Book: Boys Don’t Cry

Book Title:

Boys Don’t Cry: Why I hid my depression and why men need to talk about their mental health.

Author(s): Tim Grayburn.

Year: 2018.

Edition: First (1st).

Publisher: Hodder & Stoughton.

Type(s): Hardcover, Paperback, Audiobook and Kindle.


For nearly a decade Tim kept his depression secret. It made him feel so weak and shameful he thought it would destroy his whole life if anyone found out. But an unexpected discovery by a loved one forced him to confront his illness and realise there was strength to be found in sharing his story with others. When he finally opened up to the world about what he was going through he discovered he was not alone.

Boys Don’t Cry is a book that speaks against the stigma that makes men feel like they are less-than for struggling, making sense of depression and anxiety for people who might not recognise those feelings in themselves or others. It is a brutally honest, sometimes heart-breaking (and sometimes funny) tale about what it really takes to be a ‘real man’, written by one who decided that he wanted to change the status quo by no longer being silent.

Book: Breaking the Barriers

Book Title:

Breaking the Barriers: Early Intervention to Mental Health Issues.

Author(s): Lade Hephzibah Olugbemi.

Year: 2020.

Edition: First (1st).

Publisher: Independently Published.

Type(s): Paperback and Kindle.


“If you don’t know what your barriers are, it’s impossible to figure out how to tear them down.” – John Manning, author of The Disciplined Leader.

This is true about mental health in the community. Barriers to information and understanding have affected people with mental health issues, as well as their friends, work colleagues and family members. This book seeks to shed light on the many factors that causes barriers to preventing mental health problems. It demystifies the various issues surrounding mental health, especially within the Black, Asian and Minority Ethnic (BAME) communities. It also explores the various factors that trigger mental illness, the role of the media, religion and culture in complicating the barriers.

By reading Breaking The Barriers, you will become more aware of the various issues around mental health, and better equipped to overcoming the barriers.

The Stigma of Weakness

The head of the Army’s mental health engagement team has called on the chain of command to better recognise that “vulnerability is not a failure”.

Colonel Tim Boughton said more should be done to tackle the stigma that admitting to difficulties is to show weakness. rguing that physical fitness is indivisible from mental fitness, the officer urged commanders to continue to drive the change in culture.

“Authentic leadership acknowledges that failure is progress if you learn from it,” he said. “Our darkest moments often lead to periods of greatest strength. “As a commander you have a legal and moral duty of care for your subordinates. Think from the perspective of a soldier or junior officer – it can be a lonely place and they may rely on you for confidential advice within the regiment.”

Describing how he believes organisational change can be achieved, Colonel Boughton emphasised that leaders at all levels should allow others to make mistakes and improve, be aware of the emotional environment in their unit and establish shared values by encouraging honest conversations on mental health.

He added: “Resilience starts with a choice – to give in or move forward and become stronger. Self awareness gives you the tools to influence your situation and control it.”


Soldier. (2020) Strength from Failure. Soldier. November 2020, pp. 10.

World Suicide Prevention Day


World Suicide Prevention Day (WSPD) is an awareness day observed on 10 September every year, in order to provide worldwide commitment and action to prevent suicides, with various activities around the world since 2003.

The International Association for Suicide Prevention (IASP) collaborates with the World Health Organisation (WHO) and the World Federation for Mental Health (WFMH) to host World Suicide Prevention Day.

In 2011 an estimated 40 countries held awareness events to mark the occasion. According to WHO’s Mental health Atlas released in 2014, no low-income country reported having a national suicide prevention strategy, while less than 10% of lower-middle income countries, and almost a third of upper-middle and high-income countries had.

On its first event in 2003, the 1999 WHO’s global suicide prevention initiative is mentioned with regards to the main strategy for its implementation, requiring:

  1. “The organisation of global, regional and national multi-sectoral activities to increase awareness about suicidal behaviours and how to effectively prevent them.”
  2. “The strengthening of countries’s capabilities to develop and evaluate national policies and plans for suicide prevention.”

As of recent WHO releases, challenges represented by social stigma, the taboo to openly discuss suicide, and low availability of data are still to date obstacles leading to poor data quality for both suicide and suicide attempts: “given the sensitivity of suicide – and the illegality of suicidal behaviour in some countries – it is likely that under-reporting and misclassification are greater problems for suicide than for most other causes of death.”


An estimated one million people per year die by suicide or about one person in 10,000 (1.4% of all deaths), or “a death every 40 seconds or about 3,000 every day”. As of 2004 the number of people who die by suicide is expected to reach 1.5 million per year by 2020.

On average, three male suicides are reported for every female one, consistently across different age groups and in almost every country in the world. “Conversely, rates of suicide attempts tend to be 2-3 times higher in women than in men, although the gender gap has narrowed in recent years.” More people die from suicide than from murder and war; it is the 13th leading cause of death worldwide. According to the WHO there are twenty people who have a suicide attempt for every one that is fatal, at a rate approximately one every three seconds. Suicide is the “most common cause of death for people aged 15 – 24.”

According to the WHO, suicide accounts for nearly half of all violent deaths in the world. Brian Mishara, IASP president, noted that, “more people kill themselves than die in all wars, terrorist acts and interpersonal violence combined.” As of 2008, the WHO refers the widest number of suicides occur in the age group 15 – 29, while the lowest in the 80+ although representing as well the one with the highest rate (per 100,000) of all age groups, with 27.8 suicides and 60.1 for females and males respectively. In 2015 the reported global age-standardised rate is 10.7 per 100,000.

Social norms play a significant role in the development of suicidal behaviours. Late 19th century’s sociological studies recorded first ever observations on suicide: with statistics of the time at hand, sociologists mentioned the effects of industrialisation as in relations between new urbanised communities and vulnerability to self-destructive behaviour, suggesting social pressures have effects on suicide. Today, differences in suicidal behaviour among different countries can be significant.


  • 2003 – Suicide Can Be Prevented!.
  • 2004 – Saving Lives, Restoring Hope.
  • 2005 – Prevention of Suicide is Everybody’s Business.
  • 2006 – With Understanding New Hope.
  • 2007 – Suicide prevention across the Life Span.
  • 2008 – Think Globally, Plan Nationally, Act Locally.
  • 2009 – Suicide Prevention in Different Cultures.
  • 2010 – Families, Community Systems and Suicide.
  • 2011 – Preventing Suicide in Multicultural Societies.
  • 2012 – Suicide Prevention across the Globe: Strengthening Protective Factors and Instilling Hope.
  • 2013 – Stigma: A Major Barrier to Suicide Prevention.
  • 2014 – Light a candle near a Window.
  • 2015 – Preventing Suicide: Reaching Out and Saving Lives.
  • 2016 – Connect, Communicate, Care.
  • 2017 – Take a Minute, Change a Life.
  • 2018 – Working Together to Prevent Suicide.
  • 2019 – Working Together to Prevent Suicide.
  • 2020 – Working Together to Prevent Suicide.


Suicide prevention’s priorities, as declared on the 2012 World Suicide Prevention Day event, are stated below:

  • We need to continue to research suicide and non-fatal suicidal behaviour, addressing both risk and protective factors.
  • We need to develop and implement awareness campaigns, with the aim of increasing awareness of suicidal behaviours in the community, incorporating evidence on both risk and protective factors.
  • We need to target our efforts not only to reduce risk factors but also to strengthen protective factor, especially in childhood and adolescence.
  • We need to train health care professionals to better understand evidence-based risk and protective factors associated with suicidal behaviour.
  • We need to combine primary, secondary and tertiary prevention.
  • We need to increase use of and adherence to treatments shown to be effective in treating diverse conditions; and to prioritise research into effectiveness of treatments aimed at reducing self-harm and suicide risk.
  • We need to increase the availability of mental health resources and to reduce barriers to accessing care.
  • We need to disseminate research evidence about suicide prevention to policy makers at international, national and local levels.
  • We need to reduce stigma and promote mental health literacy among the general population and health care professionals.
  • We need to reach people who do not seek help, and hence do not receive treatment when they are in need of it.
  • We need to ensure sustained funding for suicide research and prevention.
  • We need to influence governments to develop suicide prevention strategies for all countries and to support the implementation of those strategies that have been demonstrated to save lives.


Suicide has a number of complex and interrelated and underlying contributing factors … that can contribute to the feelings of pain and hopelessness. Having access to means to kill oneself – most typically firearms, medicines and poisons – is also a risk factor.

The main suicide triggers are:

  • Poverty;
  • Unemployment;
  • The loss of a loved one;
  • Arguments; and
  • Legal or work-related problems.

Suicide results from many complex sociocultural factors and is more likely to occur during periods of socioeconomic, family and individual crisis (e.g. loss of a loved one, unemployment, sexual orientation, difficulties with developing one’s identity, disassociation from one’s community or other social/belief group, and honour).

In richer countries, three times as many men die of suicide than women do, but in low- and middle-income countries the male-to-female ratio is much lower at 1.5 men to each woman.

In the United States, for example, males are four times more likely to die from suicide than are females. However, females are more likely to attempt suicide than are males.

The disparity in suicide rates has been partly explained by the use of more lethal means and the experience of more aggression and higher intent to die in men than women.

Physical and especially mental health disabling issues such as depression, are among the most common of the long list of complex and interrelated factors, ranging from financial problems to the experience of abuse, aggression, exploitation and mistreatment, that can contribute to the feelings of pain and hopelessness underling suicide. Usually substances and alcohol abuse also play a role.

Prevention strategies generally emphasise public awareness towards social stigma and suicidal behaviours.

Cultural and Religious Attitudes

In much of the world, suicide is stigmatised and condemned for religious or cultural reasons.

In some countries, suicidal behaviour is a criminal offence punishable by law. Suicide is therefore often a secretive act surrounded by taboo, and may be unrecognised, misclassified or deliberately hidden in official records of death.

Stigma, particularly surrounding mental disorders and suicide, means many people thinking of taking their own life or who have attempted suicide are not seeking help and are therefore not getting the help they need.

The prevention of suicide has not been adequately addressed due to a lack of awareness of suicide as a major public health problem and the taboo in many societies to openly discuss it.

Raising community awareness and breaking down the taboo is important for countries to make progress in preventing suicide.


Medical Students & Doctors: Mental Health & Stigma

Research Paper Title

Reducing Mental Health Stigma in Medical Students and Doctors towards their Peers with Mental Health Difficulties: A Protocol.


Mental health problems are over-represented in doctors and medical students. However, stigma and ‘a culture of shame’ are formidable barriers to mental health services and consequently many doctors and medical students with mental health difficulties continue to suffer in silence despite the availability of effective treatment.

Indeed, a recent study on over 2,100 female physicians who met the diagnostic criteria for a mental disorder revealed that 50% were reluctant to seek professional help due to fear of exposure to stigma.

Left untreated or undertreated, mental health problems in doctors can result in impairment of occupational functioning, compromise patient safety and place considerable strain on the economy (by increasing the amount of sick leave taken).

Moreover, the consequences of mental health stigma in the medical profession can be fatal. Dr Daksha Emson, a psychiatrist with bipolar affective disorder, tragically killed herself and her baby daughter during a psychotic episode. An independent inquiry into Dr Emson’s death concluded that she was the victim of stigma in the National Health Service.

The mental health of medical students and doctors, in all of its aspects, must therefore be addressed with the urgency that it demands. Stephanie Knaak and colleagues conducted a data synthesis of evaluative studies on anti-stigma programmes for healthcare providers and identified six key ingredients one of which was a personal testimony from a trained speaker who has lived experience of mental illness.

In this paper the authors outline a study protocol with the aim of answering the following research question, ‘Does attending an anti-stigma programme comprised of a medic with first-hand experience of a mental health condition cause immediate and sustained reductions in mental health stigma from medical students and doctors towards their peers with mental health difficulties?’


Hankir, A., Fletcher-Rogers, J., Ogunmuyiwa, J., Carrick. F.R. & Zaman, R. (2020) Reducing Mental Health Stigma in Medical Students and Doctors towards their Peers with Mental Health Difficulties: A Protocol. Psychiatria Danubina. 32(Suppl 1), pp.130-134.

PLA Navy Personnel in Relation to Attitudes & Barriers to Mental Healthcare

Research Paper Title

Attitudes and perceived barriers to mental healthcare in the People’s Liberation Army Navy: study from a navy base.


The People’s Liberation Army (PLA, China) Navy is increasingly conducting military operations other than war overseas. Factors such as confrontations with pirates, special environments and long sailing times have resulted in mental health problems. However, the navy’s actual utilisation of mental health services is low.

This study examined members’ rate of willingness to seek help and the factors that act as barriers to willingness to seek mental health services in the PLA Navy.


This cross-sectional study was conducted at the Zhoushan Base, operated by the East Sea Fleet, between March 2019 and April 2019.

The researchers distributed a 12-item questionnaire to examine participants’ attitudes and perceived barriers to mental healthcare. They recruited 676 navy personnel. Participants’ willingness to seek help if they had mental health problems was also assessed.


The response rate was 99%. A total of 88.44% of the sample reported being willing to seek help. Univariate analysis suggested that those not willing to seek help were more likely to agree with the items, ‘Mental healthcare does not work’ and ‘My unit leadership might treat me differently’ and all organisational barriers, and they were more likely to have concerns about ’embarrassment’ and ‘being weak’ than those willing to seek help.

After controlling for demographic characteristics, binary logistic regression analyses confirmed that a lack of knowledge regarding the location of mental health clinics and being perceived as weak were the main factors preventing participants’ willingness from seeking help.


Extensive efforts to decrease organisational barriers and stigma towards mental healthcare should be a priority for researchers and policymakers to improve the usage of mental health services.

Psychoeducation aimed at de-stigmatising mental health problems should be delivered and the accessibility and availability of mental health services should be increased.


Gu, R-P., Liu, X.R> & Ye, X.F. (2020) Attitudes and perceived barriers to mental healthcare in the People’s Liberation Army Navy: study from a navy base. BMJ Military Health. doi: 10.1136/bmjmilitary-2019-001396. Online ahead of print.

Do Adults Experiencing Mental Illness & Homelessness follow Distinct Stigma & Discrimination Group Trajectories based on their Mental Health-problems?

Research Paper Title

Trajectories and mental health-related predictors of perceived discrimination and stigma among homeless adults with mental illness.


Stigma and discrimination toward individuals experiencing homelessness and mental disorders remain pervasive across societies. However, there are few longitudinal studies of stigma and discrimination among homeless adults with mental illness.

This study aimed to identify the two-year group trajectories of stigma and discrimination and examine the predictive role of mental health characteristics among 414 homeless adults with mental illness participating in the extended follow-up phase of the Toronto At Home/Chez Soi (AH/CS) randomised trial site.


Mental health-related perceived stigma and discrimination were measured at baseline, one, and two years using validated scales.

Group-based-trajectory modelling was used to identify stigma and discrimination group trajectory memberships and the effect of the Housing First treatment (rent supplements and mental health support services) vs treatment as usual on these trajectories.

The associations between mental health-related characteristics and trajectory group memberships were also assessed using multinomial logistic regression.


Over two-years, three group trajectories of stigma and discrimination were identified.

For discrimination, participants followed a low, moderate, or increasingly high discrimination group trajectory, while for stigma, participants followed a low, moderate or high stigma group trajectory.

The Housing First treatment had no significant effect on discrimination or stigma trajectories groups.

For the discrimination trajectories, major depressive episode, mood disorder with psychotic features, alcohol abuse, suicidality, severity of mental health symptoms, and substance use severity in the previous year were predictors of moderate and increasingly high discrimination trajectories.

History of discrimination within healthcare setting was also positively associated with following a moderate or high discrimination trajectory.

For the stigma trajectories, substance dependence, high mental health symptoms severity, substance use severity, and discrimination experiences within healthcare settings were the main predictors for the moderate trajectory group; while substance dependence, suicidality, mental health symptom severity, substance use severity and discrimination experiences within health care setting were also positive predictors for the high stigma trajectory group.

Ethno-racial status modified the association between having a major depression episode, alcohol dependence, and the likelihood of being a member of the high stigma trajectory group.


This study showed that adults experiencing mental illness and homelessness followed distinct stigma and discrimination group trajectories based on their mental health-problems.

There is an urgent need to increase focus on strategies and policies to reduce stigma and discrimination in this population.


Mejia-Lancheros, C., Lachaud, J., O’Campo, P., Wiens, K., Nisenbaum, R., Wang, R., Hwang, S.W. & Stergiopoulos, V. (2020) Trajectories and mental health-related predictors of perceived discrimination and stigma among homeless adults with mental illness. PLoS One. 15(2), pp.e0229385. doi: 10.1371/journal.pone.0229385. eCollection 2020.

Is There a Mental Health Crisis among Canadian Postsecondary Students?

Research Paper Title

Mental Health among Canadian Postsecondary Students: A Mental Health Crisis?


Recent reports express concerns about a mental health crisis among postsecondary students. These assertions, however, often arise from surveys conducted in postsecondary settings that lack the broader context of a referent group. The objectives of this study were:

  • To assess the mental health status of postsecondary students 18 to 25 years old from 2011 to 2017; and
  • To compare the mental health status of postsecondary students to nonstudents.


Prevalence was estimated for a set of mental health outcomes using seven annual iterations of the Canadian Community Health Survey (2011 to 2017). Logistic regression was used to derive odds ratio estimates comparing mental health status among postsecondary students and nonstudents, adjusting for age and sex. Random effects metaregression and meta-analyses techniques were used to evaluate trends in prevalence and odds ratio estimates over time.


Over the study period, the prevalence of perceived low mental health, diagnosed mood and anxiety disorders, and past-year mental health consultations increased among female students, whereas binge drinking decreased among male students. With the exception of perceived stress, the odds of experiencing each mental health outcome were lower among postsecondary students compared to nonstudents.


These findings do not support the idea that postsecondary students have worse mental health than nonstudents of similar age. The perception of a crisis may arise from greater help-seeking behaviour, diminishing stigma, or increasing mental health literacy. Regardless, the observance of these trends provide an opportunity to address a previously latent issue.


Wiens, K., Bhattarai, A., Dores, A., Pedram, P., Williams, J.V.A., Bulloch, A.G.M. & Patten, S.B. (2020) Mental Health among Canadian Postsecondary Students: A Mental Health Crisis? Canadian Journal of Psychiatry. 65(1), pp.30-35. doi: 10.1177/0706743719874178. Epub 2019 Sep 4.

Changing Attitudes & Stigma toward Mental Health in Nursing Students

Research Paper Title

Attitudes and stigma toward mental health in nursing students: A systematic review.


This systematic review seeks to ascertain whether mental health-specific education reduces stigmatising attitudes in nursing students.


A systematic review of the literature was performed.


Thirteen studies met the inclusion criteria.

Most of the results show an improvement in attitudes toward mental health, both in theory and clinical experience, but a greater improvement toward these stigmatising attitudes was observed in clinical placements than in theory.


Mental-health-specific training seems to improve perceptions toward mental health.

Clinical placement underpins theory, leading to a decrease in negative attitudes and stigma regarding mental health.


Palou, R.G., Vigue, G.P. & Tort-Nasarre, G. (2020) Attitudes and stigma toward mental health in nursing students: A systematic review. Perspectives in Psychiatric Care. 56(2), pp.243-255. doi: 10.1111/ppc.12419. Epub 2019 Jul 28.

Linking Attitudes towards Mental Illness & the Media

Research Paper Title

Turkish newspaper articles mentioning people with mental illness: A retrospective study.


Because a great majority of the public knows about mental disorders primarily through printed or visual media, the attitudes exhibited in mass media might be predictive in stigmatizing individuals with mental disorders.

The aim of this study was to retrospectively assess the articles in Turkish newspapers that mention individuals with mental disorders.


This study was designed to retrospectively investigate and analyze newspaper content in Turkey; the newspapers’ circulation information was collected by examining the websites of the four newspapers with above 1% of the total circulation.

The News Evaluation Form was used to evaluate a sampling of articles that met the inclusion criteria of having appeared in the lifestyle and agenda pages of newspapers, and of using neutral or negative labelling keywords about psychiatric patients.


Almost all the articles reviewed were negative toward individuals with mental disorders.

Three quarters of the reports were forensic, among which two thirds of the individuals with mental disorders were criminalised, and one third were victims of crime.

In approximately half of the news reports, most images were related to the news and were not protected.

Although not all the articles contain stigmatising elements directed toward people with mental disorders, two thirds of the subjects’ images in the news were found to have stigmatising elements.


Media has an impact on attitudes toward people with mental disorders mostly negatively along with individual experiences and peer interactions.


Aci, O.S., Ciydem, E., Bilgin, H., Ozaslan, Z. & Tek, S. (2020) Turkish newspaper articles mentioning people with mental illness: A retrospective study. The International Journal of Social Psychiatry. doi: 10.1177/0020764019894609. [Epub ahead of print].