{"id":352,"date":"2023-06-14T21:42:33","date_gmt":"2023-06-14T20:42:33","guid":{"rendered":"https:\/\/blogs.qub.ac.uk\/sssj\/?page_id=352"},"modified":"2025-08-15T11:31:32","modified_gmt":"2025-08-15T10:31:32","slug":"male-suicide-deaths-a-review-of-suicide-prevention-policy-in-northern-ireland-andrew-rawding-1st-year-social-work","status":"publish","type":"page","link":"https:\/\/blogs.qub.ac.uk\/sssj\/male-suicide-deaths-a-review-of-suicide-prevention-policy-in-northern-ireland-andrew-rawding-1st-year-social-work\/","title":{"rendered":"Male suicide deaths: A Review of Suicide Prevention Policy in Northern Ireland. Andrew Rawding – 1st Year Social Work"},"content":{"rendered":"\n

Abstract<\/strong><\/p>\n\n\n\n

In Northern Ireland, three times more men die by suicide than women (O\u2019Neill & O\u2019Connor, 2020). Latest figures reveal that in 2021 there were 237 suicide deaths, the highest number since 2015, representing an increase of 18 (8.2 per cent) from the 219 suicide deaths registered in 2020.  Of these, 176 (74.3 per cent) suicide deaths were males and 61 (25.7 per cent) were females (Northern Ireland Statistics and Research Agency (NISRA), 2022). For decades the rates of male suicide deaths in Northern Ireland have been consistently high. This social policy review will discuss suicide prevention strategies in relation to male suicide deaths in Northern Ireland, analysing policies implemented by local government since 2003, followed by a focus on the current \u2018Protect Life 2\u2019 (2019) suicide prevention strategy. It will highlight gender inequality in terms of deaths by suicide, which appears to be a gap in current  suicide prevention policies, as male deaths by suicide remain high. Policies that potentially blame and shame men for being reluctant to talk about \u2018mental health\u2019 issues have not worked. This review  argues that a proactive approach to preventing male suicide deaths is required, which is focused not only on \u2018mental health\u2019 but also solutions to the problems for men that lead to them ending their lives by suicide.<\/p>\n\n\n\n

Death by suicide is a serious public health problem in Northern Ireland. Death by suicide is \u2018a self-inflicted death\u2019 (O\u2019Connor, 2021: 17). Suicide is complex with genetic, psychological, and environmental risk factors (Joiner, 2005). In an exploration of two leading theories of suicidal ideation, De Beurs et al. (2019:8) found that feelings of \u2018perceived burdensomeness\u2019 from the \u2018interpersonal theory of suicide\u2019 (Van Orden et al., 2010) and  \u2018internal entrapment\u2019 of painful thoughts and feelings from \u2018the integrated motivational-volitional model of suicidal behaviour\u2019 (O\u2019Connor, 2011; O’Connor & Kirtley, 2018) were \u2018strongly related\u2019  to suicidal ideation. The impact of trauma from violent conflict in Northern Ireland (McLafferty et al., 2016), and the conservative religious nature of society with high levels of homophobia and transphobia (Travers et al., 2020), means that as a result burdensomeness may not just be \u2018perceived\u2019 but real, and painful thoughts and feelings like rejection and shame remain trapped internally, for example for loyalist former prisoners (Shirlow, 2014)..<\/p>\n\n\n\n

Between 2000 and 2018, 4,783 suicide deaths were registered in Northern Ireland, increasing from 185 deaths in 2000 to 307 deaths in 2018 (Black & McKay, 2019). Since 2005, close association with the deceased has directly affected an estimated 219,000 people (Department of Health (DOH), 2019). Three times as many people die by suicide in Northern Ireland than in road accidents (DOH, 2019). This social policy review will discuss suicide prevention strategies in relation to male suicide deaths in Northern Ireland, analysing policies implemented by the local government since 2003, followed by a focus on the current \u2018Protect Life 2\u2019 suicide prevention strategy (DOH, 2019). <\/p>\n\n\n\n

Death by suicide is a gendered issue (Freeman et al., 2017; Struszczyk et al., 2017; DOH, 2019:19; Samaritans, 2020). In 2019 suicide rates globally were 2.3 times higher in males than females: 12.6 per 100,000 for males and 5.4 per 100,000 for females (World Health Organization (WHO) 2021). In 2019 in Northern Ireland, suicide rates were 19.4 per 100,000 for males compared to 6.3 per 100,000 for females (Samaritans, 2022). In Northern Ireland, men are three times more likely to die by suicide than women (DOH, 2019:17,19; O\u2019Neill & O\u2019Connor, 2020; Samaritans, 2020; Black, 2021). From 2000-2005, 83.3% of deaths by suicide in Londonderry were male, with rising unemployment and divorce rates and substance misuse contributory factors (Burns et al., 2008:156). From 2005 to 2011, 77% of 1,671 deaths by suicide in Northern Ireland were male, and 23% were female (O\u2019Neill et al., 2016). <\/p>\n\n\n\n

A steady increase in male suicide deaths in Northern Ireland has been evident since the late 1990s (Department of Health, Social Services and Public Safety (DHSSPS), 2006). Comparing average deaths by suicide in 1984-1993 and 1994-2002 revealed that \u2018female suicide rates decreased by 17%, male suicides increased by 13.2%\u2019 (Largey et al., 2009). Research and reports stress that women are more likely to \u2018attempt suicide\u2019 (O\u2019Neill et al., 2014; O\u2019Neill et al., 2016; Black, 2019; Black, 2021:17), and men are reluctant to talk about mental health and help-seek (O\u2019Neill et al., 2014; DOH, 2019:19). However, even when men do seek help, they are still at higher risk of death by suicide. For example, just over 60% of the 118 deaths by suicide from 2008 to 2011 of crisis line \u2018Lifeline\u2019 clients were men, \u2018compared to 42% of Lifeline service users generally\u2019 (Ramsey et al., 2018).  Research of the effectiveness of crisis helplines suggests that it is not so much that men are reluctant to talk but that there may be \u2018gender bias\u2019 in telephone crisis workers, requiring research and education to ensure services are better at responding to the specific suicidal presentations and needs of men (Hunt et al., 2018:4). <\/p>\n\n\n\n

The high rate of male deaths by suicide in Northern Ireland is acknowledged in all the strategies published by the local government since \u2018Promoting Mental Health Strategy & Action Plan 2003-2008\u2019 (DHSSPS, 2005). \u2018Suicide Prevention\u2019 formed Annex 3 of this \u2018Mental Health\u2019 strategy. However, previously mentioned rates of registered deaths by suicide show that the strategy did not reduce deaths by suicide. Rather, a \u2018significant increase\u2019 in suicide deaths in 2005 led to the publication of a specific \u2018Northern Ireland Suicide Prevention Strategy and Action Plan 2006-2011\u2019 called \u2018Protect Life: A Shared Vision\u2019 (DHSSPS, 2006).<\/p>\n\n\n\n

The overall aim of \u2018Protect Life: A Shared Vision\u2019 was \u2018to reduce the rate of suicide in Northern Ireland,\u2019 with a target of \u2018by 15%\u2019. None of the \u2018key objectives\u2019 specifically mention males (DOH, 2006:19). In the \u2018Action Plan,\u2019 males are not included as an \u2018Action Area\u2019 in the \u2018Population Approach,\u2019 though \u2018Children and Young People\u2019 are. Only \u2018Young Males\u2019 are included in the \u2018Targeted Approach.\u2019 Researching suicide deaths from 2005-2011, O\u2019Neill et al. (2014:468) highlight that \u2018whilst suicide prevention efforts typically target the young, the average age of the individuals in this population was 40 years and the rates of suicide were highest in those aged 20\u201350 years.\u2019 Even though deaths of males generally, not just \u2018young males,\u2019 had consistently been three times higher than females for many years (Largey et al., 2009), this is not mentioned in \u2018Protect Life 1\u2019. More vulnerable \u2018not young\u2019 males are not specifically targeted. This could be because older males are assumed to be included in \u2018Action Areas\u2019 like \u2018High Risk Occupations\u2019 and \u2018Prisoners\u2019 (DHSSPS, 2019:35). However, there was no mention of the gender inequality evidenced by male suicide death rates. As previously highlighted, male suicide deaths in Northern Ireland increased at more than three times the rate of female suicide deaths (Largey et al., 2009).<\/p>\n\n\n\n

Four years after the publication of \u2018Protect Life: Shared Vision\u2019 suicide rates in Northern Ireland reached the highest ever total of 313 registered deaths by suicide in 2010 (NISRA, 2011: 28; . The \u201815% by 2011\u2019 reduction target aim had not been achieved (Black & McKay, 2019). In 2012, \u2018Refreshed Protect Life: Shared Vision\u2019 for 2012-2014 was published (DHSSPS, 2012). This acknowledged that males accounted for over three quarters (77%) of the 1,288 deaths by suicides in Northern Ireland between 2005 and 2009 (DHSSPS, 2012:50, 84), and \u2018males are three times more likely to die by suicide than females\u2019 (DHSSPS, 2012:81). The strategy placed renewed emphasis on the vulnerability of young males, and highlighted \u2018learning\u2019 which encouraged \u2018greater focus on males from deprived areas\u2019 (DHSSPS, 2012:27) . This reinforced  the negative impact of poverty on mental health and the increased suicide risk linked to socio-economically deprived areas being worst affected by the violent conflict of \u2018The Troubles\u2019 (O\u2019Connor & O\u2019Neill, 2015). A revised action plan included: \u2018Objective 6: Enhanced outreach services for males at risk of suicide in deprived areas\u2019 (DHSSPS, 2012:37) and \u2018Implementation of a targeted information and awareness campaign for young males\u2019 (DHSSPS, 2012:44). \u2018Protect Life: Shared Vision\u2019 (2012) raised awareness that for men the term \u2018mental health\u2019 was associated with \u2018stigma and stereotyping\u2019 (2012:31), particularly in rural areas, and that research from the \u2018Men\u2019s Health Forum\u2019 suggested \u2018mental fitness\u2019 as a better term (2012:72).  There was also mention of \u2018a male culture of not sharing feelings\u2019 (2012:69), which might be considered victim-blaming in the light of research associating adverse childhood experiences with suicidality (Dube et al., 2001; Bruffaerts et al., 2010).<\/p>\n\n\n\n

In \u2018Refreshed Protect Life: Shared Vision\u2019 (2012), there was an emphasis on the high numbers of deaths of the \u201csingle\u201d marital status group\u2019 (DHSPPS, 2012:52, 55), but this does not account for the higher risk proportionally of other \u2018marital status\u2019 groups. For example, O\u2019Reilly et al. (2008) identified that separated\/divorced males were three times more likely than married\/cohabiting males to complete suicide. Corcoran and Nagar (2010), researching \u2018Suicide and Marital Status in Northern Ireland\u2019, also demonstrated that divorced men and women were three times more likely to die by suicide than married persons and that divorced young men aged 20\u201334 years old were at highest risk.<\/p>\n\n\n\n

Tomlinson (2007:116) had drawn attention to the need for more research into groups involved in the conflict in Northern Ireland, including police, emergency services and British Army personnel, paramilitaries and \u2018ex-prisoners.\u2019 Tomlinson (2007:80) also cited sociological literature which argues that it is not \u2018deprivation\u2019 that causes high suicide rates but \u2018social isolation that often accompanies aspects of deprivation.\u2019 O\u2019Reilly et al. (2008) argued that \u2018individual and household factors\u2019 like relationships and connectedness were more significant than deprivation, concluding that \u2018differences in rates of suicide between areas are predominantly due to population characteristics rather than to area-level factors, which suggests that policies targeted at area-level factors are unlikely to influence suicides rates\u2019 (2008:110) significantly. This raises question about why the new aim of the \u2018Refreshed Protect Life: Shared Vision (2012) strategy was \u2018to reduce the differential in the suicide rate between deprived and non-deprived areas\u2019 (DHSPPS, 2012:35).<\/p>\n\n\n\n

In 2019, \u2018Protect Life 2: A strategy for Preventing Suicide and Self Harm in Northern Ireland 2019-2024\u2019 was published (DOH, 2019). This current strategy has two aims: \u2018Reduce the suicide rate in Northern Ireland by 10% by 2024\u2019 and \u2018Ensure suicide prevention and support are delivered appropriately in deprived areas where suicide and self-harm rates are highest\u2019 (DOH, 2019:11).  The first stated principle of the strategy is to \u2018be evidence-based where possible, achieve measurable outcomes and be fully evaluated.\u2019 (DOH, 2019:12). There is much description in the strategy about who is impacted by suicide, who is at risk of suicide, and who accesses services but little evidence of what \u2018delivered appropriately in deprived areas\u2019 actually means from critical research and the effectiveness of what has been delivered since the original \u2018Protect Life: A Shared Vision\u2019 was published in 2006. <\/p>\n\n\n\n

The opening line of \u2018Chapter 2: Strategy Aims, Principles, Scope and Objectives\u2019 is: \u2018Protect Life 2 seeks to build on the achievements of Protect Life since it was originally published in 2006\u2019 (DOH, 2019:11). However, the \u2018achievements\u2019 of Protect Life (DHSSPS, 2006) did not contribute to any significant reduction in suicide death rates; the strategy aim was not achieved (Black, 2021). Rondon-Sulbaran et al. (2012:106),  exploring the impact of social exclusion amongst young men in Northern Ireland, raised a concern about the evidence base (NSRF & DHSSPS, 2010) for Protect Life (DHSSPS, 2006) and therefore the continuing effectiveness of the strategy. This raises an issue of the evidence-base for the efficacy of \u2018Protect Life 2\u2019 in reducing the rates of male death by suicide and proactively addressing gender inequality (Freeman et al., 2017), where male rates of suicide continue to be three times greater than female rates (O\u2019Neill & O\u2019Connor, 2020:538; Samaritans, 2020). <\/p>\n\n\n\n

The terms \u2018males\u2019 or \u2018men\u2019 are not used in the \u2018Aims\u2019, \u2018Principles\u2019, \u2018Objectives\u2019, \u2018Action Grid\u2019, nor the ‘Action Plan\u2019 of the  \u2018Protect Life 2\u2019 strategy (DOH, 2019: 11, 12, 16, 56-61). Rather than being listed as a priority, \u2018engaging men in suicide prevention\u2019 is described as \u2018a challenge\u2019 (DOH, 2019: 46). The main emphasis is on males needing to seek help for mental health difficulties rather than on strategies which specifically and proactively target high risk groups of males like middle-aged men (Struszczyk et al., 2017; Samaritans, 2020). The continued emphasis on \u2018promoting help-seeking behaviour, especially in males\u2019 could stigmatise and even shame males, rather than prioritizing the creation of services that men want to and are content to access.  In an exploration of \u2018help-seeking prior to male suicide\u2019, Oliffe et al. (2022:1) highlight three significant dimensions which include not just males \u2018concealing the need for help\u2019, but also \u2018ineffectual\u2019 systems and services, which contributed to the hopelessness of \u2018overwhelming illness that couldn\u2019t be helped\u2019. In Protect Life 2 (DOH, 2019:19), under \u2018Gender and suicide\u2019, evidence for higher suicide death rates for men includes \u2018cultural perceptions of masculinity\u2019. Seemingly men are blamed for not help-seeking as: \u2018psychological distress is perceived by many men as a weakness and as representing a loss of control, whilst seeking support equates to an acknowledgement of vulnerability\u2019 (DOH, 2019:19).  Arguably, if men see current services as for the \u2018vulnerable\u2019 then services need to be improved to reinforce a \u2018strengths-based approach\u2019 (DOH, 2019:20), and also men need to be convinced that the services on offer are what they need and will actually help.  In a systematic review of masculinity and men\u2019s help-seeking for depression, Seidler et al. (2016: 106) highlight that \u2018men prefer collaborative interventions involving action-oriented problem solving.\u2019<\/p>\n\n\n\n

In \u2018Protect Life 2\u2019, males are held responsible for not receiving help as \u2018males can be reluctant to disclose health concerns to their GP\u2019 (DOH, 2019:19) which raises questions about trust and congruence. \u2018Risk Factors\u2019 (DOH, 2019:27) do explicitly mention \u2018working-age men\u2019 and \u2018males in unskilled occupations and trades\u2019 but this is not followed through with an \u2018action.\u2019 Crucially, under the heading \u2018Support for those not known to mental health services \/ engaging men in suicide prevention\u2019 (DOH, 2019: 46) it is acknowledged that \u2018the vast majority of the people who die by suicide but who are not known to mental health services are males aged from their late teens to late 50s.\u2019 Mallon et al. (2019) highlight \u2018the limitations of primary care in suicide prevention\u2019 for men. In the earlier \u2018Protect Life: Shared Vision\u2019 local research from the \u2018Men\u2019s Health Forum\u2019 stated that \u2018mind fitness\u2019 was a better term for men than \u2018mental health\u2019 and language used should be \u2018positive\/solution focused\u2019 (DHSSPS, 2012: 74). If the current  strategy (2019) could possibly stigmatise and make men feel shamed for not seeking help for \u2018mental health concerns\u2019 with primary care or \u2018mental health services\u2019, then it is unlikely to reduce the gender inequality of male suicide death rates in Northern Ireland.<\/p>\n\n\n\n

The \u2018necessary step\u2019 of \u2018community outreach programmes into non-health settings\u2019 for men (DOH, 2019:46; Jordan et al., 2012) needs to be focused on the life issues that contribute to some men ending their lives by suicide, which men themselves may not regard as \u2018mental health\u2019 issues. O\u2019Neill et al. (2016:13) produced the \u2018first profile of deaths by suicide in Northern Ireland\u2019, concluding with the need \u2018to target people who have difficult life experiences in suicide prevention work, notably men, people with employment, financial and relationship crises, and those with mental disorders.\u2019 In 2012, \u2018Samaritans\u2019 (Wylie et al., 2012) published nine recommendations based on research to \u2018reduce suicide in disadvantaged men in mid-life\u2019. It is not possible to determine if \u2018Protect Life 2\u2019 has been effective in implementing them. However, arguably the first recommendation to: \u2018Ensure that suicide prevention strategies include explicit aims to reduce socio-economic inequalities and gender inequalities in suicide\u2019 (Wylie et al., 2012:3) has not been met.<\/p>\n\n\n\n

Research on the impact of relationship difficulties for men (Uggla and Mace, 2015; O\u2019Neill et al., 2017) also highlights the need to take seriously the recommendation to \u2018recognise the profound role of social disconnection in the suicide risk of men in mid-life, and support men to build social relationships\u2019 (Wylie et al., 2012:3). This includes recognition that for some men being \u2018disrespected,\u2019 shamed\u2019 or \u2018dishonoured\u2019 by their partners and not having contact with their children contributes to death by suicide in some men (Wylie et al., 2012:2). \u2018Divorced men have more thoughts about suicide than divorced women; separated men are twice as likely as separated women to have a suicide plan\u2019 (Samaritans, 2012:4). Finally, O\u2019Neill and O\u2019Connor (2020:544) highlight the need for more research into deaths by suicide in the criminal justice system.  Male prisoners are three times more likely to die by suicide than men in the general population, and males released from prison are eight times more likely to die by suicide in the first year of release (Samaritans, 2019). <\/p>\n\n\n\n

If \u2018Protect Life 2\u2019 is \u2018Refreshed\u2019 then Rodriguez-Otero et al.\u2019s (2021) critical analysis of suicide prevention strategies that place the responsibility on the individual who has a \u2018problem\u2019, or a \u2018disorder\u2019 should be taken seriously. Questioning \u2018the social\u2019 in the \u2018biopsychosocial model of suicide prevention,\u2019 Rodriguez at al. (2021:5) conclude that \u2018universal suicide prevention should be expanded beyond anti-alcohol policies, awareness campaigns, restriction of lethal means, and work with the media.\u2019 Society needs to change to reduce death rates of men by suicide. <\/p>\n\n\n\n

Suicide is complex and continues to be a serious public health issue in Northern Ireland for both males and females, with the suicide death rate (standardised for age) on a general upward trajectory for both genders since 2019 (NISRA, 2022).   However, appraising suicide statistics and local government suicide prevention strategies since 2003, this review has highlighted the clear gender inequality related to deaths by suicide. In Northern Ireland, three times more men than women have died annually for at least the last several decades (Black & McKay, 2019). Local government suicide prevention strategies in Northern Ireland since 2003 have not successfully addressed this inequality as male deaths by suicide have not been significantly reduced (NISRA, 2022). Whilst all men are uniquely complex, an overall emphasis on men seeking help themselves for \u2018mental health\u2019 problems has not worked. A proactive \u2018men-seeking\u2019 approach is required, targeting men struggling with social connection, relationship issues and internal entrapment (O\u2019Connor, 2011), which relieves \u2018perceived burdensomeness\u2019 (Joiner, 2005), rather than stigmatizing and shaming men by placing the responsibility on men to seek help from services that may not actually be effectual for men (Seidler et al., 2016; Mallon et al., 2019; Oliffe et al., 2022).  An explicit suicide prevention strategy aim to prevent male deaths by suicide is required, rooted in evidence-based research on men\u2019s needs and what actually works for men, and including an in-depth evaluation of the effectiveness of current publicly funded suicide prevention initiatives, particularly those in deprived areas. <\/p>\n\n\n\n

References:<\/strong><\/p>\n\n\n\n

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Wylie, C., Platt, S., Brownlie, J., Chandler, A., Connolly, S., Evans, R., Kennelly, B., Kirtley, O., Moore, G., O\u2019Connor, R., Scourfield, J. (2012) Men Suicide and Society: why disadvantaged men in mid-life die by suicide, Ewell: Samaritans. Available at: https:\/\/media.samaritans.org\/documents\/Samaritans_MenSuicideSociety_ResearchReport2012.pdf<\/a>  Accessed: 13 April 2022. <\/p>\n","protected":false},"excerpt":{"rendered":"

Abstract In Northern Ireland, three times more men die by suicide than women (O\u2019Neill & O\u2019Connor, 2020). Latest figures reveal that in 2021 there were 237 suicide deaths, the highest number since 2015, representing an increase of 18 (8.2 per cent) from the 219 suicide deaths registered in 2020.  Of these, 176 (74.3 per cent) suicide deaths were males and 61 (25.7 per cent) were females (Northern Ireland Statistics and Research Agency (NISRA), 2022). For decades the rates of male suicide deaths in Northern Ireland have been consistently high. This social policy review will discuss suicide prevention strategies in relation to male suicide deaths in Northern Ireland, analysing policies implemented by local government since 2003, followed by a focus on the current \u2018Protect Life 2\u2019 (2019) suicide prevention strategy. It will highlight gender inequality in terms of deaths by suicide, which appears to be a gap in current  suicide prevention policies, as male deaths by suicide remain high. Policies that potentially blame and shame men for being reluctant to talk about \u2018mental health\u2019 issues have not worked. This review  argues that a proactive approach to preventing male suicide deaths is required, which is focused not only on \u2018mental health\u2019 but also solutions to the problems for men that lead to them ending their lives by suicide. Death by suicide is a serious public health problem in Northern Ireland. Death by suicide is \u2018a self-inflicted death\u2019 (O\u2019Connor, 2021: 17). Suicide is complex with genetic, psychological, and environmental risk factors (Joiner, 2005). In an exploration of two leading theories of suicidal ideation, De Beurs et al. (2019:8) found that feelings of \u2018perceived burdensomeness\u2019 from the \u2018interpersonal theory of suicide\u2019 (Van Orden et al., 2010) and  \u2018internal entrapment\u2019 of painful thoughts and feelings from \u2018the integrated motivational-volitional model of suicidal behaviour\u2019 (O\u2019Connor, 2011; O’Connor & Kirtley, 2018) were \u2018strongly related\u2019  to suicidal ideation. The impact of trauma from violent conflict in Northern Ireland (McLafferty et al., 2016), and the conservative religious nature of society with high levels of homophobia and transphobia (Travers et al., 2020), means that as a result burdensomeness may not just be \u2018perceived\u2019 but real, and painful thoughts and feelings like rejection and shame remain trapped internally, for example for loyalist former prisoners (Shirlow, 2014).. Between 2000 and 2018, 4,783 suicide deaths were registered in Northern Ireland, increasing from 185 deaths in 2000 to 307 deaths in 2018 (Black & McKay, 2019). Since 2005, close association with the deceased has directly affected an estimated 219,000 people (Department of Health (DOH), 2019). Three times as many people die by suicide in Northern Ireland than in road accidents (DOH, 2019). This social policy review will discuss suicide prevention strategies in relation to male suicide deaths in Northern Ireland, analysing policies implemented by the local government since 2003, followed by a focus on the current \u2018Protect Life 2\u2019 suicide prevention strategy (DOH, 2019).  Death by suicide is a gendered issue (Freeman et al., 2017; Struszczyk et al., 2017; DOH, 2019:19; Samaritans, 2020). In 2019 suicide rates globally were 2.3 times higher in males than females: 12.6 per 100,000 for males and 5.4 per 100,000 for females (World Health Organization (WHO) 2021). In 2019 in Northern Ireland, suicide rates were 19.4 per 100,000 for males compared to 6.3 per 100,000 for females (Samaritans, 2022). In Northern Ireland, men are three times more likely to die by suicide than women (DOH, 2019:17,19; O\u2019Neill & O\u2019Connor, 2020; Samaritans, 2020; Black, 2021). From 2000-2005, 83.3% of deaths by suicide in Londonderry were male, with rising unemployment and divorce rates and substance misuse contributory factors (Burns et al., 2008:156). From 2005 to 2011, 77% of 1,671 deaths by suicide in Northern Ireland were male, and 23% were female (O\u2019Neill et al., 2016).  A steady increase in male suicide deaths in Northern Ireland has been evident since the late 1990s (Department of Health, Social Services and Public Safety (DHSSPS), 2006). Comparing average deaths by suicide in 1984-1993 and 1994-2002 revealed that \u2018female suicide rates decreased by 17%, male suicides increased by 13.2%\u2019 (Largey et al., 2009). Research and reports stress that women are more likely to \u2018attempt suicide\u2019 (O\u2019Neill et al., 2014; O\u2019Neill et al., 2016; Black, 2019; Black, 2021:17), and men are reluctant to talk about mental health and help-seek (O\u2019Neill et al., 2014; DOH, 2019:19). However, even when men do seek help, they are still at higher risk of death by suicide. For example, just over 60% of the 118 deaths by suicide from 2008 to 2011 of crisis line \u2018Lifeline\u2019 clients were men, \u2018compared to 42% of Lifeline service users generally\u2019 (Ramsey et al., 2018).  Research of the effectiveness of crisis helplines suggests that it is not so much that men are reluctant to talk but that there may be \u2018gender bias\u2019 in telephone crisis workers, requiring research and education to ensure services are better at responding to the specific suicidal presentations and needs of men (Hunt et al., 2018:4).  The high rate of male deaths by suicide in Northern Ireland is acknowledged in all the strategies published by the local government since \u2018Promoting Mental Health Strategy & Action Plan 2003-2008\u2019 (DHSSPS, 2005). \u2018Suicide Prevention\u2019 formed Annex 3 of this \u2018Mental Health\u2019 strategy. However, previously mentioned rates of registered deaths by suicide show that the strategy did not reduce deaths by suicide. Rather, a \u2018significant increase\u2019 in suicide deaths in 2005 led to the publication of a specific \u2018Northern Ireland Suicide Prevention Strategy and Action Plan 2006-2011\u2019 called \u2018Protect Life: A Shared Vision\u2019 (DHSSPS, 2006). The overall aim of \u2018Protect Life: A Shared Vision\u2019 was \u2018to reduce the rate of suicide in Northern Ireland,\u2019 with a target of \u2018by 15%\u2019. None of the \u2018key objectives\u2019 specifically mention males (DOH, 2006:19). In the \u2018Action Plan,\u2019 males are not included as an \u2018Action Area\u2019 in the \u2018Population Approach,\u2019 though \u2018Children and Young People\u2019 are. Only \u2018Young Males\u2019 are included in the \u2018Targeted Approach.\u2019 Researching suicide deaths from 2005-2011, O\u2019Neill et al. (2014:468) highlight that \u2018whilst suicide prevention efforts typically target the young, the average age of the individuals in this population was 40 years and the rates of suicide were highest in those aged 20\u201350 years.\u2019 Even though deaths of males generally, not just \u2018young males,\u2019 had consistently been three times higher than females for many years (Largey et al., 2009), this is not mentioned in \u2018Protect Life 1\u2019. More vulnerable \u2018not young\u2019 males are not specifically targeted. This could be because older males are assumed to be included in \u2018Action Areas\u2019 like \u2018High Risk Occupations\u2019 and \u2018Prisoners\u2019 (DHSSPS, 2019:35). However, there was no mention of the gender inequality evidenced by male suicide death rates. As previously highlighted, male suicide deaths in Northern Ireland increased at more than three times the rate of female suicide deaths (Largey et al., 2009). Four years after the publication of \u2018Protect Life: Shared Vision\u2019 suicide rates in Northern Ireland reached the highest ever total of 313 registered deaths by suicide in 2010 (NISRA, 2011: 28; . The \u201815% by 2011\u2019 reduction target aim had not been achieved (Black & McKay, 2019). In 2012, \u2018Refreshed Protect Life: Shared Vision\u2019 for 2012-2014 was published (DHSSPS, 2012). This acknowledged that males accounted for over three quarters (77%) of the 1,288 deaths by suicides in Northern Ireland between 2005 and 2009 (DHSSPS, 2012:50, 84), and \u2018males are three times more likely to die by suicide than females\u2019 (DHSSPS, 2012:81). The strategy placed renewed emphasis on the vulnerability of young males, and highlighted \u2018learning\u2019 which encouraged \u2018greater focus on males from deprived areas\u2019 (DHSSPS, 2012:27) . This reinforced  the negative impact of poverty on mental health and the increased suicide risk linked to socio-economically deprived areas being worst affected by the violent conflict of \u2018The Troubles\u2019 (O\u2019Connor & O\u2019Neill, 2015). A revised action plan included: \u2018Objective 6: Enhanced outreach services for males at risk of suicide in deprived areas\u2019 (DHSSPS, 2012:37) and \u2018Implementation of a targeted information and awareness campaign for young males\u2019 (DHSSPS, 2012:44). \u2018Protect Life: Shared Vision\u2019 (2012) raised awareness that for men the term \u2018mental health\u2019 was associated with \u2018stigma and stereotyping\u2019 (2012:31), particularly in rural areas, and that research from the \u2018Men\u2019s Health Forum\u2019 suggested \u2018mental fitness\u2019 as a better term (2012:72).  There was also mention of \u2018a male culture of not sharing feelings\u2019 (2012:69), which might be considered victim-blaming in the light of research associating adverse childhood experiences with suicidality (Dube et al., 2001; Bruffaerts et al., 2010). In \u2018Refreshed Protect Life: Shared Vision\u2019 (2012), there was an emphasis on the high numbers of deaths of the \u201csingle\u201d marital status group\u2019 (DHSPPS, 2012:52, 55), but this does not account for the higher risk proportionally of other \u2018marital status\u2019 groups. For example, O\u2019Reilly et al. (2008) identified that separated\/divorced males were three times more likely than married\/cohabiting males to complete suicide. Corcoran and Nagar (2010), researching \u2018Suicide and Marital Status in Northern Ireland\u2019, also demonstrated that divorced men and women were three times more likely to die by suicide than married persons and that divorced young men aged 20\u201334 years old were at highest risk. Tomlinson (2007:116) had drawn attention to the need for more research into groups involved in the conflict in Northern Ireland, including police, emergency services and British Army personnel, paramilitaries and \u2018ex-prisoners.\u2019 Tomlinson (2007:80) also cited sociological literature which argues that it is not \u2018deprivation\u2019 that causes high suicide rates but \u2018social isolation that often accompanies aspects of deprivation.\u2019 O\u2019Reilly et al. (2008) argued that \u2018individual and household factors\u2019 like relationships and connectedness were more significant than deprivation, concluding that \u2018differences in rates of suicide between areas are predominantly due to population characteristics rather than to area-level factors, which suggests that policies targeted at area-level factors are unlikely to influence suicides rates\u2019 (2008:110) significantly. This raises question about why the new aim of the \u2018Refreshed Protect Life: Shared Vision (2012) strategy was \u2018to reduce the differential in the suicide rate between deprived and non-deprived areas\u2019 (DHSPPS, 2012:35). In 2019, \u2018Protect Life 2: A strategy for Preventing Suicide and Self Harm in Northern Ireland 2019-2024\u2019 was published (DOH, 2019). This current strategy has two aims: \u2018Reduce the suicide rate in Northern Ireland by 10% by 2024\u2019 and \u2018Ensure suicide prevention and support are delivered appropriately in deprived areas where suicide and self-harm rates are highest\u2019 (DOH, 2019:11).  The first stated principle of the strategy is to \u2018be evidence-based where possible, achieve measurable outcomes and be fully evaluated.\u2019 (DOH, 2019:12). There is much description in the strategy about who is impacted by suicide, who is at risk of suicide, and who accesses services but little evidence of what \u2018delivered appropriately in deprived areas\u2019 actually means from critical research and the effectiveness of what has been delivered since the original \u2018Protect Life: A Shared Vision\u2019 was published in 2006.  The opening line of \u2018Chapter 2: Strategy Aims, Principles, Scope and Objectives\u2019 is: \u2018Protect Life 2 seeks to build on the achievements of Protect Life since it was originally published in 2006\u2019 (DOH, 2019:11). However, the \u2018achievements\u2019 of Protect Life (DHSSPS, 2006) did not contribute to any significant reduction in suicide death rates; the strategy aim was not achieved (Black, 2021). Rondon-Sulbaran et al. (2012:106),  exploring the impact of social exclusion amongst young men in Northern Ireland, raised a concern about the evidence base (NSRF & DHSSPS, 2010) for Protect Life (DHSSPS, 2006) and therefore the continuing effectiveness of the strategy. This raises an issue of the evidence-base for the efficacy of \u2018Protect Life 2\u2019 in reducing the rates of male death by suicide and proactively addressing gender inequality (Freeman et al., 2017), where male rates of suicide continue to be three times greater than female rates (O\u2019Neill & O\u2019Connor, 2020:538; Samaritans, 2020).  The terms \u2018males\u2019 or \u2018men\u2019 are not used in the \u2018Aims\u2019, \u2018Principles\u2019, \u2018Objectives\u2019, \u2018Action Grid\u2019, nor the ‘Action Plan\u2019 of the  \u2018Protect Life 2\u2019 strategy (DOH, 2019: 11, 12, 16, 56-61). Rather than being listed as a priority, \u2018engaging men in suicide prevention\u2019 is described as \u2018a challenge\u2019 (DOH, 2019:…<\/p>\n","protected":false},"author":1154,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-352","page","type-page","status-publish","hentry"],"jetpack_likes_enabled":true,"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/blogs.qub.ac.uk\/sssj\/wp-json\/wp\/v2\/pages\/352","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.qub.ac.uk\/sssj\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/blogs.qub.ac.uk\/sssj\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.qub.ac.uk\/sssj\/wp-json\/wp\/v2\/users\/1154"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.qub.ac.uk\/sssj\/wp-json\/wp\/v2\/comments?post=352"}],"version-history":[{"count":4,"href":"https:\/\/blogs.qub.ac.uk\/sssj\/wp-json\/wp\/v2\/pages\/352\/revisions"}],"predecessor-version":[{"id":576,"href":"https:\/\/blogs.qub.ac.uk\/sssj\/wp-json\/wp\/v2\/pages\/352\/revisions\/576"}],"wp:attachment":[{"href":"https:\/\/blogs.qub.ac.uk\/sssj\/wp-json\/wp\/v2\/media?parent=352"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}