When Chris Kelly first began having difficulties with his mental health, he was asked probably a dozen times a week if he was okay. His answer was always the same: yes, he was fine, thanks for asking.

Kelly, a police officer, had been injured on the job when a motorist he was pursuing rammed his car. Shortly afterwards, while he was recovering, Kelly’s wife was diagnosed with aggressive breast cancer.

Though colleagues and loved ones often checked in, Kelly never admitted how he was feeling. ‘I didn’t want to be seen as someone who was struggling,’ says Kelly, 57, from Wigan. He wouldn’t seek help for another two years, until he reached what he now calls ‘crisis point’.

We have perhaps never been more aware of the importance of mental health; that it’s ‘okay to not be okay’ and asking for help ‘is a sign of strength’. Often, these campaigns are aimed at men, who are known to be more reticent than women to admit when they’re struggling and proactively seek support, but who are also at greater risk of suicide.

But awareness isn’t necessarily translating into action. Earlier this year, the British Association for Counselling and Psychotherapy (BACP) found 65% of men had struggled with their mental health in the past three years, yet only 32% had sought therapy. Three-quarters of the total 2,500 respondents said they would only consider it after reaching ‘breaking point’.

The cost of what the BACP is calling ‘crisis point culture’ is not just protracted suffering and a slower route to recovery: the delay can be fatal, with men consistently accounting for 75% of deaths by suicide annually in the UK.

So, what is the psychological breaking point, why are men waiting to get help until they can no longer go on without it and is it possible to reach them any sooner? What constitutes breaking or crisis point will differ between individuals; there is no formal definition, but in its survey, the BACP used the phrase to describe the critical state of becoming overwhelmed by emotional distress.

‘The common language that I hear in the therapy room with men is, “I just can’t do it any more”,’ says Rahi Popat, a registered counsellor based in Leicester.

Sometimes this refers to suicidal thoughts, but more often it reflects a gradual breakdown in coping mechanisms, such as addiction issues, substance abuse, dysfunctional relationships or an unhealthy investment in work or exercise. These tend to mask a deeper psychological wound, which ‘needs proper treatment’, Popat says. An adverse life event, such as a relationship breakdown or job loss, can push someone towards a crisis point.

This isn’t unique to men, but research consistently shows they are less likely than women to seek help for mental health problems.

Popat says this can be due to feelings of fear, anxiety and shame, as well as persistent, gendered social stigma. Though ‘the landscape is changing’, he says, many men still feel that they are ‘not supposed to’ seek therapy and even that it is somehow feminised.

They might know that they’d benefit from opening up but lack the confidence or vocabulary to do so; or they might downplay how they’re feeling, telling themselves it’s not that bad or others have it worse.

In forcing the issue, breaking point may be experienced on some level as a relief, Popat says. ‘It almost gives them permission: I’m now allowed to get therapy.’

Taking Action

Today, the memory of the phone call from his wife, telling him she’d found a lump, causes Kelly to be overcome with emotion. But back in 2015, all he knew was to shut down and ignore any emotions that made him feel uncomfortable. ‘I got very, very good at hiding behind that mask,’ he says.

After a year of gruelling treatment, Kelly’s wife was finally given the all-clear (the couple are now celebrating 11 years in remission), but just as Kelly had exhaled, Manchester Arena was bombed.

For the month following the attack, Kelly was posted in Manchester’s city centre, working 12-hour shifts, with one streak of 18 days. He recalls standing in St Ann’s Square at 4am one morning, ‘with all the tributes and teddies, just wanting to break down in tears’. Kelly felt he had to keep it together for his colleagues. ‘That just added to the weight on my chest,’ he says.

He finally hit breaking point not long afterwards, after attending to a particularly upsetting death by suicide. Despite Kelly’s best efforts, the man died en route to hospital with another officer.

‘I felt guilt because he died,’ says Kelly, growing emotional again at the memory, ‘and because I put someone in the back of the ambulance who witnessed that.’

Kelly started compulsively replaying the scenario in his head, reviewing what he could have done differently and breaking down before, during and after shifts. He knew his response wasn’t proportionate, that he needed some time off to get his head straight.

When he nearly lost his temper at a member of the public who was giving him grief about a road closure, Kelly accepted he needed help. ‘You get to the crisis point where you think to yourself, “I’ll either lose everything or I do something,”’ he says.

In England and Wales, suicide is around three times more common among men than women and the gender gap has increased over time. With suicide still the leading cause of death of men under 50, earlier interventions could save lives.

‘It does take a lot of courage to reach out for help,’ says Brent Leyshon, a 55-year-old engineer from St Albans. Leyshon has struggled with anxiety and depression since he was a child, and had his first serious episode soon after starting university. ‘It kind of blew a fuse in my head,’ he says; he persistently heard internal voices saying he was worthless and didn’t belong, and subsequently lost all confidence and felt out of control. The episode was ‘incredibly frightening’, Leyshon says. He might have continued on that downward spiral, with perhaps tragic results, had he not sought help.

Instead, a counsellor explained what he was feeling and some of the physiological processes at play in anxiety and depression, appealing to his logical mind. ‘It really helped me to understand what I was feeling and unravel that confusion.’

He still feels lucky to have had such a positive first experience of therapy, equipping him with both practical strategies for how to respond to that hostile internal voice and confidence to pursue professional help. ‘I’ve always got that fallback, to say, “I need therapy.”’

Many men don’t feel that the option is available to them, Leyshon acknowledges. ‘When you’re in that frame of mind, it’s really hard to do anything, particularly to reach out for help… and you know the tragic results that can happen.’

The suicide rate within Leyshon’s industry, construction, is nearly four times the national average. Leyshon himself has twice got to the point of calling the Samaritans – most recently two years ago. Now a programme manager for Transport for London, Leyshon is also a trained Mental Health First Aider and advocates within his industry for suicide awareness and prevention. Often, after he’s presented, there will be men hanging around, trying to drum up the courage to have a conversation.

Older generations, in particular, can struggle, as typical midlife stressors and challenges collide with fear and stigma embedded in childhood, of being institutionalised and ‘men in white coats’, Leyshon says. What he tries to impress upon men he meets now is that mental illness is a health issue, no more a sign of weakness than asthma or diabetes, but just as serious and worthy of professional help. Like Popat, Leyshon is working with the BACP on its Outside View campaign, encouraging men to be aware of symptoms and seek out therapy well before reaching crisis point.

‘They’re not just feeling crap – there is something going on in their head, which needs to be addressed… The most important message for them is that you will get better.’ Through therapy you can even thrive, Leyshon suggests. ‘You come out more resilient, more robust and just generally more content with yourself.’

Culture Clash

It’s always better to ask for help than suffer in silence, but finding the right help can be a process – and some men face more barriers than others.

When Taimour Ahmed presented at an NHS walk-in centre with symptoms of anxiety, a doctor asked him some routine questions about diet and lifestyle – then summarily wrote a prescription for antidepressants. ‘I walked out of there, ripped up the thing and just threw it in the bin,’ remembers Ahmed, now 35 and based in London. It wasn’t just the lack of consultation and apparent care that he found off-putting, but also the disregard for cultural nuance. The stigma over mental health and being vulnerable as a man was intensified for Ahmed, coming from a traditional Pakistani family.

It had felt hard enough to take the time off work, he says. ‘To build up enough courage to go to that A&E and say, “I’m experiencing these symptoms.” I just don’t think that it was dealt with in an empathetic way.’

Ahmed didn’t seek help again until seven years later, when he started therapy after a relationship breakdown. That proved similarly unhelpful. ‘I hated it,’ he admits. He frequently felt shut down by his therapist and caught him glancing at the clock. When, after a year of sessions, Covid provided an excuse to stop, Ahmed felt relieved. Now, Ahmed chalks it up to a bad match, plus not being ready to open up. He still recommends men give therapy a try as a dedicated time and space for processing, but to take their time finding a suitable practitioner. He likens it to dating, ‘You have to go through a few before you find the one right for you.’

When Ahmed began struggling again three years ago, what made a difference for him was peer support through Taraki, which supports Punjabi communities with their mental health. Now, Ahmed works for the organisation as a facilitator, helping others over the same hurdles he faced himself.

‘Men who don’t feel ready for therapy really value a shoulder-to-shoulder approach… With us, it’s like, “Come down and have a chat.”’

A conversation itself can be life-changing to someone who is nearing crisis point, with men tending to have ‘measurably lower access’ to social support than women. Not only may men lack the bravery to express their vulnerability during a conversation, but they may also have a shortage of vocabulary.

‘I think the missing piece is emotional literacy,’ says Peter Meades, a London-based integrative psychotherapist with over 25 years’ experience across the NHS and private practice. ‘Expressing what they are feeling exactly, why they’re feeling it and what to do with it – that’s the struggle.’

Dr Meades’ take on why men delay seeking support is ‘because it feels unbearable to admit they need it’, likening the perceived shame to asking for directions. ‘The shame is that they are continuing to struggle and they haven’t been able to resolve the problem… It goes against the masculinity script, which says you should have the resources to deal with this yourself.’

Alternative Solutions

The specific pressures facing men do warrant targeted measures, as the government has recognised with England’s first-ever Men’s Health Strategy, promising ‘comprehensive, co-ordinated action’ to tackle suicide rates and stigma over mental health, among other areas.

At the individual level, therapy is not the only appropriate response – as Dr Meades is quick to acknowledge, ‘It isn’t for everyone.’

He wrote his new book, I’m Fine (But Not Really): What Men Need To Know, Without Going To Therapy, recognising that not only can therapy be expensive, but ‘there are so many men who just won’t get over that threshold’ of building up the courage to seek help of this kind.

They may nonetheless benefit from Dr Meades’ simple strategies and exercises for making sense of difficult feelings, recognising patterns and cultivating self-awareness. These can help men get better at realising when they’re entering a downward spiral, and be faster to act on it.

‘It is often quite eye-opening for a man to understand that the anger he’s struggling with, for example, is actually sadness, or unresolved grief.’ But, before men can ask for help, Dr Meades says, they need to really feel that it’s okay to need it. Having finally admitted that he was close to crisis, Kelly began weekly therapy through the police force’s Benevolent Fund.

‘I didn’t have a clue what to expect,’ he says. But instead of lying down on the couch or talking about his childhood, ‘it was a chat… Instead of being told, I was allowed to explore it on my own’.

The experience was life-changing, Kelly says, enabling him to process and properly file away his challenging experiences. ‘It still affects me now – but I can talk about it.’

Since retiring from the police four years ago, Kelly now supports other men to have those vulnerable conversations as a facilitator with Andy’s Man’s Club – a men’s suicide prevention charity offering peer support across the UK.

Between those relationships, therapy and his own strategies, Kelly now feels confident about his ability to steer away from breaking point. ‘If I have that bad day, bad week, bad month – I’ve got this toolkit.’

Late last year Kelly was struck by a depressive episode and his mood descended sharply over a matter of days. He immediately got in touch with a friend from AMC, then resumed therapy for a few months.

Now he’s struck by the contrast between this swift, confident response and his earlier struggle. Having previously taken years to seek help, this time, Kelly says proudly, ‘I never even gave it a second thought.’

To find a BACP-registered counsellor or therapist, visit bacp.co.uk. For more information about the Outside View campaign, visit outside-view.co.uk. When life is feeling difficult, Samaritans are here – day or night, 365 days a year. You can call them for free on 116 123 or visit samaritans.org to find your nearest branch

1/ Weight Loss or Gain

A significant change on the scales in either direction can be an indicator of a looming crisis.

2/ Changes to Sleep Patterns

Sleeping more is widely recognised as a symptom of depression, but sleeping less or experiencing disrupted sleep can also be a warning sign. You might feel persistently sluggish, unproductive or like there’s a persistent weight on your chest.

3/ Personality Change

You may have lost interest in hobbies or passions, be acting out of character or simply not feel like yourself. Loved ones might have commented on you being more angry, quiet, negative or fidgety than usual.

4/ Self-Isolating

Men, in particular, tend to withdraw from friends and family when struggling with their mental health. You might avoid social occasions, reject offers of support and struggle to be honest about how you’re feeling.

5/ Self-Criticism

Your inner voice may get more critical or louder as crisis point approaches. You might begin to see yourself as a failure or a burden to others.