Promoting Men's Mental Health

David Conrad, Alan White

• Publisher: CRC Press
• Year: 2018
• ISBN:
  9781315357690
• Edition: 1
• Topic: Medicina
• Subtopic: Teoría, práctica y referencia médicas

A welcome and important contribution to a thankfully growing debate. Mental illness remains in some ways the last great taboo in our society, a taboo which leads directly to stigma and discrimination which for some can be even worse than the symptoms of their illness. This book in part is about encouraging men who have reached crisis point to seek help. Equally it's about prevention, and sets out some of the excellent work being done on that. I hope it can inspire practitioners and policy makers to initiate similar interventions, develop new ones and lift the promotion of men's mental health much higher up the agenda, both in the UK and abroad.A" - From the Foreword by Alastair Campbell Men - in all their diverse groups, settings, lifestyles and stages of life - can face considerable challenges to their mental wellbeing from specific cultural and societal factors, causing difficulties for themselves and those who live and work with them. In addition, these men may respond better to certain approaches and treatment. Promoting Men's Mental Health outlines the breadth of the challenges and provides guidance for those working in primary care on targeting and helping men who need support. Good mental health is more than the absence of mental illness, and this book therefore highlights methods to promote positive mental health by increasing psychological wellbeing, competency and coping skills, and by creating supportive living and working environments The book highlights examples of best practice throughout the UK, Europe and America, and will be essential reading for primary care and mental health professionals, and all those with an interest in men's mental health. 'We need to be more innovative in the way we try to reach men. This book will help stimulate further discussion and hopefully encourage men to seek help or support.' From the Foreword by Louis Appleby

CHAPTER 1

Introduction

Alan White

Go along to any sporting event and you’ll find no shortage of men giving vivid displays of their current mental state! But in other settings we see a very different picture – we see boys having difficulty sharing their grief over bereavement, we see sadness erupting as anger, or unexpected suicide in men who were found to have hidden depths of despair. This book seeks to unravel the complexities of men’s mental health and offer practical guidance on how services can be developed that can reach out to men at the most vulnerable times of their lives.

Though the book is aimed specifically at practitioners, its message also needs to be heard by those setting health policy and strategy, as we have to see a shift in the way that health services are provided for men with emotional and mental health problems – something that cannot happen without their support. We also hope that this book is not just of interest to those working in the health and social care sector. Men themselves have to become more aware of their mental and emotional health needs and so do their families and friends. It’s necessary for us to get the messages out to teachers and others who work with boys and men as well, such that they can, perhaps, interpret behaviour in a different light and offer support and guidance to those boys and men who are experiencing difficulties.

The World Health Organization (WHO) has a broad definition of mental health, describing it as a state of well-being in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to his or her community (WHO 2002). This definition neatly reflects the range of issues that make up mental health, but can also be broken down further into more specific elements. In 1997, the ‘Key Concepts’ project (EC 2004) was set up by the European Commission to look at how mental health is conceptualised and concluded that mental health is best considered as including positive (mental well-being) and negative (mental ill-health) elements. Positive mental health, or mental well-being, is not merely the absence of mental ill-health but the ability to cope with adversity. Negative mental health, or mental ill-health, can be further divided into psychological distress and psychiatric disorders. Psychological distress is a continuum of mental health difficulties often associated with common negative and stressful life events that would not meet the diagnostic criteria for discrete psychiatric disorders. As such, psychiatric disorders are not necessarily worse than psychological distress but they may be chronic, whereas distress may be transient.

Whichever way you look at it, it’s apparent that the mental health of the population is increasingly being recognised as one of the most important areas of public health.

WHO have estimated that unipolar depression will be the second most significant contributor to the global burden of disease by 2030 (Mathers and Loncar 2006). The case for the new European Pact on Mental Health and Well-being is in part based on the recognition that mental disorders are on the rise in the EU, with almost 50 million citizens (about 11% of the population) estimated to experience mental disorders and depression – the most prevalent health problem in many EU-Member States (EC 2008). In the UK, one in four people suffer some form of mental illness at some point in their lives and at any one time one sixth of the population are suffering from a common mental health problem (DH 2009).

The high cost of mental health problems can be seen not only in the misery of the disrupted lives of those affected on a day-by-day basis, but also starkly through the mortality data. The inability to deal with problematic emotions is seen as a major contributing factor in the continued high numbers of suicides, with 2481 men (and 684 women) dying from intentional self-harm in England and Wales in 2007, the majority of these deaths occurring in middle-aged men (ONS 2008). If the deaths that are categorised as ‘event of undetermined cause’, which are often seen as unproven suicides, are included (men with 827 deaths and women with 333 deaths recorded) then some 3304 male deaths have as a core an emotional cause. This is not just a problem in the UK; across the world men’s suicide levels are extremely high, such as in Lithuania where the suicide rate is over 10 times higher than that for women in the 35–44 age range (White and Holmes 2006).

The problems of mental health go well beyond the mortality data. The Sainsbury Centre for Mental Health (2007) has estimated that in the UK alone mental health problems account for:

➤ £8.4 billion a year in sickness absence. The average employee takes seven days off sick each year, of which 40% are for mental health problems. This adds up to 70 million lost working days a year, including one in seven directly caused by a person’s work or working conditions.

➤ £15.1 billion a year in reduced productivity at work. ‘Presenteeism’ accounts for 1.5 times as much working time lost as absenteeism and costs more to employers because it is more common among higher-paid staff.

➤ £2.4 billon a year in replacing staff who leave their jobs because of mental ill-health.

A recent Kings Fund report on the cost of mental health care in England to 2026 (McCrone et al. 2008) forecasts that the combined cost of lost productivity due to mental health problems and the direct cost of health and social care will double in real terms.

MEN AND MENTAL HEALTH

It has been suggested that the way that men present with mental or emotional difficulties is different from women and that this also causes problems in the effective diagnosis of the problem and referral on for effective treatment (Brownhill et al. 2005, White 2006). This was recognised within the European Mental Health report, where it is noted that whilst women have higher levels of depression and anxiety (or internalising disorders) men have higher levels of substance abuse and antisocial disorders (or externalising disorders) (EC 2004) which can be detrimental for men, their friends and family, and their community (Stewart and Harmon 2004, Kupers 2005, Winkler et al. 2006).

In England and Wales, for the category of deaths ‘Mental and Behavioural causes’ (ONS 2008) there were 5390 male and 11 192 female deaths recorded in 2007, but if you break these down by age you find that in the 15–64 (working) age range there are 1034 male deaths, compared to 331 female deaths (a ratio of 3:1). These deaths do not include suicide and in this younger age group are predominately made up of accidental deaths due to psychoactive substance use (alcohol, opioids and dependence). It is also salutary to note that a recent large-scale study from Denmark (Nielsen et al. 2008) has shown that chronic long-term stress can affect life expectancy, the effects being most pronounced amongst younger and healthier men.

In 2001, White (2001) undertook Scoping Study on Men’s Health for the then Minister for Public Health. Four key areas emerged as the most relevant in understanding men’s health problems: men’s access to health services; men’s lack of awareness of their health needs; men’s seeming inability to express emotions; and men’s lack of social networks. All of these were interlinked in terms of how men have been socialised to manage their health and well-being, but they also reflect a society that has not given sufficient attention to targeting men, either through services that reflect their needs or through the enablement of men to manage their health more effectively. As Micale (2008) notes, it is often the case that men’s emotional problems are explained away rather than being seen as the cry for help they often are. As we come to recognise the complex pathways men take to get help for their emotional and mental health difficulties, we need to be able to identify ways in which public health interventions can be made more accessible (Möller-Leimkühler 2002; Brownhill et al. 2002; Brownhill et al. 2005; Emslie et al. 2006; White 2006; Payne 2008).

In 2006, the Men’s Health Forum focused their National Men’s Health Week on men’s mental health. In their accompanying policy document ‘Mind Your Head’ (Wilkins 2006) and through the collaboration of over 41 organisations for the development of the ‘Brain Manual’ (Banks 2006) there was the first national recognition of the state of men’s problems with their emotional and mental health. More recently a principal mental health charity, Mind, focused their 2009 mental health week onto ‘Men and Mental Health’, accompanied by their report ‘Get It Off Your Chest’ (Mind 2009). Both these campaigns have called for a more proactive approach to reaching out to men.

POLICY DEVELOPMENTS

The wish to see a broader approach to men’s mental health has come at a good time with regard to health policy developments, both in the UK and across the globe. In the UK there have been significant changes to the way healthcare is being viewed, one of the main catalysts being the publication of Lord Darzi’s ‘High Quality Care For All’ report (DH 2008), which advocates that comprehensive well-being and prevention services should be commissioned to meet the specific needs of local populations, with family doctors being encouraged to help individuals and their families stay healthy. The report also notes the benefits to general well-being from stronger mental health promotion.

In the UK, the National Service Framework for Mental Health (DH 1999) has been the main guide for how services should be configured. It is now being replaced by the ‘New Horizons’ strategy,^* which aims to promote good mental health and well-being whilst also improving the services for people who have mental health problems. Its ten-year goal is to reduce the stigma associated with mental health and to promote a whole-population approach to the challenges posed by an increasingly stressed community. It is important that this new strategy coincides with the European Pact on Mental Health and Well-being, the focus of which is also on trying to reduce the burden of mental distress on the state, the individual and their families.

There is an added impetus for this text and that is to help guide those tasked with meeting the needs of the Equality Act of 2006, which has placed a gender equality duty on all those providing services that have to meet the needs of men and women. The basis of this duty is that the legal responsibility has moved to the provider to ensure that they have considered whether their population group has had their specific needs incorporated within the design and delivery of their provision. For men, with regard to their mental health, this must include an understanding of their differing presentation of mental health problems, their specific needs with regard to their help-seeking behaviour and the type of approach that would be most effective in reaching out to them.

Taking on a whole-population approach to mental health, as advocated within the UK Government’s ‘New Horizons’, requires us to look beyond mental illness into those aspects of our lives that affect our emotional stability. As these are many and varied, we need to be looking for a complex solution to what is obviously a complex problem. It requires us to understand how men manage their mental and emotional health if we wish to fully comprehend the genesis of the difficulties that they face. We then need to adopt a much broader strategy in tackling men’s mental health needs.

REFERENCES

Banks I (2006) Brain Manual: The Step-By-Step Guide for Men to Achieving and Maintaining Mental Well-Being. Sparkford: JH Haynes & Co Ltd.

Brownhill S and Wilhelm K (2002) Detecting depression in men: a matter of guesswork. Int J Men’s Health. 1(3): 259–280.

Brownhill S, Wilhelm K, Barclay L and Schmied V (2005) ‘Big build’: hidden depression in men. Aus and NZ J Psychiatry. 39: 921–931.

Department of Health (DH) (1999) National Service Framework for Mental Health. London: DH.

Department of Health (DH) (2008) High Quality Care for All. London: DH.

Department of Health (DH) (2009) A New Vision for Mental Health and Well-being. London: DH.

European Commission (EC) (2004) Action for Mental Health: activities co-funded from European Community Public Health Programmes 1997–2004. Available at: http://ec.europa.eu/health/ph_determinants/life_style/mental/docs/action_1997_2004_en.pdf (Accessed 1 May 2009).

European Commission (EC) (2008) European Pact for Mental Health and Well-being ‘Together for Mental Health and Well-being’, Brussels, 13 June 2008, Slovenia Presidency of the EU. Available at: http://ec.europa.eu/health/ph_determinants/life_style/mental/docs/pact_en.pdf (Accessed 1 May 2009).

Emslie C, Ridge D, Ziebland S and Hunt K (2006) Men’s accounts of depression: reconstructing or resisting hegemonic masculinity? Social Science & Medicine. 62: 2246–2257.

Kupers TA (2005) Toxic masculinity as a barrier to mental health treatment in prison. J Clin Psych. 61(6): 713–724.

Mathers CD and Loncar D (2006) Projections of Global Mortality and Burden of Disease from 2002 to 2030. PLoS Med 3(11): e442. doi...