I run a Suicide Crisis Centre in Gloucestershire. This month we were invited to give evidence to a Parliamentary Select Committee which is undertaking an inquiry into the action needed to help prevent suicide. Many of the questions and comments made by the committee related either directly or indirectly to the kind of support men in crisis are seeking.
Men often tell us that they come to us because they wouldn't have felt able to seek help from their GP. They were concerned that information about their suicidal intent would be documented in their medical records and they believed that this could affect their current job or their future job prospects. A confidential service was important and appealing to them.
We have noticed significant differences in the way men and women access our services. Some of our male clients have only felt able to be supported by one member of our team. It has been hard enough for them to open up and tell their story to one person. They felt unable to do it a second time to someone else. Indeed, some of them say that if we had asked them to be supported by two people during their time with us, they would not have come back after that initial appointment.
I very clearly recall David, who told me that he had paced up and down outside our Centre for several minutes before he felt able to come inside. When I walked into our reception area to welcome him, I saw how apprehensive and fearful he was. The prospect of sharing highly personal information with someone was terrifying for him. In sharing such information, clients make themselves so vulnerable.
In coming to see us, our clients take the hugely courageous step of expressing their deep emotional pain, their distress, and their fears to another person. This may be something they have never revealed to anyone before, because they have spent their adult life keeping this part of them hidden. They may only feel able to show this level of vulnerability to one person in our team.
One of our male clients wrote to me after he had left our services and explained how he had felt able to cry in front of me, something he could never have done in front of his family, friends, colleagues or doctor. "Crying was okay. I could cry in front of you. You took away the embarrassment of my plight, not judging me."
Asking for help is something many of our male clients say goes against all their instincts and the expectations that they feel are placed on them.
As a result of the sense of vulnerability which disclosure and seeking help can create, we put clients in control as much as possible. They decide how often they come to see us, the type of care they receive and its duration. They decide - not us.
Many of them say they are the person within their own family who supports everyone else. That has been how they have been perceived. It has become their role, they tell us. They sometimes feel unable to tell anyone in their family, although we always encourage them to do so. This lack of family involvement makes it even more important that the organisation supporting them provides care, a sense of connection, warmth, empathy, and acceptance. It is a professional relationship and there are clear boundaries. But caring about clients is absolutely compatible with that.
One of the primary reasons men come to us in crisis is because of relationship breakup or the loss of a partner through bereavement. In those circumstances they may feel bereft and alone, and the connection with us and warmth and care that they receive becomes very important. Although the confidentiality of a service was so important to them in feeling that their job would be unaffected, they said they were not seeking an anonymous service. They wanted to be known to and feel connected with the people supporting them.
Some members of the Select Committee expressed a concern that GPs are not informed whenever a client comes to us. Although we frequently communicate with GPs about our clients, and our confidentiality policy is clear about the occasions when we need to break confidentiality and inform health professionals, we do not do so routinely. If we did have a policy of routine disclosure to GPs, it could dissuade very high risk individuals including high risk men from accessing our service. It may remove their opportunity for any support. Many would simply not come to us, because they would not want their GP informed. Their subsequent silence about their suicidal intent would place them at great risk. Surely we should do all we can to encourage people to seek help, not put measures in place that may dissuade some from doing so.
We have been providing services for over three years and have never had a suicide of a client under our care. We work very tenaciously to ensure that our clients survive. I question how routinely informing a GP every time a client comes to us would improve our service. It would clearly deter some of our clients. In looking at the setting up of other Suicide Crisis Centres, the Select Committee may recommend that the GP becomes a central part of the care within them. I hope they think very carefully about the consequences, if they do decide to recommend this.
For information about the Suicide Crisis Centre: http://www.suicidecrisis.co.uk
HuffPost UK is running a month-long focus around men to highlight the pressures they face around identity and to raise awareness of the epidemic of suicide. To address some of the issues at hand, Building Modern Men presents a snapshot of life for men, the difficulty in expressing emotion, the challenges of speaking out, as well as kick starting conversations around male body image, LGBT identity, male friendship and mental health.
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