How do you define dignity? Perhaps it seems like an old-fashioned word, but it is central to people's self-esteem, the way they treat themselves and the treatment they accept.
The dictionary calls it a number of things: worthiness, self-respect, bearing, rank, and nobility, or elevation of character, to name a few, I think it is central to identity and value. As the theme of this year's World Mental Health Day, it is impossible not to think back to times within living memory, certainly within my working life time when anyone with mental health issues or anyone who took their own life, was excluded and treated unfairly.
Part of that was fear and fear is often associated with ignorance and at the root of stigma which does not make it any more excusable: suicides buried in non-consecrated ground, their families stigmatised, any examination of whys and wherefores hushed up to avoid blame or shame. Anyone with any kind of mental issue could be subjected to imprisonment and physical abuse in the name of a "cure" without comment or concern.
We have moved on, but people who are struggling to cope can feel they are losing their dignity. And that is a step on a slippery slope - once such a loss is felt it is difficult to claw back.
Samaritans' research* indicates it is particularly relevant when examining why middle-aged men are currently at three and a half times greater risk of taking their own lives in the UK and the Republic of Ireland.
Men from the lowest social class, living in the most deprived areas, are up to ten times more likely to end their lives by suicide than those from higher social classes in the most affluent areas. This particularly applies to men in mid-life when a gap between someone might have thought life would be and what it actually is can be felt a vengeance.
Some men subject to gender stereotyping might hold themselves up to a mythical gold standard of masculinity which can be toxic and puts them at greater risk of suicide. They can blame themselves for not measuring up to a narrow definition of what is perfect and see anything less than perfection as a personal failure.
This combines unhelpfully with the fact that many men from every social class can be reluctant to talk when struggling and put it off until they are at crisis point - and that may be too late.
Men can see themselves as falling short if the perceived ingredients of a successful life are not in place: a job which provides for a family and confers power is still important to them. Losing your job for whatever reason has a major impact, especially if you look to it to define yourself, job insecurity and low pay also impact but also on key personal relationships which play a vital protective and restorative role in difficult times . This is the reason suicide rates rise during an economic recession.
Family breakdown also contributes to loneliness because men have fewer friends than women after early adulthood and rely more heavily on their partners for emotional support.
Achieving a long term stable relationship and children, plus a home is also seen as the gold standard and if that goes wrong many men can feel shame and defeat, and blame themselves. A feeling of dignity and self-respect can be hard to hold on to under those circumstances.
Poor education, substandard housing and low income, also cited as part of deprivation, can leave people struggling to cope and with less choice and control.
It also increases the likelihood of mental health problems, loneliness, and depression - and can contribute to physical ill-health, as well as making misuse of drugs and alcohol more likely.
Misuse of drugs and alcohol added to the mix above can cause additional problems as 65 per cent of suicides have alcohol as a feature.
Society is changing but people follow at a much slower pace, and the current generation of working class men is caught between traditional fathers and the generation following them, their sons, who are seen as more flexible, less macho and not so tied to the old roles.
Suicide in middle aged men needs to be treated as a health and social inequality issue and suicide prevention training and policy should be more tailored to reach men, taking account of their needs and concerns.
We can take action to help people hold on to their dignity. Encouraging men to strengthen social relationships can help to fend off loneliness and make it easier for them to talk about what is bothering them so it doesn't build up to a crisis without release.
Expanding local suicide prevention plans to cover all areas of the UK and Ireland, and embedding suicide prevention as standard when training social workers and NHS staff would help to stop so many men falling through the safety nets which at the moment have too many holes in them, or don't exist at all.
Ruth Sutherland is the chief executive of Samaritans
Need help? In the UK, call The Samaritans free on 116 123. For more support and advice, visit the website here.