Too High Risk to Talk, Too Well to Treat: The Erosion of Male Resilience
By Laurie Simmonds, Team Manager at Greater Manchester Mental Health NHS Foundation Trust
The 4:30 p.m. Email
The referral lands in the inbox at 4:30 p.m., marked URGENT. The word, framed by asterisks, feels hollow in a system where urgency has become routine.
Triage mode takes over. Thresholds, criteria, and capacity pressures all compete in the background, each one another reminder of how overstretched community mental health services have become.
Expecting the usual referral, a few vague notes from a GP requesting an “urgent assessment”, I’m surprised to find a detailed letter from a psychotherapist.
Meet Lee
The referral is about a man I’ll call Lee.
Lee is in his late twenties. The last year has not been kind: he lost his job, ended a long-term relationship, and has since moved back in with his parents. He’s looking for work and occasionally helping a friend on a building site, labouring, plastering, anything that pays. On the surface, he’s functioning. Keeping busy. Doing what’s expected.
But beneath that, Lee has been drinking more, what we’d describe clinically as a maladaptive coping strategy. He’s been isolating himself, eating less, washing less, and lately, he’s been having thoughts that life isn’t worth living.
It’s fair to say that Lee has been feeling, in the words of A.A. Milne’s loveable Piglet, “not very okay at all.”
The Door That Closes
His GP prescribed antidepressants, but after three days, Lee stopped taking them. “They don’t work,” he said. He was also referred for talking therapy. During his first phone consultation earlier that day, he opened up about his childhood, his relationships, and some of the trauma he’s carried quietly for years. It was the kind of honest beginning that could form the foundation of real therapeutic work.
But then came the PHQ-9, the standard questionnaire for assessing depression. Question nine asks whether you have thoughts of being better off dead. Lee said yes.
He didn’t describe any plans or intent to end his life. He hadn’t self-harmed. But still, the door closed. Lee was deemed “too high risk to access talking therapy at this time.”
Following a thorough triage, more detailed than I have time to explain here, the outcome was predictable: Lee was also deemed not risky enough for crisis services.
And so, he was left in the middle ground, a space between too unwell to talk and too well to treat.
The Slow Erosion of Resilience
There’s a myth that resilience is a fixed quality, that you either have it or you don’t. But resilience is more like scaffolding: something that’s built, maintained, and supported over time. When the scaffolding weakens, through stress, isolation, or lack of help, people start to crumble in ways that don’t always look like crisis.
For many men, that process happens quietly.
They keep working, joking, managing the basics. They show up for others even when they can’t show up for themselves. And because they appear functional, their pain is often invisible, both to the world and to the systems meant to support them.
We tell men to talk, to open up, to share, yet when they do, the infrastructure around them often isn’t equipped to respond. The reality is that most men experiencing suicidal thoughts are not in psychiatric wards or crisis houses; they’re in offices, on building sites, driving vans, caring for children.
Recent research suggests that a significant proportion of men in talking therapies are employed and outwardly functioning, living proof that suicidality and capability can coexist. Yet our services are rarely designed to recognise that complexity.
Lee’s resilience hasn’t vanished; it’s been worn away. Not by weakness, but by exhaustion. By the slow drip of unmet need, social expectation, and a system stretched past breaking point.
The System Running on Empty
This isn’t a story about professionals not caring. It’s about professionals trying to do their best in a service that has been pared back to its limits.
Community mental health teams were designed to prevent crisis, to offer early, meaningful intervention. Now, they often act as gatekeepers to services stretched so thin that even those in visible distress can’t meet the threshold for help.
Clinicians are trained to sit with risk, to support people through it. But under chronic underfunding, they’re increasingly forced to measure it instead. Risk assessment becomes a substitute for genuine engagement. Not out of indifference, but because there are no resources left to manage what’s found.
When the Scaffolding Fails
Resilience isn’t about never falling apart. It’s about knowing that, if you do, someone or something will be there to help you rebuild.
When community care collapses, that safety net disappears. The message that reaches men like Lee is painfully simple: you’re on your own.
It’s no coincidence that suicide remains the leading cause of death for men under fifty. Despair isn’t always loud; it’s often found in quiet resignation, in the long pause between asking for help and realising that none is coming.
Resilience doesn’t shatter in an instant; it wears down through neglect.
Rebuilding What We’ve Lost
If we want to stop losing men like Lee, we have to rebuild the foundations that make resilience possible.
That means investing in community mental health, not just as a response to crisis but as a space for prevention, connection, and continuity. It means giving clinicians time to work the way they were trained to, with empathy, patience, and humanity.
Because triage doesn’t save lives; people do.
About the Author
Laurie is a Mental Health Social Worker and Approved Mental Health Professional (AMHP) with over ten years’ experience in community mental health. He currently manages a Community Mental Health Team (CMHT), leading a multidisciplinary service focused on person-centred care, recovery, and crisis prevention. He also leads Waymark Training, a suicide prevention and safeguarding training consultancy.
His practice is grounded in social work values, promoting independence, protecting human rights, and ensuring that people’s voices remain central to care planning. Laurie is committed to ensuring that individuals and unpaid carers are heard, respected, and supported as equal partners in care. He is particularly interested in the integration of social work values within mental health recovery and co-occurring substance misuse.
Laurie is passionate about improving operational systems to create more responsive and sustainable services. This includes strengthening pathways between health and social care, reducing unnecessary complexity, and fostering a culture where staff can work collaboratively and with confidence under pressure.
About Our Quarterly SPARK Report
What does SPARK stand for? Suicide Prevention: Attitudes, Risk & Knowledge. Our role is not to deliver direct suicide prevention services, but to empower the organisations and individuals who do. Our mission is to equip decision-makers, campaigners, and service providers with the data they need to drive informed action and lasting impact through robust, actionable suicide prevention statistics and insights.
Conducted by M·E·L Research, SPARK is a catalyst for change, providing critical evidence that helps to shape suicide prevention strategies in the UK. Visit the SPARK webpage for further information.
Do You Need Support?
If you or someone you care about is experiencing an emotional or mental health crisis needing immediate attention: Reach out to the person’s GP, the GP out-of-hours service, or call NHS on 111.
If you fear for your (or someone else’s) immediate safety: Guide them to Accident and Emergency or dial 999 for immediate assistance.
Samaritans – Call 116 123 or email jo@samaritans.org (24/7). Welsh line: 0808 164 0123 (24/7)
National Suicide Prevention Helpline UK – Call 0800 689 5652.
Papyrus HOPELINEUK – For under 35s or those worried about someone under 35: 0800 068 4141, pat@papyrus-uk.org, or text 07786 209 697 (24/7)
Campaign Against Living Miserably – Call 0800 58 58 58 or live chat (5pm – midnight daily)
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