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The silent epidemic of male suicide
By Dan Bell
BBC News

Whatever the individual reasons that drive people to suicide, the one thing that puts you most at risk is being a man under the age of 35.

Of the 13 people who killed themselves in South Wales over the past year, all but one were men aged under 27.

John Hogan, the father who threw himself off a hotel balcony in Greece, was aged 32. When his two brothers Stephen and Paul killed themselves, they were aged 17 and 35.

Suicide is the second most common way for a man between the ages of 15 and 34 to die. It is outstripped, only just, by road deaths.

Suicide 'epidemic'
About 900 young men take their own lives each year, and they account for about 75% of all suicides in this age group.

"You've had what is effectively an epidemic of young male suicide," says the National Director for Mental Health in England, Professor Louis Appleby. Between 1970 and 1998, the rate more than doubled. At its peak, five men were dying for every woman.

Yet according to Prof Appleby, less than 20% of young men who commit suicide have had any contact with either their GP or mental health services in the previous year. Quite simply, he says, "they don't seek help when they have problems."

If suicide is the second most serious public health issue for young men, why don't we know about it?

According to Jane Powell, coordinator of the Campaign Against Living Miserably (CALM), the only national organisation that specifically reaches out to young men at risk of suicide, it is because no-one wants to know.

With endless headlines about Asbos, knife crime and guns, she says, "It's just a very tricky thought that young men might need care and attention, because they are very often seen as the cause of the problems."

In 2002 the National Institute for Mental Health in England (NIHME) launched the first National Suicide Prevention Strategy (NSPS). Its goal is to bring about a 20% reduction in suicides by 2010, and young male suicide is touted as top of the agenda.

One of the first tasks of the NSPS was a review of studies on what works and what does not when it comes to preventing young men from killing themselves.

"Historically it has not been the top of people's agendas," says Angela Harden, co-author of the report.

The NSPS discovered that not only are young men less likely to seek help, they also need a different kind of help. "[Young men] often don't conceptualise their problems as problems of a medical kind," says Prof Louis Appleby.

"I don't think we can expect young men's suicide rates to come down dramatically just by providing mental health services. There has to be a partnership with agencies that men go to and trust."

The NSPS has taken some important steps, and the number of male suicides has recently shown a steady decline.

The prison service is introducing anti-ligature furniture to prisons across the country, and there has been a significant fall in in-patient suicides due to the removal of non-collapsible curtain and shower rails from psychiatric wards.

Jane Powell says removing the means by which men kill themselves is only a plaster on the wound. The real question is why so few men seek help in the first place.

A huge factor is the pressure on men not to show any weakness, she believes.

"The one thing that they are supposed to still be is strong and silent," she says, "and if you are going to be silent, then of course you are not going to take any action over the problems that face you, and if that's the case it's just going to get worse."

It is perhaps telling that pundits lauded Casino Royale for showing a new sensitive, vulnerable Bond, even though the film contains an extended torture scene during which the hero has to fire off hard-bitten one-liners to show how tough he is.

According to Dan Kindlon, a Harvard lecturer, and co-author of Raising Cain: Protecting the Emotional Life of Boys, young men don't ask for help because we don't allow them to.

Even from early childhood the emotional 'steering' that boys and girls get is different.

Parents encourage boys more than girls to 'tough it out' if they fall over, or suffer a disappointment, he says, and they unconsciously encourage emotional conversations with their daughters, but discourage them with their sons.

By the time he reaches school, these patterns have not only become more entrenched, but more brutal as well. "In school a boy who shows a more effeminate side, or cries, or expresses his feelings, he's open to a lot of ridicule and teasing," says Kindlon. "Especially at these vulnerable ages when we see a lot of suicides."

Alone and adrift
And it's a vicious circle: the less a young man shows his feelings, the less anyone sees he has any. "Because boys have been taught to not show their emotion," says Kindlon, "too often we don't know there is a problem until they do something that is fatal, and people need to do more to notice sooner."

There are two main groups of young men who kill themselves, says Professor Appleby. There are those with severe mental illness, and those who are defined by "a set of social facts that mean they have lost their ties to society, work, family and friends." In other words, they have come adrift in their own lives.

All of this resonates with a fact about suicide that was discovered over a hundred years ago by the founding father of sociology, Emile Durkheim.

Durkheim established that the rate of suicide in different countries remained stable over time, and at different levels, despite the fact that it was different people killing themselves for different reasons.

His conclusion was, that it wasn't the overall degree of despair in society that determined its suicide rate, but how effective the society was in creating ties between the people within it.

With this in mind, it is worth mentioning another two statistics: men make up 73% of people who go missing each year, and 85% of people who sleep rough.
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