The big issue: In your corner
Therapy Today, April 2026

'I cried like a baby,’ says Sean McNicholas remembering his first experience of therapy, aged 44. ‘It was the first time I was able to speak about what I’d been through in my life, all the pain that I’d been pushing down for years just spilt out of me.’ Sean had grown up in a working-class family. Both of his parents were alcoholics, and his father died when he was five years old. His mother raised him and his siblings in a state of poverty, and social services intervened in his care.

As Sean grew older he got involved in petty crime and drugs. He experienced business success in his 20s and 30s but continued to cope with unprocessed childhood trauma through the use of alcohol and drugs. ‘By the time I was in my 40s I was married with kids, but really I was a mess,’ he says. ‘Eventually my wife and I got divorced, and I had to cope with living apart from my kids. I went into a spiral. I had to reach rock bottom before I finally sought professional help.’

Like so many men of his age and class background, therapy had never seemed like a realistic option. ‘It wasn’t even a consideration,’ he says. ‘My idea of therapy was whatever I’d seen in The Sopranos: sat on a couch talking to a woman about my mother. I was raised to think a man had to fight his feelings and just get on with it. I’d have been worried about my mates taking the mickey out of me had they known I was seeing a therapist.’ 

Eventually therapy helped save his life. ‘I went there asking, “what’s the matter with me?”’ he says. ‘But I quickly learned the real question should have been “what happened to me?”’ Such was the positive impact that Sean trained and qualified as a therapist himself. Now he finds his own background to be a powerful tool in connecting with other men. ‘I share my story with clients to help them understand that they’re not alone. I can relate to what they are going through, and that helps them open up,’ he says. 

Crisis point 

I grew up in a working-class household, struggled with addiction and depression in my 30s, and steadfastly refused to ask for help for many years. Amid a laddish social environment feelings are rarely discussed, and any self-reflection is often labelled as self-indulgent. I always regarded therapy as the domain of middle-class hippies. Only hitting a crisis point at 40 forced me to give therapy a try as a ‘final throw of the dice’ before my life imploded. It turned out to be the best decision of my life. The therapist I met for the first time in June 2016 was brutally honest in her assessment of my problems. The fact that she had struggled with similar issues herself disarmed me. The fact that she would occasionally swear in our sessions softened me further. I have returned to my sessions with her almost every week for the past 11 years and have been sober for the same length of time. 

I consider myself lucky to have hit the crisis that led me to therapy. But wouldn’t it have been better had I sought help sooner, before hitting rock bottom? Men of my age and background rarely do. 

Celebrity ambassadors 

The former boxing champion Ricky Hatton was 46 when he died last year as a result of suicide. Hatton was from a workingclass background in Stockport. For many he represented the perfect role model for struggling midlife men: successful yet down-to-earth, a charismatic man of the people who had conquered his sport yet was happy to discuss his mental health struggles publicly. He was an ambassador for the suicide prevention charity Campaign Against Living Miserably (CALM). and was one of numerous male celebrities who had spoken out about their mental health in a bid to destigmatise the issue. The likes of Romesh Ranganathan and Declan Rice have also worked with CALM, while Freddie Flintoff, Rio Ferdinand and Matt Willis have made impactful documentaries discussing their own vulnerabilities. In 2022 Liam Gallagher released a single ‘You’re too good for giving up’ in partnership with the charity Talk Club to raise awareness of male suicide. But there isn’t much evidence to suggest celebrity advocacy is making any real difference to those men most at risk. In spite of numerous changes in social attitudes, midlife men – especially those from working-class backgrounds – remain as vulnerable to suicide today as they were 14 years ago.

In 2012 Samaritans published Men, Suicide and Society,¹ concluding that the high suicide rate among middle-aged men, particularly those from disadvantaged backgrounds, could not be explained by mental illness alone but by a combination of social, economic and cultural pressures. The report argued that this cohort represented a ‘buffer generation’ caught between traditional stoic models of masculinity and newer expectations of emotional openness, often lacking the language, networks and confidence to seek help. Many had experienced insecure employment, debt, relationship breakdown and social isolation, particularly following the decline of manual industries and stable working-class roles. The report emphasised that men often relied on their partners for emotional support and became extremely vulnerable when romantic relationships fractured. 

Samaritans framed male suicide as a public health and inequality issue rather than simply an individual clinical problem. Back then they called for three prevention strategies: address socioeconomic disadvantage; design better services that engage men before the crisis point; and challenge restrictive masculine norms.

Over the subsequent 14 years progress has been slow. There has been positive movement in the third strategy: masculine norms have been challenged successfully, thanks in part to the role modelling of highprofile men.² But the socioeconomic pressures on working-class men have, if anything, worsened. Real wages in the UK have barely risen since 2008, meaning many of the men identified as at risk in 2012 have spent their entire midlife under prolonged economic stagnation.³ Meanwhile men remain significantly less likely than women to access psychological therapies, and that pattern has persisted rather than improved. In the NHS Talking Therapies programme – the main route for state-funded psychological support in England – men still account for only around one-third of all referrals,⁴ even though they carry a disproportionate share of the suicide burden and common mental health problems.

Sean McNicholas, therapist

Seeking support

According to the Office for National Statistics, men still account for around three-quarters of all suicides in England and Wales.⁵ Rates remain highest among men in midlife, particularly those in their late 40s and early 50s, and the risk is markedly elevated in the most deprived areas. Occupation data continue to show higher suicide rates among men in lowerskilled and manual roles.⁶ In other words, while the cultural conversation around men’s mental health has improved, it has not made much practical difference to outcomes among the buffer generation.

30% of men account for only around one-third of all referrals to therapy⁴ 

Economic, social and policy issues are beyond the control of most of us. But what can those working in mental health support do to better encourage the buffer generation to engage with therapy? 

‘Therapy is a process, and I’ve found that many men favour immediacy,’ says BACP registered psychotherapist Dr Natalie Cawley, author of Just About Coping: a real-life drama from the psychotherapist’s chair (Picador). ‘Drink and drugs offer many men an instant way of dealing with feelings in the short term. I’ve also heard men say things like “This isn’t a big issue, it’s probably wasting your time.” They devalue their experiences if they feel they aren’t “topline trauma” like abuse.’ 

This tallies with the experiences of Paul Harrington, who sought help from a hypnotherapist in his 40s. ‘At that time I just wanted someone to stop me from drinking. I wasn’t interested in anything deeper,’ he says. ‘Once [the therapist] started asking me to look at the reasons why I might feel the need to drink, I lost interest. I wanted him to just cure me.’ 

My own experience is that therapy works best when you embrace it as an ongoing part of a healthy lifestyle, like flossing your teeth or visiting the gym. While I initially wanted help with getting sober, I understood fairly quickly that therapy offered a form of maintenance that rendered life more manageable – and hence I felt less inclined to drink. While many celebrities have spoken out about their mental health issues, their stories will often focus on ‘topline traumas’. In order to help men stop devaluing their problems, perhaps therapy needs to be reframed as a useful tool for anyone and everyone. 

Cost remains a key obstacle. But, says Sean McNicholas, some of his clients have come to see the sense in making therapy a higher financial priority. ‘A lot of working- class men I work with connect with me on Zoom from their vans during a break in their working day,’ he says. ‘They often compare the cost of a session to the amount they might otherwise spend in the pub or on drugs, and see the value in it.’

Alex McClintock, ANDYSMANCLUB

Nevertheless, waiting lists for NHSfunded therapy are long (six weeks on average, longer for many),⁷ and more than half of practitioners listed on BACP’s website charge £40-£60 per hour on average.⁸ Median average weekly pay for British workers in 2024 was £728.⁹ 

Meanwhile cultural barriers to therapy remain strong. Alex McClintock was in his mid-40s when he tried therapy for the first time, having previously experienced substance misuse issues and lived through a suicide attempt. ‘I only went because I was signed off from my job in the prison service, and trying therapy was one of the terms,’ he says. McClintock is an imposing figure: six foot nine, bearded and tattooed, with a thick Scottish accent. He had been raised in a working-class environment where therapy was considered ‘unmanly’. ‘Most of the therapists available were women,’ he says. ‘That put me off at first. Why would I want to talk to a woman about all these feelings that I thought were so unmasculine?’ 

Had he not been obliged to attend he might have quit after the first session, he says. However, the female therapist assigned to him by the NHS earned his trust within two sessions, after which he began to open up. ‘It helped me through an identity crisis after leaving my job of 20 years,’ he says. Today he is a regional organiser of the men’s support group ANDYSMANCLUB (AMC) in Scotland. He doesn’t do therapy anymore but does encourage other men in the AMC sessions to explore the option and shares his own positive experiences. ‘I think the best thing to get more men like me interested is for anyone who has had a positive experience of therapy to share that as widely as possible,’ he says. ‘Celebrities obviously have a role to play but ordinary blokes should tell their mates too.’ 

75% of men still account for around three-quarters of all suicides in England and Wales⁵  

He says groups like AMC can be a good bridge to one-on-one therapy: they provide an informal and free-of-charge environment to explore mental health issues for the first time. There are currently 335 AMC groups that meet across the UK every Monday at 7pm. 

Callum Goodall, CALM

Breaking barriers

Overall, the signs of improvement for buffer generation men are incremental rather than transformative. The overall volume of men accessing therapy has increased but their proportional representation remains stubbornly low. Meanwhile the therapy workforce remains overwhelmingly female, with only a minority of psychological professionals and accredited psychotherapists identifying as male.¹⁰ Access has widened; visibility has grown, but the structural and cultural barriers that Samaritans described in 2012 remain pretty much the same. 

Callum Goodall from CALM says that while discussion of mental health has become more normalised, there is a sense of ‘saturation’ that might discourage some men from engaging. ‘The language of mental health can be complex and confusing,’ he says. ‘There are so many different terms, different approaches and different opinions that it can be overwhelming for some people. There is a tone about it that can seem quite middle class. I think we need to make a greater effort to help people understand that therapy is accessible to all.’ CALM works with many high-profile celebrities to help them do so. 

Not everyone agrees that celebrity interventions are effective. ‘Many workingclass men will see therapy as expensive and inherently middle class,’ says John Mercer, Professor of Gender and Sexuality at Birmingham City University. ‘Seeing relatively wealthy sportspeople and celebrities embracing it doesn’t really shift that perception. So access, cost and inclusivity are basic things that clearly need improving. I think there’s also a sense when you reach your 40s, 50s and beyond that it’s too late to make meaningful changes. And for men whose identities have been built around being stoic and in many cases literally not speaking, this is a real obstacle.’

Celebrity advocacy may loosen stigma but it doesn’t automatically remove cost, cultural mismatch or deeply embedded beliefs about masculinity. If the gap is closing, it is doing so slowly. For therapists the question is not whether working-class men can benefit from therapy – Sean’s story and numerous others make that clear – but whether language, structures and outreach policies make it feel possible before rock bottom forces the issue. The work ahead may be less about persuading men to change and more about showing them that therapy was made for them in the first place. 

Professor John Mercer