Unwanted and unhappy?

As Men's Health Week 2006 with the theme of men and mental well-being approaches, MHF policy officer David Wilkins reflects on how to improve the mental health of a group in society which many appear to consider redundant.

A few years ago, I was involved in a small research project looking at the behaviour and attitudes of adolescent girls. In one of the discussion groups, the girls turned their attention to the subject of adult relationships.

The consensus seemed to be that there was no longer much security to be expected within the traditional family structure. It seemed that though most of the girls looked forward to having children, they did not anticipate that those children would necessarily be raised in a lifelong relationship with a male partner. As one girl was heard to be saying: 'you can have a child without a man now, so…'

This story serves neatly to illustrate one of the most favoured theories about the increase in self-damaging male behaviour that has so troubled the western world in recent years. At its most basic, this theory holds that a combination of the decline in "men's work", the increase in women's political and economic power, and the changes in our understanding of what constitutes a family have left the traditional "bloke" facing "redundancy". These changes, it is argued, have sufficiently undermined men's sense of their role and purpose that some individual men are inevitably left feeling insecure, troubled and hopeless — especially at times of personal crisis.

It is further suggested that those aspects of a man's traditional view of himself to which he clings — that he is strong, capable, self reliant and so on — are ironically, his greatest enemy.

Unlike a woman in emotional distress, a man may find it extremely difficult to seek help from friends, family, or even from professional helpers because to do so would be to abandon his remaining sense of masculinity.

These societal changes are undoubtedly real, and they broadly coincide with the increase in suicide among young men that began markedly — at least in the UK - in the 1960s. It is further suggested by some observers that some "accidental" deaths among this group may occur in situations where a young man has taken such significant risks with his life that it could be hypothesised that he did not care whether he survived or died.

In recent years I have spent many hours in discussion with health professionals about this issue. What emerges is an enormous wellspring of concern and no shortage of professional experience from which we could learn. There is however, little sense that we have yet got to grips with what actually to do. We know, by and large, what factors increase a young man's likelihood of taking his own life - for example: having experienced family breakdown, having a history of substance misuse - but of course, the great majority of young men who have these risk factors do not attempt to harm themselves.

If we believe that we can change the way men respond and behave at times of personal crisis, then it is self-evident that we need to start with boys. If we chose to prioritise the emotional health of boys and men, then there is much that could be done. Schools, for example, might be invited to encourage the development of coping skills as part of boys' education, or health professionals working with families might be asked to discuss with parents the importance of allowing and encouraging their boys to express emotion.

Support for fathers too, might be of great importance since some studies have shown that in homes where fathers are emotionally expressive, then their sons are likely to be so too.

Professionals who work in settings where they have regular contact with adolescent boys may be in a position to concentrate support for those who are on the verge of manhood and who are wrestling with the question of how far to shut down their emotional responses in order to accommodate a "grown-up" male world view.

Government policy might prioritise the support of family relationships since marriage is known to be protective of men; divorced men, for example, have an increased suicide risk of up to five times that of married men and stable two-parent families are known to be protective of boys in terms of many of the risk factors.

The question of service provision is rather more vexed. It is arguable that many existing health services are poor at providing for men in a way that is amenable to men; why, for example, are men so much less likely than women to visit GP surgeries (only half as often among those aged under forty)? Those men who are at greatest risk of suicide in terms of the risk factors, are amongst those least likely to present themselves for help and (we might hypothesise) amongst those least likely to receive a good service when they do.

It is predicted by the World Health Organisation that, by 2020, depression will be the second leading cause of illness and disease in the developed world.

Throughout the developed world however — and paradoxically so, when one considers the facts about suicide - men are far less likely than women to be diagnosed as suffering from depression. Several speakers at the World Congress on Men's Health in 2003 addressed this difficult question by speculating that the diagnostic criteria for depression may effectively discriminate against men in two ways.

This is first because there may be a specifically male set of symptoms which are under-recognised. These symptoms differ from the established symptomatology for depression and are characterised by abusive, anti-social behaviour of various kinds. Secondly because the very nature of those symptoms may act to minimise the contact time between the male patient and the health professional (angry or threatening patients do not bring out the best in health professionals).

It would be difficult, without a major shift in definitions, protocols and practice, to do anything about this but at a local level, health professionals who know the patient may be in the strongest position to recognise these symptoms (perhaps, in some cases, by hearing them reported by another family member). A timely offer of support, advice and treatment might help reach some men whose distress would otherwise go unrecognised.

Failing to recognise and treat depression is of course just one example — albeit an important one — of the way in which present service provision may be letting down some of those men — especially younger men — who are at greatest risk of unresolved emotional distress and perhaps, of taking their own lives. Another valuable piece of work might be to help male patients look at their use of alcohol. There is a strong general association between alcohol misuse and suicide, and alcohol intake is known to be a factor in many completed suicides — and indeed, in accidental deaths resulting from reckless behaviour of all kinds. Indeed, any initiative of any kind (i.e. whether it is in the field of mental health or not) that encourages men to feel comfortable in engaging with health services might, in the long run, pay a dividend for an individual man who needs support in an emotional crisis.

• A slightly longer version of this article first appeared on the European Men's Health Forum website.
• Click here to register for Men's Health Week 2006 - men and mental well-being.