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A recent rise in suicides in Massachusetts — an increase of 40 percent from 2004 to 2014 — is driven by a rise in middle-aged men taking their own lives, according to the Massachusetts Department of Public Health. In fact, 40 percent of all people who die by suicide in the United States are men between the ages of 35 and 64. It’s a staggering number, especially since this demographic represents only 19 percent of the nation’s total population.
So what is driving this increase?
A new report by the Suicide Prevention Resource Center, which I direct, at the Education Development Center in Waltham points to our cultural expectations about masculine identity — expectations that can amplify risk factors for suicide, as well as reduce the effectiveness of intervention programs to prevent it. These cultural expectations include being independent and competent (and thus not seeking help from others); concealing emotions (especially emotions that imply vulnerability or helplessness); and being the family “breadwinner” — an identity that is challenged when a man is unable to provide for his family (e.g., because he has lost his job).
These factors are coupled with lower rates of seeking behavioral health care among men. In fact, men receive less behavioral health treatment than women even though mental and substance abuse disorders — especially depression — are major risk factors for suicide among men. Possible explanations: Men may be reluctant to recognize or acknowledge that they could benefit from behavioral health services; clinicians may not recognize depression in men and refer them to appropriate care — perhaps because depression screening tools are largely developed for women; men may believe that such services are not effective; they may feel shame and fear — or confront — lingering prejudice about behavioral health diagnoses and treatment.
In fact, men receive less behavioral health treatment than women even though mental and substance abuse disorders -- especially depression -- are major risk factors for suicide among men.
The report makes recommendations including educating crisis center staff about suicide risk among this group, working with the media on help-seeking messaging and improving referral and support services for men experiencing financial, legal or relationship problems, and who may be at risk of suicide.
These recommendations may provide a foundation for a suicide prevention program for men in the middle years. But they can only be successful if we also work on changing how we talk about suicide.
The public dialogue around suicide needs to change from one of despair to one of hope, health and resilience. We need to remind people at risk, their friends and their families that there is help. We can teach family and friends to identify people at risk of suicide and how to encourage them to seek care. More can be done to promote help-seeking as a social norm. Posting a helpline phone number is helpful, but that alone is not enough.
This is not the first time that changing the public conversation has been necessary to make a major public health breakthrough. In the 1950s, cancer was the “c-word.” We did not speak its name because we could not cure it. Yet once we started talking about cancer, we started dedicating resources to its prevention and treatment. While the fight against cancer is far from over, the number of people who now survive cancer and lead healthy and productive lives seems like a miracle.
These recommendations may provide a foundation for a suicide prevention program for men in the middle years but they can only be successful if we also work on changing how we talk about suicide.
With suicide, we are certainly making progress in changing the conversation. The voices of people with direct experience of suicide, including those who have lost a loved one to suicide and those who have lived through a suicide attempt or suicidal crisis, offer a moral imperative for suicide prevention and a perspective that research alone cannot provide. With their help, we are bringing suicide out of the shadows and into discussions of public policy, school and workplace assistance programs, and health care clinic and hospital procedures.
The increased public dialogue and the voices and experience of many touched by suicide have led to a number of best practices in suicide prevention. One example is the tremendous success of the Zero Suicide approach -- based on the idea that suicide deaths are preventable among people already receiving care -- a model for health care systems, similar to their work toward zero infections, zero medical errors and zero patient falls.
Those of us in the field of suicide prevention are working toward a national goal to reduce suicide rates 20 percent by 2025. To reach that goal, we must focus on groups at increased risk, like men in the middle years, and ensure they get the care and treatment and follow-up they need to stay healthy.
We must also continue the conversation.
Resources: You can reach the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) and the Samaritans Statewide Hotline at 1-877-870-HOPE (4673)
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