Found on Mens' Lib - a Horizon documentary on male suicide.

This documentary was broadcast tonight. Hosted by Dr Xand van Tulleken. I thought it was generally a well-made documentary. It showcased male vulnerability and put forward concrete steps to prevent suicide. It advocates for the healthcare system being more thorough in screening for suicidal people.

I would liked to have heard accounts from people who have been failed by the healthcare system in terms of suicide prevention, whose problems have been made worse not better or whose cries for help were simply ignored. From my disabled, neurodiverse, and/or mentally ill friends here in the north of England, I hear how many NHS services not specifically for suicide will utterly shut you down and kick you out if you mention suicidal thoughts. This is of course very harmful because programmes for managing bipolar disorder, providing art therapy for autistic people, facilitating medical transition for gender dysphoric people, etc. are important in preventing people ever becoming suicidal and in managing suicidality when it arises. My friends' accounts are that they have been discharged from these programmes and put on months-long waitlists for talk therapy for suicidality, so they lose their support and are given nothing. But the state of the NHS is not entirely on topic.

For discussion, what do you think about the documentary? What are your views on male suicide -- reasons for it, methods to prevent it, ways in which it is specifically a male issue?

Below is the summary I made while watching the documentary, for those of you outside the UK.

The documentary asks what drives suicide in men and what can be done to prevent it. We open with some statistics about the prevalence of male suicide both in the UK and worldwide. In the UK, suicide is the biggest killer of men under 50.

A London lifeboatman says some people he rescues swim away from the boat or swim under the boat, trying to die, while others say thank you and say they were "just having a bad day". Narrator says we must intervene must earlier.

Narrator discusses how he personally used to think suicide made no sense but he now has many worries in life and he has experienced suicidal thoughts -- no one is immune.

A man whose son who committed suicide in his final year of school is interviewed about his experiences and feelings. "Edward told five different medical professionals that he wanted to potentially take his life on the railway and nobody told us, even though he'd explicitly given his consent for his parents to be consulted on two occassions."

A man severely neglected in early life talks about his trauma and bipolar disorder. In fourth grade he heard voices but didn't tell anyone because he was scared; he then had a mental breakdown and went to see a psychiatrist. He explains his current medications and what they help with. "I probably have suicidal ideations two to three times a month. Planning, much more rare, every couple of months. ... I was having this constant conversation with the man in the mirror whom I no longer knew. He was telling me how useless and terrible I was. "Kevin, you need to die. I'm going to kill you and there's nothing you can do." I so wanted to live but my brain was trying to kill me."

Narrator points out that most diagnosed mentally ill people do not attempt suicide and most people who attempt suicide are "not in contact with mental health services". Narrator interviews a person at Men's Health magazine about a nationwide survey on male mental health, where 56% of men admitted suicidal thoughts; interviewee says many of these do not have mental illnesses. Most respondents say their mental health is not "good"; interviewee attributes this to ideas of masculinity and the ideal man, ideas for a good career and being the breadwinner, and isolation when these goals are not met. 69% of men said they were good at intervening with friends and helping them get help but would not get help themselves. Interviewee: "They're fighting an internal dialogue between the man they feel they should be and yet the man that they can't help but be. It's preventing them from speaking out."

A man whose friend committed suicide talks about how the friend's concerning social media posts were interpreted as "banter" by friends, "when Dan really needed an arm around the shoulder". When the friend died, "it just didn't make sense. I hadn't seen it coming. He was the last person you'd think would follow through with something like that. ... But just three months before he died, he texted me "I'm on suicide watch, mate"."

The northeast of England has a particularly high suicide rate. There is a map of suicides in local towns/villages on the wall; one town has more female suicides than male ones, but most have mostly or entirely male suicides.

Bereavement, finance, and relationship breakdown are the three main factors associated with suicide, and these aren't typically things your GP can help with. Unemployment is a huge problem in the northeast. Those in the lowest socioeconomic group are 10x more likely to commit suicide than those in the highest groups. "Feeling alone and hopeless is a dangerous place."

Another factor that can increase suicidal behaviour is when someone close to you commits suicide. To illustrate this, the interview continues with the man whose friend committed suicide; he was already suffering from depression and turning to alcohol. "There were so many things in my head bouncing off each other. I didn't know where to turn or how to articulate what I was feeling." He lost his job and home and became suicidal. "That was the only option I saw that was available to me." After he tried to hang himself, he "had a eureka moment" and committed to staying alive in the present.

Narrator questions why with suicide, more women attempt but more men die. The director of the Suicidal Behaviour Research Lab says men use more lethal methods, have a higher physical pain tolerance, and are less likely to seek help. As a generalisation, he says men get most of their emotional support from their partner and so they can be very isolated if that relationship breaks down.

He goes on to say that asking someone directly if they are suicidal can help and protect them, because it gives them a sense of being cared about among other reasons. The narrator says his own brother does this for him and he hadn't realised how significant it might be -- then the narrator phones his brother. "The power of a single conversation should not be underestimated."

The man with bipolar disorder from earlier recounts how he took the bus to the Golden Gate Bridge and started screaming at the voices in his head while on the bus, saying the things he heard in the mirror. He made a pact with himself: "If one person looks at me and says "Are you okay?", I'll tell that person everything and beg for their help." A bus full of blank faces looked back at him. He stood crying by the bridge for 40 minutes and police officers on the lookout for suicidal people walked right by him. He jumped; he regretted it the moment his feet left the bridge.

The impact from the water shattered his spine. Underwater, he could not hear the depressive thoughts, "just the complete will to not die", and he started praying not to die. He was rescued by the coastguard and he couldn't explain to them why he jumped. At hospital, he saw his father cry for the first time in 19 years. Both he and his father felt immensely guilty. Things didn't get suddenly better after that; he had 7 psych hospital stays in the next 11 years for critical suicidal thoughts, but he is glad to be alive.

A police officer who patrolled the Golden Gate Bridge says he has learned to listen to potential jumpers so they know someone cares, and most potential jumpers he has reached did not jump. He explains the planned anti-suicide net on the bridge; the narrator says studies show such preventions reduce suicide in the surrounding area too, not just the location of the net.

Discussing predicting suicide, a researcher says no one factor is much better than a coin flip, and invokes a metaphor of a broken-down car which I don't understand. The researcher is developing an algorithm which accounts for many demographic risk factors and predicts, separately, successful and unsuccessful suicide attempts with 90% accuracy, several years before they happen. I have some unanswered questions here about whether they are retrofitting data or testing it on new data. The narrator raises problems with practicalities and ethics in implementing such an algorithm on a large scale but concludes it would be very helpful.

"Simply changing our attitudes towards suicide could give dramatic results." The narrator visits Detroit to meet with a founder of the Zero Suicide Program there at the Henry Ford Health Service (notably, a private company). The program involves primary care doctors screening every single patient they see about suicidal thoughts and referring them to appropriate care (talk therapy, medication, home visits), regardless of why they went to the doctor in the first place. There is an appointment with a man with Crohn's who was helped through the program; in the appointment, the doctor helps him create a plan for getting help when he has critical suicidal thoughts. The suicide rate among patients of the health centre decreased by 85%, with zero suicides in certain years since the beginning of the program. The average number of suicides per capita per year before the program is not given.

The man whose son committed suicide has launched the Zero Suicide Alliance in the UK with a similar method. He says this will not require any additional NHS funding and will save money on treating suicidal people at later stages.

Narrator: "What I've learnt is that we have to think of all deaths from suicide as preventible. I think there are two things we can do: most healthcare professionals asking about suicide, and all of us at home asking our friends and family if they are thinking about killing themselves."

Closing text: The man with bipolar disorder travels as a suicide prevention campaigner. The man whose friend committed suicide had another friend commit suicide shortly after his interview for this programme. The man whose son committed suicide continues pressuring the government for reform on the topic.