These words were emailed recently to youth suicide-prevention charity Papyrus by a young man who tried to kill himself 10 years ago. He would have liked to have heard these words himself back then and now he hopes they can help others.
He continues: "So much hinges on how you use that power, not just for you, but for everyone around you. Like it or not, you have a place in many people's hearts. If you rip yourself away from this world, then you rip something alive in each of them away with you. And you can never heal those wounds."
His potential audience is sizeable. Suicide rates among 15- to 24-year-old men in England may have fallen to their lowest rate in 20 years, but they still represent the second-biggest cause of death in this age group - a trend that cuts across national boundaries. In every UK country, the number of suicides carried out by young men is generally at least three times higher than suicides by young women.
Although the rates are higher among 20- to 24-year-olds, the Health Development Agency warns that suicidal behaviour is established in the earlier years.
An estimated 19,000 15- to 24-year-olds in the UK attempt suicide each year and more than a third of these succeed, according to figures published last year by Mind. The mental health charity claims that teenage girls are more likely to try to kill themselves, but young men are more likely to succeed.
Professor Louis Appleby, England's national director for mental health, says: "My suspicion is that young male self-harm is closer to male suicide than female self-harm is to female suicide. There's something about young men that gives them problems in coping with emotional situations and sharing their feelings."
Studies carried out across the UK indicate that the majority of young male suicide victims make no contact with support services in the year before their death. And a recent survey led by the Health Promotion Agency for Northern Ireland showed that talking to an advice service ranked bottom among 16- to 24-year-old males when asked to identify how they coped with depression.
Even the young men who manage to pick up the phone appear to struggle to articulate their problems. Of the 208,768 calls answered by the young men's helpline operated by the Campaign Against Living Miserably (CALM) between 1997 and July last year, the majority - 185,642 - were silent.
The factors that trigger suicidal feelings in young men are complex and no conclusive evidence has yet been gathered to prove the effectiveness of any particular means of intervention. But most professionals agree that further work is needed to find more effective ways of encouraging suicidal young men to open up about their feelings. This is the challenge now facing organisations in Camden, Bedfordshire and Manchester - three pilot areas set up for this purpose in October by the National Institute for Mental Health in England (see box, p16).
Silent sufferers
The institute, which launched in June 2002, believes that more needs to be done to establish effective measures to encourage young men to access services. The pilots aim not only to reduce suicides in this group but also to encourage young men to seek help at an earlier stage before their problems become critical; and to encourage closer working between drug and alcohol services and mental health services.
Camden, Bedfordshire and Manchester were chosen from 27 statutory and voluntary organisations that applied for pilot status.
In Camden, a team of psychologists has been consulting groups of young men to help them shape Sort Out Stress - a multi-agency project that will begin next month.
Project leader Jeff Halperin says: "We had to start from the assumption that traditional services had failed to reach young men. What we did find out from young people is that they don't want to go to GPs - they don't trust these services," he says. "They think GPs will not be interested in them and everything they tell them will go on to a computer and the world will be told."
The team is using its dialogue with young men to help put together a web site and booklet offering support and information, due to be distributed in young people's venues from next month. The launch event in May will feature an animated film based on the real experiences of one young man, which Halperin hopes can be shown alongside trailers in cinemas across the borough. Advertising for the campaign may even be printed on fast-food wrappers. Efforts are being made to avoid the word "feelings" - Halperin argues it has little place in young men's vocabulary. "Boys and young men are often blocked from thinking about themselves and we're trying to find a language and approach to encourage them to reflect a little," he says.
Camden has a suicide rate among 15- to 24-year-old males of about 18 for every 100,000 of the population, compared with a rate in England of 10.57. Halperin partly attributes this to the fact that young men in this age group make up nearly a quarter of the borough's population. He describes the area as a microcosm of suicide risk factors: a transient population with many young people living without family networks; high rates of drug and alcohol abuse and homelessness; and one of the steepest divides between rich and poor in the country.
Halperin believes there are two states of mind that make young men particularly predisposed to suicide - hopelessness and impulsiveness. He hopes to tackle these factors with trial sessions of cognitive behaviour therapy at both a mainstream school and one for young people with behavioural difficulties.
The sessions will involve encouraging young men to make connections between their behaviour and how they feel and Halperin hopes the process can be rolled out to vulnerable groups in other schools.
His team is also putting together a training package for staff from Connexions and other agencies to further their understanding of how to approach the issue of mental health in young men. "In some ways, the statutory services have been very bad at engaging with young men," says Halperin.
"Even among Connexions workers, these are really difficult waters to enter. There's a real hunger for more mental health training; they worry that they don't feel sufficiently trained or expert in the field. They feel they lack the skills to pick up problems and to know what to do about them and that they need to know when to worry and when they don't need to worry."
In Scotland, where the rate of suicide among 15- to 24-year-old men is roughly twice that in England, a new system of specialist training is being extended beyond obvious frontline roles like Connexions advisers and youth workers. Choose Life, a three-year suicide prevention strategy led by the Scottish Executive, includes a national programme of Applied Suicide Intervention Skills Training, which is being spread to workers including lollipop men, dinner ladies, or anyone else a young person could regularly cross paths with.
Warning signs
The programme, which was developed in Canada, provides skills in spotting the early signs of suicidal behaviour and approaching those who may be at risk. Choose Life's head of implementation, Caroline Farquhar, says: "People are very uncomfortable about asking somebody if they're thinking of killing themselves. You should say: 'Somebody else in your situation may have thought about taking their life. Have you?' The best way to help somebody is to get them to admit this. It's really important."
The programme is being co-ordinated by at least two people in every Scottish local authority, with the aim of extending the skills to at least six per cent of the community workforce and creating a network of community support. Participants are taught to make a pact with a young person they suspect of being at risk of harming themselves, which Farquhar describes as a form of first aid.
"You can put a plaster on somebody and call an ambulance, but you don't want them to run away while you're doing it, because they could injure themselves quite severely," she explains. "In the same way, you say to young people at risk of harming themselves: 'I want you to agree to do nothing until we can take forward the following plan. I'll contact somebody who can help you with your problem.'"
In Northern Ireland, a resource was launched last week to help youth workers become more effective at supporting young men's mental and emotional health.
Called R U Right in the Head, the resource provides guidelines in methods of working with 11- to 16-year-old boys, encouraging youth workers to explore issues of masculinity and helping them engage young men and build relationships with them.
It has been developed by the Health Promotion Agency for Northern Ireland with an advisory group of representatives from the education, health, voluntary and community sectors and has been written by Dr Ken Harland, a lecturer in community youth work at the University of Ulster. The resource was due to be introduced to youth workers yesterday and today (22 and 23 March) at a training course.
Among the services already available to young people in Northern Ireland is Zest - a Derry-based project set up under the name of Combat Suicide in 1996. It provides one-to-one counselling, group work, personal development sessions and alternative therapy to under-18s.
The project, which was accessed by 500 young people last year, delivers training across Northern Ireland to help professionals develop their understanding of the correlation between self-harm and suicide and spot the early signs of risk.
"Those who self-harm are 100 times more likely to commit suicide within a year," says project manager and counsellor Noella McConnellogue, whose role in supporting young people under 18 is funded by BBC Children in Need. "Suicidal behaviour tends to peak in older young people, so we need to intervene as early as possible."
She adds: "The most important thing for us is not focusing on the person's behaviour, it's seeing the person behind the behaviour. We won't take away their method of coping until we can put something back in its place."
Zest is also the representative for Northern Ireland on the National Inquiry on Self Harm, a UK-wide inquiry on self-harm among young people (YPN, 8-14 December 2004, p7). The organisation is currently identifying suitable locations for outreach work.
It is a belief that there are no available solutions that leads young men to end their lives, says Farquhar, a myth that Papyrus's young correspondent is keen to correct.
"'There is no way out' is the biggest lie of them all," he writes. "It's a good one though, and lots of people fall for it. Something about the way our minds work, I guess. I look back now and I see I actually had a few ways out of my situation. Call somebody and when they mouth the platitude, 'How are you?', tell them: 'Actually, not so good right now. I almost killed myself today. I need you to listen for a while.'"
JIM'S STORY
Jim is 19 years old and his story provides the narrative for the animated film made by Sort Out Stress in Camden.
"I was about 14 or 15, that's when it really went bad. If I went to school and saw someone I knew, and they wouldn't talk to me, I would think it was a direct problem with me. It just got to the point where it was only my problem, it was only my world. It was like a web and I was stuck in the middle, but the only way out was all these kind of negative loops.
That's where a lot of the isolation and separation from my family started as well, and that just created this vast space between us - both ends were trying to reach out, but they met three miles apart.
"I just basically turned to drugs. I would wake up in the morning and feel really bad about myself. 'Just look how everything's gone wrong, look at what you've got, you've got nothing,' and then the next thought that followed that was, 'How am I going to get stoned, how am I going to get wasted.' That was my aim, to get as out of my head as I could."
BEDFORDSHIRE PIONEERS SUICIDE PREVENTION
Bedfordshire Breakout is one of the three pilot projects selected by the National Institute for Mental Health in England to pioneer methods of preventing suicide in young men.
The project, a partnership between Bedfordshire Heartlands and Bedford Primary Care Trust and organisations including Connexions and Bedfordshire Youth Service, encourages professionals to keep a daily diary, alongside four training days called "learning sets".
The training programme, developed for representatives of 30 organisations by the Men's Health Forum and Mentality, encourages participants to spend the weeks in between their training days noting how their services work with young men and how they can be better tailored to their needs.
The training explores the theme of masculinity and preventative methods for 13- to 19-year-olds. It also enables participants to devise their own action plans, with the help of focus groups of young men.
Project co-ordinator Debbie Adger hopes that by the end of the training in June, 30 "young men's champions" will have been formed. Participants will be given 500 each to implement their own action plan.
"The diary gets them to start thinking once they're back in their place of work," says Adger. "It's the way services are marketed that can put young men off. They need things to be discreet: through web sites, texting or out-of-hours services."
One of Bedfordshire's future young men's champions is Cassandra Swan, PUKE (prevention, understanding, knowledge and education) outreach worker for Alcohol Services for the Community in Mid-Bedfordshire, which provides activities to promote emotional wellbeing. The majority of young people are referred by youth offending teams and about 80 per cent are male.
"It's been really useful networking with professionals in all sorts of other fields," she says. "I'm hoping to learn how to build on young men's protective factors, rather than allowing them to fall into a situation where they're coping by using alcohol."
FACTS AND FIGURES
- According to the Department of Health, 334 young men aged 15 to 24 killed themselves in England in 2003, a mortality rate of 10.57 per 100,000 people. This compares with 92 young women in this age group - 2.97 per 100,000. Suicides made up 16.6 per cent of all deaths in young men and 12 per cent of young women
- According to Choose Life, 72 young men committed suicide in Scotland in 2003 - a mortality rate of 22 per 100,000 people - compared with 31 young women
- According to the General Register Office, 18 young men took their own lives in Northern Ireland in 2003 - a mortality rate of 14.3 per 100,000 - compared with five young women
- According to the Office for National Statistics, 41 young men committed suicide in Wales in 2003 - a mortality rate of 22 per 100,000. Suicides among men made up 31 per cent of all deaths in this age group
- The suicide rate among 15- to 24-year-old men in England in 2003 was the lowest in the past two decades and has fallen steadily in the past five years. The Government wants to reduce the suicide rate for all ages from the 9.2 deaths per 100,000 recorded in the mid-1990s by 20 per cent by 2010
- According to a report by the Health Development Agency, suicide rates among young men in Scotland are the highest in the UK - they ranged from 21 to 38 per 100,000 between 1991 and 2001
- In Northern Ireland, the rates ranged from 16.7 to 31.8 per 100,000 over the decade, compared with a range of between 13.1 and 26.6 per 100,000 in Wales and 11.6 and 16.3 in England
- Suicide rates within social class five are four times as high as those in class one
- The main methods of suicide among young people in the UK are hanging and self-poisoning.
