Suicide rates among men are almost four times higher than among women. Pharmacy provides many opportunities to help

This year’s Oscars ceremony was marked not only by the fact that Eddie Redmayne won the best actor award or that Birdman beat Boyhood, but that male suicide featured in two of the acceptance speeches. Graham Moore’s best adapted screenplay win for The Imitation Game showed how far he had come from the 16-year-old who attempted suicide, while Dana Perry dedicated her best documentary short Oscar to her bipolar son, who took his life at the age of 15. These are far from isolated stories, but the fact that they were aired at such a high profile event suggests that now is the right time to be more open about the somewhat hidden issue of male suicide.

It is certainly a widespread problem. The latest data from the Office of National Statistics (ONS) show that 4,858 men aged over 15 committed suicide in 2013, compared with 1,375 women. Not only is the death rate among men almost four times that of women, it is also higher now than it has been since 2011.

This is not a problem that’s unique to the UK. According to Dr Ian Banks, vice-chairman of the European Men’s Health Forum (EMHF), more men commit suicide than women across most European countries. “There has to be a reason for this,” says Dr Banks. “If there wasn’t, it would be equal everywhere and would be due to being a man.”

Middle-age risk

As a first step to improving the situation, it is important to target those who are at greatest risk. While suicide is the leading cause of death for men aged 20 to 34 years (14.9 deaths per 100,000 or almost one in four deaths in this age group), rates are higher among older men, with 21.5 suicides per 100,000 men aged 35 to 39, rising to 25.1 in those aged 40 to 44. Overall, men aged 40 to 54 have the highest suicide rates. This tallies with research undertaken by the Samaritans.

Middle-aged men from lower income backgrounds or with poorer education are “vulnerable to death by suicide compared to males in other age groups and females of all ages”, according to a Samaritans report. The recession seems to have been partly to blame for the increasing numbers of suicides among middle-aged men. “Research says there were 800 extra suicides in men between 2008 and 2010 that could be linked to the recession,” says Gopa Mitra, vice-chair of the Men’s Health Forum (MHF).

This is just one possible contributor, however. Other factors are said to include the fact that, generally speaking, men have more negative life experiences, poorer mental health, greater stigma and disrespect, more social exclusion and unhealthier lifestyles than women. Of these factors, mental health is the most important and plays a role in most suicides. “It’s a very complex process that leads someone to take their own life, says Gopa.

“Apart from a diagnosis of depression, lots of mental health-related issues are more common in men, such as substance misuse, anti-social behaviour, ‘disappearing’ from home and homelessness.” Dr Banks points out that while more mental health problems are diagnosed among women, the impact is more severe in men, who are more likely to experience problems with alcohol and drug abuse, as well as homelessness. Underlying much of this is an inability for men to talk about their issues.

Dr Banks believes this is down to the way boys are brought up. “It’s not just the UK where there is a ‘stiff upper lip’,” he says. “There is a macho approach across Europe. Men also have a risk-taking behaviour and don’t admit to needing help.”

This ‘masculine’ approach doesn’t focus on social and emotional skills. While women are more open to talking about their problems, men can ‘bottle it up’, allowing feelings to escalate to crisis point, say the Samaritans.

Pharmacy is female

Men’s inability to discuss their problems also extends to talking to healthcare professionals. “We know that women are better at coping and can use the systems better than men. They have better health literacy and they come more into contact with the health systems,” says Dr Banks. “Men, and particularly younger men, come into contact far less.”

However, it is important not to reinforce the stereotypical idea that men are reluctant to access primary care, says Dr Paul Galdas, senior lecturer in the Department of Health Sciences at the University of York, in an EMHF report. He believes there is a need to consider men’s particular lifestyles and behaviours so that information and initiatives can be appropriately targeted.

For pharmacy, this is critical. Research by the MHF found that UK men regard pharmacy as a ‘female’ environment. In its report Racks of make-up and no spanners, the MHF found that men:

• Felt the open pharmacy environment was more suited to the way women communicate, whereas they preferred privacy when discussing concerns
• Were unaware of how to use consulting rooms
• Had a lack of knowledge of the pharmacist and the pharmacy team’s role and training
• Needed what they felt to be a ‘legitimate issue’ to visit the pharmacy or doctor and would prefer to have an appointment.

Dr Banks is, however, a huge fan of pharmacy. “Pharmacists are one of the best trained people in community health and medicines. Tragically, men do not use pharmacy enough.” He believes pharmacy should maximise their “fantastic advertising space” in raising the issues of mental health through window posters.

He also recommends that pharmacies stock items that are appealing and attractive to men, such as the MHF’s Men’s Manuals, which cover health topics in the style of a car manual. “This allows the man to ask a question of the pharmacist – getting them to talk is the first step to avoiding suicide,” adds Dr Banks.

Use every opportunity

Starting the conversation is one area where pharmacy has multiple chances to engage with men. “We are often the people who have the opportunity to make an input,” says Alyson Brown, community pharmacist and lecturer in Pharmacy Practice at Robert Gordon University, Aberdeen. “For example, while a patient on a repeat medication may not have seen their doctor, the pharmacy team still has a chance to make a difference when the patient collects their prescription.”

Her advice is to use this as an opportunity to have an informal conversation. “It’s not a threatening environment; people don’t have to make an appointment. So make it feel open and check how they are and how they are getting on. Sometimes all that’s needed is just listening.”

Having regular conversations with patients who are taking mental health medications will also help the pharmacy team to identify when patients are not doing so well or are likely to relapse. Offering a medicines use review also creates a more formal appointment where men can raise concerns. Alyson also recommends being alert to possible mental health worries outside of the dispensary.

Sleep problems and smoking are more common in those with mental illness and customers purchasing St John’s Wort are likely to be buying it to manage depression. Highlighting the availability of the consulting area could help, says Gopa. “Men may then be able to talk about why they are after particular products – for example, when they want help with tiredness, or finding it hard to concentrate, or for lots of headaches.”

Being aware of the fact that men find it hard to talk about mental health is also important, adds Dr Banks. “The vast majority of pharmacy assistants are women and this is one of the barriers we have identified for men. They also hate having to wait. So, speed things up, get him into a dialogue quickly and refer immediately to the pharmacist.”

Although the figures for male suicide are gloomy, Dr Banks believes there is good news. “There is something we can do,” he says. For pharmacy, thinking of the journey male customers make before speaking to anyone is important. Start with window displays on mental health to draw the customer in, make the pharmacy a more appealing environment and use every opportunity to start the conversation.

Who knows, just asking how one of your male customers is getting on really could be the difference between life and death.

Further information

• This year’s Mental Health Awareness week runs from 11-17 May. Contact the Mental Health Foundation for a supporter pack
• The Men’s Health Forum offers posters on mental health to download, and copies of the Beat Stress Feel Better man manual are available to order here
• The Samaritans current campaign focuses on male mental health. For more information, click here.

 

It’s a very complex process that leads someone to take their own life