Mental health

Compiled by Men’s Health Forum, March 2013

While women are more likely to be diagnosed with common mental disorders, there are important indicators of widespread mental distress in men.

The prevalence of psychotic illness is believed to be low, around 0.4% in the population as a whole, and is roughly equally distributed between men and women (Reference: K. Saddler and P. Bebbington (2009), ‘Psychosis’, in Adult Psychiatric Morbidity Survey) (although the onset of some particular forms of psychosis seems to occur earlier in the lifespan in men (References: Journal of Psychiatry, D. Castle)

At any one time, one in five women (19.7%) and one in eight men (12.5%) (Reference: C. Deverill and M. King (2009), ‘Common mental disorders’, in Adult Psychiatric Morbidity Survey) are diagnosed with a common mental disorder (e.g. depression, anxiety, phobia, obsessive compulsive disorder and panic disorder).

There is considerable debate about the true level of common mental health disorders in men and whether larger numbers of men than women may be undiagnosed. The Men’s Health Forum has argued that the following might provide a better picture of the state of men’s mental health than the number of clinical diagnoses:

• Almost three quarters of people who kill themselves are men (Reference: National Statistics Quarterly). 
• 73% of adults who ‘go missing’ are men (Reference: University of York).
• 90% of rough sleepers are men (Reference: Department of the Environment, Transport and the Regions (1999), Rough sleeping, the government strategy).
• Men are three times more likely than women to become alcohol dependent (6% of men are alcohol dependent compared to 2% of women) (Reference: Department of Health).
• Men are more than twice as likely to use Class A drugs (4.8% compared to 2% of women) and 79% of drug-related deaths occur in men (Reference: Information Centre).
• Men make up 94% of the prison population (Reference: Ministry of Justice). 72% of male prisoners suffer from two or more mental disorders (Reference: Social Exclusion Unit).
• More than twice as many male psychiatric inpatients are detained and treated compulsorily (Reference: Information Centre).
• Men have measurably lower access to the social support of friends, relatives and community (References: R. Boreham and D. Pevalin).
• Men commit 87% of violent crime (and are twice as likely to be victims of violent crime) (References: Home Office).
• Over 80% of children permanently excluded from school are boys (Reference: Department for Children, Schools and Families, Assembly for Wales and the Scottish Executive (2008), cited at The Poverty Site. Joseph Rowntree Foundation; 2008).
• Boys are performing less well than girls at all levels of education. For example in 2008 only 60.9 per cent of boys achieved 5 or more grade A*-C GCSEs compared to 69.9 per cent of girls (see Department for Education).

The MHF suggests that these statistics indicate that male emotional and psychological distress may sometimes emerge in ways that do not fit comfortably within conventional approaches to diagnosis. They also show that men may be more likely to lack some of the known precursors of good mental health, such as a positive engagement with education or the emotional support of friends and family.

A picture begins to emerge of a potentially sizeable group of men who cope less well than they might. These men may fail to recognise or act on warning signs, and may be unable or unwilling to seek help from support services. At the further end of the spectrum they may rely on unwise, unsustainable self-management strategies that are damaging not only to themselves but also to those around them. Such a picture would broadly parallel what is already known about men’s poorer physical health.

Although personality disorders are not generally considered to be a form of mental illness in themselves, they can be highly disabling and men are believed to be more likely to suffer from them (5.4% of men compared to 3.4% of women) (Reference: Rethink Personality disorders factsheet). 

People with personality disorders are more likely than the general population to come into contact with mental health services (Reference: S. Ullrich) are known to be at increased risk of substance misuse, anti-social behaviour and suicide (References: Foresight, Rethink. Personality disorders factsheet).

Suicide

Although suicide is not one of the main causes of death in men overall, it is the single most common cause of death in men under 35 (References: Department of Health).

In 2011 there were 6,045 suicides in the UK. Of the total number of suicides, 4,552 were males and 1,493 were females. The age-standardised suicide rates in 2011 were 18.2 and 5.6 deaths per 100,000 population for males and females respectively. Suicides rates have been consistently lower in females than in males over the past three decades (Reference: ONS).

The suicide rate was highest in middle-aged men (those in the 30 to 44-year-old and 45 to 59-year old age groups). In particular, the suicide rate in males aged 45 to 59 has increased significantly in the last five years to 22.2 deaths per 100,000 population (Reference: ONS).

Male suicide rates increased in the 1980s, and peaked at 21.9 deaths per 100,000 population in 1988. Suicide rates tended to decrease between 1988 and 2010, though there were some annual rises (for example, higher rates were seen in 1998 and 1999). The rate increased significantly between 2010 and 2011 (from 17.0 to 18.2 deaths per 100,000 population) resulting in the highest male suicide rate since 2002 (Reference: ONS).