Beyond ‘I’m OK’: The conversation men need about suicide

A couple decades later, Dean McKellar still remembers both the remark and the message behind it.

A young father walked into his waiting room and watched his three daughters, fresh off the loss of their mom, descend upon the pile of magazines, each picking out their favourite from the table. 

He turned to the long-time City of Edmonton social worker and asked: “Where’s the Field & Stream?”

Stereotypes aside, says McKellar, it’s a message that mental health professionals today need to hear as they try — and often struggle — to reach a group  that urgently needs their help.

In this country, men die by suicide at three times the rate of women — a long-term, consistent trend, according to Statistics Canada.

In their 40s and 50s, it’s four times the rate.

Men in their middle years die from suicide at higher rates than practically any group, and it’s made them a crucial group for mental health workers to reach.

Whether you’re a professional or a concerned friend, that’s easier said than done.

“In the field, you’ll hear that ‘men don’t talk,’” says McKellar.

The difference, he says, isn’t that they don’t talk — it’s that they talk differently.

“If you ask a guy ‘how are you,’ you are going to have to ask him three or four — maybe even five times — and each time you’ll get a different level of response,” McKellar says.

It might take a few false starts, a few ice-breaker conversations or cancelled appointments, but men approach services differently because of “friend or foe” social condition, not because they’re trying to be difficult. 

Success can depend on showing them you’re a safe person, and building trust without rushing it.

“My experience with men is they let you in one layer at a time.”

This approach may not fit with how the system traditionally works, but the system still needs to take note, says McKellar.

“It’s about working with men instead of working on men, about engaging men where they’re at and letting them determine the pace of engagement.”

Start with a conversation

Jag Atwal knows first-hand how one conversation can make a huge difference.

He just wishes he could have had that conversation sooner.

When a close of friend of his died by suicide, it was a wake up call, he says.

“We started realizing, ‘if we know this little about mental health, imagine how many other people know just as little,’” he says.

Atwal organized Edmonton’s first annual Breaking the Silence event in 2015, to promote local mental health services and help teach people how and when to reach out to loved ones in distress.

He learned how powerful and positive it can be to talk openly about suicide, and how to recognize the signs that someone is considering it.

He learned how important it is to promote services for survivors: when someone dies by suicide, the chances grow that someone in their social circle will attempt it too. 

Today, Atwal works for Alberta Health Services, helping fight stigma in AHS workplaces and create environments that promote psychological well-being, such as through education and support programs.

That first conversation — with their family doctor, with their friends — can do a person in distress so much good, but, too often, stigma stands in the way.

“The reduction of stigma is really designed to let people know it’s OK to reach out for help, it’s OK to talk to your doctor, it’s OK to start this process,” Atwal says.

Men at the tipping point

For David Long, a sociology professor at The King’s University in Edmonton and a long-time researcher in men’s health, it’s old news that men, especially in middle age, need special attention for suicide prevention.

“Male depression is actually way more common than anyone acknowledges, or maybe understands,” says Long.

But mental health, he says, can only provide part of the answer.

“My question is, what on earth is going on in their life that it’s leading to this,” he says.

Greater social isolation, divorce, depression, major life events and losses — awareness is growing about how men’s inner lives actually work, and about what makes the middle years unique and uncertain.

Uncertainty, too, comes in many forms.

Some of it is economic, like when men become less employable because of their age or industry, especially in some traditionally male-dominated lines of work.

Some of it is social.

The rise of gender equality, he says, despite being overwhelmingly good overall, has left a lot of the men he works with struggling.

Many are left with questions about their own identity — Who am I? What am I supposed to do? Am I not needed anymore?

“That idea about what it means to be a man is shifting, and I think we’re almost at a cultural tipping point,” says Long.

Men, in all their diversity, need to be able to talk these questions through.

Giving them the support and spaces to do so was a role once filled simply by friendships and community. 

In Edmonton, Long says he’s been pleased to see community — including a list of community initiatives — step up once again.

“It’s ugly to talk about suicide, it’s hard … So what do we do? We actually talk about it,” says Long.

“That’s Edmonton.”