Male Suicide Rates In Australia And The Role Of Middle-Aged Men In Prevention

Suicide is a common cause of death among people of all age groups, both women and men. However, the suicide rates in men are higher than in women. According to Nobel Laureate Sir Angus Deaton, in middle-aged suicide rate in Australia is increasing at an alarming rate. In Australia, the population of middle-aged men are identified as a priority for the prevention of suicide. The rate of suicide in men is around three times more than that of women. Data shared in 2019 by the Australian Bureau of Statistics shows that male suicides are highly prevalent among those aged above 85 years (32.3 deaths for every 100,000 males) (Australian Bureau of Statistics, 2020). The risk of suicide among the men of Aboriginal and Torres Strait Islanders is increasingly high. The data of the Australian Bureau of Statistics in 2019 shows that 70.3% of all suicides among the Aboriginal and Torres Strait Islanders are male suicides (Australian Bureau of Statistics, 2020).

Male suicide nature has been known to be often driven by situation and impulse instead of showing warning signs and hence can be challenging to recognise (Schlichthorst et al., 2020). Usually, the cases have no history of the ideation of suicide. According to data evidence, about 75% of males who have suicidal intent have been reported to lose the intent within 24 hours. The increasing impulsivity rate is determined by alcohol consumption, impacting the decision making and thought process of the men (Schlichthorst et al., 2020).

Epidemiological research related to suicide, depression, substance abuse and other mental health factors in men signifies various underpinning risk factors, and one such common determinant is occupational and employment issues. Unemployment is a chronic stressor, and being redundant and unemployed is an acute stressor (Affleck, Carmichael & Whitley, 2018). Various studies imply that unemployment has a huge effect on men’s mental health as compared to women. The difference in suicide rates between women and men can be because, traditionally, men derive their self-worth, self-esteem, and self-identity from their work (Bilsker, Fogarty & Wakefield, 2018). Work is also a symbol of income, status and resources to support their families. Discontinuity and hindrance in work can lead to notable psychosocial stress along with severe financial burden. However, conflict arising from balancing work responsibilities and family along with job insecurity are predictive of mental health issues. Poor and imbalanced mental health is related to job uncertainty and competition within the work environment (Llosa et al., 2018). For instance, many researchers have observed that industries in financial instability that are dominated by males, including commercial fishing and coal mining, have shown high suicide rates. Some of these industries have experienced a steep increase in suicide in the last three decades. In comparison, gender-balanced industries like white-collar services have seen the lowest suicide rates, and the rate of suicide has plunged over the last three decades.  Risk Factors And Prevention Strategies Discussion Paper

The mental health trends in men are associated with macro-socioeconomic aspects. In the last few decades, there has been a restructuring and shift in the Western economies, which had a transition to a service-based economy from a manufacturing economy. This resulted in the decline of male-dominated industries that provided the men, especially less-educated and rural, a job and status in their communities. Male suicides have increased in rural areas due to high rates of unemployment (Affleck, Carmichael & Whitley, 2018). The average earnings for middle-aged males have decreased over the last few years throughout Western countries, indicating that more men are taking low-skilled and low-paying jobs. On the other hand, men under 40 years and women are now remarkably out-earning the men between 40 and 60, and many middle-aged men are struggling to settle themselves in the new transformed economy.

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Impulsivity And Alcohol Consumption: Understanding Male Suicide Nature

Divorce and family issues are other determinants of men’s mental health status. Divorce and family break-up are potential risk factors for suicide and mental illness (Love et al., 2017). Divorced men are reported to experience depressive episodes following a separation than women, signifying that divorce affects men’s mental health more than women. Divorce men are likely to lose emotional connections and social support, which is a major factor leading to poor mental health (Affleck, Carmichael & Whitley, 2018). Rising cases of divorce and separation have been associated with a hike in suicide rates by many researchers.

Before caring or advocating for a person having suicidal tendencies, it is important for nurses to understand that suicidal intent and behaviours are not exclusive to mental health issues; however, the prevalence is higher for mental health patients in comparison to the general group. It is essential for nurses that they have:

• Knowledge regarding the key suicide risk indicators (Betz et al., 2018)
• Knowledge of safe ways to interact with the people at risk
• Knowledge of conversing with a person who might be showing risk indicators
• Knowledge regarding therapeutics and communicative relationships
• Understanding the patient’s mental health and applying all risk assessment methods to understand the patient’s needs
• They should develop long-term care, and treatment plans adaptable to each patient’s needs

Nurses should understand that suicidal behaviours and intent can appear due to various adverse events, cultural or family issues, social isolation, unemployment, homelessness, poor mental health and others (Betz et al., 2018). As a nurse, it is important to help these groups with varying degrees of education and socioeconomic status and advocate for their mental health and suicide prevention through community practice and striving for a better suicide prevention strategy. Community programmes are good ways to educate the general population about the risk factors and how to identify the risk factors. Community education can also provide the general population with training, materials and resources so that they can identify the risk factors in their loved ones who need help. Nurses can urge people to participate in mental health programmes and provide them with pamphlets and helpline numbers. Good communication is crucial for nurses who are engaged in the care of suicidal people. They should ask questions like, “Have you had thoughts of harming yourself?” or “Have you had feelings of loneliness and sadness lately?” (Anderson, Mitchell & Brodaty, 2017) These questions will give the health professional an idea about their intent; some more direct questions should also be asked, like asking if the patient has access to harmful and lethal means (Betz et al., 2018). It is important for nurses to understand the varying degrees of suicidal thoughts and assess the need for hospitalisation. Nurses should not convey that in order to prevent suicide, hospitalisation is requisite; instead, they should communicate that the treatments provided in the hospital will help the patient feel much better (Shin et al., 2018). It is the duty of the nurse to provide a safe environment without coercing the target groups to make a decision. The patient’s good judgment should always be considered, and their immediate family should be contacted with prior permission from them.

The objective of the Victorian Suicide Prevention Framework (2016-2025) for Victoria, in which Casey Shire is a municipality, is to reduce the suicide rate in the region by 2025 (Department of Health Victoria, 2022). Their objectives are as follows:

1. Building resiliency
2. Supporting the vulnerable groups
3. Caring for people with suicidal tendencies
4. Learning what works for the people
5. Helping the local communities for preventing suicide

The strengths of the programmes are:

Occupational And Employment Issues: A Common Determinant Of Male Suicide

The programme framework envisions improving the community and individual capacity and strengths in order to prevent suicide. This encourages a degree of self-importance, self-respect and self-dignity among the suicidal individuals in the community (Department of Health Victoria, 2022).

The framework has targeted various groups and individuals who are prone to a higher risk of emotional and psychological distress, for example, Aboriginal communities, dairy farmers, emergency service professionals, police, paramedics, at-risk occupations like trucking and construction, and the entire community of bisexual, gay, transgender, intersex and lesbian people (Department of Health Victoria, 2022). This benefits the target group of this study since the middle-aged group falls in the manufacturing-based economy like farmers and miners, being supported by the framework.

The potential weaknesses of the programmes are:

The programme is at a trial phase and has planned a coordinated approach to test and try out the strategic policies at a local and community level

The budget of Victoria for suicide prevention was $27 million for the fiscal year 2016-17, which they spent over the course of four years (Department of Health Victoria, 2022). Hence a roadmap is already in place, yet the framework is in its trial phase.

The Government of Victoria has decided to support the development and implementation of a coordinated suicide prevention model for the local communities by partnering up with the Primary Health Networks (Department of Health Victoria, 2022). The trials are gathering local expertise, skills and resources to structure a customised evidence-based framework. Important elements also include the engagement and input of the Aboriginal communities to investigate specific concerns of the Aboriginal people. The trial phase is getting implemented in twelve locations in and around Victoria by partnering up with about 300 local communities in an attempt to implement a better system for preventing suicide.

Conclusion: Importance of Nurse’s Role

Nurses are the first group in a primary care service who have a hands-on approach toward patient care, and the ability of a nurse to make therapeutic relationships with vulnerable groups assists them in picking up key indicators of risks (Ballard & Zarate Jr, 2018). Recognising these cues or indicators begins with understanding and empathising with the suicidal thoughts that are not considered conditions or illnesses, instead of a complicated set of actions or behaviours existing continuously, ranging from thoughts and ideas to ultimate actions (Wood, Chaboyer & Carr, 2019). Nurses help recognise these cues and determine the significance of the consequences of such behaviours, hence incorporating a care plan that is acted upon immediately.

Reference

Affleck, W., Carmichael, V., & Whitley, R. (2018). Men’s mental health: Social determinants and implications for services. The Canadian Journal of Psychiatry, 63(9), 581-589. https://journals.sagepub.com/doi/pdf/10.1177/0706743718762388

Anderson, J., Mitchell, P. B., & Brodaty, H. (2017). Suicidality: prevention, detection and intervention. Australian prescriber, 40(5), 162. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5662435/

Australian Bureau of Statistics. (2020). Causes of Death, Australia, 2020. Australian Bureau of Statistics. Retrieved 2 April 2022, from https://www.abs.gov.au/statistics/health/causes-death/causes-death-australia/latest-release.

Ballard, E. D., & Zarate Jr, C. A. (2018). Preventing suicide: A multicausal model requires multimodal research and intervention. Bipolar disorders, 20(6), 558. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6175633/

Betz, M. E., Brooks-Russell, A., Brandspigel, S., Novins, D. K., Tung, G. J., & Runyan, C. (2018). Counseling suicidal patients about access to lethal means: attitudes of emergency nurse leaders. Journal of Emergency Nursing, 44(5), 499-504. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6150796/

Bilsker, D., Fogarty, A. S., & Wakefield, M. A. (2018). Critical issues in men’s mental health. The Canadian Journal of Psychiatry, 63(9), 590-596. https://journals.sagepub.com/doi/pdf/10.1177/0706743718766052

Department of Health Victoria. (2022). Suicide prevention in Victoria. Health.vic.gov.au. Retrieved 2 April 2022, from https://www.health.vic.gov.au/prevention-and-promotion/suicide-prevention-in-victoria.  Risk Factors And Prevention Strategies Discussion Paper