Male mental health and suicide

Whilst the pain of mental illness can manifest in anyone, the way that people of different genders are affected appears to drastically differ: Women are twice as likely as men to be diagnosed with common mental health problems yet of the 6,233 people who completed suicides in the UK in 2013, 78% were men. [1,2] Indeed, in the UK, the most likely way a male under the age of 35 will die is by taking their own life. [3] So why is there such an imbalance in diagnoses and outcomes between genders?

One answer is that there may be an inherent difference in how males and females deal with emotional pain, something that appears to start at a young age. A study of children from the age of 8-17 years old found that disclosing personal concerns was an overall positive experience for girls as they felt cared for and understood. Boys, however were much more likely to find the experience ‘weird’ and to describe it as a ‘waste of their time’. [4] Psychological services aimed at men also describe men as prone to hide their emotions, which suggests this negative view of disclosure extends into adulthood. [5] Extending beyond mental health issues, young males are less likely to have visited the doctor in the past 12 months compared to young females (59% vs 81%). [6] General reticence to seek medical care, as well as a specific negativity towards mental health contribute to why men are less likely to seek solace in a therapist’s office.

Instead, males have a tendency to look for alternative means of release. For example, alcohol and drug abuse are 3 times more common in men than women. [7] Although this difference is not wholly explained by self-medicating, part of it is seeking ‘external’ means to neutralize internal turmoil. This can propel the destructive cycle of mental illness, and in turn lead to violent behaviour, self-harm, or even attempted suicide. One recent poll showed 24% of 16–24 year old men had self-harmed, 22% had considered self-harm, 21% had abused alcohol to cope with stress, 19% acted out by punching walls, and 10% had abused illegal drugs. [8]

Thus, it is clear that young men with mental health issues face a specific set of problems that in some cases are not similar to those experienced by women in a similar position. However, new data suggests that, like with negativity towards therapy, the danger of suicide is not only confined to the young. A recent report by the World Health Organisation revealed that men over the age of 70 have the highest rates of suicide compared to other demographics worldwide. [9] The death of Robin Williams in 2014, at the age of 63, publicly highlighted the vulnerability of this demographic. In this high-profile case, even Williams’s frankness and continued mental health treatment was not enough to avoid this tragic outcome.

All mental health is a serious problem, but with the behaviour of, and risks for men and women differing so starkly, the question of how men can be brought into mental health treatment is an increasingly urgent one.

One possible solution is the adoption of positive youth development. This method shifts the focus from the traditional risk behaviours often associated with males to an acknowledgement of their strengths. It makes seeking appropriate help part of the concept of strength and independence, rather than trying to redefine the ‘masculine narrative’ (beliefs about being masculine meaning having to be self-reliant, tough, dominant, confident, etc.). In doing so, this approach utilises characteristics that are already generally present in males, generates a more positive self-esteem, and thereby influences their behaviour and risk. [10] This approach also helps to take away the stigma of young men seeking help and provides a precedent for seeking treatment in the future. This approach for promoting good mental wellbeing and adopting prevention strategies has been found to be an effective long term solution in a variety of mental health problems. [11,12,13,14] In addition, with these treatments mental health expenditure can be 10 times lower compared to when treatment is delayed until adulthood. [15] Nonetheless, approaches such as these have not yet reached wide use in national health care provision.

A change in perspective on how we deal with mental health issues will help individuals for whom the current system is not working. In sum:

• Men and women with mental health issues are often differently affected

• Men can be resistant to some mental health therapies

• Interventions made at a young age are both cost-effective and can overcome male resistance to therapy

• Approaches that capitalise on existing ideas of masculinity can be particularly effective in getting males into treatment

Adopting changes to mental health treatment to take these factors into account is a sound investment not just for men, but indeed for the future wellbeing of society as a whole.

References:

1. McManus S, Bebbington P, Jenkins R, Brugha T. (eds.) (2016) Mental health and wellbeing in England: Adult Psychiatric Morbidity Survey 2014. Leeds: NHS Digital. Available at: http://content.digital.nhs.uk/catalogue/PUB21748/apms-2014-full-rpt.pdf [Accessed 6 Mar 2017

2. Bromley, C., et al. (2014). The Scottish Health Survey: 2013 edition, volume 1, main report. [online] Edinburgh: The Scottish Government. Available at: http://www.gov.scot/Resource/0046/00464858.pdf [Accessed 6 Mar 2017]

3. Office of National Statistics (2015) Available at: http://visual.ons.gov.uk/what-are-the-top-causes-of-death-by-age-and-gender/ [Accessed 9 Mar 2017]

4. Rose, A. J., Schwartz-Mette, R. A., Smith, R. L., Asher, S. R., Swenson, L. P., Carlson, W. and Waller, E. M. (2012), How Girls and Boys Expect Disclosure About Problems Will Make Them Feel: Implications for Friendships. Child Development, 83: 844–863

5. MensLine, Australia (2011) Available at: https://www.mensline.org.au/emotions-and-mental-wellbeing/men-and-emotions/ [Accessed 9 Mar 2017]

6. Bell, D. L., Breland, D. J., & Ott, M. A. (2013). Adolescent and Young Adult Male Health: A Review. Pediatrics, 132(3), 535–546.

7. Blunt, D. (2014) Drug Misuse: Findings from the 2013/14 Crime Survey for England and Wales. Home Office Statistics. Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/335989/drug_misuse_201314.pdf [Accessed 9 Mar 2017]

8. YouGov Poll of 500 16-24 year old males, as quoted in The Guardian & Health Insurance & Protection Daily. Available at: https://www.theguardian.com/society/2017/mar/01/quarter-of-young-men-self-harm-cope-depression-poll./ and https://www.healthinsurancedaily.com/health-insurance/product-area/occupational-health/article482104.ece [Accessed 9 Mar 2017]

9. World Health Organization (2014) Preventing suicide: a global imperative. World Health Organization, Geneva

10. DL, B., & KR, G. (2003). Connecting the adolescent male with health care. Adolescent Medicine: State of the Art Reviews, 14(3), 555–564

11. Jané-Llopis, E. (2002). What makes the ounce of prevention effective? A meta-analysis of mental health promotion and mental disorder prevention programmes. Nijmegen: Radboud University Nijmegen.

12. Jané-Llopis, E., Barry, M.M., Hosman, C. & Patel, V. (2005) Mental health promotion works: A review. In: E. Jané-Llopis, M.M. Barry, C. Hosman and V. Patel. (Eds.) The Evidence of Mental Health Promotion Effectiveness: Strategies for Action IUHPE Special Issue, Supplement 2, 2005, 9–25.

13. Gansle, K. (2005). The effectiveness of school-based anger interventions and programs: A meta- analysis. Journal of School Psychology, 43, 321–341.

14. Kraag, G., Zeegers, M. Hosman, C. & Abusaad, H. (2006). School programs targeting stress management in children and adolescents: A meta-analysis. Journal of School Psychology, 44 (6), 449–472.

15. Suhrcke, M., Pillas, D. & Selai, C. (2007). Economic aspects of mental health in children and adolescents. In: WHO. Social cohesion for mental well-being among adolescents. WHO/HBSC Forum 2007. 43–64

Adam Phillips is a Researcher on Polygeia Oxford’s Mental Health Team, and a former researcher at the Weatherall Institute of Molecular Medicine, where he specialised in induced pluripotent stem-cell neuronal modelling. This blog post forms part of a larger project looking at mental health outcomes amongst different populations within the UK.

Oxford Mental Health Team

Researchers: Arup Nath, Margot Overman, Adam Phillips, Joseph Williams

Editor: Jeffrey Martin