LIFE News issue 7

Comment - men and suicide in Australia 

Men are four times more likely to die from suicide than women; rates are highest in the 25 to 44-year-old males and in elderly men. The rates are escalating in Aboriginal young men: in the age group of 15 to 24 years suicide is the second commonest cause of death and in the age group of 25 to 44 years suicide is the commonest cause of death.

The following is a true story; the location has been changed to protect anonymity.

An ex-police officer visited the clinic in South West Sydney. He had been invalided out of the service because of Post Traumatic Stress Disorder. He wept about his marriage and the loss of his wife and three children. "Doctor, I feel like ' topping myself'; but I won't," he said. He worked in the police rescue unit where he dealt with severe injuries and fatalities. The team would retire to the pub to debrief and unburden at the end of a shift. The last straw for him was when called to a fatally injured small girl. “She was the same age as my god-daughter.”

He had been assaulted many times in the course of duty. There were two long periods in hospital; one for spinal cord paralysis when knocked down during Random Breath Testing and the other for internal and renal injuries from a gang assault. He needs strong pain medicines for persistent pain. "I should have years ahead, doc - I am sick of being treated as a ' druggie'; what else can I do?"

This one man encapsulates the risks for male suicide: age group 25 to 44 years, exposure to trauma and stress, post traumatic stress disorder, alcohol to "blot out" feelings, depression, chronic unremitting pain, incapacity for work, substance use, loss of spouse and family, marginalisation and being stigmatised by the health professions. Such patterns are common. He will get through; life has been a struggle and he is not about to give up now and, importantly, he has a supportive general practitioner.

The Australian Suicide Prevention Advisory Council's (ASPAC) submission to the consultation on Men’s Health deals with these areas and others.

There is the health and social agenda: the way male roles are modelled and portrayed, bravado in the face of distress and inappropriate use of alcohol. ASPAC argued that sporting clubs, recreational clubs and other organisations should be more tuned to the mental health risks of men and, more to the point, realise that they can construct more supportive social networks and lessen harmful practices such as the excessive consumption of alcohol.

The ability to participate and contribute is fundamental to a person’s social role. In some Indigenous communities, males have no role or social identity. Work and work roles give meaning to the lives of most men; thus to lose a job, or to become alienated at work, say from a work injury, can undermine and invalidate a person’s esteem and sense of worth. These predicaments, often combined with other health problems, lessen well-being and increase the risk of suicide.

As the Primary Health Care Strategy and the National Health and Hospitals Reform Commission reports are implemented, there is a renewed focus on community-based services closer to where people live and work. For men at work it is difficult to access GPs and other services, so the adequacy of primary health care (PHC) will be tested by the accessibility of these services to men. Front-line contact is critical for the early detection of distress and suicide risk in men and to be able to link them to mental health, to other interventions and into the “chain of care”. This affects where services are located, their times of operation and acceptability of their approach to men.

A key part of ASPAC’s thinking is that suicide prevention should be intrinsic to all health services - from Emergency Departments to specialist clinics - and should not be left solely to the mental health services; they simply can’t deal with such a load.

Men, more commonly than women, are involved in the criminal justice system. Forty percent of male prisoners in NSW prisons have a mental health disorder or a cognitive disability. Two in three prisoners at the time of reception have a 12 month diagnosis of a substance disorder, and, in the 12 months prior to imprisonment, one in 20 has attempted suicide. Indigenous males are massively over-represented in the justice system. This data points to the need for mental health and suicide prevention programmes in the justice system. This is starting to happen in some jurisdictions. The Family Court has taken steps to increase the awareness at all levels of the court’s operation to the risks of suicide and the referral pathways to care.

A neglected factor in men is the link of suicide to incapacity and depression from injury and illness. Unremitting pain has a strong link to suicide. In elderly men unrecognised depression, chronic pain and social isolation (often all three) increases the risks of suicide. These risks are of great importance in providing general health care, pain management and in geriatric care.

The pathways to male suicide starts in boys; thus the development and education of boys must be given high priority. The suicide prevention programs in schools - Mind Matters and Kids Matters - are designed to engage with young people in school settings and aim to connect with boys.

There are evolving issues. Information and communication technologies have potential for good but also carry risks. These developments can support and provide relationships for men and boys where none exist. There is potential for online social networking, SMS messaging, blogs and internet forums to help maintain mental health and lessen suicide risks in men. As the immediate future unfolds, there are expanding roles for telephone and web-counselling to reach men and boys who might be outside normal social networks.

There is much to do to prevent suicide in men, and the Men’s’ Health Strategy will have much to contribute.

MensLine Australia – encouraging men to talk

By LIFE Communications

‘What we deal with is aspects of relationships – from people wanting to get into relationships through to people in relationships and the separation process,’ says Randal Newton-John, a MensLine Australia Team Leader. ‘The majority of our callers are from people who are going through some form of separation and we aspire to help men through that process.’

Callers to MensLine Australia are encouraged to discuss issues regarding any kind of relationship including intimate relationships, work relationships, friendships and relationships with their children. The majority of callers are aged 25 to 45, a large portion of which live in rural and remote locations.

MensLine Australia doesn’t just provide assistance to men: approximately one in ten callers are women seeking advice, usually in relation to fathers, brothers and partners. In addition to live phone counselling the project also offers a wide set of resources available on its website, telegroup counselling sessions and two call back services: one for general relationship issues and another specifically related to anger management.

Newton-John says suicide prevention is a large part of MensLine Australia’s work.

‘It’s well known that relationship breakdowns are a major influence for people attempting suicide,’ he explains.

‘Research suggests there is a pattern for men to in a sense put all their emotional eggs in one basket. In the other words they treat their one relationship as their primary support and when that goes they may find themselves emotionally cut off, and this can lead to a greater risk of suicide.’

MensLine Australia counsellors have degrees in psychology, social work or counselling. They undertake a two year training course which consists of 15 modules addressing various aspects of counselling surrounding men and major issues such as suicide risk assessment, family violence and the workplace.

Later this year MensLine Australia, in partnership with the Cancer Council of Victoria, will implement a new telephone support group service for men with prostate cancer, each group comprising 6-10 participants and two facilitators.

Family violence is an ongoing concern and finding ways to engage men around the issue is a challenge that led to the development of the anger management call back service, which began in February 2009. Other recent initiatives include Bushfire EAR, a counselling and referral service for people affected by the Victorian bushfires.

Another major ongoing challenge for MensLine Australia concerns emerging technology. As the internet continues to grow and people of increasingly diverse age brackets become more comfortable using online services, MensLine Australia must find new ways to keep up with the demand for online innovations. This led to the launch of a redeveloped MensLine Australia website in mid-July, which includes the addition of discussion forums, a document library, a services database and the ability for website users to request a call from a counsellor. 

‘People can go online and request a call and we will respond to that. This gives them the chance to be able to take some control over the process,’ says Newton-John.

‘We tend to see men who respond primarily in crisis. It would be much better for the community’s health if we could deal with things before they got to that stage.’

Dads in Distress - men on a journey

By LIFE Communications

Dads in Distress (DIDs) is a national network of peer support groups for men who are experiencing difficulties in dealing with divorce, separation, depression, access to the children, family court or simply need someone to talk to. The organisation’s primary aim is to stem the trend of male suicide due to the trauma of divorce or separation. 

'We speak with men when they’ve gone through a divorce, a separation, lost their kids, lost their house or lost their job,’ says DIDs founder Tony Miller. ‘We see these guys when they are at the end of the scale and we try to gear them up to survive. We supply a safe place for these guys to come and share how they’re feeling and vent if they need to.’

Miller founded Dads in Distress in Coffs Harbor, NSW, in the late 90s after going through a painful divorce. He wrote a short story about how he was feeling which was published in a local newspaper and included information about an informal meeting organised and attended by men, with the intention of encouraging a dialogue between them. The response was quick and high impact.

‘We were inundated from day one,’ says Miller. ‘I had no idea what we were going to do, what we were going to talk about or what was going to happen. On the first night we had a guy turn up who knew a little about facilitation - at the time I didn’t even know what it meant - and he stood up and basically facilitated a group that night and from that point we developed a suitable program to assist men.’

Participants are referred to DIDs groups from a variety of sources including service providers, the Child Support Agency, the Family Relationships Centre and projects such as MensLine Australia and InterRelate. As a peer support group, DIDs do not profess to be experts and group facilitators are not supposed to give advice. Men are encouraged to talk about their feelings using a rock - like a ‘talking stick’ - which is passed from person to person so nobody interrupts or speaks out of turn.

‘The rock is very very effective - surprisingly so,’ says Miller. ‘The idea of the rock is simply that it takes the focus off. Often the men look at it and rub it with their fingers when they’re talking so they’re not concentrating on anybody else in the room…Sometimes the guys just pass it along and they won’t share but eventually they do, and it’s surprising how much comes out.

‘We are no threat to any organisation or practice, we simply support a bloke going through a hard time and point him in the direction of where suitable help can be found,’ says Miller.

DID stipulates no firm criteria for participation: any man is eligible to attend a support group, each consisting of around 6-10 men. Presently there are around 35 DIDs groups across Australia, all of which have their own facilitators. The majority are located in Victoria. While everybody is encouraged to talk in the support groups, it is not a prerequisite to do so.

‘We try to give men a sense of understanding that whatever they are going through they are not the only person in that boat,’ says Miller. ‘We encourage them to acknowledge that there are others who have been through similar experiences and come out the other end.

‘Our motto rings true at every meeting. There are three sides to every story: his, hers and the truth. Somewhere on the journey we come to that truth.’

• Visit the Dads in Distress website.
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Grow a mo’ in Movember to support beyondblue and men’s health

By beyondblue: the national depression initiative

On average, one in eight men will experience depression at some time in their lives and less than half seek help. If left untreated, depression can be a risk factor for suicide.

Movember, the month formerly known as November, is a time of the year in which men in Australia engage in valuable fundraising opportunities to improve the health of men around the country through research projects and health programs.

For four weeks men are encouraged to throw away their razors and grow the best moustache possible. One of the wonderful things about Movember is girlfriends, partners (or mothers!) can’t complain about fuzzy face because it’s for a very worthy cause.

Men who participate in Movember, known as ‘Mo Bros’, are asked to recruit sponsors who donate money to support the growing of the mo’. This year The Movember Foundation has again partnered with beyondblue: the national depression initiative and with the Prostate Cancer Foundation of Australia (PCFA). Funds raised during Movember will help beyondblue increase awareness of depression and anxiety disorders in men and encourage men to talk about mental health problems and seek treatment.

While men have lower rates of depression than women, they don’t seek help as often and are more likely to self-medicate with alcohol or drugs. Over 70 per cent of men with a mental illness don’t access services.

Through the amazing efforts of the Mo Bros and Sistas and the generosity of the Australian public, The Movember Foundation has donated more than $6 million to beyondblue from the 2007 campaign alone.

beyondblue uses Movember funds to: 

• continue research into the link between men’s cancers (testicular and prostate) and depression;
• fund  the beyondblue information line - a national depression and related disorders information and referral service 1300 22 4636; 
• support transport drivers and their families;
• support the Don’t beat about the bush! campaign which raises awareness of depression/anxiety and related disorders in rural communities; and
• fund the Men’s Sheds and Indigenous Men’s Sheds projects - spaces where men can spend time together and learn how to look after their health.

Each year in Australia, close to 3,000 men die of prostate cancer - equal to the number of women who die from breast cancer. Around 18,700 new cases are of prostate cancer are diagnosed in Australian every year.

Research carried out by beyondblue over the past few years has shown a strong link between cancer and depression.

Men with prostate cancer report higher levels of depression than the general community however, the rate of depression and anxiety in their partners is even greater - more than double the normal rate for the Australian community.

It’s for this reason that beyondblue has used Movember funds to create a new comprehensive booklet Maintaining your well-being: Information on depression and anxiety for men with prostate cancer and their partners.

It is easy to register for Movember. Log on to www.movember.com and click on ‘Register’ or call 1300 4769 66 (local call cost from a landline). 

• Visit the Movember website.
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Did you know?

TOMNet – assisting older men in Toowoomba and South-West Queensland

By LIFE Communications

 
Open Doors - a safe place for LGBT youth

Did you know?

A Model for Rural Men’s Health Promotion

By Peter Strange
Men’s Health Nurse Practitioner
Bendigo Community Health Services

Bendigo Community Health Services (BCHS) has developed a successful model of practice that enables rural men to achieve and sustain a higher standard of health. The model has been developed over the past seven years and has grown from clinical evaluation, community consultation and consideration of other men’s health models of practice. It is an exciting time at present as men’s health gains notoriety and acceptance as an important entity in its own right.

The development and implementation of a community based men’s health program in the regional city of Bendigo in central Victoria provides a valuable insight into the needs of men, and supports gender specific priorities. The model was developed using a triangulated approach to bring together community health promotion and workplace health promotion initiatives tailored to the needs of men, and support the establishment and ongoing needs of a male friendly health clinic.

An integral part of the model sees an annual Men Health Week convened each September. It is now in its 8th year. This year the organizing committee decided to focus a little more on the important mental health aspects associated with men’s health. The 2009 theme was ‘Look out for your mates’.

We all know the stereotypes about men neglecting their health and being poor communicators but we feel that things are changing. Blokes are getting better at tackling issues and subjects that would have been left well alone in days gone by. But that doesn’t mean there isn’t room for improvement! Yes, it can be a bit awkward or feel uncomfortable to genuinely enquire about a friend’s health – particularly their emotional state – but to ask how a mate is really travelling could be the most valuable thing you’ll ever do for him. When it comes to personal property we are happy to keep an eye on our neighbour’s backyards for them – so is it such a stretch to suggest that we look out for signs that a mate might be struggling in his personal life?

One of this year’s special guests knew how it felt to fall into a black hole then begin the climb back again. Nathan Thompson was an elite performer in the AFL, an accomplished media performer and viewed as a leader at his club. If blokes like Nathan needed a helping hand to get back on top of things none of us should really consider ourselves armour plated or immune.

The week’s events included:

• a free family day and concert in Rosalind Park;
• Dads Day Out, which sought to reinforce the positive role fathers play in their families and communities;
• Wednesday breakfast sessions featuring Nathan Thompson;
• a health expo;
• a delicious healthy BBQ hosted by Bendigo Rotarians; 
• a ‘Mens in Sheds’ open day;
• a ‘Men’s Health Evening’ at the Capitol Theatre;
• a Bowel Cancer Public Information Evening;
• a public bike ride hosted by the Bendigo Cycling Network; and
• free Health screenings at BUFS Pharmacies.

The BCHS Men’s Health program has received a great deal of positive feedback. The growing number of male participants who access services through the program evidences that many aspects of the model align with, and respond to the needs of the majority of men in this rural region. With the current heightened awareness about men’s health throughout the nation there is an inherent need and demand for men’s health workers.

The Men’s Health Clinic was designed from the onset to be male friendly and includes an extended consultation time that allows for a thorough assessment with time for questions, discussion and up to date health education.

Many men have questions that need to be answered, and that takes time.

Many men don’t know what questions to ask, so we ask them and prompt discussion.

Many men may consider a complete health check-up but don’t know what that involves.

At the Men’s Health Clinic men receive a full men’s health check up that includes both mental and physical assessment. The check up is based on the decades of life. Men require different health assessments at different stages of their life. A man in his 30s or 40s requires a different assessment than a man in his 60s and 70s.

Our experience shows that men are interested in their health and will engage in positive health practices if they are encouraged to do so and are in an environment which supports these positive health practices.

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Foundation 49: a holistic approach to men’s health

By Foundation 49

Foundation 49 is a men’s health initiative of Cabrini Health. It takes a holistic approach that focuses on making health information more accessible to men of all ages. This is achieved through targeted activities and resources, such as health checks within the workplace and at public events such as conferences and sporting events. To reach a broader market, health information fact sheets have been translated into eight languages, which are freely available on the Foundation’s website. (insert link)

The vision of Foundation 49 is to reduce the number of men dying from preventable diseases through raising awareness of men’s health issues, and encouraging men to have an annual health check.

Overall, Foundation 49 focuses on wellness and encourages men to be proactive about their health. Foundation 49 does this because each hour more than five Australian men die prematurely from potentially preventable diseases.

Current Foundation 9 programs include:

• workplace and community based health checks – taking healthcare to men;
• community grants to support men’s health awareness; 
• comprehensive and interactive website www.49.com.au; 
• resource development; 
• translation of resources; 
• free men’s health magazine – A Whole New Ball Game; and
• research.

One of Foundation 49’s more recent (and successful) innovations has been the development of online health surveys. A survey, sent to 500 men, received 2,064 responses as men passed the survey on to male friends and family. This was an overwhelming response, and 1600 men agreed to become an online consumer reference group.

From the responses we learned that: 

• 82% would have a health check if it was available at work;
• 26% of men don’t talk to family and friends about their health;
• 41% of men had a family history of disease or early death;
• 73% of respondents talk about their health with their family and friends, mainly at social gatherings, family functions and work (funerals also acted as a prompt for some to talk about their health); and
• key things that would encourage men to have a regular health check are having a good doctor, staying healthy for their partner and children and being able to have checks on weekends.

The tide is turning for men’s health in Australia. There is significant and growing interest in men and their health outcomes at a state and national level. The Federal Government has recently committed to developing a men’s health policy, and Foundation 49 submitted documents to inform this policy. Foundation 49 completed a submission for the Senate Select Committee on Men’s Health, and Associate Professor Gary Richardson (Chair of F49) was asked to present to the Committee. He was also invited to participate in a men’s health stakeholder forum in Canberra, by the Health Minister Nicola Roxon. Through these and other local and interstate opportunities, Foundation 49 is making a difference in men’s health in Australia.

• Visit the Foundation 49 website.
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Suicide and men mini-literature review

By LIFE Communications

This mini-literature review presents some recent research on suicide and men. Men are at significantly greater risk of completing suicide than women, both internationally (World Health Organization, 2009) and within Australia, with over three-quarters of suicide completions being male in 2007 (Australian Bureau of Statistics, 2009).

The recent research presented here suggests that there are some specific situations and variables which distinguish between men and women who complete suicide.

For instance, an Australian study (Kariminia et al., 2007) found that men were four times more likely to complete suicide during the first two weeks following release from prison than any other time during the six months following release. This trend was not present for women, who had no significant increase during this six month period. Likewise, the elevated risk lasted many more weeks for men aged over 35 years whereas this pattern did not emerge for women from older age groups. The authors posit that reasons for the difference between the trend for male and female suicide risk post-release include that women appear to be less socially isolated, have greater social support and better coping skills (Hayes, 2006; Fazel, Bains, Doll, 2006; Maris, 2002; Maris et al., 1992; as cited in Kariminia and colleagues, 2007).

According to a study conducted in Canada (Desaulniers & Daigle, 2008) the attitude men hold towards the expression of emotional pain could influence the rate of suicide. Those regions where men were found to hold a negative attitude towards expressing emotional pain were likely to have a higher male suicide rate. They were also more likely to have a lower level of education. Conversely, those men who held a more positive attitude towards the expression of emotional pain came from regions that had a higher divorce/separation rate. The authors suggest that this may be a consequence of realising that such expression is important once they have experienced a relationship breakdown (Desaulniers & Daigle, 2008). Taken together, one of the conclusions from the above cited papers suggests that men who are better able to draw on social supports and talk to people about how they are feeling are less likely to complete suicide.

Another pattern of suicide completion that was only present for men is the discrepancy between the rate of suicide between rural and remote and urban regions of Australia. A discrepancy was only evident for men (Kapusta et al., 2008); men in rural and remote regions were found to be at greater risk of completing suicide than their urban counterparts.

Another variable that may contribute to suicide risk for men is the severity of major depression. A long-term Swedish population study (Brådvik et al., 2008) found that 20% of men who had severe depression were likely to have completed suicide during the years that the study had been running (1947-1997).

A qualitative assessment (Clarke, van Amerom, 2008) of the content blogs (i.e. online journal or newsletter) written by men and women who referred consistently to depression found that 37.5% discussed self-harm (including cutting and suicide) whilst 7% of women had made such references. One of the men described his suicide attempt in great detail.

One more detailed qualitative study (Barnes, Lawal-Solarin, & Lester, 2007) is that of 23 letters written to a friend by a young man over a two year period. By the end of this two year period the author of the letters completed suicide aged 20 years old. The types of emotion words (positive/negative) and proportion of death-related words were included in the linguistic analysis. They found that the proportion of negative emotion words reduced during this period whilst the use of death-related words increased.

These observations were found to be different to those presented in an analysis of a diary by a woman who had completed suicide (Pennebaker & Stone, 2004; cited in Barnes and colleagues, 2008). The main differences noted were that over time the woman’s writings contained reduced references to death and that with the decreasing use of negative emotion words came an increasing use of positive emotion words. One commonality was both subjects increased their use of question marks, which Barnes and colleagues (Barnes) suggest may be a predictor of suicide.

It must be acknowledged that the qualitative studies reviewed here represent an infinitesimal sample of the population of people who complete suicide. However, such detailed analysis has the potential to provide insight into the minds of people who go on to complete suicide. Hopefully such research will continue to be undertaken.

In summary there are apparent differences between men and women when it comes to risk and protective factors. For men risk factors may include social isolation and an inability to express negative emotion.

Readers are invited to comment on any matters presented in this review on the Forum (available via LIFE’s Professional Development Network).

References
Australian Bureau of Statistics (2009). Causes of death, Australia, 2007 (3303.0). Australian Bureau of Statistics: Canberra.
Brådvik L, Mattisson C, Bogren M, Nettelblad P (2008). Long-term suicide risk of depression in the Lundby cohort 1947–1997 – severity and gender. Acta Psychiatrica Scandinavica 117, 185-191.
Barnes DH, Lawal-Solarin FW, Lester D (2007). Letters from a suicide. Death Studies 31, 671-678. 
Caldwell TM, Jorm AF, Dear KBG (2004). Suicide and mental health in rural, remote and metropolitan areas in Australia. Medical Journal of Australia 181, S10-S14.
Clarke J, van Amerom G (2008). A comparison of blogs by depressed men and women. Issues in mental health nursing 29, 243-264.  
Desaulniers J, Daigle MS (2008). Inter-regional variations in men’s attitudes, suicide rates and sociodemographics in Quebec (Canada). Social Psychiatry and Psychiatric Epidemiology 43, 445-453.
Kapusta ND, Zorman A, Etzersdorfer E, Ponocny-Seliger E, Jandl-Jager E, Sonneck G (2008). Rural-urban differences in Austrian suicides. Social Psychiatry & Psychiatric Epidemiology 43, 311-318. 
Kariminia A, Law MG, Butler TG, Levy MH, Corben SP, Kaldor JM, Grant L (2007). Suicide risk among recently released prisoners in New South Wales, Australia. The Medical Journal of Australia 187, 387-390. 
World Health Organization (2009). Distribution of suicide rates by gender and age, 2000. World Health Organization: Geneva.

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