Men’s Mental Health: BeyondVictim-Blaming
Investigating the impact of gender on mental health is anenduring tradition in psychiatric research. Much of this hasfocused on women’s mental health, examining the socialexposures that influence the onset and course of mental dis-orders with a high prevalence in women. This includes clas-sic work exploring the role of chronic and acute stress in theaetiology of depression in women1,2and research on therelationship between media consumption and eatingdisorders.3,4In contrast, a definable field of men’s mental health hasonly emerged in the last decade, and even then, this has beena quiet emergence.5,6This developing field is based on epi-demiological findings that men experience much higherrates of certain mental health outcomes in comparison towomen. For example, research consistently shows than menmake up around 75%to 80%of all completed suicides inCanada and other western countries.7,8Likewise, rates ofsubstance use disorder are significantly elevated in men,with around 3 out of 4 cases being male.9Moreover, menstill tend to under-utilize mental health services, with figuresindicating that only around 30%of people who use mentalhealth services are men.10All this is instantiated in recent years through examina-tion of statistics related to Canada’s ongoing fentanyl crisis.Statistics released by the B.C Coroner’s office indicate thatover 80%of deaths in this crisis are male, mirroring statisticsin other jurisdictions.11This has led researchers, commenta-tors, and journalists to describe men’s mental health issues(and male suicide in particular) in ominous terminology: a‘silent epidemic’,12a ‘quiet catastrophe’,13‘a gender gapthat is a matter of life and death’14and ‘an invisible crisis’.15Given this situation, this in review series attempts to amplifythe discussion about men’s mental health, illuminating con-cepts and underlying issues.The 2 papers that make up this in review series advancethe literature on men’s mental health. The first paper, byAffleck et al., investigates the social determinants of men’smental health, and implications for mental health services
The second paper, by Bilsker et al., outlines critical issues inmen’s mental health, examining clinical interventions andpopulation-health initiatives to tackle underlying issues.Although each paper touches on unique concerns, it is inter-esting to note that both papers 1) adopt a public-healthapproach to the underlying issues, moving beyond the com-montendencyto‘victim-blame’menwhohavementalhealth issues; 2) emphasize the importance of documentingand addressing the oft-ignored social determinants of men’smental health; and 3) encourage critical reflection on theconfiguration and nature of mental health services vis-a`-vismen’s mental health.
Men and Mental Health Services:A Critical Analysis
Much research indicates that men under-utilize mentalhealth services for various reasons.31-33In a recent editorialfor the Canadian Family Physician, prominent men’smental health researchers at the University of BritishColumbia argue that this may be because ‘a lot of guyshave the perception that current mental health services aresetupmainlytoservewomen’.34This idea has been takenfurther by British researchers in a commentary entitled,‘Are mental health services inherently feminised?’.35These and other authors argue that a clinical focus on talk,emotional vulnerability, and face-to-face self-disclosuremay be alienating for many men.Indeed, some research indicates that men may prefer ahealing environment that involves ‘shoulder-to-shoulder’,action-oriented tasks outside of a formal clinic, rather than‘face-to-face’, talk-focused therapy in a formal healthclinic.36,37Both papers in this in review series grapple withthese critiques, engaging in critical discussion on the config-uration and nature of mental health services vis-a`-vis men’smental health needs.The paper by Bilsker et al. in particular examines reasonsfor low rates of mental health service utilization in men,discussing male-specific mental health programs. Bothpapers argue that there are different modalities of healingin the face of mental health issues, and that gender may playa role in determining individual preferences. Both papersargue against a deficit-based approach that focuses on ‘stub-bornness’ or a tendency to ‘bottle-up’. These recommenda-tions are consistent with other recent reports on men’shealth; for example, a prominent British charity recommendsthat ‘practice needs to move from “blaming men for notbeing like women”‘.38Instead, the authors argue for more choice within themental health system, so that it becomes more male-friendly and responsive to men’s specific needs. This mayinvolve creating (and consolidating) different modalities ofhealing that build on men’s strengths. This strengths-basedapproach is embodied in new interventions, such as ‘men’ssheds’, which are well-described by Bilsker et al. Initialevaluations show that men’s sheds may improve outcomesbut there is a need for more controlled research on theseinnovative interventions.
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