Public Health Agency: Using Young Men's Experiences To Inform Mental Health Services

"Part of providing pro-active, community level service provision should be embedded in manifestly non 'mental health' contexts..."

The trend of male suicides in Northern Ireland follows a pattern that is consistent with that has been experienced in Australia.  Suicide rates remained relatively static in the first half of the 20th Century but increased significantly thereafter.  In Northern Ireland, suicides increased by 64% between 1999 and 2008, accounted largely by increases in suicides among males in the 15-34 age group. In 2008, almost 77% of suicides were by males.

This paper set out to uncover the experiences of males aged 16-34 of being suicidal and what measures would amount to 'effective care', and uncover the specific processes in caring that would make a difference to suicidal males. These are important questions that follow the recommended approach towards balancing why men consider or take suicidal actions and what health services can do to orient themselves to better manage this situation.

How can mental health care services be most appropriately configured to encourage their use by suicidal men aged 16-34?

• Suicide related services need to reach out to young men pro-actively. These services should be community based and open-access.
• Part of this pro-active, community level service provision should be embedded in manifestly non ‘mental health’ contexts. These include sports clubs, schools, the workplace and community interest/self-help groups.
• Services, particularly those based in the community, need to be advertised more widely and in ways which reach out to young men. A range of media should be used to promote access and provide culturally relevant care, including media which have become a regular means of communication amongst young people.
• Services should be premised on an acknowledgment of the need for support to be provided to young men over the long-term so that they are to be enabled to move forward with their lives in a positive manner once the initial risk of suicide has been removed.
• Novel forms of suicide prevention outreach work should include those media that have become a regular means of communication among young people. This includes social networking systems, the Internet, ‘text messaging’ and/or email.
• Services must continue to address the concerns of young men about issues of stigma and confidentiality regarding the care and treatment of suicidality. Some issues around signposting and labeling of suicide prevention services should be addressed immediately.
• Care should be based on a broad Recovery approach. The need to skill and support young men operates at both an individual and societal level and a fundamental part of this must involve creating an appropriate environment to promote participation and social inclusion of young suicidal men generally.
• Irrespective of the particular form of care/service provision, help and support needs to be delivered by those appropriately skilled and resourced.

What is the required response of mental health care services for suicidal men, aged 16-34?

• It is essential that health care professionals care for young suicidal men in ways which respond to their basic emotional and interpersonal needs. It should be ensured that health professionals possess and convey therapeutic and supportive (non-judgemental) attitudes and realise the important bonding role they have in enabling young men to reconnect with humanity.
• Health care professionals should appreciate that their demeanour and attitude is crucial to a young man’s sense of meaningful therapeutic engagement. Effective care is as much about how a young man perceives the relationship between himself and professional carer as it is about the ‘technical’ components of care.
• Care should be premised on an explicit acknowledgement of a young man as a human being with a unique personal biography.
• It should be ensured that treatment and care is relevant to recovery and onward trajectory through life if it is to be perceived as effective by young men. As part of this sense of ‘moving forward’, care should include help and support to develop a realistic appreciation of the (personal) possibilities that life offers as well as the skills to pursue these possibilities once envisaged.
• People with experience of suicide should be involved in care delivery and support. Hearing first-hand about these experiences serves as a powerful disincentive to suicide and learning about lives built successfully thereafter can act as an incentive for/basis of personal growth and development.
• Psychological therapies need to be made available as part of routine care, particularly those that equip young men with fundamental cognitive resources, including coping strategies (e.g. for dealing with stress, anxiety and disappointment) as well as other dimensions of mental/emotional well-being such as, for example, self-esteem.
• Maximising access must include taking steps to address the major challenges posed by stigma and discrimination, including comprehensive, population-level advertising and awareness raising campaigns as well as more targeted educational and workplace initiatives.
• Care should be premised on a Recovery rather than a ‘risk reduction’ approach.
• Additional education/training needs to be provided to health care professionals in order to support the provision of relevant care to young suicidal men.