World Suicide Prevention Day: Why Peer Support for Men is Key to Suicide Prevention in the Military

Editor’s note. While suicide affects individuals of all genders, this article focuses specifically on male suicide, reflecting the author’s expertise in this area. The article is approached with care but remains candid and aims to shed light on the unique challenges servicemen face. We recognise that suicide is a serious issue for all, and encourage readers and listeners to seek resources and support immediately as needed.

Introduction

Whilst our mental health awareness and offerings have increased in recent years, both in and outside the military, we’re seeing an increase in military suicides, suggesting that what we’re currently doing isn’t working for many and if we continue in this way, the results will remain catastrophic.

Peer support can have a life-changing and saving impact but only if we begin to acknowledge the specific barriers to help-seeking, risks, and tailored needs of our men. Good peer support isn’t about discouraging a man to engage with formal support but giving him the reassurance and confidence to seek it in the first place.

Advocating for men does not mean we forget, or are against, other genders and groups within our Armed Forces. There is research, for example, that demonstrates women face even greater stigma than men in seeking help for their mental health.¹ Some 62% of serving and veteran servicewomen have witnessed or received “unacceptable behaviour”² with regard to sexual harassment and discrimination, which is another extremely important issue to highlight and discuss. Suffering is not a competition and generalisation helps nobody, which is why advocacy and support must be specialised.

The current picture

Though the military had seen declining rates of suicide since the 1990s, with figures lower than the general population, these have sadly increased and are now similar to civilian rates. Men currently make up 89% of all military personnel yet account for 94% of all military suicides

Whilst military suicide tends to reflect the civilian trend of middle-aged men most at risk for suicide, it is now seeing an increase in men under 24 years old (leaving this group more high risk than their civilian counterparts), with the British Army losing more men (of all ages) annually, than the Royal Air Force and Royal Navy.

Several studies have also shown that reservists have higher rates of mental health problems than regular personnel, which could, in part, be because they are away from their unit and don’t always fall under traditional military support systems, therefore slipping through bureaucratic parameters of care.

When it comes to military welfare, suicide has taken centre stage in recent years, and whilst there is a wealth of research that has demonstrated that the “macho” or “masculine” cultures within the military can have negative effects on help-seeking and stigma around mental health,³ ⁴ ⁵ they stop short of acknowledging that we have to specifically understand and tailor support for our men.

The recently published Armed Forces Suicide Prevention Strategy ⁶ has eight focus areas, the first being “understand high risk groups within the Armed Forces” yet I see no attempt to specifically understand and support men. The AFSPS also notes that one of the key areas of the 2012 UK Government “Preventing Suicide in England: a cross-government outcomes strategy to save lives” was to “Tailor approaches to improve mental health in specific groups.”⁷ but, again, I see little evidence of specifically acknowledging our men and tailoring welfare and suicide prevention offerings to them.

Leaders within the Armed Forces cannot claim to rely on research and evidence bases to determine organisational mental health offerings, only to disregard that same evidence when it focuses on men, out of fear of being labelled sexist or discriminatory.

It’s beneficial to acknowledge our men

Studies vary, but the number of people affected by an individual suicide can be up to 135, with each suicide costing the economy approximately £1.7million. Whilst perception is that the military has one of the highest rates of mental ill health and/or suicide of any working sector, it is instead the construction industry. The main difference being that our Armed Forces run as a community and therefore perception is greater than reality – but it’s important to recognise they’re both male-dominated sectors.

The military community mindset can allow the potential for something known as suicide contagion or clusters. One suicide can lead to several others, either in the immediate unit or by those who knew the person, as many personnel will share similar risk factors to suicide. Sadly, we have seen this already with The Rifles and those involved with Op HERRICK in Afghanistan. However, it is important to note that the same community mindset – a sense of belonging and purpose, group/peer support and ‘brotherhood’ – can also be a protective factor against suicide for many.

One of the largest ever military studies into veteran suicide evidenced that personnel who had not seen combat were more likely to take their own lives than those who had fought, further demonstrating that “life” and organisational stressors can be more devastating for many. There is also an emerging bank of research demonstrating that common psychiatric disorders, such as anxiety and depression, are the majority of what our personnel are seeking support for.⁸

The problems I support the majority of military men with often have little to do with operational trauma, but life stressors such as relationship breakdowns or the trauma their services cause them. This can include everything from decision and change fatigue (poor decisions made against peoples’ will), substance abuse and imposter syndrome to poor leadership and difficult colleagues (without fair resolution); something known as moral injury leading to the wider “organisational injustice.” ⁹

Indeed, when I was invited to present my work to Commando Training Centre Royal Marines Lympstone, the Regimental Sergeant Major admitted that they were good at supporting operational trauma but that it was “life” affecting and killing their men.

When The Rifles experienced a suicide cluster in 2021, General Sir Patrick Sanders wrote an open letter to his “Fellow Riflemen”¹⁰ recognising that there were limitations to expedient available support, urging his personnel to “…swiftly look after each other.” Similarly, in the Armed Forces Suicide Prevention Strategy,¹¹ a foreword from Vice Admiral Philip Hally included “…being a good friend and looking out for each other is crucial” but we are not doing enough to educate (or encourage) our men how to do this, certainly not as expeditiously as needed.

Are our wellbeing offerings outdated?

Many military personnel, including leaders, talk about “innovation” in our armed services, yet we continue to rely on outdated common sense advice such as drink and eat less, exercise and sleep better. Those with alcohol problems, for example, were the “least likely” to recognise their own treatment needs.¹² Unless men understand why they’re drinking to cope and can be encouraged to replace this mechanism (without judgement or shame) with something healthier, the advice is a waste of time. It’s also blind to the reality of how many military social events are either mandatory, or feel mandatory, and involve copious amounts of alcohol.

“Preventing suicide is everyone’s business and we all have a part to play”

~ Air Chief Marshal Sir Mike Wigston KCB CBE ADC¹³

I also see a lot of military personnel becoming mental health first aiders (MHFA) and similar despite the Health and Safety Executive demonstrating there is no evidence to suggest it works. Similarly, we overly rely on Trauma Risk Management (TRiM), formalised peer support after a traumatic incident, to do the heavy lifting it isn’t designed for.

There are several new peer support initiatives coming through in the military, which are to be commended and encouraged, but we must recognise that many men won’t engage as they’re still perceived as ‘formal’ (i.e. as they’re delivered by the service) therefore coming with a fear of lack of confidentiality and career consequences.

I always educate men on practical coping mechanisms but with the caveat, for example, that if you’re under bad leadership and your marriage has broken down, there’s only so much mindfulness and a gym session is going to do for you. And that it’s not a personal failing if you’re struggling. If, for example, you are in a psychologically unsafe unit (from abusive leadership and/or processes etc.) not only will you be unable to remain individually resilient (rendering any resilience training pointless) but are unlikely to seek formal support from those within the unit.

How can we help our men?

A lot of my work with uniformed services is around education of risk factors for men, to encourage those around the individual to proactively recognise potential issues, and give them the confidence to start having conversations with them around their mental health, and suicide.

We have to acknowledge the many myths surrounding military mental health, which can bring biases to initiatives offered, as well as adding to perceived stigma. Say “military mental health”, for example, and most people will immediately jump to a conversation around post-traumatic stress disorder (PTSD), disallowing many men who don’t fit (or want) that label to engage with support. Or, they find the support initiative not applicable to them as they do not reach the required psychological criteria for such diagnosis and subsequent processes.

This is important because I often see “comparative suffering” in men. Many will attempt to downplay their own suffering and need to seek support because they feel their situation ‘isn’t that bad’ in comparison to a colleague or peer. Conversely, they’re so worried about a potential diagnostic label that they’ll not seek support at all.

Another barrier to help-seeking is that many men do not realise how unwell or traumatised they are, as they have internalised, and therefore normalised, their struggles, fearing career or personal consequences for seeking help. Fikretoglu et al.¹⁴ found “80% of those [military] who might have benefited from mental health treatment failed to recognise their own treatment needs and did not seek help,” which is why I consistently advocate for improving self-awareness and proactively ‘reaching in’ to men.

How can men tell they might be unwell?

Given that many men struggle to identify their psychological ill health, here is a non-exhaustive list of some of the ways men might be able to recognise they’re unwell/traumatised:

Decrease in risk aversion
Increase in apathy & risk-taking behaviour
Emotional numbness
Homesickness (when deployed, even as training)
Imposter syndrome
Self-sabotage (increase in drinking, affairs etc.)
Scrolling for long periods on social media
Self-harm
Substance misuse as well as gambling/shopping
Memory problems
Passive suicidal ideation (wishing not to wake up, to be killed in action etc.)
Difficulty in completing simple tasks such as personal hygiene
Nightmares/difficulty sleeping or sleeping too much
Increase in anger/irritability/organisational defiance
Change in sexual libido/behaviour (including affairs & increase in use of porn)
Physiological symptoms (nondescript aches & pains, digestive problems etc.)
Low self-esteem and self-loathing
Identity crisis
Problems with appetite/exercising (too little or too much)
Lethargy/cognitive dysfunction (brain fog)

It is, however, often easier for those around the man to potentially recognise he is struggling and proactively offer support, than it is for the man to acknowledge his struggles and seek help. We can’t spend men’s entire careers encouraging independence then expect them to easily ask for help, which is why I always advocate ‘reaching in’ to a man struggling.

Below is a non-exhaustive list of risk factors that can help you identify a colleague potentially in need of support:

Undergoing investigation or disciplinary proceedings
Downgraded (loss of privileges)
Sudden change in role
Moral injury (unfair treatment)
Uncharacteristic disciplinary issues (insubordinate)
Late to shift/making simple mistakes
Personality (i.e. those with high levels of perfectionism)
Family/relationship breakdown
Marital status (single/widowed/divorced men are most at risk)
Series of traumatic incidents (professionally and/or personally)
Becoming a parent (men are 47x at risk for suicide post-birth)
Recent death or suicide of friend/colleague
Limited social support (especially outside of the military)
Sudden change in behaviour (more drinking etc.)
Homesickness
Childhood trauma (if known)
Financial concerns (if known)
Injury (preventing exercise and/or operational duties)

The above, however, does come with an emphatic acknowledgement that, sometimes, there really are no signs to a man’s suicide and that is not a failure on those left behind.

What are some barriers to help-seeking?

We must also recognise that a lot of issues that impact men’s mental health begin with emotional states and issues. It’s struggling with imposter syndrome or not feeling good or ‘worthy’ enough personally. It’s a stale partnership at home, with subsequent loss of affection and sexual intimacy. It’s worrying about his physical health and appearance.

None of these are considered mental health issues in and of themselves, or service-related, but can lead to severe mental ill health and illness if not acknowledged and supported. This is one of the many reasons peer support is so vital. A lot of men don’t feel that these emotional issues are severe enough to warrant formal support or that their issues don’t meet the necessary thresholds for formal treatment. So they don’t seek any.

Although individual and organisational stigma (perceived or realised) is one of the leading factors preventing help-seeking, “status anxiety” is also a significant barrier. This is the recognition that status, whether social, personal, or professional (or a mixture of all), is precarious and can, therefore, be lost or taken away. This is particularly important when we acknowledge that the Armed Forces are hierarchical organisations.

Though peers are equal, status anxiety sadly still applies as many men fear they will appear ‘less masculine’ to other men if they share their ill health and seek support, especially given the ‘machismo’ involved in military life.¹⁵ As the saying goes, “masculinity is hard won, but easily lost.”

The ‘problems’ with talking

The Men’s Health forum found that 35% of (civilian) men spent over two years in crisis before disclosing their mental ill health to friends and family, or never told anyone, despite Movember finding that 77% of men “think that talking is an effective way to deal with problems.”

However, it’s a myth that men don’t talk. Yes, they talk and seek help less than women (for both mental and physical health) but I also know that men want, can and do talk under the right circumstances and to the right people because I’ve spent years listening to them. Similarly, it’s the way men talk that is important.

If you listen to banter and dark humour, you can often read between the lines and hear how they’re really feeling. For example, self-deprecating humour such as ‘I can’t eat more or I’ll get fat’ despite their great physical shape can point to them potentially having body/food issues and a low sense of self-worth.

Likewise, a lot of men will do something I call “truth and deflect” in that they will be honest about their emotional or mental ill health but immediately deflect, often with humour, as they regret sharing their vulnerability and fear judgement and ridicule. It’s okay to laugh but it’s vital we also acknowledge the truth they have shared.

Not every man wants to talk face to face either. One study found men were 300% more likely to speak to an AI chatbot about their mental health than a human, and I certainly find I offer a lot of support through messages, as it’s often less confronting for the man.

From a financial perspective, the return on investment for mental health initiatives in the workplace can be anywhere from £5-9 per £1 invested, but in larger organisations, team-level leadership is the significant determinant factor in this return. Indeed, one study found that decreased military unit support predicted increased stigma and barriers to care.¹⁶

Culturally, we must do better

Cultures are set from the top down and strong leadership in this area incorporates something known as “lived experience leadership,” which we’re beginning to see with high-ranking leaders publicly discussing their suicidal thoughts and mental health struggles, such as PTSD, giving others permission to others to seek help. I do, however, feel it’s important to caveat this by saying that the majority of these leaders (throughout all uniformed services) often only publicly discuss their mental ill health once they are in positions of career safety, and not when they are continuing up the career ladder.

Whilst it’s easy for leaders, and even peers, to vaguely instruct men to seek help, it’s also naive to the realities of it, and the volume and depth of individual and organisational obstacles a man must overcome to seek and receive it in a way that negates further harm caused.

Having the courage and skill to be deployed and having the courage and skill to ask for help with mental and/or emotional health are two entirely different threats, except we only train our men in one.

We can and must do better.

Feature photo by Daniel Reche via Pexels

Toni White

Toni is a trauma-aware peer specialist with over 20 years experience in supporting people through mental ill health, trauma and suicidal ideation. She has spent the last ten years focusing on male mental health and is deeply passionate about advocating for and supporting men, especially in uniformed services, of which she has six years of professional practice.

Toni is also a published author writing a considered exploration of issues in reporting sexual violence in the criminal justice system, supporting many female victims of male sexual violence.

She is currently working on her next two books around men's mental health and suicide prevention. Cake is her weakness.

World Suicide Prevention Day: Why Peer Support for Men is Key to Suicide Prevention in the Military

Introduction

The current picture

It’s beneficial to acknowledge our men

Are our wellbeing offerings outdated?

How can we help our men?

How can men tell they might be unwell?

What are some barriers to help-seeking?

The ‘problems’ with talking

Culturally, we must do better

Toni White

Footnotes

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