Despite sustained public health efforts to address men’s mental health and suicide risk, suicide mortality among men remains persistently elevated across high-income countries, according to an editorial in PLOS Medicine by Prof. Seena Fazel, a psychiatrist and suicide prevention researcher at the University of Oxford. The article argues that while population-level mental health strategies continue, mortality data suggest that more intensive, individualized interventions for high-risk groups must become a central pillar of suicide prevention policy.
Key takeaways
- Men account for the majority of suicides in high-income countries, yet suicide prevention strategies have not sufficiently reduced this disparity
- Population-wide mental health awareness campaigns, though important, must be paired with intensive clinical interventions targeting individuals at highest risk
- Specialized approaches—including risk stratification, close clinical follow-up, and crisis support—show stronger evidence for reducing suicide mortality in high-risk male populations
Suicide prevention requires a two-tier approach
Population-level strategies and targeted clinical interventions for high-risk individuals must both be prioritized
Illustrative comparison of intervention intensity and evidence support. Source: PLOS Medicine Editorial | Georgian Medical Journal News
Why broad mental health campaigns have not closed the gender gap
Population-level mental health interventions—such as public awareness campaigns, workplace mental health programs, and media literacy efforts—serve an important role in destigmatizing mental illness and increasing help-seeking. However, Prof. Fazel notes in his PLOS Medicine editorial that these strategies alone have not substantially reduced suicide mortality among men in high-income nations. This gap between intervention uptake and mortality reduction suggests that population strategies, while necessary, are insufficient without concurrent investment in high-intensity clinical approaches.
The persistence of male-dominated suicide statistics, even as mental health awareness improves, points to a structural gap in how suicide prevention is organized. Men may be less likely to access general mental health services, and those who do may not be identified as being at imminent suicide risk—a failure of both engagement and risk stratification at the clinical level.
Targeted clinical approaches show stronger evidence for mortality reduction
According to Prof. Fazel’s analysis, clinical interventions that focus on identifying and intensively managing individuals at highest suicide risk—through structured risk assessment, frequent follow-up, and rapid crisis response—demonstrate measurable reductions in suicide mortality. These approaches include psychological interventions delivered by trained specialists, pharmacological management of underlying psychiatric disorders, and coordination between primary care and specialist mental health services.
The key distinction, as outlined in the PLOS Medicine editorial, is that targeted interventions allow clinicians to concentrate resources on the individuals at the greatest risk of dying by suicide—often those with prior suicide attempts, active suicidal ideation, untreated major depression, or substance use disorders. This risk-stratified approach contrasts with one-size-fits-all population campaigns and reflects the reality that suicide risk is concentrated in a smaller subset of the population.
Integrating population and clinical strategies into a coherent prevention model
Prof. Fazel advocates for a dual-level prevention framework in which population-level mental health initiatives provide a broad foundation of support and destigmatization, while simultaneous investment in specialized clinical pathways ensures that high-risk individuals are identified early and managed with sufficient intensity. This approach aligns with the public health prevention pyramid: universal prevention (population-level awareness), selective prevention (targeting at-risk groups), and indicated prevention (intervening with individuals showing early warning signs).
The editorial emphasizes that neither level can succeed in isolation. Broad awareness campaigns without accessible, high-quality clinical services leave identified individuals without adequate care; conversely, intensive clinical services without population-level destigmatization and help-seeking support will fail to reach those who remain hidden or reluctant to disclose suicide risk. The implication for health systems is clear: suicide prevention funding and policy must support both simultaneously, with particular attention to ensuring that men—who are statistically underrepresented in mental health service uptake—are actively engaged through culturally informed outreach and clinical pathways that meet them where they are.
Targeted, specialized approaches for high-risk individuals should be prioritized alongside broader population-level strategies to achieve meaningful reductions in suicide mortality among men.
— Prof. Seena Fazel, University of Oxford (PLOS Medicine)
What this means
Frequently asked questions
Why do men account for more suicides than women if they use mental health services less often?
Men may experience barriers to accessing mental health services—including stigma, reluctance to disclose emotional distress, and lack of culturally tailored engagement strategies—yet those who do reach crisis may be at particularly high risk due to late intervention and often more lethal means. The lower service engagement combined with higher mortality suggests that clinicians must actively identify and follow high-risk men, rather than waiting for them to self-refer.
What is the difference between population-level and targeted suicide prevention strategies?
Population-level strategies (e.g., public awareness campaigns, workplace mental health programs, media guidelines) aim to reduce suicide risk across entire populations by reducing stigma and increasing help-seeking. Targeted strategies identify individuals at high suicide risk through clinical assessment and provide intensive interventions—such as frequent psychiatric follow-up, psychotherapy, or medication—to prevent imminent suicide attempts. Both are necessary; population strategies create a foundation, while targeted strategies save lives among those at greatest risk.
How can primary care clinicians help reduce male suicide rates?
Primary care providers are often the first point of contact for men experiencing depression or other mental health symptoms. Clinicians should routinely screen for depression and suicidal ideation, use structured risk assessment tools, initiate treatment or refer to specialists, and maintain regular follow-up—particularly for those at higher risk due to prior suicide attempts, substance use, or social isolation. Training in suicide risk assessment is an evidence-based investment in prevention.
As health systems worldwide continue to invest in mental health awareness and anti-stigma efforts, the evidence increasingly shows that these initiatives alone will not close the gender gap in suicide mortality. The path forward requires equal commitment to identifying and intensively supporting the men at highest risk—through structured clinical pathways, adequate specialist capacity, and health policy that treats suicide prevention as a clinical priority, not just a public health communication challenge. For further context on mental health policy approaches, see our Health Policy coverage.
Source: Improving suicide prevention in men, Seena Fazel, PLOS Medicine
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