aged care and curbing suicides represents a shared responsibility, with families, GPs, staff, providers and policymakers all holding a role to play. He said the release of the study had elicited strong community views but stressed its goal was to improve understanding around quality aged care services.

“[Some] people are using this as a way to argue for euthanasia, which is incredibly disappointing and distressing because the message really ought to be how is it that suicides occur in supervised care and if there are deficiencies in care we should be fixing those.

“But the point of view that seems to come across is I don’t want to get old and if I get old I want to make sure I kill myself before I get to residential care.”