Back from the brink: Dr Phil Kieran on why men are five times more likely to commit suicide than women

Though our macho culture can make it difficult for men to discuss their mental health, it’s essential they speak up, writes Dr Phil Kieran.

A short time ago I found myself running along Sunday’s Well in Cork, at four in the morning, just as dawn was breaking over the city.

I was taking part in the Darkness into Light event for Pieta House. It was an inspiring experience.

Two and a half weeks earlier, I was at home with my family and I got a text asking had I heard anything from a friend of mine over the past day or two?

Nine minutes later, I received a phone call to say that he had been found dead. That distressing call led to other calls and trips and chats with friends I hadn’t seen in too long.

This is the second colleague I have known well to have taken their own life in the decade since I graduated.

Unfortunately, I’m sure for a number of you reading this, the story I have outlined is a familiar one.

In the aftermath of suicide I am always struck by the sadness in those left behind and their desire to go back and tell the person who died that they are loved, that things can get better and it’s OK to talk about this.

How big a problem is suicide?

There were 425 deaths in Ireland reported as suicide in 2015. This is three times more people than were killed in road accidents in the same year.

The official number of deaths by suicide are believed to be an underestimation as it is thought that a number of deaths due to falling, drowning or single vehicle car crashes are likely suicides.

And, although a diagnosis of depression is twice as common in women as in men, men are five times more likely to die by suicide.

This discrepancy suggests that the higher level of suicide in men may be a reflection of under-reporting of depression in this group.

This could be due to social stigma, or the fact that, particularly in young men, peer support can tend to avoid talking about emotional problems.

This can lead to a lot of men not getting the help they need. We also know that another reason more men die of suicide is because of the choice of method.

Men tend to use more violent means to commit suicide therefore have less attempted suicides but more completed suicides.

Can anything be done?

You may notice at certain places around the country there are signs with a phone number to ring if you are feeling suicidal.

These are often at railway lines, road flyovers and near rivers or the sea. The Samaritans put these up in locations that have had high incidence of suicide.

There was a study done in Britain in 2005 which showed that these signs can be very successful, reducing suicides in the locations studied from 10 to three per year.

This reduction proves that there are effective ways to reduce suicide and to save lives.

There can be a fatalism associated with suicide, that this is a hidden problem, that nothing can be done about it before its too late and, for those who find themselves contemplating suicide, that it is the only option that makes sense.

However talking to someone, be it a counselor, friend or your GP could save your life.

Depression mindset

Depression can take away your ability to see through the difficulty in which you are currently mired.

It can make you believe that there is no way you will ever feel better often because it makes you feel that this despair is due to unchangeable factors in your life, none of which is in your control.

It can make you believe that no one cares and that in fact some people in your life will be better off when you are gone.

This is not the case. This is how depression warps your thinking and it can be helped.

However, you can feel better even if the obstacles in your life remain the same.

They can become manageable if your depression, just like pneumonia, is treated.

Overstretched service

So far this year I have had two acutely suicidal patients in my surgery and talking to my friends in general practice this isn’t above average. These patients need a few things immediately.

Firstly, they need time. Time to discuss what is going on with them.

Secondly, they need ongoing support and planning to help them recover.

Unfortunately, due to time pressures I often have to sit them in a different room in the surgery and keep checking in while attending to my other patients.

The system is too stretched at the moment to be able to give these people enough time until either lunchtime or the end of the surgery.

During this time I was frantically ringing the psychiatry services and other support groups to try and arrange follow up, and in both cases I was left with no option but to bring the patient to the emergency department.

What scares me is the fact that it can be quite difficult for my patients to get a same-day appointment with me. How many might ring and decide not to come in when they hear this?

I usually try to sign off with something lighthearted but this isn’t the topic for that. If you need help please talk to someone. Suicide is permanent, depression doesn’t have to be.

Samaritans: www.samaritans.org, freephone: 116 123

Pieta House: www.pieta.ie, freephone 1800 247 247 (Text HELP to 51444)

The facts

  • Suicide kills between 300 and 500 people per year in Ireland.
  • Men are five times more likely than women to die by suicide.
  • Suicide kills three times as many as die on our roads each year.
  • The overstretching of every part of our health service is putting lives at risk from suicide.

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