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More men kill themselves than die in car crashes. According to the Office of National Statistics, 34 per cent of the 16,569 accidental and violent deaths in 2001 were as a result of male suicide. Road accidents accounted for 22 per cent of men's deaths. Among women, half of all accidental and violent deaths were as a result of falls and 19 per cent were suicide.¹

Suicide by younger men has long been a concern. The National Strategy for Suicide Prevention for England, published last autumn, aims to reduce the number of suicides by at least 20 per cent by 2010. It also contains a target to reduce the number of young men killing themselves. But it is not just young men who are ending their lives: more older men are, too.

There are complex and varied reasons why more men than women kill themselves. They include being more socially isolated and at risk of an emotional breakdown, the belief by some men that poor mental health only affects women, and the overall socialisation of men to think that seeking help "is shameful".

Men tend to use more violent methods than women to kill themselves and therefore are more likely to be successful on the first attempt. The figures found that hanging, strangulation and suffocation were the most common (44 per cent) methods of male suicides.

John Roberts, a social worker with male clients at the Leicester branch of the Family Service Units charity, believes social and health care professionals are just starting to realise the scale of the problem.

"There are large numbers of men succeeding in killing themselves who professionals have not reached," he says.

Although professionals take the threat of suicide by young men seriously, they still struggle to engage and communicate with older men: "Staff may not pick up that their client is in a crisis because he presents himself as being in control."

Roberts has spoken openly to one of his clients about the man's suicidal feelings, but even when male clients are willing to broach the subject, it does not mean they will not attempt it, he warns.

The Maytree Respite Centre in north London has provided six emergency beds for adults at risk of suicide since December last year. Clients self-refer or are referred by voluntary or statutory agencies or families and friends. They can stay at the centre for four nights, but only once. After an assessment, clients can take advantage of the centre's befriending service and they may be referred on to other services.

Some clients, says Maytree chairperson Michael Knight, may feel suicidal on impulse and this makes it particularly difficult to reach men who are not in contact with social or health care services. He says: "If someone is suicidal they can become withdrawn and the willingness to outwardly express their feelings is limited."

This point is elaborated by Jo Robinson, senior project manager of the national confidential inquiry into suicide and homicide by people with mental illness at Manchester University's centre for suicide prevention.

The inquiry found that, between April 1996 and March 2000, 16,697 men committed suicide compared with 5,451 women. Of these men, 20 per cent were in contact with psychiatric services compared with 31 per cent of women.

The average age for men was 39 and they were less likely to be married, more likely to be unemployed and living alone than women who killed themselves.

Robinson says: "These men are possibly harder to keep engaged [with services], particularly due to the behavioural features associated with this group such as drug and alcohol misuse along with violent behaviour." Such behaviour can result in men being excluded from a service or falling between two services.

Too few existing support services for those feeling suicidal meet men's needs, says Andrew McCulloch, chief executive of the Mental Health Foundation. "A lot of services feel comfortable dealing with women in distress because they may break down and cry but men are more likely to flip and do something that is labelled antisocial."

Roberts agrees that some professionals are not comfortable responding to men. "We use language to identify feelings, but this is an anathema to many men who prefer to operate on a factual level."


A Department of Health suicide prevention officer says suicidal men may miss out on accessing appropriate help because of where services are based. He says: "Many men don't use health services or mental health services and some GP surgeries can be oriented towards women."

This month the government is inviting expressions of interest from voluntary and statutory sector young men's organisations to establish three young men's mental health promotion projects.

The DoH officer adds: "We want the pilots to raise awareness of mental well-being and coping skills to deal with distress." He expects the pilots to start in January 2004 and, depending on their success, future projects may be created for men of all ages.

He advocates trying to reach men by putting posters and helpline information in places such as job centres, leisure centres and football clubs. He also wants health and social care staff who work with male clients to be trained to conduct risk assessments.

Roberts says services could be made more accessible to men by ensuring an appropriate physical environment. "In agencies' waiting rooms the pictures on the walls are all of women and children and all the magazines are for women," he says. "We need to create a gender-neutral environment to make men feel they can access it."

McCulloch adds: "We have a huge army of troubled men out there and we are not addressing their needs. We need to ask how we are going to modify our services to deal with that distress."

¹ Mortality Statistics 2001, Injury and Poisoning, England and Wales, Office of National Statistics, 2003

'Express ticket to hell'

Joseph Briggs (not his real name) suffered a "complete breakdown because my family life was hell" during his A-levels. Now 28, he first attempted suicide when he was 18. He was at university and not enjoying his environmental course. He felt no one liked him, he did not get on with his flatmates and found his family unsupportive.  

He spoke to a counsellor who made him feel even worse. A few days later, he took 122 painkiller tablets and went to sleep.  

"I thought it would be over soon but I woke up a few hours later with terrible stomach pains and threw up everywhere," Briggs recalls.  

He vomited blood because the aspirin had caused his stomach to bleed. Eight hours later he called an ambulance and was rushed to hospital. The doctor said he could have suffered kidney and liver failure because of the high level of paracetamol and aspirin in the tablets. Briggs spent the next week in hospital before his father took him home.  

"My mother was upset about it but no one ever said anything useful or helpful to me," he says. His parents sent him back to university seven days later and he says everyone regarded things as "business as usual".  He gave up on college and his parents let him move home. He took a "string of overdoses which were half-hearted" before moving into his own flat when he was 22. He decided that he wanted to see whether he could live without attempting suicide and became a practising Christian.  

"I now believe that suicide is the express ticket to hell," he says.  He receives regular support from a Mental Health Foundation project and is keen to come off income support and find a job. He says suicidal men can be helped by social care staff befriending them and offering practical support.