More and more countries are reporting declining rates of suicide among men. Does this mean that suicide is no longer the problem it was? Reports from two countries that have seen male suicide levels fall – Scotland and Finland – suggest that for some groups of disadvantaged, isolated men, suicide is just as big a risk as it ever was. Men's health campaigners must be wary of any complacency based on apparently promising headline figures.
SCOTLAND: the suicide rate is significantly higher among men in unskilled occupations
In 2005, there were 763 suicides recorded in Scotland, a decrease of 8.6% on 2004, when there were 835 suicides. This is the lowest number of suicides recorded since 1991 but it is still too early to tell whether or not this is a significant downward trend.
Suicide remains a major concern for men’s health across Scotland. It is a well documented fact that suicide is more common among men, particularly young men and that 3 out of 4 suicides in Scotland are by men.
In October 2005 a study commissioned by the Scottish Executive shows that across Scotland as a whole, male Suicide rates increased by 22% over the period 1989-2004, compared to 6% increase for females. The highest rates among males occurred in the 25-34 year age group, high rates were also evident among males aged 35-54 years.
The study also undertook an area deprivation analysis for the period 1989-1995 and 1996-2002 which showed a clear social gradient during both periods, whereby suicide increased with increasing levels of area deprivation.
The suicide rate was also found to be significantly higher in the V class (unskilled occupation) than in other social classes in all local areas, suggesting that the main influence on suicide rates is at the individual level, rather than the area level.
The findings also showed that male vulnerability to suicide was greater in the more rural and remote areas of the country.
There were differences in the methods used between men and women. The most common methods for men were hanging, drowning, self-poisoning and gassing and the most common method for women was self-poisoning.
Organisations working on recovery and social inclusion are all likely to be contributing to the recent reduction in the suicide rate in Scotland. For its part, Men’s Health Forum Scotland recognise that suicide, in addition to other mental or emotional health problems, continues to be an issue of high significance to men in Scotland, and presents a real challenge to policy makers and services providers.
Men’s Health Forum Scotland will:
- Work to raise the profile of suicide amongst men and agencies in Scotland
- Continue to work in partnership with service providers and specialist agencies to tackle the significant and disproportionate rates of suicide in Scottish men
- Explore new partnership opportunities to help identify work that addresses the social inequalities that contribute to higher rates of suicide among certain groups of men
Maureen Dunn,
Men's Health Forum Scotland
FINLAND: Research indicates pre-existing mental health disorders in 93% of suicides
In Finland, the incidence of suicide has been on the decrease for several years. Statistically, the primary causes of death amongst working-aged men are alcohol related. In second place, the cause of death is coronary artery disease, followed by fatal accidents, and in fourth place suicide. In 2005, in Finland, 724 men committed suicide. The majority of suicides were amongst men in the 20-59 year age group. The most common method of suicide used by men was, and still is, hanging, followed by medicinal products and third came shooting.
Research results indicate that mental health disorders pre-existed in 93% of suicide cases. The most common mental health disorder was depression; other disorders were alcohol addiction and personality disorders. Often, men had suffered from long-term untreated depression combined with the excessive use of alcohol.
It is apparent that suicidal young men (15-24 year age group) are more the victims than they are the protagonists. In their cases, the processes that lead to suicide were often long-term, and firmly connected to family related factors. Often, behind a suicide, a model for suicide is found amongst relatives. The manner in which problems are solved – ie with suicide - are handed down from generation to the next.
Depression is also the most common mental health problem of Finland’s youth. The concealment of self destructive tendencies from family is specifically a characteristic of young suicides. It is only discussed amongst friends. Adults, on the other hand, discussed their suicidal thoughts more widely. Characteristically, young men have little use for health services and outsider aid, in general. It is difficult for adults to meet the needs of the young. Disagreements connected to human relationships are often triggers for the young.
The operations and services of the Finnish Association for Mental Health attempt to prevent suicide in Finland. The Association together with local associations, maintains 17 crisis or SOS centres.
The SOS or crisis centres offer aid by telephone and the internet. Crisis workers travelling in the SOS Car, meet customers at their homes, at emergency rooms, outside, etc. There is a 24 hour service in Helsinki and Tuusula. There are personal meetings with crisis workers, professionally guided group therapy for those who have attempted suicide and "recovery from crises" rehabilitation courses for the relatives of suicides.
Group therapy and rehabilitation courses are also arranged for children and young people. Their objectives are to deal with sorrow and loss. The ultimate aim is to break the pattern of the suicide model that is handed down from one generation to the next in crisis situations. This work has been going on for 37 years.
These operations are funded by RAY (Finland’s Slot Machine Association) and the municipalities where the crisis centres are located.
Seven principles have been developed to decrease the incidence of suicide in Finland:
- Every suicide attempt should receive as effective assistance as possible. Thoughts of self destruction and attempted suicides are the best premonitory indicators of the risk of suicide. The path to suicide should be recognised and stopped at that stage.
- Depression should be recognised and the necessary support should be offered. Everyone suffering from depression should receive effective and multifaceted care. There are effective means of treatment for depression, but the problem lies in its deficient diagnosis and insufficient care.
- The use of alcohol as a solution to life’s problems should be avoided, and instead better coping methods should be acquired. Alcohol problems require appropriate treatment. The early identification of problems improve the prognosis. The reduction in alcohol usage on population level, reduces the likelihood of the long-term adverse effects of alcohol, and also reduces the incidence of suicide.
- Mental and social support should be added to the treatment conventions of physical diseases. Adjusting to protracted and/or severe illness is difficult for many people, especially for men who have passed middle-age. Many patients are left too alone with their illness, and without sufficient support.
- During life crises, people should get support from their close ones, and when necessary from professionals. Often, suicide is preceded by a demanding incident or a change in life that requires significant adjustment. In such cases, a small but well-timed support action could thwart a suicide.
- The process of marginalisation of young men should be impeded, and the opportunity to develop coping skills and feelings of self worth should be assured. Young men especially experience the changes that occur in our society, particularly those who are most likely to compete and experience failure.
- The reduction of judgementalism, stigmatization and punishment, and the increase of people’s faith in life, bravery, self-respect, enterprise and mutual support would most likely reduce the incidence of suicide. A generally positive and hopeful atmosphere reduces suicides, while attitudes of negativity and hopelessness more than likely have the opposite effect.
Tapio Moilasheimo
Finnish Association for Mental Health
