Gerry McNally was lying on the sofa in his Wexford home, tossing and turning.
For the previous six weeks he had been unable to sleep properly, kept awake by profound anxiety about his work, family and housing situation.
“In the middle of the night, I heard a voice in my head,” he says. “It told me to do something that was very disturbing. I couldn’t understand it.”
Speaking now, six years later, the 54-year-old gets upset at the memory of one of the worst times in his life.
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This voice, he says, told him to hurt himself and others.
“It said that was the only way. The more I thought about it, the more I thought: No, no, there has to be another way.”
McNally was speaking following the launch this week of a new report on men’s health that found two in five men die prematurely – before the age of 75 – and the vast majority of these deaths are preventable.
The report, which was commissioned by men’s health charity Movember, warned suicide was a “critical concern”, citing figures that show men account for four in every five suicides.
McNally, who is originally from the North but now lives in Wexford, says his mental health is something he always struggled with, particularly following the death of his mother when he was 17.
The sudden nature of her death – she went to sleep and never woke up – also adds to this grief, he says, adding that it’s something he has never got over.
“I did what men of my generation did: I just thought about it and thought about it. You didn’t act on anything. And you just let it bottle up,” he says.
“I kept thinking I was a male and I should be able to handle these things. You have to stay strong for other people. But inside I was kind of crumbling.”
In 2019, things worsened, he says. He moved from Westmeath to Wexford, started a new job, recently got remarried and had a son, Oisin, who was diagnosed with a brain condition, resulting in additional health needs.
He discovered his landlord was in debt, and began to worry bailiffs would appear at the home he was renting and kick his family out.
Then he had a panic attack in work and was too afraid to return for several weeks out of embarrassment and shame.
“I was just worrying, worrying, worrying. I had a constant pain in my chest. I thought I was going to die.”
When he heard that voice in his head that night in May 2019, he drove to Wexford General Hospital but talked himself out of getting help, believing his struggles were “trivial”.
The following morning he spoke with his counsellor, who said he needed additional support, and who brought him to the out-of-hours GP service, where he was referred for acute mental health care.
“They quickly diagnosed it as being a result of sleep deprivation due to everything that was going on in my head,” he says. “I was released to Wexford mental health services where I was in respite for six weeks.”
They just try to power through it. And that’s why, unfortunately, the suicide rate among that age group is so high
Ralph de Kramer, a GP based in rural Cork, says men traditionally haven’t been very good at talking about their emotions.
“It comes down to that big boys don’t cry nonsense,” he says.
“Most of my patients are farmers. They’re not very forthcoming about mental health. All the ones of an older generation – let’s say in their 60s up – they really struggle to admit that everything is not well emotionally. It’s a very touchy subject.
“They just try to power through it. And that’s why, unfortunately, the suicide rate among that age group is so high. The loneliness and depression has been left untreated for years.”
Often, he adds, it’s when these men are at breaking point that they finally speak out and seek help. But in the younger generation, Dr de Kramer says there is growing recognition that mental health is part of health.
“You don’t call it kidney health, or lung health, or heart health or bone health. You just call it health,” he says. “And then we say mental health on the side as if it’s something completely separate. But the younger generation is much more aware.”
This is reflected in Movember’s research too. It found 97 per cent of GPs had encountered men presenting with suicidal ideation in the past year.
On average GPs reported seeing 15 male patients per year presenting with suicidal behaviour, with most cases in the 18-34-year-old and 35-54-year-old age groups.
Cliona Fitzpatrick, policy and evidence director at Movember, said there was a disparity in health outcomes between advantaged and disadvantaged areas.
Men living in the most deprived areas in Ireland were 150 per cent more likely to die before the age of 75 than those living in the least deprived areas, the report found.
“Looking at those trends over time, that is remaining steady or worsening in some cases,” she says. “That is a massive problem that we need to do something about.
“We need a national focus but being locally tailored because not everything works for everyone. People say stigma, stoicism are reasons why men don’t seek help, but the way the healthcare system and society responds to men also plays a role.”
This is true for physical health, just as much as mental health, the charity has found.
The report highlighted how men were 40 per cent more likely than women to die prematurely, and premature death was higher for men across each of the five leading causes in Ireland, which includes cancers and circulatory diseases.
James Monks was diagnosed with cancer when he was a teenager. He underwent treatment and recovered well, though he struggled mentally for a number of years after this. Then, in 2021, when he was 39, he was ill again, this time with acute stomach pains.
“It was one of those things I wouldn’t call the doctor unless I need to,” he says. “Eventually my wife said I needed to call an ambulance.
“When the ambulance came, he checked me and said they think I’m grand. But my wife was like: ‘No, I don’t think he is.’ I was waiting around [in the hospital] for hours. I underwent tests. And then they sent me home. They kind of made me feel like I was wasting their time.”
But because his pain remained, his wife wanted him to get a second opinion. The family, who have private health insurance, attended a private hospital, which identified a need for urgent surgery.
“They said it sounds like I have what’s called a volvulus, which is essentially a splitting of the colon. Basically you can be dead in a couple of hours,” he says. “They told my wife it was touch and go for a while.
“I would’ve been that statistic: that he seems fine, and then a day later he’s gone. My wife wanted to make sure I was completely seen. I would’ve stayed at home, I wouldn’t have went back to hospital.”
Though he was recovering physically, he was struggling mentally. After facing his own mortality, combined with a lack of sleep, he couldn’t get out of bed and felt “the lowest I’ve ever felt”. Thankfully, he says, “my family pulled me out of it”.
It took him a good bit of time to feel like himself again.
“But now I’m at the best place I’ve ever been. So I want people to learn from things that happened to me.”
Giving back is also why McNally is speaking out. He hasn’t heard a voice in his head or experienced a panic attack since his crisis point in 2019. He now has tools that help calm him down when he’s feeling overwhelmed.
He has, he says, more good days than bad. But it’s important to him that other men don’t struggle in silence like he did for so many years.
“I came from the school of thought that you don’t talk about these things and if you do it’s a sign of weakness. Not to your family, not to your work colleagues, not to your wife. But we need to speak out. We need to get help.”
If you have been affected by this article, please contact The Samaritans at 116123 or email jo@samaritans.ie
