Dr Deborah Lee from Dr Fox Online Pharmacy discusses men’s mental health, including common barriers to seeking help and the measures needed to improve overall awareness and support
The negative impact of poor mental health on quality of life is often not fully appreciated. Mental ill health brings distress, lack of control, poor self-esteem, low self-confidence, not feeling part of society, and a sense of hopelessness, all of which decimate many people’s lives. We need to raise awareness of the plight of those with mental ill health and try to reverse this sad situation. Severe mental illness reduces life expectancy by 10-20 years, which is worse than the effects of cigarette smoking. Huge efforts have been put into public health campaigns to stop smoking, but mental health has never received the same attention, priority, or funding. It is time to redress the balance.
How mental ill health differs between men and women
Men suffer from the same mental health problems as women, but the statistics are slightly different. The most common mental health disorders are anxiety, stress, and depression.
Anxiety is common in both men and women. Eight million people in the UK are currently suffering from some form of anxiety disorder, but less than 50% seek medical help. In 2022/23, 37.1% of females and 29.9% of men were found to have severe anxiety symptoms. These figures have significantly increased over the past ten years. Many anxiety symptoms are the same in women and men. However, men are more likely to suffer from anger outbursts, insomnia, and turn to drugs and alcohol. Anxiety can also affect sexual performance and cause erectile dysfunction (ED) and premature ejaculation (PE).
Stress is also prevalent, with 74% of UK adults saying they regularly feel overwhelmed and unable to cope. Stress is a cause of mental health problems such as anxiety and depression. It also has a major negative effect on general health – it dampens the immune response, raises blood pressure, impairs sexual function and damages relationships.
Although women are more likely to feel stress than men as they usually bear the brunt of raising children, household duties and juggling work and other domestic/social responsibilities, men have their stresses to cope with. They are often the major breadwinner and work unsocial hours and overtime with a poor work-life balance.
Men are also less likely to recognise stress than women and less likely to ask for help. They tend to internalise their emotions, feeling it isn’t ‘manly’ to show weakness. Male stress often manifests itself as anger and irritability, smoking or drinking more alcohol, impulsiveness and risk-taking behaviour and can result in conflict at work and home.
Stress and anxiety are closely linked with depression. Around 5% of the adult population suffers from depression. It is slightly more common in women than men, occurring in 6% of adult women and 4% of adult men, but the suicide rate is three times higher in men than in women. 35.2% of adult men have had some mental health problem in their lifetime. However, 40% of men do not discuss their thoughts, feelings, and emotions with friends, family, or a health professional.
Depression is a serious problem for men – 75% of suicides every year are in adult men, the most common occurring in those aged 50–54.
Risk factors for mental ill health
Mental health conditions have the same shared risk factors. The top stressors are work issues (32%), financial problems (31%) and health concerns (23%). Depression may be triggered by a relationship breakdown, divorce, or bereavement.
Major life events such as becoming a parent are also a risk factor; the number of men who experience depression in the first year after becoming a dad is twice that of the general population. Approximately 25% of new fathers experience mild depressive symptoms, and around 10-12% are diagnosed with depression.
Depression may also stem from childhood neglect, emotional, physical, or sexual abuse, or a physical illness such as heart disease, diabetes, Parkinson’s Disease, or cancer. When depression is present, symptoms of physical illness are worse, and any disease is harder to cope with.
Why men are less likely to seek help
Societal norms have often deemed men to be the hunter-gatherer and the breadwinner, and men can feel the need to fulfil this stereotypical role. They also regard it as not masculine to admit their feelings when they are depressed and internalise their emotions, not wanting to talk to anyone. In trying to ‘man up’, they often disguise their feelings from all around them. All too often, their depression was kept well hidden, and no one knew until it was too late.
Typically, men throw themselves into their work or use other escapist tactics to avoid facing up to how they are feeling. They may also be drinking and smoking more heavily. They may withdraw from social events with friends and family. People may notice personality changes, mood swings, or work absences. It is imperative to intercept if a man is showing suicidal tendencies before they take any action.
Supporting mental health and wellbeing at work
The National Institute of Care and Health Excellence (NICE 2022) has recently issued guidelines for employers for mental wellbeing at work. These can be used as an evidence-based framework for creating a safe and supportive working environment for good mental health. Employers have a duty of care to provide a safe workplace for their employees, including their mental health.
Strategic support
There needs to be a supportive culture regarding mental health in the workplace at all levels of the organisation. Managers need to be aware of job roles, workload, work stress, mental health attitudes, and any stigma. A stress risk assessment should be conducted for each role and action taken to address/minimise these factors.
Staff need to be aware and understand the role of stress on their mental health, the symptoms and signs of stress, anxiety, and depression, and know when and how to call for help. Having a mental health champion or buddying up as a means of peer support is recommended.
Undoubtedly, some of the stressors that affect mental health occur outside the workplace, and managers need to recognise when this is the case and be able to intervene and signpost for help and care as needed.
There should be no discrimination in the workplace. Managers must ensure an inclusive atmosphere for every race, gender, culture and ethnic background. Policies that are adhered to and regularly audited must be in place, including an anti-bullying policy.
Every work environment should allow for a good work/life balance. Employees need to know what mental health resources are available at work and be able to use their computers to access these in their free time.
External sources of support
Staff need to be made aware of external sources of support they can tap into, such as The Department of Work and Pensions Access to Work Mental Health Support Service. Mind also has valuable online workplace support. The NHS has its own staff mental health and wellbeing hubs.
Training managers
Managers need to be trained in mental health to recognise the importance of maintaining good mental health, instil a positive well-being culture, and identify an employee with poor mental health.
They should consider conducting a survey to assess their department’s stress levels and mental ill health. Each manager needs to be able to converse with a staff member about their mental health, which means listening, recognising signs and symptoms of distress, and knowing how to signpost the person appropriately to the correct service. This could be Occupational Health or the person’s GP. A manager also needs to address their own mental health needs.
Employees must be made aware of and encouraged to attend in-house sessions designed to help relieve stress, such as yoga, mindfulness, and meditation.
If an employee is suffering from poor mental health, the manager needs to ensure the employee knows they can speak confidentially about their mental health issues. No one has the right to 100% confidentiality in all circumstances, and if the manager learns that they or someone close to them is in danger, they are duty bound to pass on this information to the relevant specialist team. A wellbeing plan must include time off or flexible working hours. Treatment should be available, such as a stress management programme, counselling, or cognitive behavioural therapy (CBT).
Engaging with employees and their representatives
Looking after an employee’s mental health may mean meeting with their trade union or staff representative. Their work contract protects the employee’s position. The manager may wish to sign up for the Mental Health at Work Commitment, a framework created by employers and mental health experts to achieve better mental health outcomes at work.
Workplace support can be put in place in many different guises. These should be positively named as stress awareness sessions rather than depression or counselling.
Managers can direct employees to mental health apps, for example, Headspace and Calm. An alternative is Peppy, an employee wellness app. Men can be introduced to other initiatives that run outside work, such as Andy’s Man Club, The Men’s Shed Association and The Mankind Project UK and Ireland.
The Work Foundation 2018 have produced guidance in their document Men’s Mental Health and Work.
Increasing awareness of men’s mental health at a policy level
National campaigns need to be put into action to break down the stigma associated with male mental health. There are four types of stigma: social, perceived (self), and professional. We can also add cultural stigma, as personal beliefs and attitudes within different ethnic and racial groups can lead people to distrust healthcare professionals, and this is particularly prevalent in the Black community.
Setting up community-based programmes
There is a need to set up community-based programmes for men with mental health problems. Below are two good examples.
The Becoming a Man (BAM) programme which has been established in Lambeth to help boys aged 12-16 to help them reach their full potential. This is delivered in schools in BAM circles of 8-12 participants and a BAM counsellor and aims to help young men express their thoughts, feelings and ambitions.
Comhar men’s groups, established in Ireland 20 years ago, are aimed at men going through midlife. The Mental Health Foundation runs the project in partnership with Immigration, Counselling and Psychotherapy (icap). These are self-management courses aimed at reducing the risk of depression and suicide, which also include peer facilitators.
Organise healthcare with a gender focus
Universal policies should address common health measures such as a healthy diet, exercise, etc., but beyond this, they should acknowledge the different needs of women and men.
Direct services to high-risk groups
Male healthcare should be specifically directed at high-risk groups, including men aged 45-59, those who are unemployed, those working in the construction industry, those in the criminal justice system, Black and ethnic minority groups and anyone experiencing a relationship breakdown.
The government must be proactive
Men often shy away from healthcare, so the government must be proactive and reach out to engage men. This means targeting them at places they frequent, such as pubs, sports grounds, and betting shops.
The workplace must be well-equipped to address mental healthcare needs in men
Occupational health needs to collaborate with employers to ensure the workplace is adequately equipped to identify and support men with poor mental health. The Department of Health and Social Care (DHSC) have been encouraged to produce a workplace stress manual.
Recognising and treating depression should be prompt and effective, not an afterthought, if we are going to reduce the rate of male suicide successfully. Services need to be in place, such as peer-led sessions, mental health walk-in centres, and the opportunity for emergency support, also out of hours. These need to be diverse and include all members of society.
Final thoughts
Ignoring men’s mental health has far-reaching consequences, including unemployment, poor work productivity, poor physical health, and relationship breakdown. If we can change the stigma of men’s mental health and take a proactive stance, especially in the workplace, there is so much that can be done to improve the health and happiness of men’s lives.
For more information
Mental Health Foundation – Men and mental health
NHS – Where to get urgent help for mental health
NICE – Mental Wellbeing at Work (2022)
