It has been an interesting exercise to read the submissions from various stakeholders to the Mental Health of Men and Boys Inquiry being conducted by the Women and Equalities Committee of the Houses of Parliament. This new Committee has been hearing evidence on the most pressing issues that affect men and boys’ mental health, and how these are different to the wider population. How to help men achieve better therapeutic outcomes is an ongoing challenge facing all of society, not just the responsibility of the counselling and psychotherapy professions, so it is very welcome that lawmakers are taking this issue seriously.
Men often struggle in the modern world, not knowing which role they should play, whether they are, or should be, the main breadwinner, the gentleman, the leader or the defender, such as the knight protecting fair maidens yet their mental health needs are often overlooked. More attention is needed to address the issue of improving uptake of mental health services by men. Large parts of the therapy world tends to view male engagement with therapy services being hampered by barriers at both the personal level (men struggling to ask for help) and at the systematic level (the inherent lack of male-friendly therapeutic services).
Issues surrounding the so-called ‘mental health debate’ in the media (particularly when focused on men) often get talked about after a dramatic news event such as a high profile suicide. I can think of various footballers and musicians. The reluctance of men especially to talk about mental health issues is thankfully slowly changing with more openness surrounding emotional health issues. This greater openness has been helped in part by health promotion campaigns such as Heads Together and Ask Twice, led by Time to Change, which help to send the message that it is okay to share your feelings, and that matters need not reach crisis levels before help is sought.
The so-called ‘mental health debate’ is gradually becoming more open and real with increasingly more men disclosing their struggles with anxiety, depression, sexual abuse, self harm, addictions and loneliness.
I often wonder, though, how the internal bias, and sometimes blatant prejudice, of some therapists help to sustain poor outcomes for men in therapy and in therapy training. Men, for some reason, are often excluded from therapeutic groups. Time and time again one is witness to advertisements in therapy centres for participants in therapeutic groups that specifically exclude men from applying. I often wonder about how such a negative bias permeates through the ethos of psychotherapy training centres and how these attitudes end up ultimately failing men when assessing health outcomes. For instance, it is not uncommon to hear some fellow therapists talk unashamedly, and without any restraint, about how they object to male privilege and how they wouldn’t work with such clients. This belief that simply being male confers privilege, when in reality the vast majority of men are not privileged, is fairly obvious to most, but then prejudice, of any description, hardly ever stands up to logic and reason or any scrutiny. Many men are working class, unemployed, in prison, homeless, divorced without access to children, addicted, depressed or even suicidal yet attitudes to men are less sympathetic as reflected in the lack of recognition of male victimhood and the correspondingly limited services for male victims.
Lets explore male privilege:
- Men are three times more likely to take their own lives than women are (19 vs. 5.1 per 100,000; ONS, 2015), and significantly less likely to seek mental health support. Whilst every death is one too many, the trend of male suicide has at least been dropping in recent years.
- According to NHS Digital (formerly the Health and Social Care Information Centre) men are three times more likely than women to become alcohol dependent.
- Missing person statistics from National Crime Agency (NCA) police force data do not break down incidence of mental health issues by gender but the statistics demonstrate that men account for two in three missing incidents among people aged 18 and 59. (It is unlikely to be a coincidence that the incidence of mental health and suicide markers are also much higher among men in this age group).
- Men account for 86% of rough sleepers in the UK (latest Ministry of Housing figures, 2019) but statutory agency approaches to the problem of rough sleeping are not gender-specific (or indeed adequately funded).
- Young men are already a third less likely than young women to attend university (Stoet, 2019), but there is still little government publicity, policy or action to remedy this inequality.
- Men do not seek psychological help as much as women do (see Addis & Mahalik, 2003; Kung, Pearson, & Liu, 2003).
- Men account for about 95% of the total prison population. In 1900 there were 152 male prisoners per 100,000 men in the population. This rate has increased to 339 per 100,000 in 2018. There were 27 female prisoners per 100,000 head of female population in 1900. In 2018 this rate had decreased to 16 per 100,000. Many male prisoners have significant mental health problems that often go unaddressed.
- Men account for about 99% of all military deaths and about 96% of deaths in the civilian workplace. Men are still required by society to perform the heaviest, riskiest and most dangerous physical tasks in order to build and maintain the physical infrastructure that society depends upon. It is by no coincidence that the highest rate of self-harm for men takes place in traditional male workplaces such as farming and forestry, construction and the armed forces.
- This “death gap” is not recognised in public policies or in gender equality narratives, yet a much smaller “pay gap” is magnified as an issue of social justice even though men and women on average choose different kinds of occupation with different hours, pay rates and risks.
Sometimes the prejudice from therapists against men is often extreme. I recall listening to a therapist in a therapy waiting room talking to another therapist about how she was dreading her session with a male client, who she claimed had poor body odour. I then listened to her explain the negative effects of testosterone on her senses. Such prejudicial attitudes were not in themselves that surprising, as prejudicial views of all sorts can be as prevalent in therapy circles as they can be elsewhere in society. What was surprising to me was how open this person was in expressing her prejudice, and in such an unashamed manner.
These distorted attitudes and biases towards the male gender have recently been conceptualised as “gamma bias”. Put simply this is a combination of “alpha” and “beta” bias) (See Seager & Barry, 2019). As the Male Psychology Network outlined in their submission to the aforementioned parliamentary enquiry, included in this is the male “empathy gap” which means that perceptions of male privilege, power and toxicity are blown up and magnified whilst perceptions of male achievements, problems, disadvantages and victimhood are played down and minimised. Men are implicitly or explicitly blamed for their own problems and assumed to be reluctant to seek help due to problems of personal stubbornness when the reality is that when men do seek help e.g. as a victim of domestic violence there is no help and no services.
How can the world of therapy better help men?
Lets start with statutory services. Child and Adolescent Mental Health Services (CAMHS) clinic opening hours have never been favourable to including fathers. CAMHS practitioners do not think inclusively about fathers. There is no adequate literature on fathers to inform course design in training schools. The materials and training are often mother-centric.
When it comes to how men are viewed in therapy there is often a binary choice to be made between two divergent approaches to helping men and boys: One approach is to try to change men, and masculinity itself, on the basis that it needs reform and improvement. Such an approach urges men to seek help and to access services that are already available. This approach is preferred in mainstream academia and public life and is often treated as the only possible way forward. Another approach is to try to develop and offer new ways of delivering services that appeal more specifically to men and meet their needs as gendered beings. Liddon et al, (2019) have shown that there is some evidence for showing that this approach can produce positive results.
Men are socialised not to share their feelings and to believe that any problem that they encounter should be solved by them alone. This can partly explain why men are reluctant to engage with support services. Men tend to bottle things up, and because of lad culture, men often see talking about problems as a sign of weakness. There are many toxic myths about men and mental health, one that that being depressed makes you a burden and that it’s cowardly to seek help. Such toxic messaging systems only help to feed isolation and increased vulnerability.
It could be that men don’t seek therapy because, compared to women, they prefer not to talk about their feelings. This raises important questions, such as: if therapy emphasised talking about feelings less, would men seek therapy more? And should we be trying to change men to fit therapy, or instead be trying to change therapy to fit men?
So often the traditional therapy room, with boxes of tissues, pictures of sunsets and flowers, is perceived to be primarily female centered and not really the terrain for men to explore their problems. Many psychological interventions are more emotion-focused than solution-focused, thus preferred by women rather than men. Yet men benefit as much as women from emotional disclosure, but men may be put off seeking help because of reluctance to engage in interventions in which the focus is on emotional disclosure. There is some evidence that men are more likely to open up about personal issues when it was impacting their work (Russ et al., 2015) or when prompted by a female family member or partner (Lemkey et al., 2015; Norcross, Ramirez, & Palinkas, 1996).
Ultimately, a more positive view of masculinity is needed and we should all be doing everything we can to encourage men to see therapy as a positive option for helping with their problems. The provision of therapeutic services need to be delivered in more suitable settings, when men feel more comfortable. The perception of therapy as being anti-male will make therapy less attractive to men, which potentially has dire consequences, given that men are already less likely to seek help than women.
Noel Bell is a UKCP accredited psychotherapist based in London. He can be contacted on 07852407140 and noel@noelbell.net
