Commentary paper: Tony Salvatore (2014)
Anyone who turns to the suicide prevention literature for insight on the topic of suicide and mental illness will quickly encounter this statement in some form: Ninety percent of suicide victims had a psychiatric disorder (Goldsmith et al., 2002; Litts et al., 2008; American Foundation for Suicide Prevention, 2014)
The implication of this contention is almost causal in nature.
In this commentary, Tony Salvatore questions this statement and gives us an insight as to why the 90% statistic still looms large today.
Research Paper / Henson et al.
JAMA Psychiatry. 2019;76(1):51-60. Published originally November 21, 2018
This research paper highlights a clear association between cancer diagnosis and risk of suicide.
A diagnosis of cancer carries a substantial risk of psychological distress.
This is the first national population-based study in England on the area of the risk of suicide after cancer diagnosis. This paper also looks at different types of cancer and associated risk factors for suicide.
Publication. Birmingham UK 2019. Birmingham City Council
Death through suicide reflects the ultimate loss of hope and leaves a significant and lasting impact on families, communities, employers and society.
The prevention of suicide requires partnership working across the breadth of society and building on the 2012 national strategy this strategy has been developed through a co-production partnership between the Council and a wide range of organisations as a shared approach to reducing deaths through suicide.
Rates in Birmingham
Although in Birmingham the rate of suicide is low compared to other cities, and the national rates, there is a shared ambition to maintain the lowest rate of suicide of any of the core cities in England and continue to reduce deaths through suicide in the City over the next decade through a Zero Suicide approach.
The Birmingham Strategy
The Birmingham Suicide Prevention Strategy is a co-produced strategy that sits alongside national strategy and is based on a combination of local and national evidence and data.
In Birmingham in addition to the nationally recognized high risk groups we also have higher rates of suicide among individuals working in skilled trade occupations like construction and among citizens born in Poland and Eastern European countries.
Key areas of priority
The Strategy sets out a series of key priority areas for action across the partnership under six core areas:
- Reducing the risk of suicide in high-risk groups
- Improving mental health in specific groups
- Reducing access to means of suicide
- Provide better information and support to those bereaved or affected by suicide
- Support the media in delivering sensitive approaches to suicide and suicidal behaviour
- Support research, data collection and monitoring
An Approach to Suicide Prevention
SCHEMA is a suicide prevention course that supports professionals and community members in effectively helping people with suicidal thoughts.
Suicide doesn’t discriminate
Death by suicide is devastating and far reaching across our communities. It takes 3 times more lives per year in the UK than lives lost in accidents on all our roads. The most recent data tells us that 6000 people died in the UK by suicide in one year. That means that every day, 16 people take their own lives in the UK.
But we can have an impact on this devastating act through learning skills to support a person with suicidal thoughts to consider life as an achievable plan. This course has been being designed and developed by experienced facilitators and practitioners in the fields of suicide prevention, mental health and well-being.
Who is SCHEMA for?
The SCHEMA suicide prevention course is suitable for all walks of life and this is because suicidal behaviour occurs across all our communities and is everybody’s responsibility. Whatever your background, by attending SCHEMA you will feel better prepared to support someone who has suicidal thoughts.
What would I learn?
- Spot the signals of possible suicide ideation
- Ask the right questions
- Explore with empathy
- Assess level of risk and develop a life-plan
- Enable short-term support
- Consider appropriate signposting
- Learn the skills that can save lives and promote hope for the future
Our SCHEMA briefing paper
Since 2018 we have delivered SCHEMA to over 500 delegates across the UK including delivering SCHEMA training on behalf of Birmingham and Solihull NHS CCG and the Coventry and Warwickshire NHS Partnership Trust as well as nationally recognised Charities and Housing Associations across the UK. For an overview of this training check out our most recent briefing paper.
What our delegates say about SCHEMA
“This was a really useful course both for professionals and people who know someone with a mental health issue. Infact, it’s useful for anyone who knows anyone who might need support”
“Will definitely recommend to others, friends and professionals. It helped me to think about suicide in a structured way to help with immediate and long-term support.”
“It was a great day and I feel much more confident now talking to people both as a professional and a friend.”
“Great days training. Reinforced my own practice and learnt new ways of working. Trainers very knowledgeable.”
Fantastic course; Very knowledgeable facilitators who used simple and precise methods to make course content very clear. Thank-you.”
If you wish to discuss SCHEMA with one of our facilitators to help you decide if this training is right for you/your organisation, please contact us.
The Background to ManMade
Forward For Life, in partnership with Common Unity and associates developed ManMade to empower are men to have the strategies and coping skills to manage the challenges they may experience as a result of job loss including reduced financial income, loss of time structure, isolation, loss of purpose and changes in identity and relationship status.
ManMade is a very unique man orientated peer support programme. Through a range of approaches, the ManMade project supported men to talk about some of the issues they may have faced since being out of work and address some of the obstacles affecting men being able to talk about how they feel and seek help for these challenges.
ManMade Dudley – 2015
Commissioned initially by Dudley Metropolitan Borough Councils’ Office of Public Health, ManMade was a forward thinking programme that supported men between the ages of 20 and 60 to realise their full potential – initially a tailored 8 week programme providing participants with the skills and knowledge to support their own health and well-being.
The areas covered included:
- Confidence Building and self-esteem
- Physical Health
- Social Interaction
- Suicide Prevention
- Mental Health Awareness
The programme sought to provide men with the coping strategies to manage distress that they may be experiencing as well as looking at how men can promote their own mental health and well-being through improved resilience.
ManMade Family – 2015
In Association with Family Action, the developers of ManMade launched an eight week programme supporting men who engage with Family Action in respect of their overall health and well-being.
This men-only peer support programme, based on the highly successful ManMade Dudley Programme, covered the themes of Positive Behaviours, Mental Health Awareness, Self Esteem, Confidence building, identity, assisting life, physical health, loss as well as coping mechanisms.
The ManMade developers, Forward For Life and Common Unity alongside specialist Grassroots Associates worked with delegates to support them to realise possibilities in life through this life affirming, men only peer support group.
The evaluation against the initial ManMade Programme in Dudley clearly demonstrated that this approach gave men a place where they felt able to open up about the world according to them in an environment where positive support and shared advice reigned supreme for the improvement of well-being across the whole group.
The effectiveness and impact of ManMade Family as a pilot programme, in partnership with Family Action was highlighted at ManMade | The Conference on June 13th 2016.
ManMade Dudley 2 – 2016
The ManMade Programme came back to Dudley in 2016. But this time it came with a twist.
Again, wth an emphasis on hope, opportunity, resilience, confidence, wellbeing, interaction and inclusion, ManMade was successful in gaining funding from Dudley Metropolitan Borough Council Office of Public Health to run the programme once more, but this time it’s the members who were driving this opportunity forward.
ManMade proved to be so successful first time round at the beginning of 2015 that the men who took part in it wanted to give something back – that something being themselves. They set up their own recognised member led group and successfully won a small grant from Dudleys Office of Public Health to make ManMade Dudley (2) a reality for other men in Dudley.
With ongoing support from Forward For Life, Common Unity and Grassroots Associates, this groundbreaking approach engaged men who were struggling with life and all it threw at them.
Using the Warwick and Edinburgh Well Being Scale, the ManMade Dudley Peer Support yet again proved to be an enormous success with the men engaging with programme clearly benefiting from the process of engagement utilising a tailored approach that spoke to men and enabled them to speak up for themselves.
ManMade: The Conference
ManMade : The Conference
Men Surviving Change in an ever Changing World – June 13th 2016
These men are husbands, brothers, fathers, sons, work colleagues, guides, friends and soul mates and there is a story to be told.
Suicide affects all parts of society, but suicide rates amongst men remains markedly high in comparison to women. More traditional approaches have focussed on reducing access to means and targeting people with mental health needs to better assure suicidal behaviour and suicide completion is minimised. However, although not always with an aim of preventing suicide, there are many innovative upstream solutions that through placing emphasis on well-being, social inclusion and resilience building, support men to reconnect with life and living.
This conference brought together private, public, voluntary and community sector organisations, individuals with lived experience of suicidal behaviour as well as forward thinking innovative organisations from across the country who work with men who need support.
To date discussions in Public Arenas had given us a wealth of knowledge in respect to clinical and wider service provision challenges, statistics, economic and human costs, theories as to the reasons specific groups of men may be more at risk than others. But whilst the debates raged on in the background and decisions were being made, individual stories from the front line were unheard. ManMade: The Conference provided the opportunities for stories of loss, survival and hope.
As part of Mens’ Health Week 2016, ManMade: The Conference threw on the table an invitation to all (and we mean everybody from all walks of life) to better understand the reasons why many men may think they would be better off dead, the impact of suicide by men, what solutions are already being developed and implemented as best practice examples as well as provide a forum where new possibilities can be considered and new partnerships developed.
“Give me the child of 7 and I will show you the man” – the origins of this quote are disputed but the applicability I believe has deep resonance in the world of suicide prevention, especially when the world they have been prepared for moves the goalposts.
Age is just a number
Working in the field of suicide prevention since before the turn of the century I have witnessed more than my fair share of sweeping statements, confusing statistics and utter nonsense’s; some of the former and the latter I have fell foul of myself before I learned the often underrated wisdom of listening and learning before speaking. But by being so entrenched in this field one of the most overlooked facts is that, for both men and women, the age of the person most vulnerable to undertaking a suicidal act has been shifting over time. Not sporadically but in a slow, steady and clearly distinguishable wave. This wave is known to many as Generation X.
Who is the X Generation?
Between the post war Baby Boomers and the mid-80’s born Millenials sat Generation X – people born between the mid 1960’s and the early 80’s. A demographic that is often referred to as the MTV Generation, followers of Grunge or Hip-Hop and viewed by many as slackers, cynical and disaffected during the 90’s and obsessed with the concept of work/life balance today. They are the generation of the Sinclair home computers, desktop word-processors, the pager, the brick sized mobile phones, the CD, the DVD, the answering machine, the Walkman, mixtapes recorded directly from the radio, the video store and the shopping centre.
On August 13th 2019, the Office of National Statistics produced a report entitled Middle-aged generation most likely to die by suicide and drug poisoning – although devastating in nature, I was relieved to see overt recognition of the challenge of Generation X in black and white from the ONS. This is because I remember all too well the mid 90’s when the age highlighted for being most vulnerable to suicidal acts was in the mid 20’s and by the turn of the century is was the 30 year olds, in 2010 we were concentrating on those in the 40 year age bracket and now, it is those in the late 40’s age bracket – my age bracket – my Generation X
Throughout the report there are relationships being lightly drawn between deprivation and suicide rates as well as drug poisonings and suicide. This phenomenon is not only restricted to England and Wales though as it is noted it is equally relevant in the USA as well as Canada. However, even though there is reference made to Generation X, there is no reference to another set of crucial levers that I believe has a huge influence on suicides amongst this generation being the effect on individuals being socialized according to the values of our Baby Boomer parents and the impact of socialization in a world that for many countries changed significantly. A world that no longer lay in-sync with ideals and values of Generation X. It should be noted though, that the ONS writers cannot be held to account for this – after all, this concept is floating into the arms of sociological theory – not a place where ONS understanding has a strong allegiance.
From a personal perspective (which this whole article is), socialization of Generation X by the Baby-Boomer generation can be best encapsulated between the pages of the Ladybird “Peter and Jane” series.
From the toys we were given as boys and girls our futures were being laid out before us. Peter with his crane, toy soldiers, diecast cars and train set and Jane with her dolls, kitchen playset and toy pram. Peter helping his Dad with DIY and Jane baking cakes with mum…for the Dad and Peter.
Peter giving Dad a hand with securing the car whilst Jane helps her mum to get the tea. For many people of Generation X, these publications ‘helped’ to mould our identities, define our anticipated roles in society as well as subdue any alternative ‘outlandish’ ways of being that sat outside these specific frameworks of how to be a man and a woman in the making.
In addition to the written word for Generation X (including Jacky annual for the girls and Victor for the boys), further reinforcement from peers and family members served to reinforce the mould for what we represented in adulthood. We become the products of ‘hard working’, sole bread-winning fathers and grand-fathers in the manufacturing industries who never spoke of the war, never uttered their feelings, never asked for help but instead spoke through their actions and found their leisure pursuits traditionally best served by the local public house on the evening and weekends. On the other side were our mothers and grandmothers who stayed at home, ‘did their motherly duty’, patched us up, cooked, cleaned and generally served us and our male seniors; All of us in preparation for our well-defined futures. And, to be honest, it was all good, because that was reality for many of the Generation X’s as we knew nothing else – and the repurcussions of a short, sharp, smack to get us back on track reinforced this reality as the only reality available.
But the 70’s and the 80’s also saw wider upheavels – it saw legal changes in respect of divorce laws and sex discrimination; it witnessed Thatcherism and it’s push for home ownership; fragmentation through the miners strikes leading to the demise of power across traditional working class represented unions, the painful shift from the traditional UK based manufacturing stronghold and mass unemployment; a passionate ground-swell of rights for women going into further education and beyond and a strong will to push through the glass ceiling of business as well as a belief that both parents can ‘bring home the bacon’ and with that came the ‘latch-key kids’ who were desperately looking to work out how they fitted.
I believe most passionately that because of these wider societal shifts and many more (unmentioned but as valid) besides, Generation X were provided with one framework with a clear purpose yet found themselves growing up in a society where this framework and societally defined purpose became for many, unfit for purpose – it became redundant. Adaptation to these new set of rules has been unbelievably hard for many Generation X women and men with for too many fatal consequences.
For me, I got lucky if lucky is the word. Until the age of 11 I thought I knew reality and knew my purpose. Then my Mum upset the family apple-cart and went to University to study Sociology, something back then that warranted a column in the local town’s newspaper when she obtained her degree. The (often perceived) change in the status-quo at home contributed to a number of outcomes – some unfortunate (divorce being one of them) and some fortunate, being mainly an opportunity to question what had recently been unspoken territory nor up for negotiation until that point. But for many family members, their view of how the world worked was entrenched in them until their last day – socialization is a very powerful force indeed. When I was 20, I was made redundant from the warehouse I was employed at. I loved my job, made some excellent life-long friends and feel that my life benifitted hugely from this experience. But for me, my next step was to look at a different direction of vocational travel. During Sunday Roast with my family, I told my Grandad that I wanted to go to University and study to be a Social Worker and his well intentioned response will always stay with me….
“A social worker? That’s no job for you. You should be a soldier like your brother or a welder. A proper mans job.”
Now, I loved my Grandad to bits with his no-nonsense view of the world, but thankfully on that occassion I didn’t take his advice although sometimes when I look at what Social Workers have to deal with on a day to day basis I often wonder whether his advice had some legs.
Eyes on the horizon
Today, as part of the SCHEMA: An Approach to Suicide Prevention training and as part of the ManMade Peer Support Programme we run, we set aside time to discuss and reflect on the wider influences that may have an impact on Generation X regarding suicide – we recognise deprivation, we recognise substance misuse but we also recognise that suicide is not only about trying to understand the individual and their perceived problems – it’s much bigger than this and goes much deeper. It requires us to look at ourselves, our histories, our societies and what drives us in truly understanding why people may take their own lives. The challenge then is that when we have come to a clearer conclusion as to why Generation X is at risk we then need to look at what can be done about it – without taking our eyes off the generations to come – an opportunity to use what we have learned to make all our futures brighter.
Written by Terry Rigby: Company Director of Forward For Life 2019
Suicide doesn’t discriminate.
Suicide is a devastating act and takes more lives per year in the UK than lives lost in accidents on all our roads. But we can have an impact on this devastating act through learning skills to support a person with suicidal thoughts to consider life options.
Learning the skills that can save a life
At Forward For Life we offer a number of courses to better enable people from all walks of life to support others who may be thinking of suicide. Our courses are both face to face as well as online and include both standardised and our own tailored training options.
Check out our one-day one-day face to face SCHEMA: An Approach to Suicide Prevention programme as well as our online WISE Steps workshop.
What our delegates have told us about our suicide prevention training:
“Will definitely recommend to others, friends and professionals. It helped me to think about suicide in a structured way to help with immediate and long term support.”
“This was a really useful course both for professionals and people who know someone with a mental health issue. Infact, it’s useful for anyone who knows anyone who might need support”
“It was a great day and I feel much more confident now talking to people both as a professional and a friend.”
What are you doing for World Suicide Prevention Day – Are you going to wear purple, wear a yellow ribbon, light a candle in a window, cycle, walk?
If you are doing any of these things then that’s great.
But what about the day after? The 11th September, what will you do then?
Will you stop and just get on with your day to day life until next World Suicide Prevention Day comes along or are you willing to carry on – to take the next steps in continuing to make a real difference?
Are you going to get clued up about what to do if someone close to you appears to be in turmoil, appears to be crying out for help, appears to be in a place where you need to ask the question “are you thinking of ending your life?” and then actually ask the question.
…and if they say “yes”…
…are you willing to listen, non-judgmentally, as to why they may want to die?
Are you going to help them realise alternatives?…and if so, do you know what services, what options, what possibilities there might be to help this person live if they so choose?
For me, Suicide Prevention is not all about being aware of services, but it is all about being aware of what you can do to make a difference. Being aware of what you are capable of.
Suicide prevention is not the sole responsibility of mental health services. It is not the sole responsibility of suicide prevention organisations…and nor should it be… It is everybody’s business…everybody’s responsibility.
So what are you going to do about it…not just on World Suicide Prevention Day, but also for the rest of the year?
Written by T Rigby. Director at Forward For Life
What’s all the fuss about?
Written by T. Rigby, Director of Forward For Life. November 2016
November 19th 2016 celebrated another International Men’s Day. Inaugurated in 1999, this day is celebrated in over 80 countries including the UK. But you might be thinking…”What’s the fuss all about?” After all this is a man’s world, ruled by men for the benefit of men. But is this the story for ALL men?
November 17th 2016 witnessed a House of Commons Parliamentary Debate in advance of International Men’s Day. But it was much less about celebrating men and much more about asking hard questions as to why men were finding it so hard to survive…and there’s good reasons to ask these questions – because in this so called patriarchal society, the benefits of being a man in today’s world are not so easily straight forward to highlight.
To be frank, there is a need for a proper fuss when it comes down to men in modern day UK and here’s why…..
The high male suicide rate
The suicide rate amongst men in the UK is over three times higher than women. This gap has increased since 1981, when the male rate was just less than double the female rate. Since 1981, the female rate has reduced by around 50%, while the male rate has decreased by 14%
When asked, what steps the Government plans to take to improve suicide prevention policies in response to the statistics, this was their response…
The Government has invested over £1.5 million on suicide and self-harm prevention research since the National Suicide Prevention Strategy to inform and target our strategy for reducing suicide rates.
The human cost
But this is surely a drop in the ocean compared to the magnitude of the challenge at hand. Over 4,500 men take their lives each year in the UK. Each suicide attempt has an immeasurable emotional cost on family, friends and the wider community.
The economic cost
But let’s be brutal from a “typical man’s” view, let’s look at the pounds, shillings and pence – the economic cost. The estimated cost for each death by suicide is £1.6 million pounds – it therefore beyond belief as to why an investment of £1.5 million in research over a 3 year period is somehow proportionate to the magnitude of the issue at hand.
Lets do what need’s to be done.
The other question we must ask is whether this amount of investment in research is money well spent. I’m not saying that research isn’t important, but what I am saying is that at some juncture we need to draw a line in the sand. Maybe, stop asking so much “what else can we know?” and start asking “what do we need to do based on what we know now?”
The answers, I believe, were staring the parliamentarians in the face today as the rest of the debate regarding men and their situation gave clear statements as to what specific wider issues in society need to be addressed if we are to tackle suicide amongst men.
The areas discussed, that made grim reading, covered the following:
- The challenges faced by boys and men at all stages of education including attainment
- Men’s health, shorter life expectancy and workplace deaths
- The challenges faced by the most marginalised men and boys in society (for instance, homeless men, boys in care and the high rate of male deaths in custody)
- Male victims of violence, including sexual violence
- The challenges faced by men as parents, particularly new fathers and separated fathers
- Male victims and survivors of sexual abuse, rape, sexual exploitation, domestic abuse, forced marriage, honour-based crime, stalking and slavery
- The negative portrayal of men, boys and fathers
The size of the challenge
Now, it is true that men aren’t as likely as women to engage with universal services regarding their health and it is true that many men don’t seek support from their peers. In addition, many don’t talk openly about their problems and it is true that many men see strength in silence whereas the real strength would be to ask for help. However, this does not mean that we should lay the blame at the feet of men – not all men anyway.
The challenge is bigger than most of us would like to admit. Individual blame is too short-sighted; we need to look at ourselves and our taken for granted assumptions as to who men are. To me, it appears that the silent majority has been overlooked and no one is responsible for dealing with this oversight.
If this is a man’s world, then why are so many men taking their own lives?
To get your copy of the full parliamentary report and debate pack from from 2016 then click on the image below.
On the 13th June 2016 ManMade | The Conference took place. It was a hugely powerful day where delegates got the chance to properly engage with the issue of men and suicide.
Key note speeches from both professional and personal standpoints kept the delegates firmly rooted.
After saying my goodbyes to delegates, speakers and all the supporters at this event I eventually got to sit my exhausted carcass down at a local watering hole with a pint of oddly named real ale alongside the ManMade co-founders to look through the feedback sheets.
There were the usual odd niggles regarding the menu offered, the heat within the venue, a workshop being a little too short or too long, but in the vast majority of responses the overall feeling was unanimous – ManMade had been an absolute success – a number of delegates even said this had been the best conference they had ever attended (and we didn’t even pay them!)
But something had been bothering me – it felt like something hadn’t been answered as well as it might have been on the day – and then it clicked – the one question that had been asked that hadn’t been fully explored:
“How do we get boys to talk?”
A long slow road to change
Answers to this question on the day revolved around the need for giving boys time, space, encouragement, opportunities through peer group empowerment, through training of youth peers, via education within schools as well as improving personal relationships with their adult male peers (whoever their positive adult male peers may be).
But there is a bigger challenge…a challenge that can’t be just tinkered with at the edges.
A challenge at a societal level
ManMade is an amazing programme. It gives us as men the unique opportunity to enter into conversation with other men about the world we inhabit; a world we directly affect and are directly affected by. The framework for ManMade is designed to achieve this by being both necessarily structured in format yet flexible and open in its application. Conversations can swing from the sublime to the ridiculous yet always brings about a sense of hope and well-being that is palpable for all participants.
In essence, ManMade, as a peer support programme promotes well-being. The opportunity and space to reconsider ourselves and how we fit in the world around us aids to protect us to an extent from some of the emotionally debilitating crap that life with all its broad-brush expectations will inevitably throw at us. But ManMade falls short of doing one thing, and that one thing at the moment, is “prevent” because to prevent men from getting to this point, there needs to be a much deeper sea change. A change that questions the whole notion of gender allocation. A change where gender is either totally redefined or completely thrown out (and that’s not just the male identity). To define us by deeply embedded societal norms before we even start to crawl for many men (and women too) only serves to set us up for one mighty fall.
So in answer to the question “How can we get boys to talk?” Simply put, it’s by taking a long hard look at how we define the boy and their enforced identity from the very start, at all levels, in each and every section of society and changing it BIG STYLE! A very simple solution in word but not in deed and a solution that I for one believe will not be witnessed fully in my lifetime.
In effect, we all, often unwittingly, set men up to fail because of the very nature of our taken-for-granted assumptions of them and so in effect, we all have to shoulder some responsibility for the number of suicides by men, as we all, without even realising it, are perpetuating the myth of what a man is expected to be; And no man can nor should be all that.
Written by T Rigby - Director of Forward For Life June 2016
Together, they conceptualised, designed and delivered ManMade, an innovative peer-led support service aimed at reducing male suicide. Initially piloted and recommissioned in the Midlands, the developers of ManMade are looking to establish it as an approach further afield.
Terry Rigby – Co-Founder of ManMade
If you are having thoughts of suicide or concerned about someone else please go to The Waiting Room
Or contact – Samaritans // Listening service – 24 hours a day, any day – CALL 116 123 (UK, ROI) // EMAIL firstname.lastname@example.org
CALM // Suicide Prevention support (5pm – Midnight) CALL 0800 58 58 58 // SMS (text messsage) 07537 404717