Dr Ian Banks, the president of the European Men’s Health Forum, reflects on mental health in men and the high rate of male self-harm in Europe.
Men made up 77% of all people who committed suicide in the European Union in 2014.1 The enormity of this crisis is such that in 2015, self-harm was the tenth leading cause of death in men of all ages in the WHO European Region, and the number one cause of death in 15-29-year-old men.2
Underlying this is a surprising statistic: men in Europe are almost five times more likely to commit suicide than women, but women are up to three times as likely as men to be diagnosed with depression.3
What is behind this seeming discrepancy? And what can be done to effectively address the ‘silent epidemic’ of male suicide? Health Europa Quarterly spoke to the president of the European Men’s Health Forum (EMHF), Dr Ian Banks, to find out.
Far more women are diagnosed with depression than men. Do you feel this obscures the issue of men’s mental health?
It’s important not to pit men’s and women’s health against each other – the two are inextricably linked and cannot be separated. We know that men’s health can be very much tied up with the mother’s health or the sister’s, and that when a person self-harms, it can have a huge impact on their partner’s health.
We know as well that if a father self-harms then their sons are much more likely to also self-harm and indeed take their own lives.
It’s important, then, that we see male self-harm not just in relation to individuals, but like dropping pebbles in a pond: the ripples expand out and out, through their siblings, their parents, their employers, their colleagues, and on and on it goes, this misery that is created by somebody taking their own life.
Self-harm is a leading cause of death among men in Europe. How much is understood about the reasons behind this?
Self-harm and suicide are much more common in low-income groups and in countries with high rates of poverty. That’s important, because it means we can do something about it.
There’s a myth that it’s the rich executives who actually take their own lives – that’s absolute nonsense. Suicide in high-income groups is actually quite low; it’s in the low-income groups when a man loses his job, loses his partner – that’s where suicides are at their highest.
Unless we make that very clear, it sounds as though we’re talking about all men when we talk about suicide, and we’re not; we’re talking about men who are the most vulnerable in our society: the homeless, the imprisoned and so on.
Men are more likely than women to abuse alcohol, to gamble, to do drugs – all behaviours which are linked to suicide. Why, then, are most referrals for depression for women? You would think that, given the message we’re getting, men would be referred more often.
In my mind, this fact is not the fault of doctors and nurses, it’s the fault of society, and the way it treats men who want to seek help.
If you speak to the relatives of a young man who’s recently taken his own life, most of them will say that they never had any idea it was going to happen – that’s their first comment. But, actually, when you dig a little deeper into that, what you find is that this young man had been expressing problems but just never did anything about them. This is one issue: men tend to go for help much less than women.
Why is that? It’s not that men are stupid or lazy, it’s that we unfortunately bring them up to hide their fears and their feelings and to hide from the help that’s actually out there. Society has a real problem with the way it raises boys to become men, and that’s something that’s really important to understand.
Princes William and Harry have received widespread praise in the UK for speaking openly about their own mental health; is this the beginning of a step-change in the way we view men and mental health?
I think it is, but at the same time it’s localised to the UK. You just wouldn’t see the same kind of shift in attitudes in Poland, for instance, or Romania or Ukraine.
Russia has one of the highest suicide rates in the world, and Russian men have a very low life expectancy compared to women. When the Soviet Bloc collapsed, men’s and women’s health dropped dramatically, and while women’s health began to improve quite quickly, men’s health has never really recovered. Violence, self-harm and alcoholism are still very high in Russia.
Vladimir Putin is a good example of the kind of typical male role model you can expect to find in Russia and other Eastern European countries – a hard, almost emotionless character who wades through huge international problems without even a smile or a grimace.
Even in Western Europe, this is a problem. It’s very rare that you see a sportsman express their feelings as a sportswoman would, for example.
On top of that, there are very few male teachers in primary schools, which is crazy because it’s primary school where you first learn about what it is to be a person. If children only ever come into contact with women in those formative stages of their lives, then their perception of what it is to be a man is going to be skewed. And it’s also a terrible shame for the girls; they’re not seeing what men are as role models either. We need men and women to be equally represented in primary schools.
Does the help that is available to men go far enough to treat these underlying problems, or does it just treat what it sees as a temporary condition?
This is very much dependent on which country you live in, which part of society you come from, and what services are provided where, and this is reflected in the fact that suicide rates are not uniform, even in a small country like the UK.
Unfortunately, at the moment, we are living under the most dreadful government here in the UK, which seems to have no awareness of the value of health or the way that health can drive the economy and make our nation stronger. They do not respect us whatsoever, and they are driving the health of our society down. As a result, instead of being on the decline, things like suicide are on the rise in sections of our society, and what’s so desperately sad is that we could do something about it if only we had the willpower, but unfortunately this present government doesn’t seem to have the political will to do anything about it at all.
How is the European Men’s Health Forum working to raise awareness in this space?
One of the things we’re particularly looking at right now is cancer. Thanks to modern medicine, cancer is becoming a long-term medical condition rather than an instant death sentence. We need, then, to start thinking about how we live after cancer, and one of the interesting things about that is that if you ask a man recovering from cancer what normality is to him, he’ll tell you that it’s going work.
Men identify much more with their work than women do. When two men meet for the first time, one of the very first things they’ll ask each other is, ‘What do you do for a living?’ It’s their way of finding out if they have anything in common.
Men’s friends are tied to their work; if they lose their job, they lose their mates, and when they get a new job, they make new mates. That tends not to be the case with women, who more often make friends within their community, which means they have people to go and talk to no matter their employment status.
By contrast, if a man loses his job then he has no outlet to talk about whatever’s worrying him.
If we want to get a message across to men, what we’ve found is that the best way to do it is to target them at work, because that’s where they’ll talk to their mates about it.
We’ve put together a manual and video – both available on our website – which gives men the advice and support they need to get back to work during or after a cancer diagnosis, if they want to. It’s not about pushing sick men back into work; it’s about recognising that you’re much healthier if you are able to work.
Being out of work has the equivalent health impact of smoking ten packs of cigarettes a day. We know that if men are out of work, their mental health can decline pretty rapidly, and this is where they become more at risk of falling into crime or alcohol abuse.
What we want to do with this campaign, then, is help support men to go back to work if they want to, and thereby improve their mental health and their physical health, which you cannot separate.
The European Men’s Health Forum
Founded in 2001, the European Men’s Health Forum is the only European organisation dedicated to improving all aspects of men’s health. To this end, the Brussels-based NGO promotes collaboration between all interested parties on the development and application of health-related policies, research, education and prevention programmes, and advocates for a future in which all men in Europe have an equal opportunity to attain the highest possible level of health and wellbeing.
Dr Ian Banks
European Men’s Health Forum
This article will appear in issue 4 of Health Europa Quarterly, which will be published in February.