Read Wesley Mission's Vision and Values Statement

This Report was prepared by the Strategic Planning and Development Department in conjunction with the LifeForce Suicide Prevention Program.

We acknowledge the contribution of Randall Pieterse (LifeForce), Bernard McNair (Senior Manager Wesley Health & Counselling), Dr Keith Suter (Social Policy Consultant), David McGovern (Manager Public Relations), Lyndal Parker (Graphic Designer), Sharon Hoogland and AnneMarie Maizey (Strategic Planning and Development) and Kathy Moir (for Research Assistance).

For further information contact Sharon Hoogland on (02) 9263 5555.

(Biographical details. Authors: Sharon Hoogland, Randall Pieterse. 2000. Pub: Wesley Mission, Sydney.)

GENDER FACTS

• 2,150 of these suicides were males.9
• Male suicides outnumber female suicides by a ratio of 4:1.
• The all-age standardised rates of male suicide registered in 1997 and 1998 were the highest since 1963 and, before that, 1931.9
• Suicide is the leading external cause of death among men.9
• Suicide is the second leading cause of death among 25 - 44 year old males.9
• Suicide rates for males increased from 16.5 in 1979 to 23.1 in 1998.9
• Suicide rates for females decreased from 6.6 in 1979 to 5.7 in 1998.9
• For every completed male suicide there are five attempts.
• For every completed female suicide there are 35 attempts.
• Homosexuality issues may be involved in up to one third of young men under 24 who suicide.11\

YOUTH SUICIDE

• Suicide is the second leading cause of death among 15 - 24 year olds.9
• Youth suicide accounts for 16.6% of the total number of suicides in 1998.
• The largest increase in death by suicides was in the 14 - 24 years age group between 1921-25 and 1996-98.14

MIDDLE AGED SUICIDE

• Men aged 25 - 44 made up about 40% of total suicides for 1998.14
• Men aged 25 - 44 have the highest age specific rate of suicide with an 80% higher suicide incidence rate than that of women of the same age 9
• The number of suicides by men aged 25 - 44 has risen by 44% since 1979.12

ELDERLY SUICIDE

• Men aged over 80 years have a suicide incidence rate six times greater than that of women the same age.11
• Elderly suicide accounted for nearly 20% of total suicides in 1998.
• 600 Australians over the age of 55 killed themselves in 1997.

RURAL SUICIDE

• Suicide is more common amongst males in rural and remote areas.14
• The rate of suicide increases in communities with populations of less than 4,000.

INDIGENOUS AUSTRALIANS

• Approximately 86% of all Indigenous suicides are by males.9 (Only four States have indigenous death data considered to be of publishable standard.) 
• Aboriginal suicide rates are possibly two to three times that of non-Aboriginal Australians.15

METHODS OF SUICIDE

• The four most common methods of suicide among men are: firearms (27%), hanging (26%), carbon monoxide (20%) and poisonings (19%).14
• The most common methods among women are: hanging, poisonings, carbon monoxide and firearms.14

FOUR LEADING EXTERNAL CAUSES OF DEATH 1998

Source: Australian Bureau of Statistics (1999), Causes of Death Australia 1998. Canberra

AUSTRALIAN DEATHS BY SUICIDE (COMPARING 1997 AND 1998)

Source: Australian Bureau of Statistics (1999), Causes of Death Australia 1998. Canberra

Table 1: Suicide rates per 100,000 population.16

Year Male Female Year Male Female
1980 16.3  5.5     1990 20.4 5.0
1981 16.9  5.5     1991 21.4 5.9
1982 17.4  6.0     1992 20.9 5.4
1983 17.0  5.4     1993 19.2 4.4
1984 16.8  5.2     1994 20.6 4.8
1985 18.1  5.0     1995 20.8 5.5
1986 19.1  5.6     1996 21.2 5.0
1987 21.8  5.7     1997 23.3 6.2
1988 21.0  5.6     1998 23.1 5.7
1989 19.8  5.2

Suicide Defined

According to Butterworth's Concise Australian Dictionary:
Suicide can be defined as the deliberate act of taking one's life.17

According to Shneidman, suicide is
a conscious act of self-induced annihilation, best understood as a multidimensional malaise in a needful individual who defines an issue for which suicide is perceived as the best solution.18

Kosky et al. further observes that
suicidal behaviour can be interpreted as a manifestation of distress associated with loss or abandonment, a release from despair, an expression of hostility or revenge, an appeal for help, a wish to test fate or to be reunited with a loved one, or a response to the disordered thinking of a psychotic illness or drug intoxication.19

David Lester argues that
death caused by one's own voluntary act is not necessarily a sufficient criterion to use when judging whether the psychological process of suicide has occurred. There are examples of cases where people have died accidentally by suicide and other examples of cases where a person intended to die but who lived because they were accidentally found. 

Such cases make it clear that we cannot understand the suicide process simply by looking at the end result of the actions taken. In the same way, we cannot assume that certain life circumstances invariably cause suicidal acts. Many persons who find themselves in similar situations do not behave suicidally. Some people kill themselves because they are disturbed about an event that would not upset other people. The process that leads to suicide cannot be determined by looking at whether death actually occurred, nor by investigating whether a person's life was objectively miserable. Rather, we must examine the purpose of the suicidal act within the pattern of the individual's life.20

The complexity of circumstances and the multidimensional nature of suicide means that attempting to pinpoint the exact cause for a suicidal event is difficult. As this report asserts, there are many factors and issues, often interacting, which can lead a person to suicide. At the point of the suicidal crisis, however, there is a far greater degree of commonality, than the circumstances and issues which might have led individuals to suicide.

Suicide Statistics and what they do not tell us

Statistics 'mask' the individual and their personal struggles. The suffering of a suicidal person is much more significant than an analysis of statistics can reveal. "All that anguish, the slow tensing of the self to that final, irreversible act, and for what? In order to become a statistic."21 Despite this, numbers do matter, and statistics provide vital insights into the scale, development and circumstances of suicidal behaviour. They record its social impact.

To be classified as a suicide, death must be recognised as due to other than natural causes. It must also be established by coronial inquiry that death results from a deliberate act of the deceased with the intention of ending his or her own life.22

It is in determining the intent behind the suicidal behaviour, that a number of difficulties arise. Evidence of the deceased's intent, societal attitudes, the wishes of family and the guidelines for registration of suicide as the cause of death, impact on the accuracy of suicide statistics. How is it possible to clearly determine that a motor accident fatality was an 'accident' or indeed a suicide, or a death registered as an overdose was not in fact a suicide?

In addressing the accuracy of suicide statistics Lester argues:
Not only is it possible that there is a systematic bias about the certification of deaths by suicide, but there may also be deliberate attempts to conceal suicidal deaths. There are clearly many reasons to attempt to hide the fact that a death was caused by suicide. Some religious groups refuse normal funeral rites to people who commit suicide. Insurance policies often do not pay the survivors any benefits beyond the premiums after a death by suicide within two years of taking out the policy, and they frequently pay more for a death judged to be accidental than for a suicide or a natural death. We can only presume that the reporting of suicidal deaths would be more accurate if less opprobrium were attached to suicide by society.23

It is even more difficult to calculate rates of attempted suicides:
metaphorically, completed suicides are just the tip of the self-destructive iceberg, we need also to consider attempted suicide… Although various attempts have been made to define accurately the incidence of suicide in Australia, the same cannot be said about attempted suicide. There is a paucity of data on the rate of attempted suicide in Australia, not only because distinguishing intentional from unintentional death is inordinately difficult, but also because no register exists at this time to provide accurate data.24

Causes of Suicide

A number of theories have been developed to explain the cause of suicide. Psychiatric theories emphasise mental illness; psychological theories emphasise personality and emotional factors; while sociological theories stress the influence of social and cultural pressures on the individual. In the table below, a list of factors based on each of the three disciplines has been compiled to assist in understanding the complexity of suicide.

Table 1: Some factors influencing suicide. 

What is evident from a survey of the literature, is that feelings of isolation, alienation, helplessness and hopelessness can be identified as possible 'causes'. William Glasser, the father of Reality Therapy argues that everyone who needs psychiatric treatment suffers from one basic inadequacy: they are unable to fulfill their essential needs. He expands on the essential needs as being the need to love and be loved and the need to feel that we are worthwhile to ourselves and to others. It is the pain that results from these emotional needs not being met (regardless of the cause), the feelings of isolation, alienation, helplessness, hopelessness, worthlessness, anxiety, stress, despair, rejection and failure which form the essence of the emotional pain experienced by the suicidal person. Shneidman describes this emotional pain as 'psychache'. 27

SUICIDE AS PSYCHACHE
After working in this field for over 50 years Shneidman says:
Nearing the end of my career in suicidology, I think I can now say what has been on my mind in as few as five words: Suicide is caused by psychache. Psychache refers to the hurt, anguish, soreness, aching, psychological pain in the psyche, the mind. It is intrinsically psychological - the pain of excessively felt shame, or guilt, or humiliation, or loneliness, or fear, or angst, or dread of growing old, or of dying badly, or whatever. When it occurs, its reality is introspectively undeniable. Suicide occurs when the psychache is deemed by that person to be unbearable. This means that suicide also has to do with different individuals thresholds for enduring psychological pain. 28

Suicide in 1998: An Overview
1997 and 1998 Statistics Compared

Figure 1: Age-specific suicide rates 1997
Rate per 100,000 persons

Source: Australian Bureau of Statistics (1999). Suicides: Australia 1921-1998. 1997. Canberra


Figure 2: Age-specific suicide rates 1998
Rate per 100,000 persons

Source: Australian Bureau of Statistics (1999b). Suicides: Australia 1921-1998. 1997. Canberra


Observations: Comparing age specific suicide rates in 1998 with 1997

Source: Australian Bureau of Statistics (1999). Suicides: Australia 1921-1998. 1997. Canberra

1997 and 1998 Suicide Numbers Compared (States and Territories)

                                                  
    

Observations

• Youth (15-24) suicide decreased in most states

Victoria saw the most significant decrease in young male suicide, but this was accompanied by in increase in     young female suicide.

        Western Australia experienced a significant increase in youth suicide. 

• Male (25-44) suicide increased in most states

        Most significant increases in NSW, Qld, SA, WA and Tas.

        ACT and Vic were the only 2 states to see decreases.

• Female (25-44) suicide numbers increased significantly in Qld and SA. 

TRENDS IN SUICIDE RATES
Statistics show that in the range of 10 - 14 suicides per 100,000 people, Australia's suicide rate has been reasonably stable since the 1920s. However, increases have occurred in specific age groupings.

Some trends are obvious: fluctuation rates during the two world wars, the 1930s economic depression and the significant increase of female suicides during the 1960s, which has been attributed to the increased accessibility of barbiturates and new drugs. Following a campaign targeted to educate practioners, prescribing patterns were regulated with increased control and the female suicide rates declined.

Trends among selected groups

Youth Suicide
When comparing age groups, the biggest increase in deaths from suicide over the period 1921 to 1988 has been in the 15-24 years age group (approximately 6 per 100,000 in 1921 to 17 per 100,000 in 1998). Increased suicide rates in this group, particularly among young males, began in the late 1960s with a sharp increase in the 80s and 90s, peaking in 1997, when Australia recorded the highest youth suicide rate among industrialised countries. In 1998 youth suicide saw a decrease of 64 deaths, dropping the age-specific rate from 19.1 in 1997 to 16.7 in 1998.30

Middle-aged Suicide: In 1998:

• Nearly 24 per cent were by people aged 20 to 29
• More than 25 per cent were by people aged 30 to 39
• About 17 per cent were by people aged 40 to 49
• About 27 per cent were by people aged over 50
• About 12 per cent were by people aged over 65; and
• Less than 6 per cent of suicides were by people aged under 20.31

There has been an overall increase in rates among persons aged 25-44. In 1921 the age-specific rate for this age group was approximately 15 per 100,000, as compared to 20 per 100,000 in 1998. This group has the highest age-specific suicide rate among all age groups. Within this group the majority of the increase occurred in male suicide rates - the focus group of this report.

Aboriginal Suicide

Professor Colin Tatz, the author of the most comprehensive study on Aboriginal suicide in Australia, notes that it has only been in recent times that suicide has emerged as an issue among Aboriginal communities.33 A review of Aboriginal history suggests that

…suicide was an alien concept in Aboriginal life…It was never mentioned by Aboriginals, anthropologists, linguists, government officials, missionaries, magistrates, pastoralists or police. In 1968, Kidson and Jones found an absence of 'classical neuroses psychosomatic illness and suicide' among Western Desert people. John Cawte's medico-sociological expedition to Arnhem Land in 1968 found 'nothing alarming' about Aboriginal suicide rates… Hunter-Reser et al state that 'some three decades ago the suicide of an Indigenous Australian was a rare occurrence'.34

While the collection of data, specific to suicide rates by race of origin has only been a recent initiative by relevant state bodies, with information on Aboriginal peoples unreliable, it appears that suicide rates have increased considerably over the past two or three decades.37

Between 1 January 1996 and 30 June 1998, 43 Aboriginal suicides were reported in NSW and the ACT alone, which equates to 40 suicides per 100,000 Aborigines per year.38 There were a further 31 suicides in that period amongst those of uncertain Aboriginality. If they were, as is suspected, Aboriginal suicides, then the rate would be much higher. Tatz suggests that "if the Australian figures are even reasonably accurate, Aboriginal rates are possibly two to three times the non-Aboriginal.39

Despite the limited amount of research on Aboriginal suicide, most Australian commentators acknowledge that this is a relatively recent trend, which needs to be addressed immediately and addressed as an issue different to non-Aboriginal suicide. 

"Aboriginal suicide has unique social and political contexts, and must be seen as a distinct phenomenon."40

It is recognized that indigenous issues cannot all be solved by non indigenous individuals and organisations. However, that is not to say that external assistance is unwelcome, or unnecessary, and improved resources and materials for professionals working with indigenous Australians would enable us to better understand and respond to their particular needs and problems.41

Gay and Lesbian Suicide
Although the issue of suicide has been recognised as a problem from within the gay and lesbian community, it has only recently attracted some media and government attention. While research in this area is very scant, the idea that gay men, lesbians and bisexual people are at an increased risk for suicide is not new. Havelock Ellis' Sexual Inversion, first published in the late 19th century noted that homosexual men "frequently commit suicide"42

Kent Fordham, in his study on Sexuality & Suicide argues that
"Anecdotal evidence of the phenomenon of suicide among gay men and lesbians has, then, been around for at least a century. Despite this, very little research was conducted in the field until the past decade. Rather than being due to lack of interest in the area, the paucity of research was more likely due to the stigma surrounding homosexuality. Homophobia permeates all levels of society, and it is not surprising that potential researchers would have avoided the area, for fear of damaging their reputations or careers."43

Recent studies in the USA and Canada suggest that homosexuality issues are involved in up to one third of young men under 24 who suicide. A recent Australian study replicates these findings. In his study for the US Department of Health, Gibson states that

"Suicide is the leading cause of death among gay male, lesbian bisexual and transsexual youth…Gay males were six times more likely to make an attempt than heterosexual males. Lesbians were more than twice as likely to try committing suicide than the heterosexual women in the study. A majority of the suicide attempts by homosexuals took place at age 20 or younger, with nearly one-third occurring before age 17."45

Several recent studies have shown that gay, lesbian and bisexual people, particularly adolescents and young adults, are at substantially increased risk of suicidal behaviours and suicidal thinking. For gay, lesbian and bisexual young people (up to age 27), studies in the United States have found risk of suicide attempt ranging from 3.5 to nearly 14 times that experienced by heterosexual young people. 

A recent Australian study found that gay-identified young men (aged 18 - 24) were 3.7 times more likely to attempt suicide. Most of these attempts occurred after the person had self-identified as gay, but before having a same-sex experience and before publicly identifying themselves as gay.46

Overall, studies of completed suicides have not found gay youth over-represented, however, studies focused on suicidal ideation and suicide attempts show significantly higher rates among gay and lesbian youth compared to heterosexual youth.47

Rural And Remote Communities
It is only since 1998 that data disaggregated by capital cities, other urban and rural locations has become available. 

The past 10 years have seen a higher rate of suicide amongst males in rural and remote areas than in urban areas. 

Throughout the 10 year period, 1988 to 1998, rural areas had the highest rates of suicide ranging from 14.6 to 17.1 per 100,000 persons, while other urban areas had the next highest rates of suicide ranging from 14.7 to 14.9 per 100,000 persons, and capital cities had the lowest rates ranging from 12.8 to 12.9 per 100,000 persons.48

In 1998, the Northern Territory recorded the highest suicide rate, at 21 per 100,000 persons. This was followed by Queensland and South Australia at 16 per 100,000; Western Australia at 15 per 100,000, New South Wales, 13 per 100,000, Tasmania and Victoria at 12 per 100,000 and the ACT at 9.5 per 100,000.49

Whilst suicide rates for males have increased in metropolitan areas, the most significant increases have been in communities with populations of less than 4,000.50

Economic and social change in Australia, particularly in the last 30 years have had a dramatic impact on farming and rural areas. In some cases, whole communities have suffered economic hardship and many are struggling to survive. Indeed, it is widely accepted that small communities, with populations of less than 10,000 are no longer economically viable, as we witness farm repossession, business and industry closures, the removal of medical and educational services, and the exodus of people to larger commercial centres.51

Such drastic changes have taken their toll on the people in farming communities, whose already high sense of alienation and isolation is exacerbated by financial insecurity and family breakdown.

A further factor is the availability of guns in rural areas. Whilst restrictive gun laws have seen a decrease in gun related incidences of suicide and self harm in general/in metropolitan areas, this has not been the case in rural Australia where guns are commonplace. 

A comprehensive study of male suicide in Victoria presented to the National Conference for Suicide Prevention, highlighted the effects of social disadvantage on the health of many young men in rural communities in the state. It found that those young men with lower levels of education were grossly over represented in suicide rates. Moreover, funding for suicide prevention services had targeted schools and mental health services. Given that the majority of young men committing suicide were neither in school, nor in a position to seek medical help, prevention efforts were not reaching those most in need.54

Middle-Aged (25-44) Male Suicide
Statistics at a Glance

• 80% of suicides in 1998 were committed by men, a total of 2,150.55
• More men are killing themselves than are dying in road accidents.56
• Men aged 25-44 made up about 40% of total suicides for 1998.
• The number of suicides by men aged 25-44 has risen by 44% since 1979.57

Throughout Australia's history, males have always committed suicide at greater rates than females even though females have traditionally attempted suicide at greater rates than men.55 Whereas long term trends show a relatively stable incidence of female suicide in Australia, the picture for men is substantially different. In fact, the rise in suicide in recent years is almost wholly attributable to an increase in male suicide.

Men of all age groups in Australia are far more likely than women to die from suicide, with 1998 rates at 23 per 100,000 men (2,150 deaths) compared with 5.7 per 100,000 women (533 deaths). Rates for men have been consistently higher than for women throughout the time Australian data have been collected.58 

In recent times, there has been a strong emphasis on male youth suicide, both in the media and in funding from government bodies. The under 20 age group was seen as the most 'at risk', and initiatives developed which addressed youth issues and youth suicide.

An analysis of the most recent Australian Bureau of Statistics suicide rates by the Australian Institute for Health and Welfare dispels the widely held belief that suicide is primarily a problem among Australian youth. Their findings show that the rise in male suicide has been almost entirely due to an increase in the rates for males aged over the age of 20. Men in the 20-39 year age group now have the highest suicide rate. In a surprising contrast, the rates of male teenage suicide are much lower than for all other age groups. 

Moreover, the number of suicides among older age groups can be expected to rise, given that they constitute the fastest growing segment of the population.60

Suicide rates reach a second peak in older men over 85 years, with rates at 31.8 per 100,000. It may be that older men find themselves for the first time, physically and economically dependent, or affected by mental and physical health problems. Other treatable factors identified as contributing to suicide in old age include pain, grief, loneliness, alcoholism and carer stress. 

How do we explain this changing trend? 

What is often hidden by conventional statistical reporting methods is that youth suicide is no longer the problem that it once was. Instead, what we are seeing is a 'generational' tendency towards suicide. Men who were part of the youth suicide trend from the late 1970s are now reaching 'mid life' - and they continue to commit suicide at a rate far higher than their younger counterparts. In fact, the number of suicides for men between the ages of 25 and 44 has risen 44% since 1979.61

By breaking down the 1998 data into smaller age groupings, we find that for men aged 25-29, 30-34 and 35-39, suicide rates were at an all time high. 

Our tendency to focus on suicide amongst young people, and particularly males, has profound implications, not only for suicide prevention initiatives, but also for how we as a community view the whole issue of suicide. 'Youth suicide' somehow seems easier to grasp, linked as it has been with high levels of unemployment, family break-down and a general perception that the youth in our society were more prone to anti-social behaviour. On the other hand, suicide amongst an age group widely perceived as being more stable, both financially and emotionally turns this assumption on its head, and challenges the foundations of many of our approaches to the issue of suicide in general.

This has profound implications for Prevention Initiatives, which have tended to focus campaigns at younger age groups, and school education programs in particular. We cannot hope to make any impact on the increasing suicide rates while we still insist on focusing on young people, and ignoring the problems of middle aged men. 

Factors Influencing Suicide in Older Men.

MALE HEALTH
Until fairly recently, male health has been a much neglected issue. Women typically are much more interested in their health, evidenced by the higher numbers of women who use Medicare services. Women's health issues have, at least since the 1960s, been widely discussed in the public domain and women are well represented in health industries.

For men, however, it is a different story. Men are far less likely to visit their GP, or to seek medical advice. This, despite evidence that men participate in 'health risk behaviours' to a much greater extent. It has been argued that certain aspects of men's socialised behaviour have a major impact on their health risk. 

'Excessive competition, unrealistic and unattainable models of masculinity, poor self-esteem, lack of meaningfulness, poor identity formation and a lack of sustainable role models are some of the culprits that have left men in their teens, early twenties, after the age of 45 and after retirement feeling they have reached their use-by date.'62

Whilst a higher rate of mental disorder is typically associated with women, there is increasing evidence to suggest that men in fact may suffer depression and other forms of mental illness as much, if not more than women.63

Moreover, men respond differently to stressful and emotional events in their lives. Whilst women may show a high level of depression and anxiety, men are more likely to resort to substance abuse.64

When we examine the statistics, men's problems become painfully obvious. Huggins states:

• Our prisons are full of men (90%), they are not full of women (10%);
• Our juvenile detention centres are full of boys, not girls;
• Approximately 90% of our school suspensions and expulsions are boys, not girls;
• Our remedial reading classes are full of boys, not girls;
• Well over 80% of our drug and alcohol abusers are boys and young men, not girls and young women;
• The rate of suicide in the 15-24 year age group for males is nearly seven times the rate for females in the same age group;
• Injury rates for males are three times the rate for women;
• The perpetration of violence and abuse is approximately 95% male.65

Mental Health/Depression

The issue of male suicide in the middle-aged group was made more public earlier this year following the suicide death of a prominent Labour MP in his early forties, who had been suffering from depression following his marriage break-up. This tragic suicide shocked the Australian community, a community so accustomed to hearing that suicide was a 'youth issue'. Why would a man, at his stage in life, take his own life?

This death highlighted the very real problem of depression amongst men in general, and its links to male suicide in particular. 

There is strong evidence that mental health problems are major contributors to suicidal behaviours in people of all ages. Various studies, both in Australia and overseas have shown that more than 90% of people who committed suicide were suffering from some form of mental illness. This was the case across all age groups. Indeed, people with recognised mental illness are 10 times more likely to take their own lives than the general population.66 It has also been estimated that 15% of people suffering serious mental illness will eventually commit suicide.67 Sufferers of schizophrenia are particularly vulnerable, with up to 10% taking their own lives.68

It is quite clear that having a mental disorder places a person, whatever their age, at considerably higher risk of suicide than the general population. One of the most common forms of mental illness associated with suicide is depression. Suicide rates are higher for people who are not receiving treatment for depression, or whose current treatment is not effective. There is strong evidence that appropriate pharmacological treatment can dramatically reduce the risk of suicide in people with depression and schizophrenia, and for adults with bipolar disorder.69

A 1997 report by the Australian Bureau of Statistics into mental health estimated that only 25% of people believed to be suffering from depression were actually receiving adequate treatment.70

"We are extraordinarily bad at recognising depression in men," claims Graham Martin, the national chairman of Suicide Prevention Australia. "Men don't go to doctors and when they do they are often patted on the shoulder and told, 'Don't worry, mate.' Men don't tell anyone at work their problems. Instead, they might start drinking, get violent or do something impulsive like suicide."71

While any person with a mental disorder is potentially more vulnerable to suicide, there is particular need for vigilance with depressed older men.

The World Health Organisation has warned that depression will escalate from the fourth-greatest cause of death to the equal-biggest cause in the Western world by 2020. Mounting an attack against depression, defeatism and disillusionment will not be easy, because modern Western culture is not well equipped. Its hallmarks - such as individualism, secularism, liberalism, intellectualism, materialism, consumerism and economic rationalism - may be lauded as its strengths, but equally may prove to be its greatest liabilities when it comes to establishing sound mental health among the population.72 

Perhaps the MP's own words can shed some light on the issue. In a speech made to Federal Parliament in 1997, he said that '...people have a strong desire to feel needed, to feel that they are loved, and to feel that they have some worth and role in life. […] men kill themselves due to an inability to cope with life events such as relationship break-ups, … and unemployment."73

He concluded by saying 'There is certainly a need for our community to work towards an environment in which people feel a sense of belonging and meaning.[…] If we can achieve such a state, then the incidence of all suicides […] will no doubt be reduced. […] if we can tackle some of the fundamental problems in society, such as the quality of education, unemployment and job security, there will no doubt be a flow-on to reduced family breakdowns, and ... fewer suicides.'74

Marital Status

Interestingly, marriage seems to 'protect' people from suicide. Married people show lower suicide rates than those who have never married, or who have been divorced.75

Recent research into male suicide in this age group revealed that males in the 'separation phase' of a marriage break-up were most at risk of suicide, compared with widowed or divorced males.76 Whilst these are only preliminary findings, they suggest that the severe disruption of separation and the high levels of interpersonal conflict that were associated with it, were perhaps the greatest contributing factor, along with separation from children. 

Marriage breakdown is a significant characteristic of male suicide in the 24-39 age bracket. The anxiety and emotional pain of separation and divorce appear to effect men differently. 

Whilst suicides may simply be recorded as statistics, it is the increasing number of murder/suicides, involving children that have brought the tragic reality of male suicide, and male mental health issues in general into the public arena. 

Where children are concerned, there is evidence to suggest that many men sense they are being discriminated against in Family Court judgements, and often find themselves in financial straits having to pay legal fees and child support payments. The difficulty in maintaining access to children also heightens the frustration and isolation of separated and/or divorced men.77

Following two murder/suicides in Western Australia in 1999, where fathers gassed both themselves and their children to death, Allan Huggins, director of Men's Health, Teaching and Research at Curtin University, said "There is a whole range of psychological issues for them to deal with, but ultimately they see their situation as being totally hopeless and then a realm of fantasy begins where they want to take their children with them to what they perceive as being a better place."78

It seems that 'stressed fathers will keep killing'79 both themselves and their children, until adequate support services are provided.

Professor Pierre Baume, Head of the Australian Institute for Suicide Research and Prevention at Griffith University in Queensland found that, in a study of 4,000 suicides, at least 70% were associated with relationship break-ups. Men were 9 times more likely to take their own lives following break-up than women.80

Why do men and women respond so differently to separation? 

Research suggests that the majority of divorces are initiated by women, and that in most cases, married men did not want to separate and had tried to resolve the problems.81 Further evidence suggests that the period of 'separation' is one of the most stressful times in a man's life, and often this anxiety and frustration continues for many years.82 Moreover, men are not inclined to access relationship services, or to seek advice and support when they are in times of need.

Epidemiological studies show a strong correlation between divorce and separation, and mental health problems.83 Alcoholism and depression are much more common in those who have experienced relationship breakdown. Whilst it is not clear whether depressed people, or alcoholics are predisposed to relationship problems leading to suicide, or that these symptoms come about following, and as a result of relationship breakdown, there is no doubt that men in particular are at risk.

The Howard Government has acknowledged the problem of male suicide, particularly following relationship break-ups. It has agreed to fund a $16.5 million initiative focusing on men and family relationships. With the state governments, it continues to fund the Labor initiated mental health strategy.84

Substance Abuse

Alcoholism in Australian is a major public health problem, and is far more common in men than women.85 It has been estimated that 33% of males suffer symptoms of alcoholism at some point in their lives, compared with only 5% of women.86

Alcohol abuse, particularly when combined with other factors, is characteristic of a high proportion of adult male suicide deaths.87 Researchers have shown that approximately 15% of alcoholics die by suicide, most occurring between the ages of 40 and 59.88 The majority of these are male. 

Use of illicit drugs is less common than alcoholism, but shows similar trends, affecting approximately 6% of men, compared with only 1% of women.89 Heroin addiction, in particular, is associated with higher rates of suicide. However, it is often very difficult to determine whether death was as a result of suicide, or accidental overdose, and coroners are more likely to give the cause of death as accidental overdose rather than suicide, because of the stigma attached to suicide.

Victoria's Suicide Prevention Task Force has emphasised that substance abuse, violence, depression and access to means are a deadly combination in men.90

Unemployment and underemployment

When we examine the suicide trends in Australia throughout the last century, there appears to be quite a distinct correlation between unemployment and suicide. In periods of high unemployment, such as during the Depression, suicide rates soared. 

Underemployment is also a factor, with those at the 'lower status' end of the labour market, whose employment offered 'low job autonomy, greater external supervision, less on-the-job training, poorer promotional possibilities, lower wage levels and greater sensitivity to market forces'91 had suicide rates very close to twice that of those in 'higher status' employment, with a steady decline in suicide as occupational level rose.92 The recent rise in youth, rural and indigenous suicides is almost entirely attributable to an increase in male suicide in each of these groups.93

Unemployment and underemployment effects men and women differently. In Western societies, men are typically seen, and continue to see themselves, as 'breadwinners' and 'providers'. When this role is denied them through unemployment, or underemployment, they are left with no clear 'role' for themselves in society, and their self esteem suffers.

Women, on the other hand, are viewed as having multiple 'roles' in life, and appear to be able to adapt far more readily to changes in their employment.

Whilst unemployment does not affect all men in the same way, it does impact on the mental health of a great number of men, particularly those in lower socio-economic circumstances, who have greater difficulty in finding employment.

Choice of Method

This has been shown to be an important factor in the gender disparities in the incidence of suicide. 

Men overwhelmingly choose more lethal methods. Hanging is now the most common means of suicide, followed by carbon monoxide poisoning, and the incidence of both is steadily increasing.94 Suicide by gunshot declined by half in the 1990s, which suggests that gun control legislation has had a positive impact.95

While rates of suicide using guns have decreased in recent years, suicide by hanging and exhaust gas have increased. Firearms suicides are more common in rural areas. The vast majority of Aboriginal and Torres Strait Islander suicides are by hanging or firearms.

A report recently released by the Australian Institute of Criminology found that men who had been widowed and divorced were the most likely to kill themselves with a firearm. In fact, in 1998, 70% of deaths by firearm were suicides. The Minister for Justice and Customs, Amanda Vanstone expressed her concern over these statistics, saying that "the number of older men who use a firearm to kill themselves would appear to be one of Australia's hidden tragedies."96


Problem Gambling

Problem gambling, with its potentially devastating impacts on the finances, personal lives and relationships of the affected gamblers, is related to heightened anxiety, depression, and in extreme cases, to suicide.

A survey of 82 clients presenting at LifeLine Addictions Counselling Service at LifeLine Sydney, for counselling in relation to a gambling problem showed the following results:

	NUMBER	%
a. No thoughts of suicide	34	41
b. Suicidal thought but no clear plan	30	37
c. Suicidal thoughts with a clear plan	12	15
d. One or more previous suicidal attempts	6	7

In total, 48 clients (59%) had experienced some measure of suicidal thought. This also does not account for the unknown number who have completed suicide.

Suicide Assessments
Up to 60% of problem gamblers will experience some level of suicidal thought. This may be vague (often after major losses), or serious intent with a clear plan. It is also common for clients to have had one or more failed suicide attempts.

The results of a survey (Simon, USA, 1995) on compulsive gamblers found that:

• 20% had attempted suicide
  
• 63% had seriously considered suicide.

These figures were 50 times greater than most 'within lifetime' estimates for the general population.


Male Suicide Rates

Figure 1: Male Suicide Rates 1921 - 1998.

Source: Australian Bureau of Statistics (2000) Suicides, Australia, 1921-1998. Canberra

Australian Bureau of Statistics causes of death figures in 1998 showed that for males aged 15 to 24 years the leading cause of death was accidents, poisonings and violence, followed by motor vehicle traffic accidents, then suicide, then drug dependence. For males aged 25-44, the highest cause was accidents, poisonings and violence, then suicide, cancer, heart disease, mental disorders and drug dependence. It is not difficult to see that specifically male behaviour is involved in these causes. The only similar pattern shown by female deaths were the first three causes in the 15-24 years age group - accidents, poisoning and violence, motor vehicle traffic accidents, and suicide. However, the numbers of deaths for women were much smaller than for men, being as low as 22.5% of male deaths. 

Health and educational professionals working in rural communities where suicide is high, report a lack of training and resources with regards to mental health issues, and suicide in particular. 

There is a convincing argument for the provision of programs and interventions which are targeted at the prevention of suicide. We must offer positive alternatives for individuals at risk, and for people who fall into identified high risk groups. We must deepen our understanding both of the issues surrounding suicide and also what action should be taken.

Wesley Mission Services
How Wesley Mission is Helping

LifeForce Suicide Prevention Program.
Established in 1994, LifeForce is based on the belief that all members of the community can be trained to recognise the warning signs and intervene to save a life. The program equips people with basic suicide prevention skills, in much the same way CPR is used to intervene in medical emergencies.

No suicide, whether it be completed or attempted, is an isolated problem. Instead, the action has the potential to affect hundreds of lives, especially those who are related to, or who know, the victim.

Wesley Financial Counselling Services.
People with financial difficulties are often at risk of contemplating or attempting suicide because of the emotional, mental and physical stress they feel under. While there are no comprehensive figures available to determine how many are in this situation, it is clear that financial counselling can help remove much of this pressure and allow for early intervention and referral.

Although financial crises are often related to other emotional factors in a person's life, staff from Creditline and other counselling programs run by Wesley Mission may be among the first to hear of a person's needs. This is the ideal opportunity for early intervention and referral.

Through face to face and telephone counselling, we can provide support and advice, educate people about coping strategies, recommend a plan for dealing with the commitments and debts and refer to other relevant services. Staff also educates the community, through media work, industry briefings and public speaking engagements.
Credit Line also provides support services, such as debriefing, casework supervision, resources and networking for other financial counsellors throughout NSW and for those funded under the Commonwealth Financial Counselling Program nationally. 

This month (November 2000), Credit Line has organized the first Remote and Isolated Financial Counsellors Conference to provide further support to a group of people working in very difficult conditions. Financial Counsellors themselves can often become extremely stressed from the constant flow of people in crisis as well as other environmental factors. 

Through our Legal Services, we attempt to help people stay out of jail by providing advice and support. This is often made available to those who could not otherwise afford it.

Credit Line can be contacted on 02 9951 5544 to arrange face to face appointments at the city, Penrith, Fairfield and Sutherland offices. We also have outreach services to Emu Plains, Richmond and Quakers Hill.
Credit Helpline can be contacted on 1800 808 488.

Wesley Gambling Counselling Services.
Staff at Wesley Gambling Counselling Services provide a holistic approach to gambling. All aspects of the gambling problem and its effects - personal, social, mental, emotional, financial and legal - are addressed, This allows us to examine the reasons for the problem developing and initiate some goals and strategies for overcoming it. By restoring a sense of hope and a renewed purpose in living, we avoid the possibility of suicide occurring.

From various locations throughout the inner-city and outer-west, our staff offer personal counseling, group work, financial counseling, family or partner counseling and legal advice. Some services are offered in other languages also.

Newcastle City Mission.
One of the largest, and most rapidly growing regions in NSW is the Hunter, encompassing Newcastle and Maitland. 
In this area, services like the Newcastle City Mission are inundated with calls for help from people in emotional, physical or mental turmoil. Every week counsellors, care workers and volunteers at Newcastle City Mission encounter someone who is contemplating suicide. 

It could be an abused teenager who does not feel loved; it could be a man trying to kick a drug habit that began in high school; or it could be a mother trying to gas herself because she can no longer live with the shame and anguish of a gambling addiction which leads her to forge her husband's signature.

For these, and others, their reason for living is gone. At Newcastle City Mission, which is now a part of Wesley Mission, staff help restore pride, confidence and a passion for life.

Lifeline Sydney.
Lifeline Sydney was the first crisis telephone counselling service set up in Australia and possibly the world. The service was developed in response to the lack of support for people in crisis especially after hours, and it was the suicide of one of the congregation that really inspired Rev Sir Alan Walker to establish the service.

It is now a key referral point for people in crisis or people who are suicidal (one estimate is that up to 8 per cent of calls received by Lifeline centres across Australia relate to suicide - in Sydney, the figure is as high as 80 per cent). The telephone number for Lifeline is given out to clients in crisis by doctors, psychiatrists, hospitals, mental health teams, counsellors and other health professionals. Our volunteers offer a safety net, 24 hours a day, seven days a week. Throughout a year, this amounts to 16,000 hours of counselling support every year.

There are 42 centres throughout Australia and approximately 400,000 crisis calls each year. In 1998 and 1999 Lifeline nationally undertook a study of suicide calls received. In that time Lifeline centres took 48,678 calls across Australia (approx 24,339 per annum).

At Lifeline Sydney, our counsellors recorded 2,100 suicide calls in that period representing just over 5% of all calls. 75% of calls came from callers aged between 25 and 54, 57% from female and 40% from male callers (3% undefined). 37% of those people calling were principally concerned about issues around relationship including relationship of partner, family, friends or lack of relationships and isolation.

While callers ring Lifeline Sydney often at their point of distress, the great majority of callers are at the point of needing to talk through their issues and at an early stage of seeking help, only 11.5 per cent are considered emergency or high risk. In this way, Lifeline plays a key preventative role, while at the same time effectively intervening when the situation is critical. If the situation is very serious, Lifeline Counsellors can get help to the caller with the assistance of the local mental health teams, the ambulance and police, to ensure every effort is made to save a life. A call to Lifeline is a call for help.

Wesley Health & Counselling Services/Health Services.
WM operates a series of high class, clinically efficacious mental health services across the metropolitan area and in Taree on the north coast of NSW. These services are to help clients regain their mental health capabilities and to return to full activities within the community. 

A number of patients require inpatient care prior to moving on to the 6-8 session day program. The reasons for admission male clientele to the program is varied. Even a loss of employment or loss of other significant relationship is a significant factor. A common thread amongst this client group on admission to this service is hopelessness, helplessness, and worthlessness. This can often present as a sense of wanting to engage in self harm/suicidal activities. We believe that appropriately titrated psycho-pharmacological agents as well as supportive group and individual counselling, will prevent the client wishing to take their suicidal thoughts through to fruition.
Wesley Mission operates Wandene Private Hospital at Kogarah, Wesley Private Hospital at Ashfield and the Carlingford Centre at Carlingford. Additionally, we provide mental health services in Taree, in conjunction with our partners at Mayo private hospital. 

As well as our inpatient services, we also offer an extensive range of day programs, to meet the needs of other clients. The programs offered by Wesley Mission's Health Services include anxiety management, drug and alcohol programs, depression management, Encompass program (aimed at religious and clergy who exhibit dysfunctional sexual behaviour), gambling counselling, eating disorders, Community Reintegration program and post traumatic stress disorder (both war and non-war trauma).


Wesley Mission
220 Pitt Street, Sydney Australia
PO Box A5555 Sydney South NSW 1235
Phone: (02) 9263 5555 o Fax: (02) 9285 1140
www.wesleymission.org.au
wesleymission@wesleymission.org.au 
Superintendent: Rev Dr Gordon Moyes am
Part of UnitingCare

Recommendations

That the Australian community recognise that suicide is no longer a 'youth' issue, but one which affects all age groups.

That suicide prevention and intervention programs are made available to all segments of the Australian community.

That special focus be placed on suicide prevention programs within the rural and remote areas of Australia. 

That special focus be placed on training for professionals within all community health-related areas.

That special focus be placed on males during their school years, with programs which encourage boys to take greater interest in their health and self-esteem.

That programs relating to the building of self-confidence and the self esteem of individuals be incorporated into the mainstream educational curriculum, facilitating the development of positive self-image in individual students.

That health and educational professionals be specially recruited, trained and offered incentives to work in rural and remote areas.

That the Indigenous population is funded adequately to develop unique programs which meet their needs.

That funding be allocated to allow the conduct of research in areas of identified individuals and groups at risk of suicide, (ie: middle-aged and older men, indigenous people, the gay and lesbian community), and that positive alternatives are developed and provided.

That State and Federal governments provide new and additional resources to primary and secondary schools, TAFE colleges and universities, for the provision of specialist programs aimed at increasing awareness of mental health issues.

That older men should be encouraged to join service and community organisations such as Rotary and 'Older Men:New Ideas' (OMNI), and to undertake volunteer activities within the community.

That the destigmatisation campaign on mental health issues continues, so that vulnerable people will feel less inhibited in seeking help.

That gun control legislation be reviewed, with a view to increased control, in light of the still unacceptably high rate of suicide using firearms.

That State and Federal governments provide incentives to employers who provide apprenticeships, traineeships and vocational training.

That employers are trained in awareness of the implications of making employees redundant. (Each individual who has been employed for one or more years within a company and who is about to be made redundant, should be offered the opportunity for counselling.)

Wesley Mission's Commitment
Wesley Mission Sydney, will establish a forum for Survivors of Suicide (SOS), in an effort to provide support and referrals to survivors of suicide attempt, as well as to better understand the issues which 'motivate' a suicide attempt.

Wesley Mission Sydney, will establish a forum where relatives and friends of people who commit suicide can be given support, post trauma counselling and appropriate referral to health and community services.

Wesley Mission Sydney, will convene a forum of peak business bodies and employers which will challenge this section of the community to identify methods of helping the reduction of suicide within the community.

Wesley Mission Sydney, will challenge the producers of Australian television 'soapies' to take on an educational role regarding suicide by incorporating suitable story lines into their programs.

Wesley Mission Sydney, will work with other churches and community service providers to identify relevant and appropriate preventative and educational programs on issues regarding suicide 
and (mental) health.

Wesley Mission Acknowledges
Wesley Mission Sydney congratulates the Federal government on the formation of a National Advisory Council for Suicide Prevention (NACSP), which will address suicide issues for all age groups, and for the provision of the publication 'Living Is For Everyone (LIFE): a framework for prevention of suicide and 
self-harm in Australia'. Wesley Mission Sydney congratulates the media for sensitive and responsible reporting of issues surrounding suicide, especially in their awareness of and as they seek to avoid, the possibility of "copy cat" actions.

Case Studies