Compiled by the Men’s Health Forum, June 2016. Update September 2017.

Summary

• Just over three out of four suicides (76%) are by men and suicide is the biggest cause of death for men under 35 (Reference: ONS)
• 12.5% of men in the UK are suffering from one of the common mental health disorders
• Men are nearly three times more likely than women to become alcohol dependent (8.7% of men are alcohol dependent compared to 3.3% of women - Health and Social Care Information Centre) 
• Men are more likely to use (and die from) illegal drugs
• Men are less likely to access psychological therapies than women. Only 36% of referrals to IAPT (Increasing Access to Psychological Therapies) are men.

Male under-diagnosis?

While women are more likely to be diagnosed with common mental disorders, there are important indicators of widespread mental distress in men.

• The prevalence of psychotic illness is believed to be low, around 0.4% in the population as a whole, and is roughly equally distributed between men and women (Reference: K. Saddler and P. Bebbington (2009), ‘Psychosis’, in Adult Psychiatric Morbidity Survey) although the onset of some particular forms of psychosis seems to occur earlier in the lifespan in men (References: Journal of Psychiatry, D. Castle)
• One adult in six (17.0%) has a common mental disorder (e.g. depression, anxiety, phobia, obsessive compulsive disorder and panic disorder). One woman in five has CMD (20.7%) compared with about one man in eight (13.2%). (Adult Psychiatric Morbidity Survey 2014, Exective summary: Adult Psychiatric Morbidity Survey) 

There is considerable debate about the true level of common mental health disorders in men and whether larger numbers of men than women may be undiagnosed. In a 2016 survey by Opinion Leader for the Men’s Health Forum, the majority of men said that they would take time off work to get medical help for physical symptoms such as blood in stools or urine, unexpected lumps or chest pain, yet fewer than one in five said they would do the same for anxiety (19%) or feeling low (15%). The Men’s Health Forum has argued that the following might provide a better picture of the state of men’s mental health than the number of clinical diagnoses:

• Over three quarters of people who kill themselves are men (Reference: ONS). 
• Men report significantly lower life satisfaction than women in the Government’s national well-being survey – with those aged 45 to 59 reporting the lowest levels of life satisfaction (Reference: ONS)
• 73% of adults who ‘go missing’ are men (Reference: University of York).
• 87% of rough sleepers are men (Reference: Crisis).
• Men are nearly three times more likely than women to become alcohol dependent (8.7% of men are alcohol dependent compared to 3.3% of women) (Reference: HSCIC).
• Men are three times as likely to report frequent drug use than women (4.2% and 1.4% respectively) and more than two thirds of drug-related deaths occur in men (Reference: Information Centre).
• Men make up 95% of the prison population (Reference: House of Commons Library). 72% of male prisoners suffer from two or more mental disorders (Reference: Social Exclusion Unit).
• Men are nearly 50% more likely than women to be detained and treated compulsorily as psychiatric inpatients (Reference: Information Centre).
• Men have measurably lower access to the social support of friends, relatives and community (References: R. Boreham and D. Pevalin).
• Men commit 86% of violent crime (and are twice as likely to be victims of violent crime) (Reference: ONS).

• Boys are around three times more likely to receive a permanent or fixed period exclusion than girls (Reference: Gov.uk).
• Boys are performing less well than girls at all levels of education. In 2013 only 55.6% of boys achieved 5 or more grade A*-C GCSEs including English and mathematics, compared to 65.7% of girls (Reference: Department for Education).

The Men's Health Forum suggests that these statistics indicate that male emotional and psychological distress may sometimes emerge in ways that do not fit comfortably within conventional approaches to diagnosis. They also show that men may be more likely to lack some of the known precursors of good mental health, such as a positive engagement with education or the emotional support of friends and family.

A picture begins to emerge of a potentially sizeable group of men who cope less well than they might:

• These men may fail to recognise or act on warning signs, and may be unable or unwilling to seek help from support services.
• At the further end of the spectrum they may rely on unwise, unsustainable self-management strategies that are damaging not only to themselves but also to those around them.
• Such a picture would broadly parallel what is already known about men’s poorer physical health.

Although personality disorders are not generally considered to be a form of mental illness in themselves, they can be highly disabling and men are believed to be more likely to suffer from them (5.4% of men compared to 3.4% of women) (Reference: Rethink Personality disorders factsheet). 

People with personality disorders are more likely than the general population to come into contact with mental health services (Reference: S. Ullrich) are known to be at increased risk of substance misuse, anti-social behaviour and suicide (References: Foresight, Rethink. Personality disorders factsheet).

Stress

On average, 191,000 men a year report stess, depression or anxiety caused or made worse by work – an average of 1.2% of men in work over a 12 months period. This compares to an average of 261,000 women over the same period – 1.8% of those in work. (Source: HSE/Labour Force Survey).

The peak age group for these conditions is 45-54 - significantly higher than all other age groups.

In a 2016 survey of 1,112 employed men conducted by Opinion Leader for the Men’s Health Forum presents a picture of at least one in ten of the male workforce as significantly stressed:

• 9% described themselves as severely or extremely stressed
• 8% strongly agreed that “Overwork and stress caused by a need to achieve on the job or in school affects or hurts my life”
• 34% agreed or strongly agreed that they were “constantly feeling stressed or under pressure” and 11% strongly agreed.
• 12% of men said that the last time they were prompted to take time off work to see a GP was because they were “constantly feeling stressed or under pressure” and 11% because of “Prolonged feelings of sadness”.

Use of services

Men are significantly less likely to access psychological therapies than women. During the first 3 quarters of 2015, men were only 36% of those accessing psychological therapies. (Reference: IAPT quarterly data file)

There is no significant difference in recovery rate in response to IAPT between men and women. (Roughly the same number of men complete a course of therapy as begin it.)

In a 2016 survey of 1,112 employed men conducted by Opinion Leader for the Men’s Health Forum:

• 34% would be embarrassed or ashamed to take time off work for mental health concern such as anxiety or depression compared to 13% for a physical injury. (Amongst men with mental health concerns, 46% are embarrassed or ashamed.)
• 38% would be concerned that their employer would think badly of them if they took time off work for a mental health concern – compared to 26% for a physical injury. (Amongst men with mental health concerns, 52% are concerned.)

A survey conducted by YouGov for the Mental Health Foundation (2016) found that:

• 28% of men had not sought medical help for the last mental health problem they experienced compared to 19% of women.
• A third of women (33%) who disclosed a mental health problem to a friend or loved one did so within a month, compared to only a quarter of men (25%).
• Over a third of men (35%) waited more than 2 years or have never disclosed a mental health problem to a friend or family member, compared to a quarter of women (25%).

Suicide

Although suicide is not one of the main causes of death in men overall, it is the single most common cause of death in men under 45 (References: Department of Health).

• In 2016 there were 5,668 suicides in Great Britain. Of the total number of suicides, 76% were males and 24% were females. (Reference: ONS)
  • The age-standardised suicide rates in 2016 were 15.7 deaths per 100,000 population for males  (down from 16.2) and 4.8 deaths per 100,000 population for females (down from 5.3). 
  • Suicides rates have been consistently lower in females than in males over the past three decades (Reference: ONS).
• The suicide rate was highest in middle-aged men (40 to 44-year old age groups). The suicide rate for this group was 23.7 deaths per 100,000 population (Reference: ONS).
• The risk of suicide also varies by occupation. Men working in 'elementary occupations' have the highest risk of suicide - 44% higher than the national average - and account for 19% of male suicides. Males working in skilled trade occupations had the second-highest risk among the major occupational groups - and account for 29% of all male suicides. The lowest risk is among managers, directors and senior officials. In this group the risk of suicide was around 50% less than the national average. (Reference: ONS).

Suicide - the Samaritans Report

A review by the Samaritans in 2012 (Men, Suicide and Society) emphasised that middle-aged men in lower socio-economic groups are at particularly high risk of suicide. They pointed to the interaction of complex factors such as unemployment and economic hardship, lack of close social and family relationships, the influence of a historical culture of masculinity, personal crises such as divorce, as well as a general 'dip' in subjective well-being among people in their mid-years, compared with both younger and older people.

The report's findings were split into 6 key themes: 

• Personality traits – some traits can interact with factors such as deprivation, unemployment, social disconnection and triggering events, such as relationship breakdown or job loss, to increase the risk of suicide. 
• Masculinity – more than women, men respond to stress by taking risks, like misusing alcohol and drugs.
• Relationship breakdowns – marriage breakdown is more likely to lead men, rather than women, to suicide.
• Challenges of mid-life – people currently in mid-life are experiencing more mental health problems and unhappiness compared to younger and older people.  
• Emotional illiteracy – men are much less likely than women to have a positive view of counselling or therapy, and when they do use these services, it is at the point of crisis.
• Socio-economic factors – unemployed people are 2-3 times more likely to die by suicide than those in work and suicide increases during economic recession.

Suicide in disadvantaged men in their middle years is a health and social inequality issue. Men living in these circumstances are up to 10 times more at risk of suicide than those living in the most advantaged conditions. 

Suicide - historical overview

• Male suicide rates increased in the 1980s, and peaked at 21.9 deaths per 100,000 population in 1988. (Reference: ONS).
• Suicide rates tended to decrease between 1988 and 2010, though there were some annual rises (for example, higher rates were seen in 1998 and 1999). The rate increased significantly between 2010 and 2011 (from 17.0 to 18.2 deaths per 100,000 population) resulting in the highest male suicide rate since 2002 (Reference: ONS).