Background: It is well established that people with an intellectual disability have high rates of mental health problems, yet rates of uptake of services do not match need. Aim:To identify the current literature pertaining to the barriers and facilitators to access to mental health services for people with an intellectual disability. Method: A systematic search identified English-language articles that addressed barriers or enablers to access, mental health services and intellectual disability from 2005 to 2016. Results were synthesised according to Gulliford et al's four dimensions of access: availability, utilisation, relevance and effectiveness, and equity. Results: Barriers and enablers were identified across all the dimensions. Organisational barriers, lack of services and poor quality services related to deficits in knowledge were among the barriers discussed in the literature. Facilitators included emphasis on inter-agency collaboration, and training and education. Substantial gaps were also identified, particularly in relation to the lived experience of these barriers.Conclusions: Further research and evaluation across all aspects of access to mental health care for people with an intellectual disability is needed.

Despite higher rates of suicide in men, there is a dearth of research examining the perspectives and experiences of males at risk of suicide, particularly in terms of understanding how interventions can be tailored to men’s specific needs. The current study aimed to examine factors assisting, complicating or inhibiting interventions for men at risk, as well as outlining the roles of family, friends and others in male suicide prevention. Thirty-five male suicide survivors completed one-to-one interviews, and forty-seven family and friends of male suicide survivors participated in eight focus groups. Thematic analysis revealed five major themes: (1) development of suicidal behaviours tends to follow a common path associated with specific types of risk factors (disrupted mood, unhelpful stoic beliefs and values, avoidant coping strategies, stressors), (2) men at risk of suicide tend to systematically misinterpret changes in their behaviour and thinking, (3) understanding mood and behavioural changes in men enables identification of opportunities to interrupt suicide progression, (4) distraction, provision of practical and emotional supports, along with professional intervention may effectively interrupt acute risk of harm, and (5) suicidal ideation may be reduced through provision of practical help to manage crises, and helping men to focus on obligations and their role within families. Findings suggest that interventions for men at risk of suicidal behaviours need to be tailored to specific risk indicators, developmental factors, care needs and individuals’ preferences. To our knowledge this is the first qualitative study to explore the experiences of both suicidal men and their family/friends after a suicide attempt, with the view to improve understanding of the processes which are effective in interrupting suicide and better inform interventions for men at risk.

Knowledge about proactive strategies that men use to cope with depression and suicide is limited. This narrative review aims to provide an overview and critical appraisal of qualitative studies investigating men’s accounts of strategies used to cope with depression and/or suicidal behavior. A search was conducted of relevant databases to identify qualitative (both pure and mixed method) investigations of men’s experiences of depression and suicidal behavior, as well as the strategies used by men to cope with these experiences. The rigor and validity of studies was assessed using the Consolidated Criteria for Reporting Qualitative Research checklist. Included studies were reviewed and synthesized using the narrative methodology. Twenty studies met inclusion criteria, with 17 specifically focused on men’s accounts of depression and/or suicide, examining the topic from a masculine perspective, and 3 that addressed gender differences in coping strategies incidental to their primary aim. Specifically “masculine” methods of coping with negative feelings overwhelmingly focused on unhelpful behaviors, such as use of drugs, risk taking, irritability, and emotional withdrawal. There was limited reporting or exploration of “positive” or adaptive coping behaviors. Current qualitative studies have tended to focus on men’s unhelpful behaviors in relation to depression. Rigorous qualitative studies exploring positive strategies used by men to cope with depression are needed so that targeted public health campaigns can be disseminated.