Masculinity is a socially constructed set of behaviours, traits, roles, and practices associated with men and boys, which are learned and practiced through life. Most men do not consciously choose to learn these norms; they are inherited from families, peers, communities, media and workplaces.

Because masculinity is learned rather than inherent, it exists in multiple forms. These forms are shaped by social position, including class, ethnicity, age, sexuality, body and ability. Importantly, different expressions of masculinity are associated with different health risks, behaviours and outcomes, and can vary between cultures and evolve over time.

Sociologist Raewyn Connell’s framework helps to explain the social construct of ‘ideal’ masculinity in relation to femininity and other forms of masculinity. It explains patterns through which different individuals relate differently to masculinity, and how this shapes exposure to risk, vulnerability and health outcomes.

Raewyn's Connell masculinities framework

Summary of Raewyn's Connell masculinities framework and how they may shape harmful health and relationship outcomes.

Hegemonic masculinity

Definition

The culturally dominant ideal of manhood, which is typically characterised by strength, emotional control, self-reliance, heterosexuality and authority. This form establishes social expectations against which other men are measured and reinforces men's power over women and other men.

Potential health impacts for men

• reluctance to seek help or disclose distress
• late presentation to health services
• risk-taking behaviours, including substance use and dangerous driving
• emotional suppression, which increases risk of depression, suicide and relationship breakdown

Potential impacts for women and children

• reinforces unequal power dynamics in relationships, increasing women’s exposure to emotional labour, caregiving burdens, and, in some cases, coercive control or violence
• limits children’s exposure to emotional modelling, communication and helpseeking behaviours. Provides harmful role modelling for children regarding how men should act and relationship’s function
• contributes to cultures in which women’s safety concerns or emotional needs may be minimised or dismissed

Complicit masculinity

Definition

Describes men who do not fully meet hegemonic ideals but still benefit from the wider system of male privilege. These men may not actively promote dominant norms, but neither do they challenge them.

Potential health impacts for men

• adopting silence or emotional distance as a default coping strategy
• accepting harmful norms around drinking, work or stress as “just how things are”
• benefiting from male privilege in some settings while remaining vulnerable to poor health outcomes

Potential impacts for women and children

• increased strain within families as women act as mediators or carers
• reinforces silence around men's distress, delaying support and increasing the likelihood of crises that affect whole households

Subordinated masculinities

Definition

Masculinities that are devalued or stigmatised in relation to the dominant ideal, including gay men, emotionally expressive men, or those who challenge gender norms.

Potential health impacts for men

• higher exposure to stigma, discrimination and harassment
• increased rates of anxiety, depression and self-harm
• barriers to accessing safe and affirming services
• heightened social isolation

Potential impacts for women and children

• stress and marginalisation can affect relationships

Marginalised masculinities

Definition

Refers to men whose intersecting social positions, shaped by class, ethnicity, disability, care experience or poverty, limits access to power, status and resources. These men may be expected to meet dominant masculine ideals but lack the material conditions to do so.

Potential health impacts for men

• chronic stress linked to economic insecurity
• higher exposure to trauma, bereavement and adverse childhood experiences
• increased risk of substance dependence, poor mental health and early mortality Limited access to timely, appropriate services

Potential impacts for women and children

• economic insecurity and exclusion can increase financial strain on households
• accumulated trauma and stress may contribute to relationship conflict, instability, or intergenerational transmission of adversity to children

This framework is included to illustrate how masculinity interacts with inequality to shape health outcomes. It helps explain why:

• some men avoid help until crisis
• some men experience disproportionate harm from structural disadvantage
• one-size-fits-all approaches to men's health fail to reach those most at risk

Positive masculinities

While Connell’s framework helps explain how certain dominant forms of masculinity can generate risk and inequality, masculinity itself is not inherently harmful. Many traditionally masculine traits: loyalty, courage, responsibility, and pride in providing for others, can be protective and health-promoting when expressed in flexible and relational ways.

The aim of this report is to examine how masculinities can become harmful when combined with deprivation, trauma and structural change, and to promote healthier expressions of masculinity that support men, women and children alike.

Local expressions of masculinity

The Big Question explored local male experiences through in-depth, qualitative methods (Ashworth, E. et al, 2026). The industrial heritage and relatively isolated geography of West Cumbria have shaped a form of masculinity centred on hard work, close loyal workforces, and resilience. These strengths are sources of pride. However, when work becomes unstable, the same norms can produce silence, shame, or withdrawal. Men may avoid asking for help because it feels incompatible with family and cultural norms.

These socially learned norms can become health-harming when combined with poverty, trauma, grief, discrimination or limited opportunities. They help explain why men sometimes present late to services, respond to distress through anger, or turn to substances as coping mechanisms.

The poorer health outcomes observed among men in Cumberland do not affect all men equally. Their experience depends on intersecting factors such as socioeconomic situation, place, ethnicity, disability and sexuality, which can generate cumulative disadvantage.

Boys and men who have grown up in care, live with disability, are neurodivergent, identify as LGBTQ+, or come from ethnic minority backgrounds often encounter additional barriers in education, employment, relationships and access to support. These experiences influence not only opportunities, but also whether men feel safe in expressing their identity, asking for help, or being vulnerable.

Gender norms do not affect all men in the same way. Some men socially benefit from dominant expectations of masculinity, while others find themselves constrained or harmed by them. Men who face social or economic disadvantage often experience the sharpest consequences, as expectations of self-reliance and toughness meet with limited resources, discrimination or trauma. These patterns reflect structural conditions rather than personal failure.

Place and employment

Despite employment data that appears consistent with national averages, West Cumbrian communities face long term challenges due to deindustrialisation of coal and steel production. Recent generations have experienced the effects of unemployment, abrupt changes in work identity. The local economy remains dependent on major employers like Sellafield, which offers well-paid jobs but create economic disparity. Masculine norms shaped around traditionally male roles and breadwinning can be challenging when employment is unstable or income is disparate. This is further explored in Chapter 4: Work, place and identity in adult men’s lives.

Adversity and grief

Individuals in communities with unstable work, low income, or limited opportunities often carry high cumulative grief loads, multiple bereavements, sudden losses, or traumatic events. Without the tools to express vulnerability or seek support, grief can become internalised and have long lasting psychological and/or physical impacts. The Big Question report highlighted grief as a major factor in suicide in Cumberland (Ashworth, E. et al, 2026).

Approach and frameworks

This report draws on several established public health perspectives to guide the analysis.

Life course approach

Health inequalities accumulate across time. Early childhood experiences, school environments, work pathways, relationships and community settings all shape men’s wellbeing in adulthood.

Determinants of health framework (Dahlgren & Whitehead, 2021).

The report considers how wider systems, such as housing, employment, social security, education, justice, and service design influence health. These structural determinants explain why individuals facing similar stresses have different outcomes.

Diderichsen’s inequalities framework (Diderichsen et al., 2019)

We employ Diderichsen’s framework on how inequalities emerge through differential exposure, vulnerability, consequences, and responses.

Evidence and engagement

This report was informed by engagement with a wide range of local practitioners, service leads and community organisations working with men, boys and families across Cumberland. Contributors included representatives from Cumberland Council, Cumbria Constabulary, community and voluntary organisations and sports and wellbeing organisations.

A survey was undertaken to capture professional insight into the needs of boys and young men in Cumberland. The survey was completed by 53 practitioners working across education, youth justice, family support, wellbeing and voluntary sector services. The survey captured practitioner perspectives on needs, barriers to engagement and effective approaches. The survey does not represent the views of boys and young men themselves. Findings are used throughout this report to contextualise and corroborate population-level data.

The men’s health strategic vision for England, published in November 2025, highlights key foci for physical health of men, including:

• high levels of frailty in ‘young old’ populations who are sleeping homeless and 30 year earlier death compared with the general population. It is mainly men who are homeless and rough sleeping
• rates of cancer, circulatory and respiratory conditions drive much of the difference in life expectancy between the most and least deprived men nationally. Risk factors for these conditions, such as smoking and obesity, are higher in the most deprived areas of the country
• men develop cardiovascular disease around six years earlier than women
• there is a higher prevalence of type two diabetes in men
• cancer incidence and mortality is higher in men than women above the age of 60 years
• cancer incidence rates are 19% higher for men in the most deprived quintile compared with the least deprived quintile
• men carry the greatest burden of respiratory disease, particularly those who smoke, are former industrial workers and live in the most deprived communities
• two thirds of live disease is in men, linked with alcohol consumption, obesity and viral hepatitis

The strategy includes a plan, formed around meeting men where they are. 

Major commitments include:

• the investment of £3 million over three years from April 2026 into community-based men’s health programmes, targeting areas at highest risk
• men's health training for healthcare professionals via new e-learning modules
• workplace health pilots in male-dominated industries through the Keep Britain Working Vanguard Programme
• enhanced lung disease support for former miners via the Respiratory Pathways Transformation Fund
• home PSA testing for prostate cancer patients from 2027 via the NHS App (subject to clinical approval)
• £200,000 trial of interventions to tackle rising cocaine and alcohol-related cardiovascular deaths

An additional major investment from national government has been the Premier League’s Together Against Suicide initiative with the Samaritans, embedding match day messages and support at stadiums. While positive, this strategy fails to recognise the lack of premier league teams in the areas with the highest suicide rates, including Cumberland, Westmorland and Furness, Blackpool, and Darlington. While the strategy is welcomed, it must be ensured that interventions do not neglect those most at risk.

In the 2022 health survey for England, men were slightly more likely to self-report good health compared with women (76% vs 74%), and less likely to report acute sickness. Women more commonly reported musculoskeletal conditions, mental, behavioural and neurodevelopmental conditions and conditions of the digestive system, while men more commonly reported heart and circulatory conditions.

Hypertension and cardiovascular health

Deaths due to circulatory causes is one of the leading causes of health inequalities both within and outwith men in Cumberland (Figure 7 and Figure 8). Men are more likely to have hypertension ‘all’ and untreated hypertension than women. Modifiable risks factors for cardiovascular disease accumulate over a lifetime (obesity from childhood, poor diet, lack of exercise, alcohol consumption, obesity), while early intervention for cardiovascular health has the potential to be highly effective, if utilised. Psychological trauma and chronic stress are increasingly being recognised as increasing risk of cardiovascular disease (Song et al., 2019).

NHS Health checks are important appointments offered free to adults age 40 to 74 years, five yearly, to assess for signs of chronic conditions including cardiovascular disease. Uptake of checks in Cumberland was 27.4% in 2024 to 2025, below the national average of 37.5%. There is a stark gap in publicly available data for NHS health check uptake by gender. The last national figures on 2017 to 2018 data showed women were more likely to attend than men (44% vs 38%). Locally acquired data for 2024 to 2025 reflects this pattern, with 3,951 females attending for health checks, compared with 3,222 males.

Fingertips data indicates that men in Cumberland have higher levels of certain risk factors: smoking (three percentage points higher) and overweight and obesity (10 percentage points higher), although women have higher levels of physical inactivity (three percentage points higher).

Preventative pathways such as routine health checks rely on proactive help-seeking, yet men are less likely to engage with these services, increasing the likelihood that cardiovascular disease is first identified at either a more advanced stage, or at the point of fatal consequence. As with other health conditions, this pattern reflects not a lack of concern for health, but the interaction between masculine norms, work pressures and service design.

Prostate cancer

Other than skin cancer, prostate cancer is the most common cancer in men both nationally and in Cumberland, with risk increasing with age (Figure 12). However, lung cancer is the leading cause of cancer death nationally.

For the 12 months ending October 2025, lower proportions of people were diagnosed with prostate cancer during the early stages, one to two, in Cumberland compared with England (53.8 vs 57.5%). The difference between local and national early stage diagnosis has been reducing since 2022 (Figure 13).

There is currently no national screening programme for prostate cancer. While this remains a contested decision, the conclusion of the UK National Screening Committee remains that the current available screening tests are not fully reliable at picking up cancers that actually need treatment, and some of the investigations and treatments are invasive and harmful, not balancing the need for a screening programme to do more good than harm. However, a targeted approach to screening based on risk is currently being considered.

Instead, diagnosis with prostate cancer relies on individuals presenting to medical services with symptoms such as frequent nighttime urination, weak stream of urine or difficultly passing urine. 

The pattern of high proportions of later stages of diagnosis of prostate cancer in Cumberland may represent later presentation and delayed engagement with diagnostic pathways, consistent with wider evidence on men’s health-seeking behaviour locally, including lower uptake of preventative care and a higher tendency to seek help only at crisis point.

For many men in Cumberland, psychological distress is closely linked to experiences of redundancy, insecure employment, declining physical capacity or perceived failure to meet provider roles (Ashworth, E. et al, 2026). Contact with the justice system factor is also associated with poor mental health, with half of the boys and men in contact with the justice system reporting anxiety or depression, compared with 15% of the general population. Cultural norms that value stoicism and “getting on with it” can discourage early disclosure, leading men to internalise distress and delay seeking support. As a result, mental health difficulties frequently come to attention only once they have escalated, often alongside physical illness, financial strain or crisis events, with consequences that extend beyond individual men to families, workplaces and communities.

Available data on mental health and wellbeing is generally scarce and not available split by sex. Where data is available, the ratio of higher suicide rates in men compared with women does not tend to correlate with diagnosis of mental health conditions. NHS England population survey data conducted every seven years since 1993 show that women have a higher prevalence of diagnosed common mental health conditions than men across all age groups at all time points, including anxiety disorders, depression and phobias.

A local survey in the Cumberland, conducted by The Big Question study (explored further in the next section) found that a higher proportion of men reported thoughts of self-harm compared with women (52% vs 47%), however women were slightly more likely to have previously ever self-harmed (28% vs 25%), and slightly more likely to seek help (57% vs 51%) (Ashworth, E. et al, 2026). Participants reported varying quality of help received; while some were supported by healthcare organisations, there was report of private therapy, third-sector organisations (e.g. Andy’s Man Club and Samaritans) and organisations outside of Cumberland.

Key challenges in seeking help were varied and somewhat echoed those in surveyed professionals supporting children and young people. Some Big Question respondents reported self-reliance and management, stigma, previous negative experiences, difficulty in asking for help, accessibility, lack of long term support for men and feeling they had to reach crisis point before being eligible for support.

These findings echo wider knowledge that men are less likely to report symptoms or engage with services at an early stage, and are more likely to present later, with more severe or complex manifestations of distress. This helps explain why men in Cumberland experience disproportionate rates of mental health-related economic inactivity, substance use and suicide, despite lower diagnosed prevalence of common mental health conditions.

Debt and gambling harms

Gambling is widely known to be a harmful commodity, impacting on psychological and physical health. While overall gambling levels are highest in people with better psychological health and life satisfaction, at-risk and problem gambling prevalence is higher in those with poor health, low life satisfaction and wellbeing (source: NHS England). Being male and having poor mental health are strong predictors of at-risk gambling.

In understanding patterns of gambling, one challenge is the reliability of data. Much of what is available, and quoted below, comes from GambleAware; this is an organisation funded primarily by voluntary donations from the UK gambling industry and has previously faced scrutiny over conflicts of interest regarding ties to the industry and lack of independence concerns, including in a case raised by the Good Law Project which was later closed by the Charity Commission. The data that follow should therefore be seen in this context.

In 2020 data collated by GambleAware, around 7% of the population of Great Britain were negatively affected by someone else’s gambling. In 2020, Of the 7%, affected others were more likely to be a women, 25% were a spouse or partner, 21% were a mother or father, while 9% were a son or daughter. Impacts were felt most severely by partners, parents or children of problem gamblers.

In further data collected by GambleAware, through the Annual GB Treatment and Support Survey 2024, Cumberland appears to have gambling problems below the national average. It is important to note the limitations of the Problem Gambling Severity Index (PGSI), the screening tool used to assess problem gambling. The tool assesses for presence of harms at that moment only, not severity of harms, wider impacts or ongoing to harms to people who have previously had gambling. However, this still generated an estimated fiscal cost of £5,542,704 of harms associated with gambling, predominantly though welfare costs and hospital inpatient stays.

Direct harms to gamblers were financial harms, relationship harms, mental and physical harms (those with a gambling disorder have an increased risk of all cause mortality), employment and education harms, criminal harms and cultural harm (source: OHID, PHE). These are echoed in harms felt by those impacted by harm, with 75% reporting feelings of anger, anxiety, depression, sadness, or distress and 60% reporting negative financial impacts (source: GambleAware).

Men and women demonstrate differing patterns of gambling behaviour and associated harms. Research consistently finds that men are more likely to engage in higher-risk, competitive and rapid-cycle forms of gambling such as sports betting, poker, online betting and casino gambling, whereas women are more likely to participate in chance-based formats such as gambling machines (Baggio et al., 2018). Males gamble proportionately more than females, except regarding scratch cards. Harmful gambling among men has been more strongly associated with sports betting and substance use, whereas among women it appears less associated with substance-use networks (Baggio et al., 2018).

The structure of gambling activities also differs in ways that may influence harm. High-intensity formats such as online sports betting and casino games are characterised by rapid cycles of staking and reward, and greater opportunities for escalation and solitary play, whereas other formats are more socially embedded. Recent research indicates that for both men and women, gambling motivated by coping is strongly associated with severity of harm, with maladaptive emotion regulation emerging the key predictor (Theodorou et al., 2025).

The National Men’s health strategy highlights gambling as key concern in men’s health. Men were highlighted as more likely to experience gambling rating harms, to gamble online and engage in online gambling, increasing exposure to gambling-like content. A new national gambling tax law was announced in the 2025 budget and provides protected funding for gambling harms prevention (30% of levy funding), treatment (50% of levy funding), and research (20% of levy funding). The Government has committed to developing a coordinated approach to gambling prevention, including a new voluntary sector grant, delivering a research programme and increasing treatment and support services. It is imperative that Cumberland advocates for shared receipt of these resources and that statutory organisations support voluntary sectors in doing so.

Suicide rates

Across the UK, suicide and injury or poisoning of undetermined intent is the leading cause of death for both males and females aged 20 to 34 years. Men were more than three times as likely to die by suicide compared with women in this age group. Since 2001, the leading cause of death in men aged 35 to 49 years has changed from ischaemic heart disease to suicide in 2011-2015 and accidental poisoning more recently (source: ONS).

In 2022 to 2024, there were 137 suicides in men and women in Cumberland, the third highest out of 153 upper tier local authorities in England and a rate of 19.4 per 100,000 population (source: ONS). Suicides rates in Cumberland are increasing, and at a higher rate compared with England.

In 2022 to 2024, men in Cumberland had the 7th highest rate of suicide deaths nationally. Of the 137 suicide deaths in Cumberland, 98 were in men. This is a rate of 28.2 per 100,000, significantly above the national rate of 16.8. In the same period, women in Cumberland had the highest rate of suicide related deaths, with a rate of 11.2 per 100,000 compared to 5.5 per 100,000 nationally. This is further explored in Chapter 4: Work, place and identity in adult men’s lives.

Suicide: the Big Question report

Suicide rates in Cumberland show a persistently high burden, particularly among men. This fact prompted The Big Question, a mixed-methods study commissioned by Cumberland Council and undertaken by Liverpool John Moores University, to explore why suicide risk remains high and how it is experienced locally (Ashworth, E. et al, 2026).

Men and women were similarly likely to report suicidal thoughts (57% of men compared with 55% of women), and men were slightly more likely to report having received support. Of the 40 men who reported a previous suicide attempt, 27 (67.5%) reported receiving support after (although only 30 gave responses). Of 99 reporting suicide attempts, 52 received support (52.5%), with 94 out of 99 responding to this question. These findings suggest that high male suicide mortality in Cumberland is not by total disengagement from services, but by more complex factors. However, it may also be that those responding to the survey are a selection of people more likely to engage with health services than the general population.

Respondents were asked to comment on mental health challenges and contributing factors to the high suicide rates in Cumberland. Responses included mental health conditions, chronic pain and other long-term illness, neurodivergence (often diagnosed late), intergenerational trauma and adverse childhood experiences. Drugs and alcohol were described as coping mechanisms, and the long-term impact of suicide bereavement was prominent, with over half of respondents reporting being affected by the death of someone who died by suicide. Of the 781 respondents, 52% reported havening been bereaved or affected by the death of someone who died by suicide. This was lower in men than women (44.6% vs 55.2%). Common relationships were friend, family and work colleague, with many participants citing knowing more than one person who died by suicide.

Acute triggers reported to precede crisis included relationship breakdown, abusive relationships, interpersonal conflict and bullying. Environmental and socioeconomic stressors were also prominent, including isolation, rurality and transport barriers, financial strain, seasonal factors (poor winter weather), limited recreational opportunities and a labour market shaped by a small number of dominant employers. Some respondents highlighted access to firearms within agricultural settings as a specific risk factor, while social media was described as increasing isolation and undermining communication.

Attitudes and assumptions are known to shape help-seeking. Suicide was perceived as taboo for many, with suicidal thoughts often minimised or normalised. A “Cumbrian tendency” towards stoicism and emotional restraint among men was frequently cited, alongside shame and concerns about confidentiality in close-knit communities. Attitudes to mental health were reported to be shifting across generations to become less conservative and more liberal. Frustration with the availability and continuity of support was common.

Taken together, these findings reinforce and evidence that suicide in Cumberland reflects the interaction of identity-based pressures, place, constrained opportunity and delayed help-seeking. Men may articulate distress and access support at points, but remain vulnerable where help is fragmented, short-term or poorly aligned with lived realities. Addressing suicide risk therefore requires approaches that recognise identity and place as determinants of health, alongside timely, sustained and culturally aware support.

Suicide risk therefore requires approaches that recognise identity and place as determinants of health, alongside timely, sustained and culturally aware support.

Substance use is a significant public health concern in Cumberland, contributing to mortality, hospital admissions, crime and unmet support needs. In 2022 to 2024 there were 164 drug-related deaths in Cumberland, an age-standardised morality rate of 21.9 per 100,000 which is around double the national average. Cumberland had the third highest rate of local authorities nationally, with only Blackpool and Middlesborough having higher. Drug related deaths are around double in men compared to women, at 27.6 (7th highest) and 6.9 (14th highest) per 100,000 respectively, and are rising in recent years in both men and women (Figure 16) (Sources: ONS, 2024 and Cumberland statistical summary, 2025).

Local assessment data for Cumbria indicate that there were approximately 2,400 individuals using opiates and crack, with opiate prevalence higher than regional and national averages, and around 5,594 adults estimated to be dependent on alcohol at similar rates to England overall.

In 2024 to 2025 there were 1,940 people in treatment for drug and alcohol use (source: NDTMS), 1290 (66.5%) of whom were male, 1145 (59.0%) in the 30 to 49 year age group. People with opiate dependence formed the largest treatment group (875 out of 1940, 45.1%) with the next largest treatment group being people with alcohol misuse (685 out of1940, 35.3%).

Co-occurring mental health needs are common among those entering treatment, while unmet need for treatment among dependent people persists at similar or higher levels than national benchmarks. These patterns occur alongside rising levels of drug-related crime and a growing proportion of treatment clients who are parents, underlining both the personal and social impact of substance use in the area.

Regarding children and young people, in 2023 the youth substance team received around 100 referrals for young people across both Cumberland and Westmorland and Furness. Most of these referrals were young men, with over half of referrals for drug use and around a third for alcohol use. In 2023 to 2024, there was a rate of 44.7 per 100,000 alcohol specific admissions for under-18s in Cumberland, around double the national rate and the highest rate in the Northwest of England (source: Fingertips).

National data 2023 to 2024 collated by the Office for Health Improvement & Disparities found that 21% of people started treatment in substance services had no home of their own, higher in people starting treatment for opiate problems. Almost three quarters of adults had a mental health need. Table 2 shows the national breakdown by sex of adults in contact with drug and alcohol treatment services. The age group with the highest number of people in contact is 40 to 44 years, at 53,747 individuals.

Table 2: Adults in contact with drug and alcohol treatment services between 1 April 2023 and 31 March 2024, England, by sex

Cumberland is experiencing a crisis in drug related deaths in men and women, at 27.5 and 14.2 deaths per 100,000 population respectively. The rates of deaths have tripled for men and nearly tripled for women over the last ten years.

Safer Drug Consumption Facilities (SDCFs) are a relatively novel intervention: settings where people can consume drugs procured elsewhere while in the presence of health care professionals to reduce and respond to overdoses and offer access to healthcare and social services. Globally, many countries including Scotland have introduced SDCFs. Evaluation of existing SDCFs found they were cost-effective, reduced drug related deaths and injecting harms, associate with increased uptake of addiction care, reduced publicly discarded syringes around the facilities and can provide links to housing and mental health services. Despite the evidence in favour of SDCFs, the Misuse of Drugs Act prohibits the legal operation of SDCFs, and the UK parliament has announced their intention to keep this legislation in place, even if Scottish pilot evaluations demonstrate benefit, precluding the opening of SDCFs in England. In the face of high and up-trending drug related deaths and harms, it is important that due consideration is given to novel, potentially revolutionary drug treatment service models such as SDCFs, and that local authorities most impacted by drug related deaths advocate for these approaches.

Interpretation

While cardiovascular and respiratory disease remain important contributors to mortality among men in Cumberland, it is deaths from external causes, particularly suicide, drug poisoning and injury, that most sharply contribute to differences in men’s outcomes from both women locally and men nationally. These deaths tend to occur earlier in the life course, disproportionately affecting men of working age, and therefore contribute heavily to the gap in life expectancy. Perspectives from local practitioners and professions regarding the root causes of these patterns are explored in Box 1.

Box 1: Local professional and practitioner perspectives regarding the underlying factors in Cumberland leading to high rate of deaths due to ‘external causes’ (suicide, poisoning and injury).

Practitioners working with men and boys consistently described these deaths not as isolated events, but as the culmination of cumulative distress: unresolved trauma, economic insecurity, relationship breakdown and delayed engagement with support. This aligns with professional survey findings, where emotional suppression, trauma and low aspiration were among the most commonly observed challenges, and where the majority of practitioners reported that boys and young men often or almost always hold back from seeking help. These patterns raise the need to explore when these inequalities begin, if they can be prevented earlier and how this prevention might take shape.

Deaths of despair

The combined mortality arising from suicide, drug poisoning and alcohol-related causes is often described as “deaths of despair” (DoD). The term was originally used by economists Anne Case and Angus Deaton to describe rising mortality in the United States, particularly among White men without higher education, linked to long-term economic and social dislocation (Case & Deaton, 2022).

Subsequent research in England, including analysis by the University of Manchester, has shown a similar pattern, with deaths of despair disproportionately concentrated in the North of England and in coastal areas. This research characterises deaths of despair as an “avoidable human cost of inequitable resource deprivation” (Camacho et al., 2024). Key factors associations with DoD were living in the North, unemployment, White British ethnicity, living alone, economic inactivity, employment in elementary occupations, and living in urban areas (Camacho et al., 2024).

Many communities in Cumberland experience a clustering of these risk factors. Rising mortality due to suicide, drug-related deaths and alcohol-related harm locally reflects a pattern consistent with deaths of despair, highlighting the cumulative impact of economic insecurity, social isolation and limited access to early support. This framing reinforces the need to address upstream determinants and underlying causes of cycles of deprivation.

End of reception

Gendered differences in outcomes appear early, seen in data at the end of reception, where a good level of development1 is achieved by fewer boys (57.3%) than girls (75.3%) in Cumberland, broadly mirroring national inequities (Figure 17). The group of children with the lowest rates are boys who receive free school meals (42.6%, noting wide confidence intervals). This is in line with the national rate of 43.2%.

Of black and minority ethnic children in Cumberland, 56.2%, achieve a good level of development at reception; lower than all other children in Cumberland (65.9%), and with other black and ethnic minority children across the northwest (61.6%) and nationally (66.1%). This likely represents cumulatively poorer outcomes in boys of black and minority ethnicities, though this data breakdown is not available.

Key stage two

At the end of the academic year 2024 to 2025, 791 out of 1506 (52.5%) of boys in Cumberland finished key stage two meeting the expected standard in reading, writing and maths combined, compared with 889 out of 1513 (58.8%) of girls. These gender gaps are compounded by disadvantage; children receiving free school meals are far less likely to achieve the expected standard, with boys lower than girls (116 out of 354 (32.8%) vs 153 out of 388 (39.4%) respectively).

This patterning repeats in girls and boys with special educational needs (SEN). Out of 405 boys with SEN, 68 met the expected standard (16.8%), and 45 out of 246 (18.3%) of girls met the expected standard. It is important to note here the higher number of boys with SEN compared to girls, however systematic differences in diagnosis patterns in boys and girls likely misrepresents the true figures.

Key stage four attainment

Educational inequalities evident by the end of primary school persist into adolescence. At the end of Key Stage 4 in 2024 to 2025, boys in Cumberland achieved lower average Attainment 8 scores than girls (40.2 compared with 44.5), and were less likely to achieve grades 5 or above in both English and Maths (34.9% of boys compared with 38.1% of girls). Pupils eligible for free school meals have substantially lower attainment, though the gap between genders is narrower, at fewer than one in six boys (16.4%) achieving attainment score 8, slightly less than girls at 17.8%.

This indicates that early educational disadvantage is not corrected by secondary schooling but becomes embedded by the point at which qualifications most strongly shape post-16 pathways, employment prospects and future health outcomes.

Post compulsory education

RQF Level 42 represents a key progression point beyond compulsory education. Qualifications at this level demonstrate advanced subject knowledge and analytical skills and often provide access to professional and technical roles.

In Cumberland, progression to RQF Level 4 and above shows a clear gender divide. In 2024, 31% of men had achieved qualifications at this level or higher, compared with 42% of women. This gap reflects the cumulative effects of earlier educational divergence observed at primary and secondary school stages. Lower progression to higher-level qualifications limits access to secure, well-paid and less physically demanding employment, increasing long-term vulnerability to economic insecurity and poorer health outcomes. These patterns underline how early educational inequalities translate into constrained opportunities in early adulthood, reinforcing the importance of earlier intervention and more inclusive progression pathways for boys and young men.

Not in education, employment or training

Local data indicate that a small but significant minority of young people in Cumberland are not in education, employment or training (NEET) at ages 16–17, with boys more likely than girls to be NEET (Table 4). Although overall NEET proportions in Cumberland are relatively low, the range of alternative post-16 opportunities for those young people are more limited than in many other local authorities. This means that even small increases in disengagement have the potential for disproportionate impact due to fewer accessible pathways back into learning or work, increasing the risk of longer-term economic and social exclusion.

Table 4: Proportion of young adults who are not in educational, employment or training in Cumberland, 2024.

School suspensions and permanent exclusions

The following sub-section uses Department for Education data from autumn school term 2023 to 2024 to autumn school term 2024 to 2025 inclusive, for state funded secondary schools. Secondary schools are focused on, as there are much few suspensions and exclusions in primary schools.

Across the four terms combined, Cumberland has lower rates of suspension than England but higher rates of permanent exclusion. The largest difference is a 1.61 times increased rate of exclusions for children eligible for free school meals in Cumberland compared with England (Table 5).

Table 5: Rates and rate ratios for permanent exclusions and suspensions state funded secondary schools, Cumberland vs England, Autumn 2023 to 2024 to Autum 2024 to 2025, Department for Education.

Suspension rates in Cumberland are consistently below national averages. However, permanent exclusion rates are 35% higher overall and 61% higher among pupils eligible for free school meals (FSM). Pupils eligible for FSM in Cumberland experience permanent exclusion at over three times the overall rate (Table 6). The social gradient in exclusion is stronger locally than nationally (2.5 times the rate nationally).

Table 6: Rates and rate ratios for permanent exclusions and suspensions in children eligible for free school meals in state funded secondary schools, Cumberland vs England, Autumn 2023 to 2024 to Autumn 2024 to 2025, Department for Education

Across state-funded secondary schools, suspensions and permanent exclusions are strongly concentrated in mid-secondary years (Years 8–10), peaking in Year 9 for suspensions and Year 9–10 for permanent exclusions. This pattern is consistent nationally and locally, but Cumberland shows higher permanent exclusion rates in these key years. Given the elevated rates among FSM pupils and boys, the intersection of FSM status and mid-secondary years likely represents the highest-risk group.

Reasons for suspensions

Nationally, persistent disruptive behaviour accounts for just over half of all suspensions (approximately 55%). The next most common reasons are verbal abuse or threatening behaviour towards an adult (around 16–17%) and physical assault against a pupil (around 11–12%). Drug and alcohol-related incidents account for a smaller proportion nationally (approximately 2–3%).

Cumberland shows a similar overall picture to national suspensions, with persistent disruptive behaviour accounting for around half of suspensions. However, verbal abuse towards adults represents a consistently higher share locally in several terms (ranging from approximately 18% to over 20%). Drug and alcohol-related suspensions also account for a larger share locally in some terms (around 4–7%). Physical assault against pupils remains one of the top three causes, although slightly lower proportionally than national averages in some terms.

Reasons for exclusions

Permanent exclusions follow a similar pattern but are more concentrated in high-severity behavioural categories.

Nationally, persistent disruptive behaviour accounts for around 40–42% of permanent exclusions. The next most common reasons are physical assault against a pupil (around 16–17%) and verbal abuse or threatening behaviour against an adult (around 11–12%). Drug and alcohol-related incidents account for approximately 6–7% of permanent exclusions nationally.

In Cumberland, persistent disruptive behaviour accounts for a larger share of permanent exclusions in several terms (ranging from the mid-40% range to over 50%).

Physical assault against a pupil and verbal abuse towards adults also consistently appear among the leading causes (11 to 21% and 11 to 16% respectively). While numbers are small and therefore proportions fluctuate more locally, the dominant pathway to permanent exclusion remains persistent behavioural escalation.

Exclusions and suspensions summary

Exclusion is concentrated in mid-secondary years, a period associated with early adolescence, social identity development and increasing academic pressure. This suggests that Years 8–10 and the time immediately preceding represent a critical intervention window.

Second, inequality is pronounced. FSM pupils experience more than three times higher permanent exclusion rates, and the gradient is stronger locally than nationally. Exclusion therefore reflects and potentially reinforces wider socioeconomic disadvantage.

Third, the dominant drivers are persistent disruptive behaviour. Cumberland’s lower suspension rates combined with higher permanent exclusion rates suggest that when behavioural difficulties persist, escalation to permanent removal may be more likely locally.

Exclusion should be understood as an indicator of cumulative vulnerability intersecting with deprivation, adolescent development and emerging mental and emotional wellbeing health needs. Preventative, early intervention approaches in early and mid-secondary years, particularly for disadvantaged pupils, are therefore central to reducing long-term harm.

Adversity in childhood is a key driver of health inequality, with strong evidence linking early life stress, trauma and disrupted attachment to poorer mental health, educational outcomes and increased risk of substance use and suicide in adulthood. Ten of these have been defined, referred to as adverse childhood experiences (ACEs), though these do not capture all adversities, such as living in a community experiencing poverty, poor employment, bereavement and isolation (Figure 19). The ACE pyramid (Figure 20) is a conceptual framework, demonstrating how adverse childhood experiences influence health and wellbeing.

Evidence suggests that girls are more likely than boys to report ACEs overall, and that ACEs experienced differ by sex, with boys more likely to experience physical abuse and girls more likely to experience sexual abuse(Jones et al., 2022). Boys and girls respond to adversity in different ways: boys are more likely to exhibit externalising responses, such as anger, behavioural disruption or withdrawal, while girls are more likely to exhibit internalising responses, such as anxiety or low mood. Gendered responses to behaviours are learned through and beyond childhood, including in schools. Both biological and social factors influence the emergence of gendered behaviours, with theoretical models of development summarised from Chaplin in Table 7.

Table 7: Theoretical models of emergence of gendered behaviour, extracted from Chaplin (Chaplin, 2015).

In practice, externalising responses are more likely to be interpreted as behavioural or disciplinary problems, particularly within school settings. This increases the likelihood that boys experiencing adversity are sanctioned or excluded. Over time, this contributes to disengagement from education, increased contact with the care and youth justice systems, and reduced access to protective factors.

The 2018 Annual Public Health Report for Cumbria highlighted the importance of recognising and responding to adverse childhood experiences through whole-system, trauma-informed approaches. Understanding how adversity is experienced, expressed and responded to differently in boys is critical to preventing the escalation of risk across the life course.

Boys growing up in deprived and coastal communities are more likely to experience multiple, overlapping stressors, including economic insecurity, bereavement, parental ill-health or substance use, and limited access to services. These experiences often accumulate rather than occur in isolation. Where adversity coincides with care experience, placement instability or school exclusion, its impact on emotional development and wellbeing is amplified.

The care system

When considering ACEs, it is important to consider the care system as by definition, children in the care system will have been exposed to ACEs. Cumberland has higher rates of children in need, on a protection plan and children cared for (94.4 vs 71.3 per 10,000) compared to the national average and statistical neighbours. Over half (51.5%) of children cared for are placed outside the Cumberland boundary, but are less likely to be moved through multiple placements. However, Cumberland has shorter adoption waiting times, and higher rates on onwards employment and care experienced adults in higher education that the England average (source: Cumberland HDRC).

National data from 2011-2015 shows that across England, boys were less likely to be placed into foster care than girls, and more like to be placed into children’s homes, secure children’s home or young offender institutes (Figure 21).

Identity formation in boys and young men

Identity formation is a central developmental task of adolescence and early adulthood. Through family relationships, school experiences, peer interactions and community context, boys learn who they are, what is expected of them and how they are valued. Identity is not a fixed personal characteristic, but a socially shaped process that reflects opportunity, context and lived experience.

Erikson’s psychosocial model conceptualises identity development as a lifelong process, structured around a series of developmental stages, each involving a central psychosocial challenge. Figure 22 presents Erikson’s eight stages of psychosocial development, the associated core challenges and the psychological strengths, or “virtues”, that emerge when these challenges are successfully navigated.

Figure 22: Erik Erikson’s stages of psychosocial development, image taken from psychology today

Early childhood and school-age experiences are key periods in shaping sense of competence and self-worth. Repeated experiences of difficulty, sanction or low expectation can undermine the development of competence and purpose. Boys in Cumberland are disproportionately exposed to cumulative stressors, including poverty, bereavement, substance use and involvement with the care system. Where such experiences coincide with limited opportunities to express vulnerability or access trusted adult support, identity may become organised around emotional self-reliance, withdrawal or risk-taking. These patterns reflect adaptation to context and are reinforced by social expectations around masculinity.

As boys move into adolescence and early adulthood, these identity pathways influence how they relate to work, relationships and support. For those whose early experiences have disrupted the development of competence, belonging or role identity, transitions into employment or training may be particularly challenging, especially in areas with limited local labour market opportunities. This helps explain why early disadvantage in Cumberland is closely linked to later patterns of insecure work, social isolation and poor mental health among men. Where a sense of future role, belonging or purpose is weakened, feelings of hopelessness may emerge, a factor consistently associated with suicide risk. Consistent relationships, access to meaningful work or training, community connection and responsive services can support the re-development of identity, even where early experiences have been adverse.

Between April 2023 and September 2025 there were a total of 626 children referred to the youth justice service, 512 (81.8%) of whom were boys. The first six months of 2025 to 2026 have seen a lower number of referrals into the service. Though the reasons for this drop cannot be specifically attributed to a cause, the Pol-Ed resource was introduced on June 2nd 2025. This is a police resource for use in schools designed to help teachers deliver lesson around relationships and consent, the law, keeping safe and wellbeing.

Local Youth Justice Service referral patterns show that most contact occurs before statutory court involvement. Over a third of referrals (35.8%) relate to prevention activity, with a further 13.5% involving early assessment to understand risk or suitability for diversion. Around one third of referrals (32.5%) are managed through out-of-court resolutions, indicating a strong emphasis on diversion where offending does occur. Statutory youth justice supervision accounts for fewer than one in five referrals (18.3%), representing a smaller but higher-need group. This distribution highlights the importance of effective early intervention to prevent escalation into formal justice pathways.

Of 101 children involved with Cumberland Youth Justice Service in December 2025, 27 (26.7%) were receiving support for drug use, three (3.0%) for alcohol and ten (9.9%) support for both drugs and alcohol. During March 2025 to September 2025 the most common criminal charges associated with children referred for intervention were ‘theft/robbery/burglary’, ‘assault/ABH/ violence’ and ‘threatening/harassment/stalking’.

Online influences

In recent years, there has been growing concern about the influence of online content that promotes rigid or harmful models of masculinity, often referred to as the “manosphere”. High-profile online figures have been associated with messages that emphasise dominance, emotional suppression, entitlement and misogyny, raising concerns about their potential impact on boys’ attitudes, relationships and behaviour.

Around half of professionals working with boys and young men surveyed at the end of 2025 identified exposure to harmful online influencers as a driver of need. Trauma, emotional suppression, school disengagement, low aspiration and poor mental health were more frequently cited. When asked specifically about the impacts of online influencers, 8 out of 53 professionals answered ‘a lot’ or ‘very significantly’.

This suggests that while digital environments warrant ongoing attention, focus should lie on preventing the underlying factors that leave young children open to influence from online sources that result in susceptibility, such as early abandonment, family dysfunction and psychological vulnerabilities (Campelo et al., 2018).

Place of birth: the coastal disadvantage

The social and economic conditions children grow up in have a lasting influence on their mental health, educational engagement and life chances. Young adults in coastal communities have disproportionality poor mental health. National longitudinal research following adolescents in England found that young adults living in the most deprived coastal areas experienced around three times the risk of undiagnosed mental distress compared with young adults in inland areas with similar levels of deprivation. The key driver of this difference was household socioeconomic circumstances (Murray et al., 2025).

The authors of this research emphasise that reducing mental health inequalities in coastal communities requires both improved access to timely support and sustained action on underlying socioeconomic drivers. Recommended national actions include reducing waiting times for mental health treatment in deprived coastal areas, increasing investment in preventative programmes for young people, and prioritising the development of Young Futures Hubs in communities with the highest burden of need. At a local level, the research highlights the importance of setting clear improvement targets for young people’s mental health and committing to long-term investment in education, employment, housing and transport, recognising that mental health outcomes are shaped as much by opportunity and infrastructure as by clinical provision.

In Cumberland, many children grow up in coastal, post-industrial communities where deprivation, limited access to services and economic insecurity are more prevalent. These conditions shape health from the very earliest stages of life. Indicators such as infant mortality, early childhood emergency department attendances, and developmental outcomes consistently show social gradients.

Professional insights regarding the needs of boys and young men in Cumberland

Predominate themes around the needs of boys and young men in Cumberland gathered from surveyed professionals can be seen in Figure 23. Within the free text ‘other’ options, unmet neurodiversity needs were highlighted three times. One professional highlighted feelings of inadequacy amongst boys who ‘are not enough’ for major local employers, with one further professional citing financial concerns as an issue, particularly for the oldest child. These, together with high levels of reported needs around low aspiration and future insecure employment concerns highlights an early awareness of opportunities, and lack of, impacting the wellbeing of young men.

The majority of respondents reported that boys and young men often or almost always hold back from seeking help when they need it. Stigma around emotions, fear of looking weak and distrust of services were the three leading reported reasons for boys and young men not engaging with support when needed. The vast majority (93%) of respondents reported that local cultural norms around stoicism had a medium to very high impact. Box 2 presents an example of local work being completed to support the development of health masculinities by The Little Blackbird, founded by Adrian and Claire Dakers.

Where support is effective, professional insight points strongly towards relational and practical approaches. Boys and young men were reported to respond best to activitiesbased engagement, one-to-one relational support, and trusted adults or positive male role models. Digital-only provision and crisis-led responses were identified as less effective.

These findings reinforce the importance of preventative, community-embedded approaches that build relationships before crisis point, rather than relying on self-referral into clinical or online pathways.

Box 2: The Little Blackbird

Founded by Ade & Claire Dakers, Little Blackbird are a well-being focused organisation that offers impactful Training, Workshops and Social Value projects, across Education, Business & Community settings. Specialising in masculinity and well-being, their mission is to positively challenge cultures and beliefs by delivering programmes that improve communication, strengthen emotional intelligence and explore the power of vulnerability.

Little Blackbird created one of their core projects, “The Man I Want To Become” in 2022 following the tragic loss of a friend to suicide. Built on lived experience, it is an early-intervention, film-led initiative that supports young people to explore healthy masculinity, improve communication, strengthen emotional resilience and understand accountability. It can be delivered in schools, grassroots sport, community projects and adapted for adult groups within the same settings. Little Blackbird strives to challenge cultures and stereotypes related to old age perceptions of masculinity which are no longer fit for purpose, instead creating new ideas around what it means to be a boy/ man, and promoting a better understanding of what positive expressions of masculinity look like.

In November 2025, Little Blackbird delivered “The Man I Want To Become” project with the U16 team at Workington Zebras RFC, in collaboration with Morgan Sindall Construction as a Social Value Partner. The project was a resounding success, with exceptional feedback;

Quotes from some of lads who participated in the project;

“I’ve learnt that it’s okay to show your emotions and to know how to be brave. To really check on each other and to share how you feel, and to look at being a man not as being powerful, but being brave to share what you feel”

“Lads talking is something we need to be encouraging in this area. Times are changing and us in Cumbria are stuck in the past where men weren’t allowed to talk about their feelings”

Parents feedback;

“It’s made my lads understand that it’s ok to not be ok and we all need to vent about things that are getting us down and to understand that there’s always an answer”

Ade’s vision to create a safe space for men to have real conversations saw the introduction of the Little Blackbird podcast, “Tackling it Together” in 2024. A true labour of love, Tackling it Together has already had immeasurable impact and is now a core part of Little Blackbird’s Social Value offering. With a wide range of themes covered, Ade promotes honest and vulnerable connections and powerful conversations, demonstrating that two fellas can sit down and have an open and authentic chat without a pint.

Contact: [email protected]

Summary

This chapter has demonstrated that many of the inequalities observed in men’s health in Cumberland begin early in life. Differences in development, emotional wellbeing, educational engagement and system contact emerge in childhood and adolescence, particularly among boys growing up in deprived and coastal communities and those experiencing cumulative adversity.

For boys, adversity is more likely to be expressed through behavioural change, disengagement or externalising distress. When these responses are met primarily through disciplinary or fragmented systems rather than early, coordinated support, disadvantage is more likely to escalate than resolve. Over time, this reduces protective factors, narrows opportunities and increases exposure to further risk.

These experiences shape how men relate to employment, identity and support in later life, and set the scene for poor mental health, substance use and premature mortality observed among men in Cumberland.

The following chapter examines how these early disadvantages interact with work, place and identity in adulthood, and how economic structure and labour market conditions can either compound or mitigate the risks established earlier in the life course.

Intersecting forms of disadvantage related to gender, health, age, ethnicity, caring responsibilities and prior life experience are seen within Cumberland’s labour market. Understanding these overlapping factors is essential to explaining why some men are more likely to disengage from work and experience poor health outcomes, even where job vacancies remain high. These dynamics also have wider implications for household stability and local economic resilience.

According to the 2021 Census, around 8,000 people aged 16 to 64 from ethnic minority backgrounds live in Cumbria, representing approximately 3% of the working-age population, compared with around 20% nationally. People from ethnic minority backgrounds in Cumbria are more likely than White residents to be unemployed (5% compared with 3%) or economically inactive (26% compared with 22%), despite being more highly qualified and less likely to report disability or unpaid caring responsibilities. This pattern indicates the presence of structural barriers to labour market participation, including discrimination or a mismatch between qualifications and available roles.

These ethnic inequalities sit alongside other recognised barriers to employment in Cumberland, including long-term sickness or disability, older age, young people not in education, employment or training (NEET), caring responsibilities, and experiences of multiple disadvantage such as substance dependence, homelessness, justice involvement or experiences of domestic abuse. Economic inactivity in Cumbria is most commonly driven by long-term sickness or health conditions, accounting for 43% of all economically inactive people, followed by retirement or early retirement (22%). Caring responsibilities also remain a significant factor, with over 31,800 working-age people providing unpaid care, around half of whom provide 35 or more hours per week and are economically inactive.

These drivers of economic inactivity are gendered in different ways. Women are disproportionately affected by caring-related inactivity and lower earning potential, while men are more likely to disengage from work due to health conditions, industrial change and disrupted employment pathways. These patterns are not independent: where men experience unemployment or health-related withdrawal from work, women often absorb increased caring, emotional responsibilities within households, and are more likely to be victims of domestic abuse. This can constrain women’s own labour market participation, reinforce gendered divisions of labour and increase economic pressure within families.

Justice system involvement

Labour-market exclusion, poor mental health and justice system involvement are closely intertwined for many men. For some, contact with the justice system represents the culmination of cumulative disadvantage, including disrupted education, unstable employment, substance use and limited engagement with support. Justice involvement should be understood as part of a broader pathway of social and economic marginalisation.

The health needs of people in prison and under probation supervision are set out in detail in the Chief Medical Officer’s (CMO’s) annual report, published in November 2025. National evidence shows that people in contact with the justice system experience substantially higher burdens of physical ill health, mental health conditions, substance misuse and neurodiversity, alongside markedly lower life expectancy. Men make up the overwhelming majority of the prison population (96% in 2022 to 2023) meaning these inequalities disproportionately affect men and contribute to wider patterns of male premature mortality and morbidity (source: Ministry of Justice).

For some, justice involvement follows periods of employment instability, insecure housing, poor mental health or untreated trauma. Contact with the prison and probation services are an important intervention point. Many individuals entering custody or supervision have had limited or inconsistent engagement with health services in the community. Periods of custody or probation can therefore provide rare opportunities for sustained assessment, treatment and structured rehabilitation.

This framing is relevant to Cumberland. Poor mental health, substance misuse and late presentation to services can culminate in justice involvement, particularly for men. Without effective health and rehabilitation support, justice contact risks reinforcing cycles of disadvantage, further restricting employment opportunities and worsening health outcomes on release. Well-designed prison healthcare, skills development and linked probation services have the potential to interrupt these trajectories, supporting recovery, reducing reoffending and improving long-term employability and reintegration into the workforce.

HMP Haverigg is the only prison located within Cumberland, a Category D open prison, holding just under 500 inmates, primarily convicted of sexual offences. Following concerning inspections and riots historically, recent inspections have highlighted improvements in the rehabilitation programmes, including employment programmes and offending plans resulting in a relatively low proportion of recalls (6%). However, inspection findings also identified long waiting times for trauma therapy, an important part of rehabilitation.

It’s important to note that men from Cumberland who are remanded or sentenced to Category A–C custody are placed outside the local area. This displacement can disrupt family contact, continuity of healthcare and coordination with local probation and employment services and reducing the opportunities to support successful rehabilitation following release.

The CMO’s report emphasises the importance of continuity of care, trauma-informed practice and integration between prison healthcare, probation services and community provision. Rehabilitation involves rebuilding identity, confidence and credible pathways into employment. Addressing substance misuse as a coping response to distress, supporting mental health and neurodiversity needs, managing long-term physical conditions, and building skills and confidence for reintegration into work. Approaches that focus solely on compliance or punishment, without addressing underlying health drivers, are unlikely to prevent reoffending or support sustainable workforce participation.

Justice-based health interventions should be understood as part of a wider workforce and prevention strategy. Improving health and rehabilitation within prisons and probation services, and access to stable accommodation post-release, can reduce repeat justice contact, support transitions into stable employment, and mitigate the downstream impacts on families and communities. In this context, justice involvement is both a marker of accumulated disadvantage and a critical opportunity to reshape adult identity and life trajectory.

Loneliness and community life

Data from the Health Foundation’s Local Authority Dashboard, drawing on the Community Life Survey 2023 to 2024, provide an important insight into the social fabric of Cumberland. Nationally, Cumberland ranks amongst the highest for measures of neighbourhood belonging, speaking to neighbours and reporting that people would be there if needed, ranking 7th, 10th and 8th respectively out of 151 upper tier local authorities. However, Cumberland ranks substantially lower for loneliness, placing 66th out of 151 authorities (Health Foundation, 2024).

This apparent paradox suggests that while Cumberland benefits from strong place-based identity and visible community connection, this does not necessarily translate into protection from emotional isolation. It may reflect a distinction between social contact and emotional disclosure. In communities where norms of stoicism and self-reliance are strong, individuals may experience connection without vulnerability, belonging without necessarily sharing distress. This dynamic is particularly relevant when considering men’s mental health and patterns of delayed help-seeking.

Place, identity and aspiration

The preceding sections describe structural labour-market patterns. This section returns to the question of identity.

Chapter 3 described how identity formation in boys and young men is shaped by belonging, recognition and perceived competence within family, peer and community settings. Using Erik Erikson’s model of identity development (Figure 22) as a guide, we can understand continued identity development into adult as the navigation of intimacy and relationships in early adulthood, then contribution to society and operating as part of a family in later adulthood. This section explores the functioning of male identity through contribution to and functioning in society, through employment, unemployment, addition and physical health outcomes. For many men in Cumberland, identity and aspiration are closely tied to local labour markets, community norms and historically valued forms of work, shaping both what futures feel possible and which pathways feel socially successful.

Cumberland’s industrial history, rural geography and the presence of a small number of high-status employers have created narrow and highly visible definitions of success. Secure, skilled employment in some large employers carry strong social value, while other forms of work are often perceived as lower status. Where men do not access these roles, aspiration may narrow rather than expand, with disengagement from work experienced as personal failure rather than as a response to structural constraint.

Stakeholder feedback highlighted limited perceived alternatives among men who do not follow dominant local employment pathways. Rather than reflecting a lack of ambition, this pattern suggests constrained aspiration. In this context, staying local can be both a source of belonging and a barrier to opportunity.

These dynamics intersect with health and help-seeking behaviour. Where identity and worth are tightly bound to work, illness, redundancy or declining physical capacity can threaten a man’s sense of self, increasing shame and reluctance to seek support. This contributes to patterns of late presentation, economic inactivity and disengagement described earlier in the chapter. Over time, limited aspiration and repeated experiences of exclusion can reinforce cycles of withdrawal, risk-taking or reliance on coping strategies such as substance use or gambling.

Importantly, place also represents a potential protective factor. Strong community identity, attachment to locality and pride in place can be harnessed to support positive transitions, provided alternative pathways are made visible and credible. Creating opportunities for men to develop valued roles within their communities, including in caring, mentoring, education, health and public service settings, can broaden definitions of success. Interventions that build aspiration through locally rooted role models, skills development and supported transitions into new forms of work were championed by stakeholders.

Understanding the relationship between place, identity and aspiration is therefore central to addressing men’s health inequalities in Cumberland. Without expanding what futures feel achievable and socially valued, efforts to improve employment outcomes, health behaviours and service engagement are likely to remain limited. This reinforces the need for place-based strategies that recognise identity as a determinant of health, not merely an individual characteristic.

The ONS Domestic Abuse prevalence and victim characteristics publication (year ending March 2025) provides police-recorded data. Cumbria Constabulary covers both Cumberland and Westmorland and Furness; local police-recorded domestic abuse statistics are therefore available at Cumbria level. In Cumbria in April 2024 to March 2025 there were 6,417 domestic abuse related crimes, 17.3% of all crimes, similar to the regional proportion at 17.7%. This data is not available split by gender.

Table 8, Table 9 and Figure 29 present gender-patterns of police-recorded domestic abuse-related crimes. This data is only available nationally.

Table 8 shows that victims of domestic abuse-related crimes are predominantly female (72.1%), and this is most pronounced for sexual offences (90.0%).

Table 8: Proportion of domestic abuse-related crimes recorded by the police by sex of victim, selected offence groups, April 2024 to March 2025, nationally.

Table 9 demonstrates that the context in which sexual offences occur differs markedly by gender. For women aged 16 years and over, rape is predominantly a domestic abuse-related crime. Over half (53.2%) of recorded rapes of adult women occur in a domestic context, meaning they are linked to intimate partners or family members. In contrast, sexual assault (excluding rape) against women is far more likely to occur outside domestic settings (85.6% non-domestic).

For men, the pattern is structurally different. A relative minority of 13.7% of rapes of adult men and 12.5% of sexual assaults against men are recorded as domestic abuse related. The vast majority of male sexual victimisation occurs in non-domestic contexts (over 85% across both rape and sexual assault).

These patterns suggest three important distinctions:

• domestic abuse is a defining feature of female rape victimisation. Sexual violence against women is linked to intimate partner violence and coercive control
• male sexual victimisation is distributed differently. While male domestic sexual abuse certainly exists, the data suggests it represents a minority of recorded cases. Male victims are more likely to experience sexual assault in non-domestic contexts, including acquaintance, peer, institutional or public settings
• non-domestic contexts dominate sexual assault (non-rape) offences for both sexes

Table 9: Number of rape and sexual assault offences recorded by the police by sex of victim, April 2024 to March 2025.

These structural differences have important implications for prevention and service design. Interventions addressing violence against women must continue to focus on coercive control, partner abuse and safeguarding within relationships. At the same time, prevention of sexual violence against men requires attention to institutional, peer and community contexts, including stigma and barriers to disclosure.

Figure 29 shows the proportion of sexual offences which were recorded as domestic abuse related by age group and gender. Age patterns further illustrate the gendered nature of domestic sexual violence. Among women, the proportion of sexual offences recorded as domestic abuse-related increases from adolescence into early adulthood, peaking at over 40% in the 30 to 44 age range before gradually declining in later life. This period corresponds to peak partnering and child-raising years, reinforcing the link between domestic sexual violence and intimate partner relationships.

For men, the domestic proportion is consistently lower and flatter, supporting the above indication that male sexual offences are less concentrated within domestic partnerships and more likely to occur outside intimate contexts across the life course.

These age-specific patterns highlight the importance of safeguarding within intimate relationships, particularly during early and mid-adulthood (under 16 data was not included in this dataset), and reinforce the need for prevention strategies that address coercive control and relationship dynamics alongside broader community-based sexual violence prevention.

Domestic homicide and severe harm

Homicide data illustrate starkly gendered patterns in lethal violence. Between year ending March 2022 and year ending March 2024, there were 1,831 homicide victims in England and Wales. Men accounted for 1,313 victims (72%) of all homicides; however, only a small proportion of male homicides were domestic (107 cases, under 10% of all male homicide victims). Women accounted for 518 victims (28%) of all homicides; in contrast to men, nearly half of female homicides were domestic in nature (245 cases), meaning women were far more likely than men to be killed in a domestic setting.

The Domestic Homicides and Suspected Victim Suicides 2020 to 2024 Report highlights the most severe consequences of domestic abuse. In 2023/24, there were 98 suspected victim suicides following domestic abuse, 80 intimate partner homicides, 39 adult family homicides and 11 child deaths. The majority of victims were females aged 25-54 years, and the majority of perpetrators were male and of the same age bracket.

Domestic abuse-related death reviews and local learning

Domestic abuse-related death reviews (DARDRs), also known as Domestic Homicide Reviews (DHRs), are statutory processes under the Domestic Violence, Crime and Victims Act 2004, undertaken following the death of a person aged 16 or over resulting from violence, abuse, neglect or suicide linked to domestic abuse. There are 20 DARDRs currently open and under review in Cumberland Council; all of which should be considered as preventable deaths of individuals. At the time of writing, there were ten published Cumberland DARDRs, detailing the deaths of nine women and one man. There are a further sixteen ongoing DARDRs at various stages, all of which relate to female victims, and in 14 of these cases the alleged perpetrator is male.

Common themes identified across the Cumberland DARDRs include:

• a history of involvement with the criminal justice system
• misuse of alcohol and other substances, including methadone and novel psychoactive substances
• previous incidents of domestic abuse or violence
• missed opportunities for professional curiosity across services
• concerns raised by social housing providers
• removal of children into care

These local findings closely mirror national learning. National reviews of DHRs and DARDRs show that vulnerability is common among both victims and perpetrators. Around 70% of victims and 77% of perpetrators had at least one identified vulnerability, most frequently mental ill-health, problem alcohol use and illicit drug use. Forty per cent of perpetrators were known to mental health services and nearly one-third were managed by probation. Aggravating factors such as coercive control, financial abuse, stalking and digital abuse were present in the majority of cases, particularly among victims who died by suicide.

Participants also raised concerns about the invisibility of male victims of domestic abuse, reporting experiences of dismissal or minimisation by services, which may increase isolation and elevate suicide risk. Qualitative findings from The Big Question survey further highlight community concern about domestic abuse in Cumberland. Respondents described a reluctance to confront domestic abuse, noting that emotional neglect and harsh language were demonstrated by parents in front of children, normalising these behaviours and passing the patterns down generationally. The interviews also highlighted the invisibility of male domestic abuse victims as a cause for concern, with reports of services minimising or dismissing male victims, increasing isolation and heightening risk of suicide.

National and local evidence demonstrates that domestic abuse is not an isolated phenomenon, nor solely a matter of individual behaviour. Childhood abuse is associated with perpetrating abuse as an adult, and perpetrators often go on to repeat patterns with new partners (Huecker et al., 2025). Females who witness domestic violence are more likely to be in abusive relationships as victims in adulthood.

From a public health perspective, preventing domestic abuse requires earlier identification of risk, improved coordination across mental health, substance misuse, housing and justice services, and approaches that address the upstream drivers of harm while maintaining clear safeguarding and accountability.

In the Crime Survey for England and Wales (CSEW), “victimisation” refers to a child reporting that they have experienced one or more crimes in the previous year. For children aged 10 to 15, this includes violence against the person (with or without injury), theft, criminal damage and other personal crimes, whether or not these were reported to the police. It captures children’s direct experiences of crime and harm, rather than exposure to domestic abuse between adults.

National Crime Survey data show that boys aged 10–15 are more likely than girls to have experienced victimisation in the year prior to the survey (14.5% compared with 9.1%). Disabled children are also at increased risk (14.1% compared with 11.7% among non-disabled children). Rates peak at key transitional points in schooling, including the end of primary school (Year 6) and at the end of secondary school (Year 11), suggesting heightened vulnerability during periods of social and developmental transition.

These findings are important in the context of this report. While women are disproportionately affected by domestic and sexual violence in adulthood, boys are more likely to experience general victimisation during childhood. This reflects different exposure patterns across the life course and reinforces the need for age- and gender-responsive prevention strategies.

Childhood adversity and intergenerational harm

Parenting capacity as defined by Conley is “the ability to parent in a ‘good enough’ manner long term” (Conley, 2003). Parental capacity is shaped not only by parenting skills, but by parents’ physical and mental health, economic security and ability to engage consistently with children. Men’s health and wellbeing therefore play a critical role in shaping father–child relationships and wider family functioning.

Children’s development and life chances are shaped by both individual parenting behaviours, and the wider conditions within which families operate (source: UCL Institute of Health Equity). Men’s physical and mental health, economic stability and ability to engage consistently in family life play a critical role in shaping these conditions. Where men experience poor health, insecure employment, substance misuse or involvement with the justice system, the effects often extend beyond the individual, altering household environments in ways that increase risk for children.

Adverse childhood experiences (ACEs) provide a framework for understanding these pathways. Exposure to domestic abuse, parental mental ill-health, substance misuse, family conflict or parental absence are all recognised ACEs and are associated with increased risk of poor mental health, substance misuse, bullying and school belonging, involvement with the justice system and an increased risk of multi-morbidity, continuing to increase with higher numbers of ACEs experienced (Gu et al., 2022; Hughes et al., 2025; Senaratne et al., 2024). Figure 30 shows the occurrence of ACEs in children placed into secure estates for welfare reason. By definition, there is an extremely high prevalence of ACEs, including neglect, abuse, parental loss, parent mental illness and bereavement.

Exposure to domestic abuse, parental mental ill-health, substance misuse, family conflict or parental absence are all recognised ACEs. As outlined in Chapter 2, Cumberland has higher-than-average levels of several adult risk factors associated with ACEs, including substance misuse, suicide and justice contact, indicating increased population-level vulnerability for children.

Children learn how to understand and respond to stress by observing adult behaviour. Where coping is characterised by emotional suppression, anger, withdrawal or substance use, these responses may be normalised and reproduced across generations. Evidence demonstrates significant links between high levels of father involvement and more adaptive emotional regulation(Puglisi et al., 2024). Research from Public Health Wales and Bangor University, studying Welsh male prisoners, found that paternal ACE exposure increased risk of children experiencing multiple ACEs and recommended the need for interventions to break intergenerational continuity of ACEs, supporting both incarcerated individuals and their families (Ford et al., 2024).

Improving men’s health and wellbeing has important knock-on impacts to child health and wellbeing. Addressing upstream drivers of male distress has the potential to improve family environments, reduce childhood adversity and interrupt intergenerational cycles of harm. This reinforces the need for early, gender-aware and family-focused approaches that support men as parents and caregivers.

Community safety and emerging crime in Cumbria

Crime and community safety are a key part of “family and relationship wellbeing” because they shape fear, trauma exposure, neighbourhood cohesion and the lived experience of place. They also represent an important wider impact of the upstream drivers described throughout this report, including alcohol and drug harm, distress, exclusion and disrupted identity pathways.

Cumberland has consistently higher rates of overall crime compared with the North West region (source: Cumbria Observatory) Figure 31. However, this is not consistent for all crime types (Figure 32). Cumberland has lower levels of antisocial behaviour, vehicle crime and robbery rates that the region, and equal rates of burglaries, theft and theft from the person. Where Cumberland has higher rates of crime is most markedly violence and sexual offences (Figure 33) (the most common crime committed in Cumberland), public order offences, possession of weapons, and criminal damage and arson, followed by shoplifting, bicycle theft and drug offences.

Violence against the person accounts for almost 17,000 recorded offences across Cumbria (2022 to 2023), with rates highest in Carlisle and Furness. These two localities account for over half of hospital admissions due to violence in the county.

Alcohol is a significant driver of harm. Alcohol-related crime accounts for one in seven offences in Cumberland (14.7%). Patterns of heavy drinking, particularly when combined with economic strain and social norms around masculinity, increase risk of both self-harm and violence.

While rates for drug related offences (trafficking and possession) are lower than the regional and national average, they are increasing. Drug-related deaths in Cumbria are approximately double the national average.

Economic pressures are also reflected in crime trends. Shoplifting and residential burglary have increased in line with inflation, with rates in Carlisle exceeding regional and national levels. Fraud has risen by 11.5% since 2020 to 2021.

The multi-agency, proactive and collaborative approach by Local Focus Hubs across Cumbria has also contributed to a reduction in antisocial behaviour in recent years. Although antisocial behaviour has reduced locally (-28.2% across Cumbria), it remains one of the top concerns for residents, alongside fear of burglary. Perception of safety influences community cohesion and wellbeing, shaping how people live and engage within neighbourhoods.

Geographical concentration of crime and harm

Crime within Cumberland is not evenly distributed (Figure 37). Analysis from the Crime and Community Safety Strategic Assessment shows clear geographical clustering of harm, closely aligned with deprivation.

In 2023, across Cumberland, 36 Lower Super Output Areas (LSOAs) fell within the 20% most deprived nationally. Crime rates are highest within the Carlisle locality area. Within Cumberland, the wards identified as least safe, including Castle, Currock, Moss Bay and Moorclose, and Kells and Sandwith, together contain one third of all of Cumberland’s most deprived LSOAs.

The community panel areas with the highest crime rates, Petteril, Carlisle West and Workington Together, account for nearly three fifths (58%) of all Cumberland’s most deprived neighbourhoods.

This pattern reinforces the well-established relationship between deprivation and crime. Exposure to violence, antisocial behaviour and domestic abuse is spatially concentrated, meaning that some communities experience cumulative disadvantage: economic strain, poorer health outcomes, and higher exposure to crime.

For a report focused on men’s health, this matters. Many of the same areas facing higher crime rates also experience higher unemployment, substance misuse, poorer mental health and justice involvement. Improving men’s wellbeing in these communities is therefore both an individual health intervention and a place-based strategy to reduce violence and narrow inequalities.

Crime in Cumberland is not solely a justice issue; it is a population health issue. Patterns of violent crime, domestic abuse, alcohol-related offending and sexual offences are closely intertwined with the upstream drivers explored throughout this report: economic insecurity, mental ill-health, substance misuse, trauma and social isolation. Where male distress manifests in harmful coping, aggression or disengagement, the impacts extend beyond the individual to partners, children and neighbourhoods.

The burden of crime is experienced directly by victims through injury, fear and trauma, and indirectly through its effects on communities. High-crime environments shape perceptions of safety, restrict the use of public space, increase pressure on policing and emergency care, and generate sustained demand across mental health, substance misuse, housing and safeguarding services. Concentrated crime in areas of deprivation compounds existing inequalities, reinforcing cycles of disadvantage.

Addressing men’s mental health, substance misuse and economic exclusion is therefore relevant not only to men’s individual outcomes, but to community safety and family wellbeing. Strengthening early support, improving access to help before crisis, and challenging harmful norms that contribute to violence are central components of prevention.

Chapter summary

The evidence in this chapter reinforces a clear message: men’s health is inseparable from the wellbeing of women, children and communities. Women are disproportionately affected by domestic and sexual violence. Children experience harm both directly, through victimisation, and indirectly, through exposure to instability, conflict and trauma. Crime patterns further shape the lived experience of place, particularly in deprived neighbourhoods.

Improving men’s health, particularly mental wellbeing, substance use support, economic inclusion and access to early intervention, must therefore be aligned with safeguarding, tackling violence against women and girls (VAWG), and community safety priorities. Strengthening upstream prevention in men is key to fewer individuals and families experiencing harm downstream.

The evidence assembled in this report suggests that boys and men in Cumberland are more likely to engage when services feel accessible, relational and non-judgemental, and when they meet men geographically, emotionally and practically. This aligns strongly with professional feedback that many boys and men will hold back from disclosing distress until trust is established, and that engagement is often more successful when it is informal, consistent and built around shared activity rather than clinical framing.

Local insights from The Big Question (Ashworth, E. et al, 2026) highlight several initiatives and organisations that participants felt are helpful in practice. These include the Baton of Hope tour (as a visible, community-level way to acknowledge suicidal distress and suicide bereavement), Every Life Matters (a training, campaigning and support offer for those impacted by suicide), and The Lighthouse (Mind) (for in-person, same-day crisis appointments). These services share features that are repeatedly valued by men and those supporting them: visibility, credibility, reduced stigma, and routes into support that do not rely solely on formal referral pathways.

A consistent theme was that services work best when they create multiple entry points. including community events, peer spaces, informal drop-ins and activity-based engagement. These entry points can act as bridges into more specialist care when required, while also providing ongoing social connection that reduces isolation.

Two local examples illustrate these design principles in practice. Firstly, Andy’s Man Club provides free, peer-led groups for men, offering a non-clinical and informal environment where men can attend regularly without referral (Box 3). Andy’s Man Club is an important complement to statutory services rather than a replacement, with value as an accessible route into support and onward signposting where needed. However, peer-led groups are not suited to everyone, and it is important to offer range of open access early support services. Secondly, The Hope Haven (Box 4) offers community-based support with an emphasis on referral-free, walk-in accessibility, with multi-agency partnerships.

Box 3: Andy's Man Club

Andys Man Club
“Andy’s man club (AMC) is a national volunteer led mental health and suicide prevention charity that opened in mid 2016 following the tragic suicide of Andrew Roberts in early 2016. Starting with just 9 men meeting in a small room there are now 334 physical venues across the UK and online sessions running every Monday (except bank holidays) from 7pm until 9pm where men over the age of 18 can meet in a non-judgement neutral and confidential setting to open up about their mental health struggles and get support from a group of peers in similar situations.”

Facts and figures
In Cumberland, there are eight groups. In 2025, there were 6,672 attendees, with 402 of these being new, first-time Andy’s Man Club attendees
Brampton: 106 attendees | 20 new (opened Oct 2025)
Carlisle: 1,988 attendees | 142 new
Cockermouth: 671 attendees | 37 new
Maryport: 798 attendees | 25 new
Millom: 362 attendees | 27 new
Whitehaven: 669 attendees | 52 new
Wigton: 261 attendees | 20 new
Workington: 1,818 attendees | 79 new

Box 4: Hope Haven

Hope Haven is a radical new collaborative mental health 24/7 neighbourhood centre and one of only 6 NHS England National Pilot sites, situated in Copeland in West Cumbria.

In this service the concepts of ‘referral’, ‘discharge’ and ‘criteria’ are all removed with access to support as easy as walking through the door, ringing our telephone number or connecting online.

Our partners all work together as a ‘Team of the day’ each day. This includes ‘welcomers’ who make sure anyone walking through the door receives a warm welcome and will listen to you to find out how we can help.

What’s unique about Hope Haven is that if you need more than one type of support, we’ll build that around you – you won’t get passed between different services. Our service is built on different organisations in the local community working together and collectively aiming to support a truly community led approach to mental health and wellbeing.

Hope Haven’s model is based on partnership working around the person’s needs. People will be able to access support for mental health experiences and help to identify what areas may trigger or drive their mental health distress. Support is then arranged across varied levels from providing advice and guidance to complex interventions.

This places the person and their family at the centre of a collective approach to listen and understand their needs and help to support, build strength, value and wellbeing as part of their daily life.

Hope Haven has a range of partners offering areas including: 

Together in a crisis interventions.
Virtual safe haven (4pm to midnight 7 days a week with bookable appointments.
Support with housing needs.
Support with addictions.
Physical health support including GP access.
NHS mental health interventions for all ages.
Short stay beds for those in crisis.

Hope Haven supports a greater understanding of the person, their needs, and also their interests and aspirations, using a multi-disciplinary approach. 

Hope Haven is also keen to be part of the local community in Copeland. Our service includes supporting positive approach to mental wellbeing with our partners iCan Wellbeing, and our work with Creative Arts project ‘Everyone here’; Chatty Café’ and ‘Cammerados’ – to help tackle areas including building positive approaches to wellbeing, loneliness and suicide. Making a difference:

Hope Haven has already seen a huge difference since its community offer started in August 2025. This includes:

•    Delivering virtual and in person outreach support via Everyturn, Home Group and The Well Communities to 331 people.
•    Launched team of the day which has transformed the way in which CNTW caseloads are allocated enabling patients to able to be picked up directly by partners in the moment, therefore reducing need for secondary care interventions.
•    Delivered 100 safe haven appointments in six months – directly supporting people who feel they are in crisis, and in turn, reducing the demand on other services.
•    Delivered “Together in a Crisis” to 76 people with a total of 912 appointments delivered to date and the capacity to deliver to 304 people per year and a total of 3,648 appointments.
•    Delivering walk in and home visit GP and healthcare appointments without the need for a home visit.
•    Delivering exercise and GP interventions in homelessness accommodation and older persons accommodation.
•    Achieved a 25% reduction in the CRHT team’s workload comparing Sept – Oct 24 with Sept / Oct 25 reducing from 33.22 to 25.24.
•    Launched our 4 Short Stay Accommodation beds delivered by Home Group delivering a 35% saving on a bed per night cost.
•    Seen a 91.6% reduction in informal admissions based on a year on year comparison.

Implications for service design and system response

Evidence from The Big Question, local surveys and professional feedback converges on a clear message: improving outcomes for boys and men is about reshaping the system around accessibility, continuity and earlier engagement. Several specific implications emerge:

There is a need to strengthen crisis access and responsiveness, while avoiding an overall model where men only receive support once distress has escalated. Crisis support must therefore be visible, rapid and easy to navigate, with clear routes between crisis response and ongoing follow-up.

Cumberland requires a more geographically distributed offer, including outreach, evening provision and local “third spaces” that are welcoming and easy to access.

There is a strong case for embedding front-door early intervention and education across settings where boys and men already are: schools, colleges, workplaces, community venues and primary care, so that help-seeking is normalised long before crisis.

Services need to be more relational, recognising that engagement may be gradual and that many men present with practical, behavioural or physical concerns rather than explicit emotional distress. Models that allow men to engage through shared activity, peer spaces, trusted adults and informal drop-ins are routes to earlier contact and sustained engagement.

Peer-led spaces and public conversation reduce stigma create visible permission for men to speak about distress and suicide bereavement. These approaches work best when they are integrated with clear routes into support, so that awareness translates into access.

There is a need for stronger collaboration across statutory and third sector partners, including shared pathways, clearer signposting and smoother transitions. Many of the most acceptable entry points for men sit in community and voluntary settings, but they must be connected to clinical and safeguarding responses when risk is identified.

There must be deliberate attention to welcoming, psychologically safe spaces, including spaces that work for neurodivergent people. Across the evidence, neurodiversity, emerged as an important factor shaping behavioural presentation, disengagement from education and services, and later mental health risk.

Finally, the system should treat postvention, support after suicide bereavement, as a core component of prevention. Given the high proportion of residents reporting being affected by suicide, bereavement support is a population-level need that has the potential to reduce longer-term trauma, isolation and risk.

The recommendations in the next chapter translate these design implications into priorities for commissioning, workforce development and place-based delivery in Cumberland.

Cumberland Council

Continue the shift towards prevention, encouraging early help and reducing stigma for boys and men, prioritising life stages and groups at highest risk (including adolescence, early adulthood, working-age men and those affected by unemployment or isolation).

Embed postvention as a core prevention function, ensuring timely, trauma-informed support for individuals, families, schools, workplaces and communities affected by suicide.

Agree a concise set of important shared outcomes and indicators for boys’ and men’s wellbeing, including access, waiting times, continuity, postvention reach and inequalities by place.

Embed proportionate evaluation within new and existing initiatives, enabling learning, adaptation and scaling of what works.

Report progress publicly, ensuring transparency and accountability to communities

Strengthen early, relational support within schools, particularly for boys at risk of exclusion or persistent absence, with a focus on understanding behaviour, supporting neurodiversity and maintaining engagement in education.

NHS health and mental health services

Develop low-threshold, face-to-face access points (e.g. walk-in or drop-in mental health hubs) in key towns.

Maintain in-person routes alongside digital offers.

Simplify and increase flexibility of referral pathways, enabling referrals from GPs, schools, employers, VCSE organisations and families, and reducing repeated re-assessment or “bouncing” between services.

Strengthen crisis response and follow-up, ensuring empathic first contact, continuity after crisis and proactive re-engagement.

Improve neurodiversity pathways for all genders and ages, including workforce capacity, earlier identification and practical support for individuals and families across the life course.

Improving access to timely assessment and family support, strengthening links between schools and mental health services.

Supporting the voluntary and community sector

Formally support and connect peer-led and community-based approaches, recognising their role as entry points into the wider system rather than standalone solutions.

Strengthen coordination across VCSE providers, including shared referral routes, and clearer links to statutory services

Use visible, stigma-breaking community activity (e.g. public conversations, peer spaces, awareness events) to normalise help-seeking and reduce isolation.

Train trusted community figures to talk about mental health (e.g. barbers, sports leaders, employers, e.g. funding BarberTalk training programmes).

Encourage and support community and voluntary sectors to access additional funding opportunities.

Education and schools

Prioritise early, support for boys at risk of exclusion.

Reduce reliance on permanent exclusions by strengthening in-school support, early help links and family engagement.

Embed emotional literacy and help-seeking education within the curriculum, delivered in age-appropriate, gender-sensitive ways.

Actively raise aspiration and widen horizons, including exposure to diverse career pathway, and positive male role models from a range of backgrounds.

Employment and workplaces

Employers should recognise their workplaces as key prevention settings, equipping managers and trusted staff to identify distress, provide early support and signpost effectively.

Employers should support encourage diverse access into employment, including men into health, education, and administration.

Workplaces should lead the way in recognising and supporting men to be joint-primary caregiver.

Justice system (including prison and probation)

Strengthen the health–justice interface, ensuring continuity of mental health, substance misuse and neurodiversity support during custody, probation and transition back into the community.

Integrate family-focused and relational support into justice pathways to reduce intergenerational harm and repeat cycles of disadvantage.

This report has examined men’s health and wellbeing in Cumberland across the life course, showing a pattern of consistently poorer outcomes in some areas, high exposure to risk and later engagement with support. These outcomes are shaped by place, deprivation, rurality, employment patterns, neurodiversity and life transitions, rather than by individual behaviour alone.

A central finding of this report is that many boys and men delay seeking help because support feels inaccessible, stigmatising or poorly aligned with how distress is experienced and expressed. Services that rely on crisis thresholds, short-term interventions or verbal disclosure often engage men too late. In contrast, relational, activity-based and community-embedded approaches support earlier engagement and more sustained connection.

Cumberland has strong foundations to build on, including committed partners, active communities and examples of effective practice. However, improving outcomes will require a shift from fragmented provision towards a coordinated, prevention-first system that addresses identity, culture and aspiration, strengthens education pathways, and aligns services with lived experience.

The recommendations in this report set out a practical framework for action. By acting on this evidence, Cumberland has an opportunity to improve outcomes for boys and men while reducing avoidable harm to families and communities, and to build a healthier, more resilient future.