"Talk to us if life is getting to you", says The Samaritans sign I see each morning on the platform as I wait for another hideously packed commuter train to central London. It's a resoundingly bleak image to begin your day with: a person hurling themselves in front of a high-speed train because depression, that insidious liar, has convinced them that all hope has gone.
These signs are much needed: in 2017, 5,821 people died by suicide in the UK, of which some three quarters were men. While the numbers have fallen, men aged 45 to 49 remain at the greatest risk, with the highest age-specific suicide rate in the UK. This is an ongoing trend and was recently highlighted in a new play, Distance, at PARK90.
I was nearly another statistic. I spent the first four months of this year grappling with the most ferocious depression I've experienced since I was 18. Retreating to a rancid, over-priced room in Brixton, I began spending a not inconsiderable amount of time googling ways in which I could, as painlessly and as quickly as possible, kill myself. I wanted to vanish, completely obliterate myself.
"The pressures of London living had become unendurable..."
I'd moved six times in four years. I hadn't had what I could call a 'home' since childhood. And now I could barely afford yet another substandard hole with yet another group of strangers. Worse still, I was lurching towards 40 — and could see no way that anything would ever improve.
Surprisingly, suicide rates in London are among the lowest in the country. Says Stephen Buckley, Head of Information at MIND, "This seems counter-intuitive. After all, there are many deprived parts of London, and one would assume that rates would be higher". Still, as Buckley notes, London is overall one of the most affluent areas of the UK.
Nevertheless, male suicide remains a problem in the capital. In 2017, there were 11.6 male deaths in every 100,000 as a result of suicide; compared to just four in the same number of women. Moreover, in these times of austerity, London's mental health services are struggling to provide the kind of timely intervention required to reduce these numbers. "Cuts have had a huge impact," says Buckley. "Some services are no longer available; the threshold to being seen has gone up, and waiting times for referrals to talking therapies have increased."
And then there's the housing crisis. "After six months of living under a bad landlord in an overcrowded, insecure place, even those with the best mental health are much more likely to be feeling anxious, stressed and depressed."
"Equally, in the last few months, we've discovered that people with mental health problems applying for social housing don't get prioritised in the same way as someone with a physical disability might be prioritised. So we think there are some disadvantages in the system which we're trying to tease out that prevent people with more significant mental health problems having access to social housing."
The Listening Place
So what's the solution? The frustration of the mental health nurse I saw earlier this year was palpable. She handed me a leaflet for a confidential service called The Listening Place. Based in Pimlico, and staffed by trained volunteers, it's the only service which offers the suicidal ongoing face-to-face appointments and was set up by Terrence Collis and his wife Sarah Anderson, former Samaritans, two years ago.
"We recognised a big gap which needed filling," explains Collis. "The Samaritans offer a great service, but you're likely to speak to a different person each time you call. The kind of ongoing support we offer, which is what people need, is very difficult to find."
Over the last two years, The Listening Place has had nearly 1,900 referrals and seen roughly 900 people through a significant period of time. About 40% of these people have been men, says Collis. They have seen men from every London borough and people from as far out as the home counties.
"Men, I think, need to trust people a lot more before they talk about how they're feeling," says Collis. "We offer them the opportunity to build that kind of relationship - and that takes time. Our goal is to broaden out people’s thinking from what's called 'suicidal ideation'. Yes, we talk about suicide — but also all the other things people can do with their lives.
"London can be incredibly isolating," he adds. "It has a transient and lonely population; people who haven't settled anywhere. There's a population in London who live in a really grim situation with very little support."
Poverty also comes into play, explains Collis — though he quickly adds that The Listening Place see people from all backgrounds: "Just because you're well off doesn't mean you’re not suicidal. Everyone we see has their own story, but the overriding thing is that sense of isolation which London brings."
Doctor Huw Stone chairs the Royal College of Psychiatrists Patient Safety group, which provides practical guidance and support to the members of the college and other mental health professionals on how to help people who are self-harming — and prevent them from going on to attempt suicide. Why does he think suicide rates are so much higher among men than women?
"I don't think anyone really knows the answer," he muses, "but part of the reason is that men are less likely to seek help. They also tend to use more violent methods of attempting suicide than women."
Addressing the stigma that still exists around suicide is crucial, moving forward, stresses Stone. "The language used for suicide, for example, is very important," he says. "'Committed suicide' relates to a time when it was a criminal offence. Changing the way we talk about it helps break down stigma."
Stone also highlights the proliferation of online resources, such as forums on suicide, which allow people to explore ways to end their life. "If the media are given guidelines on how to report on suicide, the online world is a complete free for all," he says. "And certainly in a place like London, people have even greater access to that kind of information".
These comments stir a distressing memory: a crunched up figure huddled over a laptop in a darkened room, while outside the 24/7 behemoth that is London shrieks and groans to life. How, I wonder, have we come to live in this great city at a time when we are, technologically speaking, more connected than ever — and yet, it seems, when it comes to meaningful human interaction, potentially more disconnected than ever?
Perhaps the first step in addressing this conundrum, and thereby reducing the number of people who die by suicide, comes through talking freely about our hopes and fears, with compassion and no judgment.
The Listening Place is at 3 Meade Mews, SW1P 4EG, 020 3906 7676
Call Samaritans for free, 24/7 on 116 123