Suicide is the single biggest cause of death amongst UK men under the age of 45 yet there is little being done to tackle it. Alice Harrold speaks to the founder of male suicide charity CALM about how nurses can make a difference
In 1997 Jane Powell launched a pilot programme in Manchester for the Department of Health (DH). She set up the scheme, called the Campaign Against Living Miserably (CALM), with the hope of reducing the number of male suicides.
Two years later it was rolled out to Merseyside and Cumbria. Immediately following the expansion, Powell, who has been a campaigner for public welfare since the mid-1980s, moved to the US.
But when she returned to England two years later, she found the programme had hit a wall due to changes within the DH and local commissioning.
In 2004 she was asked to shut the campaign down. Instead she launched it as a national charity.
Q: What gave you the impetus to launch CALM as a charity?
A: My experience launching the pilot in Manchester and in Merseyside allowed me to meet and talk with young men about the issues and the response from them was amazing. It was always very exciting, very encouraging, young guys really liked it, they wanted to do something about it, they wanted to get involved in some way, shape or form. So I thought that kind of response, given the audience and given the need, was something that I didn’t really feel I could shut down. So, I asked permission to take the pilot and launch it as a charity.
Q: Why is there low awareness surrounding male suicide?
A: I think many of the messages about suicide have been quite unhelpful. When I launched CALM, the predominant message from the media was that suicide was a huge issue among young people, but actually the numbers showed that suicide was a huge issue among young men.
Today there are new messages. And there’s been some recent discussion about high suicide rates in new mums and older mums. It is quite hard to get the media to give a real perspective of the issue, which is whether you’re looking at teenagers or people in their 80s or people in their 50s, it is mainly men.
Focusing on one section of men is unhelpful; we need to look at what the issue is as a whole. Then come again and ask why more men take their lives, and look at some of the theories that are around, because there’s actually very little evidence.
Q: What is your message to nurses who come into contact with these patients?
A: I think that there are two big barriers to tackling male suicide. The first is what we expect men to be, and how we allow them to be. We’ve got a society and a culture, which insists that men should be in control. ‘Real men’ aren’t weak; ‘real men’ don’t need help; ‘real men’ are responsible for people around them. And that makes it very hard for a man to talk – whether he’s 16 or 60.
Most men who take their lives are not in contact with mental health agencies. The problems they’re facing are work, relationships, money, self-esteem, and they’re at the point where they can no longer cope. So, to say to them, ‘Have you got a mental health problem’, or ‘You need to access this help’ may not be terrible meaningful to them.
There is huge stigma about men talking or showing any vulnerability. And that’s what we need to change.
There needs to be that allowance and that lack of judgement. People must stop thinking ‘He’s just being pathetic’. We need to move society away from expecting men to ‘man up’, because that’s just sexist and stops them from getting help.
Men will often exhibit different suicidal signs from women. If men are in a crisis, if they are feeling down they are more likely to get quite angry, to self-medicate, to drink more, to drive dangerously.
A typical suicide that I see is somebody who is very outgoing, who is friends with everyone, who is probably quite talented, has a girlfriend, is probably quite hyper. Then he starts drinking a lot and being a bit excessive. I think many people wouldn’t recognise that person as someone who is likely to take his life.
Q: What should primary care professionals be looking out for?
A: If a guy says to you that he is severely depressed then that ought to ring alarm bells because that is very hard to say. If a man says, ‘I’m feeling suicidal and I don’t know how to cope,’ that should be taken with the utmost seriousness.
But someone who is suicidal is not always going to present in that way. If they do, then that’s great; it means you can start a proper risk assessment.
Often the risk assessments are discounted, because the man is well dressed, or because his problems focus on financial crisis, losing his home or a relationship, instead of depression and anxiety.
We hear from men and their families that they have been sent away on the grounds that ‘This is just a temporary crisis you are going through. It’s a blip, you’ll get another job soon, you’ll meet somebody else, this will pass’.
It’s crucial to take these things seriously and not discount them because they are not a mental health problem.
Mental health problems are not the only reason people take their lives. They might be driven to suicide because they don’t know how to cope when they’ve lost their partner or they’ve been dumped by their first girlfriend.
For a young boy being dumped by his girlfriend and feeling like he is going to fail his exams, that’s his world gone. Is that a mental health problem?
Q: Should nurses always take notice if a male patient brings up a personal crisis?
A: Absolutely. I think the key thing is to sit down and encourage them to talk without shutting down conversations. Tease something out by saying ‘How are you feeling, what’s going through your mind, how long has this been going on?’ and ask lots of open questions. Most of all, if someone says they’re feeling suicidal, don’t panic. Allow them to talk it through. But do a proper risk assessment and make sure you follow through on all of those actions, and try not to make a judgment about that person.
Q: There may only be one chance to intervene with a patient at risk of suicide. What should nurses do at that time?
A: I would try and equip the patient with helplines and resources so they know they’ve got somewhere to go. Emphasise that you, as a nurse, are concerned about them and their safety, and try and talk to them about who they are and if they’ve got a friend they can sit and talk to. Maybe you could contact that person with them to let someone in their life know that this is serious.
Q: What changes would you like to see to services for these patients?
A: I think it’s most frustrating to hear about men being unable to access talking therapies when they need to. Often they are drinking as a result of their mental state but are told ‘You must stop drinking before you can access talking therapy’. I think dual diagnosis can be a real barrier, and clearly there isn’t enough counselling available.
We would love to give access to men’s counselling but it’s hugely expensive and we don’t have the resources. Crisis teams are inadequately funded and too often we see them give out our own helpline number. It’s sending people around in circles and it’s simply tragic.
Also we’re seeing people sent to crisis teams or other commissioned crisis services and they’re pushed back on the grounds that they’re too severely suicidal to deal with. Or else they are not taken seriously enough. One man was told by a crisis service ‘You’ve got a son so clearly you’re not going to take your life’.
Too often, suicide prevention strategies are tokenistic, and there are no teeth to our national suicide prevention strategy. And frighteningly there’s no research on why more men than women take their lives – and that I find very hard to understand.
Q: Without a change in funding what are you hoping to see from healthcare staff?
A: I would like to see an overall change in attitudes towards suicidal men. We also need to adhere to risk assessment policy. What can they do if the queue for getting counselling is months and months? It is very tough, but I think a change in attitude can make a huge difference, as well as following through with at-risk patients.
Q: Are talking therapies good services for addressing men’s needs?
A: We’ve heard from plenty of men that have had access to counselling or talking therapies and found it hugely helpful. One of the concerns we have, though, is the level of access that men have to those therapies and the take-up and reporting. It is mainly women accessing those services and it was mainly women completing them.
I think this is because more women are referred to them. And I think that issues like dual diagnoses quite often and too often prevent men from being able to access and complete these therapies.