Men in their forties are more likely to take their own life than other groups. As part of a study funded by the National Institute for Health Research (NIHR) we talked with midlife men with experience of suicidal distress, with bereaved family members, and with professionals working in the field. They described their experiences and suggested ways to prevent and respond to suicidal distress in this group.
Recognising need: who is ‘ill enough’?
The people we spoke with were keenly aware that public resources are limited and that there are competing demands on those resources. The people we spoke to felt their needs were less deserving of support and services than others and expressed a need for people experiencing mental distress, especially men, to be informed that they are entitled to help. Previous research shows men with anxiety and depression are less likely than women with similar symptoms to access mental health services.
Some men described how, initially, they lacked awareness about how well they were coping.This misperception could be held by others around them too.Sometimes a doctor, employer, friend or family member assumed a man who appeared to be ‘functioning’ - working, dressed presentably, and able to joke - could not be suicidal. The people we spoke to stressed: don’t assume from appearances, it is necessary to ask.
There was also talk about the need to be persuaded to accept support. Men described how they had avoided and deflected initial approaches, or ignored and pushed other people away. Some told us they wished friends and colleagues had persisted and not settled for their initial response of ‘everything’s fine’. This point has been made by others in the field, such as Time to Talk’s Ask Twice campaign.
Facilitating access: finding the right words, time and place
Two levels of essential support were highlighted by the people we spoke with: to manage chronic, ongoing stress, and to address acute tipping points and crises. Many had little idea what support was out there, some had looked for support and couldn’t find it. Calls for better signposting and clear sources of information are a familiar mantra, but the issues remain. In particular, it was stressed that information needs to be provided in places where men feel comfortable.
Some men said they lacked the words to ask for help when they were low. They wanted to know: what do I say to my employer or to debt collection services? How do I explain to the GP what I am feeling? They wanted testimonials from others, and examples of ways to ask for help. Some stressed the need to develop insight and resilience from an early age.
Another theme to emerge was allowing more time. Short counselling sessions were described as inadequate, and struggles with employers or debt agencies who expected recovery to be swift were clear. Men described feeling rushed to come off medications before they were ready or were discharged from services they still felt a need for. Debt collection letters were described as threatening. Part of our wider awareness around men, mental health, and suicide needs to include messaging that acknowledges that these processes can take time. The view supports the Government’s commitment to extend the ‘breathing space’ debt respite scheme to those receiving NHS treatment for a mental health crisis, something that organisations like Money and Mental Health campaign for.
Adjusting delivery: equal engagement
Finally, some of the men interviewed described a power dynamic in health service interactions which they found uncomfortable. It was felt to be hierarchical, assumed knowledge about what ‘was best’, and was disempowering. One negative contact could have long-lasting impact, putting people off seeking help again. It was clear that every contact counted, and that negative contacts could count the most.
In facilitated peer-support groups some men found a model that provided them with training in how to talk and find connections with others who understood their experiences.Safe spaces for men may be different from what women need. What feels safe varies. Some men expressed a preference for the support of women and others felt more comfortable with peer support alongside other men with similar experiences to them. Gay and bisexual men in particular highlighted how A&E could feel threatening.
Across the interviews with men with lived experience of suicidal distress, with bereaved family members, and with professionals working in the field there were calls for longer-term respite. The Maytree Centre, a charity providing residential sanctuary for people in suicidal crisis in a non-medical setting and who assisted with this research, is all too rare a service. Secure spaces are needed - physical, emotional and temporal - and are often hard to find.
In the UK, Samaritans can be contacted on 116 123 or email email@example.com.
This report is independent research funded by the National Institute for Health Research Policy Research Programme (‘Risk and resilience: Self-harm and suicide ideation, attempts and completion among high risk groups and the population as a whole’, 023/0167). The views expressed in this publication are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.