A view from a couch The effects of the recession on mental health in Ireland

Researchers in the British Journal of Psychiatry have dubbed the recent economic downturn the mancession for its singular impact on males in western economies (Dunlop & Mletzko, 2011). As myopic and controversial as such as title may be, there are several reasons to think that males might be at particular risk in the current slump. Although there have been major job losses across the economy, traditionally male industries such as construction and manufacturing have been hit particularly hard. In contrast, health care and education (which are primarily female employers) have yet to see the same level of widespread job losses. In fact, Taylor and colleagues suggest that 75% of all the jobs lost in US since 2008 have been male (http://pewsocialtrends.org/2010/01/19/women-men-and-the-new-economicsof-marriage/). TheresnoreasontothinkthatIreland does not have a similar male to female ratio. So what does the large increase in the rate of male unemployment mean for mental health? Whethermanasbread-winnerisanevolutionaryidentityora social construct, it is safe to say that for many men in Ireland, when they lose their job their world falls apart. It is an experience which can shatter someones identity and self-esteem and leave them with haunting questions ofifImnotabletoprovideformyfamily,whoam I? What am I worth? What do other people think of me? Other than relationship difficulties, unemployment is the thing most likely to trigger depression in men. The Royal College of Psychiatry reports that 1 in 7 men who become unemployed will develop depression within the following 6 months. If we know that unemployment figures have spiked then we also know that number of people suffering from depression will have spiked. While the experience of depression isnt radically different for men and women, one disparity stands out: the number of suicides. Over the last decade, we have started to have a national conversation about the reasons for the high rate of suicide in Ireland. After years of silence, pressure from friends, family members and clinicians appeared to be having an impact on our national reticence and the political desire to brush suicide under the rug. The Irish media have been particularly strong in keeping a focus on the risk of suicide and depression during the recession. They have highlighted the increase use of Samaritan services, the 24% increase in suicides in 2009 and an Uchtarin Mary MacAleeses prescient call for greater investment in suicide prevention services in 2009. However, the minor improvements that lobby groups have fought for will now clash against a situation where thousands of men and women are stressed, unemployed, in financial difficulty and depressed. The risk factors are stacking up against the protective factors

anditshardnottothinkthattherewont be a significant on-going increase in suicide rates. So where do we go from here? We need to work concertively in three different areas: home, community and government. Families generally are the first to know. They can recognise when something is wrong and although they might not have all the answers immediately, they are the first people that the individual will look to for help. Knowing there is a risk and keeping a watchful eye is a good first step. Recognising and identifying symptoms of depression is a solid second step. Talking about it, is the third thing to do. The Royal College of Psychiatrists guide to depression has a special section on depression in males thats easy to read and has good information for everyone(http://www.rcpsych.ac.uk/mentalhealthinfoforall/problems/depressio n.aspx). Suicide and depression are ravaging our communities, with rural communities being particularly at risk. With current budgetary constraints, it is unlikely that the there is going to be centralised approach, so if communities want to protect their own, they are going to have to find a way to do it themselves. No two places are alike, so each approach will have to be tailored to that communitysneeds and resources. But it will be about reaching out to those who are isolated and most vulnerable; finding ways to give a sense of selfworth to those who have lost their jobs; using the community structures already there (e.g. gyms, churches, sport clubs) to help target depression through exercise, meditation, volunteering etc. This isnt new. This is what Ireland used to be like. We just forgot how to do it. Finally, the new government needs to see mental health as an economic issue. The London School of Economics identified in 2007 that a major difficulty in moving people on from long-term unemployment was depressive and anxious disorders. These mental health difficulties were costing the Exchequer hundreds of millions of pounds a year (The Lord Layard Report, 2007). In response, the previous and current UK governments have committed to training 3600 new therapists. Despite the good intentions of the new Irish government, it will be difficult to find the money to fund a major expansion of services. However, the process in the UK has highlighted several low-intensity, low cost but evidence-based interventions that people receive before they access a therapist. The following low-intensity approaches have all been found successful in randomised control trials and many of them are supported by the National Institute of Clinical Excellence (NICE). They are being rolled out across the UK (i) bibliotherapy (free cognitive behavioural therapy (CBT) self-help guides) (ii) computerised CBT for depression (iii) large-scale group CBT workshops (iv) group mindfulness (meditation) based cognitivetherapy.Lowintensityworkwont cure all ills but it is helping tens of thousands of people in the UK. Why not Ireland? The longer someone is depressed the harder they are going to find it to get back to work and vice-versa. We know there has been a massive increase in male unemployment and in mental health problems. The government needs to tackle the vicious cycle between unemployment and depression now before

they have a chronic mental health problem and a chronic unemployment problem throughout the next decade.
Keith Gaynor (BA, PhD, D Clin Psych) is a Clinical Psychologist working for the National Health Service. He previously worked for St John of God Services, Stillorgan.