Kirklees Council - Reducing risk in men: aligning local services to reduce risk in men

The project

Kirklees’ Suicide Prevention Action Group established a men’s mental health workstream, bringing together statutory and community-led services that are working with men. Our aims were to understand the breadth of work being done to improve men’s well-being across Kirklees, identify any gaps in provision and how this could be met, increase communication between the different offers of support, and to avoid duplication. We also wanted our work to be clear to the public, so that our offer is easier for those in need to navigate.

The challenge

We used various sources to help us identify that there is a need to focus on reducing suicide risk in men in Kirklees:

• A local suicide audit conducted every three years showed that 76% of local suicides are by men with an average age of 45 years
• The Kirklees mental health and wellbeing needs assessment highlighted that:
  • many of the clinical and social risk factors to suicide are more common in men
  • cultural expectations that men will be decisive and strong can make them more vulnerable to psychological factors associated with suicide such as impulsiveness and humiliation
  • men are statistically more likely to be reluctant to seek help from friends and services
• Improving Access to Psychological Therapies (IAPT) data showed that it is predominantly used by women and men are more difficult to engage.

These findings suggest that services appropriate for men require a move away from traditional health settings. In response to this we thought that providing and supporting services in the community might be more effective, as people do not need to have a diagnosis, they can just go and engage.

The method

The Suicide Prevention Action Group has a workstream focusing on men’s mental health, made up of representatives from public health, the clinical commissioning group (CCG), the housing commissioners, South West Yorkshire Foundation Trust, Kirklees Time to Change Hub and a range of voluntary sector organisations such as Andy’s Man Club, Platform 1 and Luke’s Lads.

We encourage open and honest dialogue between commissioners and providers so we can get the best out of our limited resources; the voluntary sector can tell us what men are saying they need, and the staff from the council, the CCG and the NHS partners support the agenda by getting suicide prevention on the radar of senior leaders and politicians.

We realise that effective suicide prevention is like completing a jigsaw - it’s complex and there is never one single issue that makes someone contemplate suicide. By working together to complete the jigsaw, we aim to be as effective as possible at reducing suicide risk in men in Kirklees. We have worked systematically across organisational boundaries to improve our local offer to the residents. We noticed that in Kirklees there were a few community groups and charities all supporting men, but we wanted to help them be aware of each other so that men could be supported in the most effective way possible for them.

We continually review our membership to ensure that we have representation from those services that reflect the wider risk factors of someone who may be at risk of suicide, such as job centre plus and citizens advice.

Our projects that reach men include:

• Platform 1: A safe place available to men 18+ with the purpose of avoiding, dealing with or recovering from a crisis. Activities are available, as are talking and wellbeing groups and volunteering opportunities. Their approach is to be: “holistic, free, non-judgemental, open door policy, peer support, friendly, informal, no waiting lists, straightforward, accessible”.
• Luke’s Lads: a circuit training class followed by support session at a local gym, providing a safe space for men to open up, set up in memory of Luke
• Men’s Talk at Community Links: using drama to tell somebody else’s story, which makes it easier for the men to open up
• Andy’s Man Club: a facilitated support group for any man who needs it, helping men open up about their lives from things that are bothering them, to what they are grateful for. Open to any man 18 and above no upper age limit.

The impact

The way commissioners and providers work together has changed. It is no longer one sided with commissioners telling providers what to do, but instead there is recognition that providers have more expertise in some areas, listening and working collaborative means we can often develop something better.

Services in the community are getting numbers and engagement that clinical services do not get – see below for a case study from Platform 1 in Huddersfield.

Impact for all the projects has not been measured yet but we have highlighted some impacts from Platform 1 and Men’s Talk projects.

• Platform 1- within two years they have had 270 members with a daily attendance of around 50-75 people
• Luke’s Lads- It has been very successful, and the format has been well received which has now resulted in establishing a session for young girls which was identified as a gap in service need
• Men’s Talk- Outcomes include men reporting that they feel there is a reason to get up in the morning, that they have made friends, and some are going for job interviews.

 We have identified the following critical success factors for working with men:

• Lead facilitators being males with lived experience willing to show their own vulnerabilities to make connections
• Services being delivered in non-clinical environments; the service doesn’t have to be associated with mental health for men’s wellbeing to improve
• Clarity that there is no expectation for verbal participation when attending
• A sense of community and peer support
• A judgement free environment.

Project enablers

We worked hard to build local connections and spent a lot of time reaching out and talking to the community to identify all the work that is happening to support men. We work closely with our Community Plus team who work in localities across the Kirklees community and often become aware of local community-based assets that we might not be.

We are also continually reviewing our membership of the Suicide Prevention Action group.

Project challenges

• Getting support to try something innovative has been challenging at times, but we have found it was important to try different approaches with regards to public mental health and build our own evidence base for local activity
• Short-term funding is a barrier to overcome
• Supporting groups/services that are not directly commissioned by the Council or CCG to become part of the bigger agenda. This includes finding out more about how they operate and to help them with aspects of support e.g. access to training
• Some of the groups we work with are part of the Working Together Better partnership, which is a council contract and requires reporting in a systemised way. Others are independent and so how they measure impact varies – we need to consider how we can collectively and consistently measure impact going forward.

Next steps

We have noticed a gap in Kirklees in relation to access to information and support, so we are in the process of establishing a mental health website for Kirklees which will help everyone find the help they need earlier and easier.

There is a consensus amongst local services that the variety of support we have for men is a positive thing and we aspire to work in partnership and increased collaboration to ensure that we aren’t duplicating work or providing conflicting messages. We will continue to raise awareness of the local Suicide Prevention Action Group as a forum where dialogue about suicide prevention amongst stakeholders helps to support services, enables networking and builds interest and support.

More broadly, we would like to work more closely with secondary care partners to improve the service available when someone is discharged back into the community. Signposting to local community organisations is key to positive wellbeing alongside seeing the person as a whole rather than each service just focusing on the part of the jigsaw that they are responsible for.

We are working with IAPT to make stronger links with what is going on in the community so they can make recommendations to people who are waiting for therapy which is common with current levels of demand and waiting lists.

Advice for other local areas

• Men are not necessarily ‘hard to reach’; consider why they are not engaging and think about how you can work differently
• Work with men who have lived experience to talk about why things have/have not worked in the past
• Don’t focus purely on numbers through the door, consider the impact on men who have been through that door
• Avoid imposing time limits; true progress can’t work to a timetable
• ‘Hand-holders’ are key to successful referrals; don’t presume that by referring a man he will go somewhere without the right support
• Work at each individual’s pace and focus on what is important to them; not everyone will want to get to the same place

Contact

Rebecca Elliott, Public Health Manager, Kirklees Council

Case study: Platform 1

Platform 1 have found, through our work with men who experience difficulties, that the problem is much greater than previously headlined. When our charity was formed in 2018 we anticipated that we would have in the region of 200 members at this stage; by end of March 2020 we had over 470, with daily attendance between 50 and 75.  The attendees are from all backgrounds and socio-economic groups, aged 18+ with an average age of 45, they come from very diverse ethnic and religious groups. 78 per cent identify as having one or more mental health conditions, 29 per cent identify as having one or more learning difficulty, 39% have committed one or more crimes. From observation we believe that many are living in poverty and/or on benefits, very few have jobs, and many show signs of self-neglect.

The men we work with report a range of issues around mental health and getting support:

• Difficulty accessing support for a variety of reasons around stigma and stereotyping, lack of self-confidence, lack of knowledge, lack of understanding of what is available
• Barriers to accessing support, such as the appointment system, lack of understanding and empathy of the issues, formal and system-based services that often limit the extent of what they will support, and how much of that service’s time is allotted
• Feeling let down by the very organisations they turned to for support and then failed to get that support
• Sometimes the remedies that men adopt can then exacerbate their problems, for example self-medication, drug use, isolation and offending.

P1 has found that a holistic approach is extremely effective in sorting the issues that cause many men to enter a down spiral of worry, stress and psychological danger. The reason that many are drawn to P1 is also part of the solution: peer support is a huge part of reconnecting, and men helping men also has two-way benefits – to wellness, welfare and wellbeing.  These are often the feel-good factors which affect not only a man but also those around him: family, loved ones, friends and society.

Bob Morse aged 70 is project Manager at Platform1.

“I attempted suicide in 1997 as a result of my mental health issues mainly depression. The decision I made to end it all was not obvious to others. I didn’t plan it! I am happy that I survived, particularly thinking about the amazing things I have experienced since. I believe that my time now is usefully spent as I help to create an environment for others to benefit from the enjoyment of life. What drives me is the belief that what is good for me is good for others. The benefits to my own mental health are completely obvious to me. I witness, on a daily basis, men experiencing radical improvements to their mental and emotional health.”

National Suicide Prevention Alliance

This case study was done jointly with the National Suicide Prevention Alliance and forms part of our suicide prevention resource.