Wednesday 19 November is International Men's Day - an annual day focused on men's health, positive male role models and improving gender relations. To mark the occasion, we're looking at the mental health issues and conditions that particularly affect men, and why there remains a stigma about men speaking out.
The crisis of men's mental health has particularly been in the spotlight recently, not least following the suicide earlier this year of celebrated actor Robin Williams. Statistics compiled by Men's Health Forum show that 75% of people who take their own lives are men, while 72% of people being treated for depression are women. In the UK, suicide is the most common cause of death in men under 35 years old; 77% of UK suicides are male, with a total of 12 men every day deciding to end their lives.
By contrast, the statistics suggest that women are actually more likely to attempt suicide, but often use methods such as drug overdoses, which are less frequently fatal, while men often choose more violent and fatal methods to end their lives.
The statistics are horrifying, and clearly there is a huge disconnect between people affected by mental health conditions and those being treated for them. But men are finally starting to have that all important conversation. Movember, the charity moustache-growing initiative, which takes place throughout November and typically raises funds and awareness for male cancers, has this year added men's mental health to the list of issues it hopes to highlight.
We asked three RSCPP therapists why it is that men are less likely to seek help and what can be done to tackle the ongoing taboo around men's mental health.
Registered Counsellor Keith Beckingham feels there are significant gender differences in the way men and women are expected to tackle difficult emotions: "It has been said that women talk face-to-face but men prefer to talk shoulder-to-shoulder and are more likely to talk to a friend whilst doing an activity together than having a 'heart-to-heart'," he explains.
"Older men may still see themselves as the hunter-gatherer who provides for the family, and over the years many men have felt defined by their job or profession. Today, young men in post-industrial communities may find it very hard to find a 'proper job' which is full time and permanent," he adds.
"Without a job, they find it impossible to be a provider and, even for many in work, house prices have escalated out of the reach of many. Combine this with student debt, and some young men have found themselves in a spiral of debt from which they see no escape."
Besides concerns about job insecurity and debt, Keith says many young men today feel unsure of their identities and what it means to be 'a man' in modern society: "In recent decades, feminism has achieved great things for women, and some would argue there is much still to be done. But some men have been left confused. What is their role now?"
Similarly, "in recent years the pressures on young women to look good have begun to apply to young men as well. If their physique, hair and fashion falls below the standards expected in a boy band, it may begin to affect their self-esteem," he adds.
Many boys have grown up without a stable male role model.
Combined with a lack of male role models, Keith says it's unsurprising that many men feel lost amidst the cultural shifts affecting people of both genders. "Many boys have grown up without a stable male role model, and even many primary schools have an all female staff," he says.
"As they reach their teens and early adulthood these boys, now young men, find themselves having to reinvent cultural norms instead of having positive examples to follow. In some cases this can draw them into a gang or lead them to imagine that what they see on their screens is the normal way to behave."
Not only are men confused about their place in the world, research by mental health charities such as Mind suggests that masculine socialisation causes men to "self-stigmatise", so that many are embarrassed to admit they have a problem or ask for help. Additionally, Mind suggests that, although 2.7 million English men are affected by depression, the symptoms may manifest differently than in women, making it harder for loved ones or health professionals to notice. Men are more likely to 'act out' their depression, through drug use, drinking and aggression, rather than crying, experiencing sleepless nights and feeling low - the symptoms more commonly associated with the condition.
So what can be done to tackle the issues many men are facing in silence? Accredited Counsellor Roslyn Byfield believes men's reluctance to seek help for mental health conditions is partly down to the lack of male-friendly services. "Stigma and socialisation of men are obviously key contributors," she says, "but several other factors emerged through research on eating disorder services. At least 10% of those presenting are now men, but many were put off by the treatment they received from their GP - scepticism, failure to notice and diagnose the problem - and discomfort with what they perceived as services aimed at women."
She explains: "This included waiting rooms decorated in pink, women's magazines lying around and so on, which could convey a powerful message of 'this service isn't for you', regardless of what is started in leaflets." For her, rethinking services must go hand-in-hand with encouraging more men to admit there is something wrong and seek help. "A good example is taking services to where men are - the Men's Health Forum has pioneered the Men's MOT, which is publicised in places men go," she says. "It's a graduated approach, not requiring men to consciously decide to seek help in a medical setting."
A good example is taking services to where men are.
In a similar vein, the BBC last month reported on a new Premier League initiative to tackle mental health issues in the macho world of professional football. Every football club in the Premier League now has its own dedicated 'mental health first aider', specially trained to provide mental health support to the young men in the clubs' training academies.
Despite the need for more of these specialised services for men, Roslyn is confident that the stigma around mental health conditions amongst men is on the decline. "Although many more women than men visit their GPs and enter therapy for anxiety, depression and other mental health issues, numbers of men are rising and, fortunately, so is awareness," she says.
This view is shared by Accredited Counsellor Maureen Cahill, who says: "One of the changes that I have noticed in private practice is that there has been a steady increase in male clients. This may be an indication that men are at least starting to recognise that they might benefit from and then seek therapeutic support for whatever life issues or crises they are facing."
She adds: "I feel very positive about International Men's Day on November 19, as it highlights the need for men to acknowledge that they may need support and it's ok to seek it. For so many men, the pressures to be the provider and protector, to be strong, to not feel, can cause anxiety, addiction and, tragically, suicide. Hopefully seeking support is becoming less of a taboo and more about making good choices."