Special report: The 'silent taboo' of suicide among young men in the UK

What makes a seemingly vital young man take his own life? Suicide is the biggest cause of death in men under 35 yet it is seldom discussed, with parents left feeling ashamed and that they have failed their child. Catherine O’Brien talks to families who want to bring ‘the greatest taboo’ into the open





Janet Cosgrove was doing a spot of Sunday afternoon gardening when the police rang. An officer explained that her 20-year-old son William had been involved in an incident and was at their local general hospital. It was the sort of call that might make any mother panic, but the policeman’s voice was calm and Janet remembers feeling no sense of alarm. ‘I said something like, “Oh, what has he been up to?” I didn’t think of it as anything major.’



Janet’s husband Tom was out walking and she decided that she wouldn’t bother him on his mobile phone. She drove herself to the hospital, and as she made her way from the car park to the main entrance, she noticed her friend Suzanne, a receptionist in the A&E department, hovering. ‘She was waiting for me. She said, “Janet, it’s William.” And it was only then that I realised it was serious.’



Much of what happened in the ensuing hours remains a blur, but Janet can recall being taken into a small room and told that William was undergoing emergency surgery to a stab wound which had pierced a major artery in his chest. Tom arrived with their 22-year-old daughter Becky. ‘I lost it then. I was screaming. Nothing seemed to make sense. We assumed William had been attacked but couldn’t understand why or how.’



And then, while William was still being operated on, a police officer arrived with a note found in the house that William shared with a rugby team-mate. Both Janet and Tom instantly recognised their son’s handwriting. He had composed a poem made up largely of song lyrics belonging to his favourite bands. But he had also written the words, ‘I don’t want to be here any more.’ ‘Our disbelief was total,’ Janet recalls. ‘It was, “No. This could not have happened. William could not have done this to himself. He would never…” We just could not contemplate it.’



William died three days later without regaining consciousness. Eleven years on, his mother now supports others bereaved by suicide. ‘I hear it so often – the utter incredulity that this could have happened to your child and the struggle that follows when, as sensible and intelligent people, you have to accept what is in front of you.’

‘It’s one of the few things that men are better at than women. And because of the way in which they try to kill themselves, they are more likely to succeed’

Every year, more than 5,000 people in the UK take their own lives – and 22 per cent of them are men aged between 16 and 24. In the 20 to 24 age group, men are four times more likely to kill themselves than women. Suicide is the commonest cause of death among men under 35. ‘It’s one of the few things that men are better at than women,’ says David Trickey, a consultant clinical psychologist and specialist in traumatic bereavement. ‘And because of the way in which they try to kill themselves, they are more likely to succeed.’



Men who die by suicide often choose to do so violently. William stabbed himself with a

kitchen knife and, although surgeons repaired his damaged artery, the blood loss he had suffered caused irreparable brain damage. Several years ago, I attended a conference on suicide at which Linda Heathcoat-Amory, wife of the then Conservative MP David, spoke with courageous frankness about the death in 2001 of their son Matthew, who shot himself, aged 19, after disappearing for a few moments at a family gathering. Clare Mountbatten, Marchioness of Milford Haven, has talked about her son James Wentworth-Stanley who died in 2006, aged 21, in similar circumstances. Matthew had become depressed after leaving school and suffered a mental collapse during his gap year. James, who was a student at Newcastle University, had become anxious that he was not recovering from a relatively minor operation. He went to a walk-in clinic saying that he felt suicidal, but was sent to queue at A&E as a low priority. He walked out, and the letter from Newcastle A&E to his GP in London saying that he had talked about suicide was sent by second-class post to the wrong postcode. It arrived after James’s death.



Suicidal men are 18 times more likely than suicidal women to shoot themselves. They are also at least three times more likely to hang themselves or throw themselves under a train (whereas women are more likely than men to take an overdose). Jane Powell, director of the Campaign Against Living Miserably (Calm), a national organisation that reaches out to young men at risk of suicide, believes the shocking absoluteness of such deaths is ‘wrapped up in their thinking that it is their final masculine act – and the final act of which they are in control’.



For those left behind, the violence magnifies the horror and anguish. It also unwittingly serves to ensure that suicide remains a taboo subject – perhaps the greatest of all our societal taboos. ‘We don’t know how to talk about suicide, so we shut our minds to it,’ says Julia Samuel, founder patron of the Child Bereavement Charity and a bereavement counsellor. ‘But it is only by talking about it that we can begin to work towards preventing it.’

Part of the stigma surrounding suicide is a hangover from the days when to kill yourself was a criminal act (today, help organisations deliberately do not refer to ‘committing suicide’, preferring instead the phrase ‘death by suicide’). But part of it, too, centres on the guilt and shame of the bereaved. Julia explains: ‘For parents, to lose a child by suicide is the most exposing definition of failure. That is not the way it is viewed by others, but it is a self-judgment – if your child has chosen to die, it must somehow be your fault. That guilt can be endless and lifelong.’



‘I still feel guilty. At first the “if onlys” were overwhelming,’ says Janet, now 61. ‘The morning of the day that William attempted to kill himself, I had almost called him to ask him over for lunch. Then I thought, “No, I won’t, because he came to see us last weekend and I don’t want to crowd him.” That will always stay with me, because I cannot imagine what sort of place he was in mentally that day.’





Certain young men are at increased risk of suicide – those who suffer from psychological disorders such as schizophrenia or clinical depression, and those who have damaged upbringings: the children of alcoholics, for example, or those who have been subjected to physical or sexual abuse. William, however, was part of the black hole – the suicides for which there is no obvious explanation.



The son of a business manager father and nurse mother, he grew up with his sister in a comfortable home. At school he loved rugby and cricket, but always seemed to under-perform academically. When he was 15, tests belatedly showed why: although he had an above-average IQ, he was dyslexic. At 17, he abandoned his education and registered with an employment agency which found him a job as a theatre porter at a local hospital. ‘He loved the job because he was a people person,’ his mother recalls.



Impressed by his approach and enthusiasm, colleagues encouraged him to enrol on an NVQ course in theatre support work, which he did. At the age of 19, he decided to move out of his parents’ house on the outskirts of his home town to be nearer to work and, after a brief spell in nursing accommodation, he took up his friend’s offer of a house-share. He had a steady girlfriend, Sarah, whom he had met through work, and a wide circle of friends. ‘We knew William as a quiet, sensitive boy,’ says Janet. ‘You had to squeeze every bit of information out of him. But we also know that with his friends he was the life and soul of the party.’



A month before he died, William dislocated his shoulder playing rugby and was prescribed co-proxamol, a painkiller that has since been withdrawn, partly because one of its side effects was depression in some patients. Although they could have blamed it for William’s death, Janet says she ‘always thought it was more complex than that’.

‘The therapist said, “You don’t have to think about your son

every day. He’s just resuming his normal place in your psyche”’

That year, William had started studying for a biology A-level at an adult education centre, but quit after finding it a struggle. Meanwhile, his sister was doing a teacher-training course, his girlfriend was forging ahead in nursing and his father had recently done an Open University course in modern languages. ‘Everyone around him was bettering themselves and my feeling is that he wanted to do the same, but he came up against this brick wall and didn’t know how to get through it.’



Janet says this with the benefit of hindsight, for William gave no inkling that he was troubled. The weekend before he died, he spent the Saturday with his parents, watching rugby on TV before joining them for a takeaway. ‘None of us picked up any signals that anything was wrong.’ He worked throughout that week, saw his girlfriend and sister on the Friday night and went to stay with some mates on the Saturday – ‘They said he was just himself.’ On the Sunday morning, he returned to his digs and tried to speak to his housemate, but the housemate didn’t have time to chat. Around midday, William was left alone in the house, and some time around 2pm another friend dropped by and found him lying blood-soaked on his bed.



The note was found several hours later. ‘I don’t know when he wrote it – I think as a family we thought he might have written it earlier. We can’t ever know if his actions were spur of the moment or whether he had planned them, but if they were planned, then he was obviously feeling very dark and hopeless and that this was his only way out.’



The Mental Health Foundation estimates that 70 per cent of suicides are carried out by people experiencing depression. And yet a study into suicide among young men found that 80 per cent had had no contact with a medical professional in the month leading up to their death. Academic pressure, family break-ups, relationship problems – all these are stress triggers that affect young men as much as women. But whereas girls may well tell someone how they feel, Jane Powell says that, ‘The message out there is that it is unmanly to talk. The idea that to be silent is to be strong is rubbish, and we have to debunk that myth if we are going to help prevent young men from feeling suicidal.’



Sir Mark Waller, a retired appeal court judge, and his wife Rachel lost the eldest of their three sons to suicide 14 years ago. Charlie Waller was a bright, good-natured 28-year-old advertising executive who seemingly had everything to live for, but the note he left behind included the line, ‘I don’t think I’m very well at the moment.’



‘It was only after Charlie died and we talked to his friends and colleagues that we were able to piece together symptoms that were clear signs of depression,’ says Sir Mark. ‘He hadn’t been sleeping or eating properly. At work, he feared he was falling down on the job, which wasn’t the case.’



The Wallers now run the Charlie Waller Memorial Trust (CWMT), which works to raise awareness of depression in young men. ‘Boys don’t talk in the way that girls do,’ says Lady Waller. ‘But we do a lot of work in schools to try to make them realise that problems can be discussed and solved and that they don’t have to be bottled up.’ CWMT also runs training courses for GPs to help them identify the signs of depression. ‘We would like to see all GPs automatically trained in the treatment of depression, phobias and panic attacks as well as the more severe mental-health illnesses, such as schizophrenia. Health services are improving in their handling of those who are potentially suicidal, but we still have a long way to go,’ says Sir Mark.



The grief that comes with suicide is widely acknowledged as more complicated, painful and enduring than with other causes of death. ‘One person described it to us as “grief with the volume turned up”,’ says Danny Nugus of the children’s bereavement charity Winston’s Wish. Stigma can mean that friends don’t know what to say, so they say nothing at all. ‘It is like a bomb going off,’ says Jane Powell. ‘The family feel guilty and that they have failed, and others feel embarrassed.’



If the death has been violent, the added trauma can ‘trip up’ the grieving process. ‘A lot of things that are helpful after a death involve talking about the person who has died,’ says David Trickey. ‘But if the death has been horrific, a vivid image may come to mind every time you think of it and that can make you too scared to be sad.’



Winston’s Wish runs workshops for children, who can often be overlooked in the midst of the trauma that follows a suicide. It also publishes a booklet on the subject, Beyond the Rough Rock. ‘Siblings may feel guilty that something they said caused the suicide,’ says Danny Nugus, ‘and their confusion may be exacerbated by adults who exclude them in the fear that they will find the details too upsetting. But there are ways of helping even the very young to comprehend what has happened.’ David Trickey talks to children about ‘mind-sickness. Children understand that when they are sick, something in their body isn’t working properly, so the idea that the person’s mind wasn’t working properly may help their understanding.’



Many bereaved by suicide are left with questions for which there can never be a clear-cut answer. David Trickey explains: ‘People will say to me, “I wish I could ask him just one more thing.” They are searching for an answer that is impossible to find, and for many, learning to live with not knowing may be the best resolution they can hope for.’



Janet took great comfort from the knowledge that William’s liver and kidneys were donated for transplant. ‘Three people are still alive because of him, and that was his destiny – I have to think that to survive.’ She also had to recognise that although Tom, 63, felt the same as she did, he couldn’t show it. ‘He could only deal with my outward showing of emotion to a certain extent.’ She had counselling and confided to her therapist that her biggest fear was that she would forget William. ‘The therapist said, “Do you think about your husband or your daughter every day?” And when I said no, she said, “You don’t have to think about your son every day either. He’s just resuming his normal place in your psyche.” That helped me enormously.’ Janet now works as a volunteer for the national helpline Survivors of Bereavement by Suicide. ‘Our lives are changed and can never be the same but giving back is a big part of moving on,’ she says. ‘And the work I do keeps William alive for me.’





HOW TO HELP

The Campaign Against Living Miserably (Calm) offers the following checklist to help spot the signs in people who might think about taking their own lives.

They may…



be sensitive to failure or criticism.

feel as though they have no friends.

set themselves hard-to-achieve targets.

find it hard to cope with disappointment.

find it difficult to admit to having problems.

find it hard to tell others how they feel.



If you’re worried that someone you know may be contemplating suicide, there are several things you can do to help get them through the crisis.



Listen to what they have to say. Don’t try to offer simple solutions. Suicidal people want someone who won’t judge and give advice or opinions, but who will just give their undivided attention.



Encourage them to talk to their doctor or to people used to dealing with this problem.



If you’re worried that they may be in danger, call the emergency services on 999 and get the professionals involved.



CONTACTS

Campaign Against Living Miserably, tel: 0800 585858, thecalmzone.net

Charlie Waller Memorial Trust, tel: 01635 869754, cwmt.org

Child Bereavement Charity, tel: 01494 568900, childbereavement.org.uk

Samaritans, tel: 0845 790 9090, samaritans.org

Survivors of Bereavement by Suicide, tel: 0844 561 6855, uk-sobs.org.uk

Winston’s Wish, tel: 0845 203 0405, winstonswish.org.uk