Policy-makers must ask: will it make us happier?

Philosopher John Stuart Mill argued for the greatest happiness for the greatest number nearly 200 years ago. Is this a policy whose time has come? MHF policy officer David Wilkins argues in the Forum's Men's Health Week 2006 report Mind Your Head, that while women may have more formal diagnoses of mental health problems than men, that doesn't mean men are not struggling.

The physical health of men in the UK is poorer than the physical health of women. Mental health seems to be the reverse; women are markedly more likely to suffer from a mental disorder.

An examination of some of the broader indicators of mental distress however, suggests that many men who may have no formal diagnosis of a mental health problem may nevertheless, be struggling to cope. In other words, as the image on the right used to promote our Men's Health Week 2006 conference suggests, men really do need to 'Mind Your Head'.

For example, men are far more likely to become alcohol dependent, to misuse drugs and to go missing from home. Men are also far more likely to take their own lives.

There is a growing international interest in the idea that the conditions for greater happiness - or "mental well-being" - at both population and individual levels can be deliberately created. Some commentators have even argued that happiness, rather than economic growth, should be the driving objective of all government policy. This idea has not previously been examined in relation to gender. If we were to construct a society in which people had the maximum chance of feeling mentally well, would the necessary conditions vary between men and women? This report looks specifically at this question in relation to men.

Six aspects of life are considered. Five of these are recognised within the literature on mental well-being as being of particular significance. The sixth, "School" has been added to enable consideration of the issues relating to boys.

1. Family

"Socialisation" of boys within the family is an important factor in creating "traditional" male attitudes. It is believed that some such attitudes may be damaging to men's mental well-being. A strong father/son relationship increases the likelihood of a boy growing up to enjoy positive mental health. Stable, long term adult relationships are protective of men's mental health.

2. Financial circumstances

Having the financial wherewithal comfortably to meet the daily necessities of life is an important precursor of mental well-being. Money may be at its most important as a determinant of mental well-being when it functions as a marker of comparative status in relation to other people. The greater the gap between rich and poor in a developed society, the greater the chances of poorer mental and physical health in the population as a whole. All these principles probably apply to men and women equally.

3. Work

Experiencing satisfaction at work is an important predisposing factor for positive mental health in men. One of the reasons for this is the importance of "breadwinning" as a cultural indicator of the "male role". This situation can however, be a double-edged sword. Lack of job satisfaction; work-related stress; pressure to work long hours; and unemployment are all damaging to mental well-being and are more likely to affect men than women.

4. School

Boys 'especially boys from BME communities' are doing less well at school than girls. This is likely to hinder their chances of growing up to experience positive mental health. Young gay men are particularly vulnerable to bullying, which can have a direct and negative impact on their mental health.

5. Community and friends

The concept of "social capital" is an accepted means of considering people's sense of "connectedness" to each other and to wider society. There is an established correlation between low social capital and greater risk of mental health problems. Men almost never score better than women on measures of social capital - and on a number of specific indicators, they consistently score markedly less well.

6. Health

Even very serious physical illness or disability does not necessarily damage an individual's capacity for enjoying mental well-being - although chronic pain and mental illness are known to undermine mental well-being. Chronic pain is bad for the mental health of both sexes but it is probable that men cope with chronic pain less well than women. Men are less likely to be diagnosed with depression but a potential explanation for this is that depression is less easily recognised in men. Black men are much more likely to be diagnosed with a psychotic illness and to experience some of the most disagreeable aspects of treatment in psychiatric hospitals.

What can be done?

Mental well-being depends on a highly complex range of interacting factors, some of which are significant enough to be embedded in culture and tradition, others of which are small enough to be within the capacity of the individual to change. Many of these factors affect men and women differentially, and some are specific to men. Men's mental well-being as a whole is poorly understood and seriously under-valued. The aim of this report is to open a debate not to offer a short cut to the solutions. Nevertheless, we are confident in five recommendations: 

1. Public policy should aim to improve men's mental well-being.

Numerous examples exist of ways in which existing policies, statutory services and legislative sysems militate against the achievement by men of mental well-being. The question should be asked of current and planned policy in any field whether it acts directly to undermine men's mental well-being. If the answer is "yes", the policy should change.

2. There must be greater recognition of male-specific indicators of emotional distress.

There is increasing evidence that men are less likely to be diagnosed with depression because male-specific symptoms may not be taken into account. Wider indicators of unhappiness in men (heavy drinking, drug misuse, "challenging" behaviours of various sorts) may not be regarded as potential indicators of emotional distress at all and may not, in any event, elicit a sympathetic response.

3. Services must adapt to meet men's needs more effectively.

The issues are not easy to resolve, but men who "present" in the kinds of "non-traditional" circumstances highlighted above need to be helped to find services that address their emotional and pyschological needs.

4. Mental health promotion aimed at men and boys should take explicit account of "traditional" masculinity.

Men may seek "masculine" solutions to problems of emotional distress. Approaches to improving mental health that rely on messages perceived as "feminine" - for example, preparedness to "open up" or admitting to vulnerability - run the risk of failing to be effective with men.

5. A national initiative is needed to help men achieve mental well-being.

The issue that emerges most clearly is how little is really known about the most effective ways to help men achieve positive mental health. We must analyse what is currently known, disseminate good practice, develop new approaches and most importantly instigate a comprehensive pro-active strategy for the improvement and maintenance of positive mental health in men.

• This article was produced for Men's Health Week 2006.