Male suicides rising: exploring the role of alcohol and community support

Dr Amy Chandler, CRFR research associate, talks about some of the issues being raised in her project, Alcohol Stories, a study of middle-aged men, alcohol, mental health, self-harm and suicide.

This is a very much a ‘work in progress’ blog – reflecting on recent statistics on suicide in the UK, and thinking through how this relates to issues I am addressing in a new research pilot project.

New figures released by the UK Office for National Statistics show that suicides among men have risen, with levels now the same as in 2011 – a potential reversal of what had been a downward trend. Rates among younger men are often highlighted, since suicide in men aged 15-29 is the leading cause of death. These latest figures show that suicides among older men, aged 45-59, are now higher than any other age group.

http://www.theguardian.com/news/datablog/2015/feb/19/rise-in-middle-aged-men-committing-suicide-all-the-uk-data

I am currently at the start of a pilot project, funded by Alcohol Research UK, which is using biographical methods to study the life-stories of men in this older age group. The study will focus especially on men’s accounts of the complex interplay between alcohol use, self-harm, suicidality, and mental health.

The men I am speaking to are in some ways ‘lucky’ – they are all being supported by community-based mental health and substance use support services. Despite this, their accounts (so far) highlight difficulties they have faced in accessing and using support at various points across their lives. News stories about the latest suicide statistics were accompanied by coverage of one particular suicide, with a bereaved family keen to highlight what they see as limitations in current mental healthcare provision in the UK. The story of Martin Strain was, sadly, familiar when I read it – elements of his struggle are reflected in the accounts of the men I have spoken with so far. In particular, Martin’s history of drug and alcohol misuse is said to have resulted in him being denied access to one-to-one psychiatric support. This highlights a significant challenge in tackling mental ill health in general, but especially for men, who are more likely to turn to alcohol to manage distress.

Around 50% of deaths by suicide occur in the context of alcohol use; and those who are alcohol dependent are at increased risk of suicide. Despite this, those identified as having alcohol use problems are – like Martin Strain – in some cases, diverted away from psychological support, into alcohol use services. Unless appropriate community based support is available (which is patchy, and will be reliant on the whims of local authority funding), people who have both mental ill-health and alcohol problems may not receive any kind of ‘joined up’ support. One of the issues I am investigating in the current study is the extent to which mental health is supported by substance use services; and conversely, how well alcohol misuse is responded to by mental health services.

In a limited way, I will also be exploring the role that community based support can have for men, who are often framed as ‘hard to reach’ and ‘hard to engage’. Yet clearly, some are reached, and some do engage – how do men account for this? In particular, I will be building on existing research which has examined the accounts that men provide when they engage in potentially ‘un-masculine’ practices, such as accessing a talking therapy. Studies have suggested that there are important differences between men in how they deal with such issues: with some men more able than others to frame ‘talking’ or ‘connecting’ with others as a responsible reaction to depression and thoughts of suicide (Oliffe et al 2011).

Additionally, I am looking at the way in which men themselves talk about their use of alcohol in the context of mental ill-health. Not all suicides are related to alcohol, and not everyone who uses alcohol will have problems with mental health, self-harm, or suicide. Already, variations are emerging in how men talk about alcohol use, and this study will provide useful insights into the diverse ways in which alcohol and mental health are understood.

Contact Amy by email.

Scots more likely to blame parents for child poverty

John H McKendrick, from Glasgow Caledonian University, recently posted this blog The Conversation. Here he kindly agrees to share it with our network.

Evidence about poverty is meant to be troubling. The only crumb of comfort for campaigners is that the harsh realities of everyday life portrayed through statistics, imagery and narratives can be the catalyst for action.

Time and again, the public is sufficiently irked by this evidence to reach for the phone, pull out the credit card and make charitable donations in the hope of tackling the burdens of poverty.

In short, we want to tackle the problem. Yet the evidence keeps coming back because the problem never goes away. We are able to reduce poverty but never eradicate it.

Today sees the launch of Poverty in Scotland 2014: the Independence Referendum and Beyond. Scotland’s deliberation on its constitutional future gives this seventh edition of the book a novel twist. Naturally, both sides in the campaign are asserting their poverty-busting credentials.

Constitutional politicking aside, the book is full of troubling evidence of the enduring and de-habilitating impact of poverty on far too many people’s lives. It finds that:

• 870,000 people in Scotland still live in poverty (17% of the population).
• 200,000 children live in poverty (20% of the total), and another 50,000 to 100,000 will be pushed into poverty by 2020.
• Almost every Scottish local authority contains wards where more than one in five children live in poverty.
• Around half of households with incomes of less than £20,000 still have no home internet access and over half have no car.
• Men living in the most deprived areas have a life expectancy 11 years shorter than those in the 20% least deprived areas of Scotland.

But there is one statistic that particularly troubles me. When asked the main reason why children live in poverty in contemporary Scotland, according to three separate years of British Social Attitudes surveys, one third of Scots say it is because “their parents suffer from alcoholism, drug abuse or other addictions”.

This is the most common answer by a considerable margin. The next most common answers are “parents do not want to work” (15%) and “parents have been out of work for a long time” (9%).

It is less common for respondents to look to the structural inequities of society for an explanation. Only a minority of Scots consider the main cause of child poverty to be, for example, that “social benefits are not high enough” (7%), “they live in a poor-quality area” (6%), “the family suffer from discriminations” (1%), “they have lack of access to affordable housing” (1%) or “there are inequalities in society” (6%).

Harsher views
Although the alcoholism/addiction answer is also the commonest in many regions of England, Scots put greatest emphasis on it. Slightly fewer than one in five people in Great Britain lay the blame at this door.

Scotland purports to be an egalitarian nation. It prides itself on its social justice credentials. It perceives itself to be different to most of the UK in this regard. Scots can cite policy divergence from the UK as evidence to support this belief.

This country has a stronger commitment to universal service provision and has recently taken actions to undermine the burdens inflicted by welfare reform upon the most vulnerable in Scotland.

So why are so many people in Scotland ready to account for social problems in terms of individuals' problem behaviour? A contribution factor might be the presentation of people experiencing poverty as public entertainment – better known as “poverty porn”.

Jeremy Kyle in the dock
This year, it’s Benefits Street and The Street. A few years ago it was The Scheme. Every year it’s the Jeremy Kyle Show (or some other variant). Anyone watching these sensationalist dramatisations could be forgiven for thinking that the people on their screens are typical of all people in poverty when in reality they are only a miniscule minority.

If viewers conclude from watching these programmes that most people in poverty are stupid, selfish, lazy or incapable of managing themselves, it wouldn’t be surprising if they thought that this was the cause of child poverty.

It would be worth researching whether this is the case, and whether it was made worse in Scotland by The Scheme, for example, which was set in Kilmarnock. It might also be aggravated by other Scottish misconceptions, such as being bigger drinkers than anywhere else in the UK.

Until someone gets to the bottom of this, anti-poverty campaigners should be cautious about the power of evidence to effect change. The public presentation of poverty quite possibly works against, as well as for, the cause.

And if the blame turns out to lie elsewhere, it doesn’t change the basic fact that Scots blame individual behaviour for child poverty more than other parts of the UK. It is high time that campaigners took notice of this in planning their strategies.

Because as things stand, the evidence on how we account for child poverty leaves me a little wary of what the future holds, whether Scotland chooses to stay together or go it alone in September.

Read the original article.  

Learning from children affected by parental alcohol problems

An estimated 65,000 children in Scotland are living with parental or carer alcohol misuse. New doctoral research from Louise Hill has explored the experiences and support needs of this hidden group of children.

The research found that while children and young people had extensive knowledge about alcohol and the impact it can have on family life and health, talking about their experiences was incredibly difficult. There was particular concern about sharing any knowledge outside of the family and careful decisions made when seeking help or support - be it formal or informal.

Perhaps not surprisingly, the children and young people experienced a roller-coaster of emotions: anxious, frightened, upset, angry, sad, with many speaking of being worried about the safety of their parents. But, many children spoke about their love for their family and loyalty to their parents, and all chldren shared their parents' optimism that they would be able to stop drinking in the future.

There are important policy and research implications to be drawn from this reserach, particularly providing confidential safe spaces for children and young people to share their worries and concerns, and in ensuring that all children affected have a right to access upport services regardless of their parents' engagement in treatment services.

A summary of Louise's PhD findings were published in a recent CRFR briefing: Listening to and learning from children and young people affected by parental alcohol problems.

Louise has also made a short video podcast talking about her research. View it on the IRISS website by clicking here.

Children’s concerns over parent’s alcohol use and misuse

CRFR research supports new ChildLine figures highlighting children’s concerns about their parents alcohol use. Today, Childline reported that more than 4000 children who rang the helpline last year said they were worried about their parent's excessive drinking and that these children were three times more likely to mention physical abuse than other children who phoned. CRFR’s own work with ChildLine also highlighted the same link between parental alcohol misuse and physical abuse. Another CRFR report, Parental drug and alcohol misuse, also discussed these issues.

Links to CRFR reports:
Childrens concerns about the health and wellbeing of parents and significant others
http://www.crfr.ac.uk/reports/rb22.pdf

Parental drug and alcohol misuse
http://www.jrf.org.uk/publications/effect-parental-substance-abuse-young-people

When soundbites don’t help addicted parents …or their children

Sarah Nelson, Author of Care and Support Needs of Male Survivors of Sexual Abuse (February 2009)

The poignantly short life and brutal death of the toddler Brandon Muir, violently killed by his mother’s boyfriend in Dundee, has provoked renewed debate and soul-searching among politicians, media and many of the public. Not just about apparent failings in child protection generally, but in particular about how to safeguard children in the estimated 50,000 Scottish families where one parent at least is addicted to drugs.

As three separate child protection reviews get underway in Dundee, drastic “solutions” have been touted, as they are each time such deaths happen. These range from taking all or most addicts’ children into care - unrealistic without huge resources, given the large numbers of children and the hard-pressed, shrunken fostering and residential sectors – to giving addicts contraception along with their methadone. (A eugenic “solution” familiar to historians, it is unclear exactly what type of contraception is being dreamt of, and how it will be given: as so often happens, the restraint seems to apply only to females).

It’s understandable that concerned people feel despairing at times about the problem, and about the suffering of some addicts’ children, and are therefore tempted by the sound and fury of such drastic solutions. Angry feelings against addicted parents, and renewed blaming of social workers and health visitors, may be merited in individual cases; but when generalised, do they help vulnerable children, or distract attention from measures that will be more constructive for them?

Does it make sense for instance to spend more on the children and less on the adults?
Some recent research suggests that putting more resources into supporting addicted adults may actually make the children benefit from better, safer parenting. One issue which has consistently been neglected in policy, despite much research and practice evidence is the very damaging trauma in the backgrounds of many addicted parents.

Those who have been addicted for a long time, or who have found it impossible to remain “clean” from substance misuse, are often using drugs and alcohol as a kind of self medication- in a sometimes desperate effort to blot out very distressing experiences and memories. That kind of misuse is much harder to stop, because the cost to them, without support, is to resurrect sometimes unbearable flashbacks and memories.

These bad experiences can include childhood beatings and sexual abuse, neglect, emotional cruelty and for adults domestic abuse from violent partners. For example my own Beyond Trauma research, published in 2001, with women who experienced childhood sexual abuse trauma revealed that a high percentage had sought refuge in drink and drugs, even as children or teenagers, and needed skilled support to help them cope with the trauma once this “crutch” was removed.

In my latest study, Care and Support Needs of Male Survivors of Sexual Abuse, a quarter of the interviewees were addicted even before their teens, and half of them by their teenage years. The prisoner and ex-prisoner group were addicted very young to a variety of drugs, after experiencing extreme forms of trauma.

Of course, not all drug addicted parents are victims of abuse. However, many are – for example in 2004, one specialist drugs counsellor in a large and busy Edinburgh health centre found that 85 % of her client group had suffered childhood sexual abuse. In fact a growing number of international studies had already revealed links between substance misusers and a history of child abuse when Dr Jane Wilson of Stirling University carried out her Scottish research , with colleagues Susan Morris and Rowdy Yates, more than ten years ago.

Her research team found even higher figures than existing studies suggested. They used the Childhood Trauma Questionnaire with male and female addicts at three Scottish treatment units. The average age when these had first misused more than one substance was only 15.

Among the women, two-thirds had experienced childhood sexual abuse and more than half childhood physical abuse. Almost half of the men had experienced childhood physical abuse, and more than a third sexual abuse. Wilson and her colleagues called for a wider look at young people and adults with poly-drug use. They warned that in most cases trauma histories may not have been shared with health and social care professionals, and that their needs may have been “unidentified and unmet”. They urged more staff training and recommended “integrated programmes, which address both trauma and substance misuse.”

Those recommendations have made little headway in those ten years, despite further recommendations from major Scottish Executive reports like “Mind the Gaps” in 2003. Specialist, dedicated resources to help addicted adults recover as far as possible from childhood sexual trauma and other violence are still tiny, particularly (and ironically) in major cities like Edinburgh where there have long been serious addiction problems.

Yet research and practice experience indicates that they can actively enable addicted adults to become both more secure and competent as parents, and equally important, to regain the self-esteem which has usually been severely undermined or lost altogether. That loss is one key reason why women in particular often feel they are worth no more than to accept a violent and abusive partner, who is dangerous not only to themselves but to their children.

Obviously, the most basic aim in child protection has to be preventing children being abused in the first place. But creating safer less neglectful home environments for those children, free of possibly dangerous people who may wander in and out to collect or to deal in drugs, will be one part of that primary prevention exercise. Boosting post- trauma services for desperate, addicted parents, and giving staff the training and confidence-building to deliver these services on a wide scale, would prove a small cost in terms of potential benefits to both vulnerable parents and their children.

For more information about the project that led to the report Care and Support Needs of Male Survivors of Sexual Abuse see http://www.crfr.ac.uk/Research/malesurvivors.html