In light of the increasing influence of toxic ‘masculinity influencers’ and a rise in male suicide rates, how can GPs better identify and support men at risk of experiencing poor mental health?
By Suzanne Harrison
In 2018 friends Leighton Bradfield and Lockie O’Donoghue lost two mates to suicide. Prior to this, Leighton had gone through his own battles with depression when he was at school and university.
“I didn’t even know it was depression. I didn’t know what to do, where to go. All of my friends were suffering,” says Perth-based Leighton, now 27 and co-founder of 20Talk, a preventative mental health organisation.
“Then we lost our friends, the second one having been at the funeral of the first. Lockie and I got together around a fire and we said, ‘We can’t let this happen again’. I have a saying of, ‘If not us, then who?’.
“The problem then came from who we could speak with. At that point in time, we didn’t know what we were doing. We just knew something needed to change.”
At the age of 20, he and Lockie – recognising what they saw as a lack of relatable, preventative mental health support for young people – founded 20Talk.
Their flagship free one-day course called Mental Health Maintenance is offered at universities, TAFEs and to the public in WA. It’s based on Dr Bill Hettler’s Six Dimensions of Wellbeing.
GPs are also encouraged to recommend 20Talk to young people who they feel may benefit from mental health support.
GPs can refer patients directly to 20Talk’s website or encourage them to engage with the charity’s social media channels on Instagram and TikTok.
The charity has also worked with mental health campaigner and founder of The Cloud GP, Dr Shiromi, to develop resources for patients on preparing for their first GP visit.
Startling stats
Leighton and Lockie’s determination to make change is desperately needed. The current state of men’s mental health is dire not only in Australia, but around the world.
In 2023, the Australian Bureau of Statistics reported that more than three-quarters (75.3%) of people who died by suicide were male, a statistic made starker after the deaths of twins Adam – a former West Coast Eagles footballer – and Troy Selwood to suicide this year.
According to Beyond Blue, death from suicide amongst men is nearly double the national road toll, with 43% experiencing anxiety or depression at some stage in their lives and 26% admitting to delaying seeing their GP for help when they needed it.
Increasingly intertwined within this issue is the rising power of social media influencers and the so-called ‘manosphere’, a concept explored in the recent explosive TV show Adolescence, in which a young boy is accused of murder after being influenced by online ‘incel’ culture.
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What once was a fringe community is reportedly now becoming mainstream. At the apex of this are digital male influencers, such as controversial Andrew Tate and Jordan Peterson, among a multitude of others globally.
Recently, The Movember Institute of Men’s Health in Australia released a groundbreaking new study, Young Men’s Health in a Digital World. It found that popular so-called ‘masculinity influencers’ are captivating millions of young men across YouTube, TikTok, and Instagram, offering them advice on everything from self-improvement and fitness to relationships, finances, and career success.
The first-of-its-kind report gathered insights from more than 3000 young men aged 16-25 across Australia, the United Kingdom and the United States.
It explored why young men are turning to these online figures and what they think about the content they consume.
“While many young Australian men turn to these figures for motivation and inspiration, a groundbreaking new study reveals that the long-term effects of this online influence may be far more complex,” the charity said in a statement.
One major finding is particularly worrisome – young men watching these influencers regularly reported significantly higher levels of worthlessness, nervousness and sadness.
They were also less likely to prioritise their mental health (45%) compared with young men who did not actively engage with these influencers (55%).
And they were significantly more likely to use performance-enhancing or body modifying substances including steroids, nootropics or supplements, and diet pills.
Specifically, 23% had taken or considered taking steroids, 22% had used or were considering testosterone injections, and 24% had taken or were contemplating diet pills.
A 23-year-old male interviewed by Medical Forum said: “While most men in that 18-30 bracket are smart enough to dismiss these influencer types as brain-dead fools, many are still subconsciously affected.
“A quiet voice of insecurity can form in their minds. Worse, the glorification of performance-enhancing drugs continues to spread the fitness epidemic. Young men take substances that temporarily enhance their physiques but eventually suffer the long-term mental and physical consequences of steroid use.”
Unchartered territory
It was no doubt timely that during International Men’s Mental Health Week in June the central theme was ‘See your GP’.
No one wants to send that message more than Dr Lloyd Evans, a Perth-based GP and the founder of MAN Health, which focuses on men’s health and wellbeing.
Dr Evans said he has seen an increase in men’s mental health cases and believes the drivers are loneliness, financial pressures, and social media.
“From a GP perspective, I’m seeing more men present with mental health symptoms, and in one way maybe that’s a positive,” Dr Evans said.
“Is it that men’s mental health is getting worse or is it that we’re encouraging more men to seek help? It’s a bit of both probably.”
Dr Evans is aware of the influx of social media that young men in particular are being exposed to, especially teens.
“They’re seeing so much of that perfectionist approach to life and I wonder if many are feeling that they can’t live up to that.”
He believes that it’s the years after a young man leaves school, around 18-25, that they are particularly susceptible.
“At school, you have an identity,” he said. “There are teachers, sport and a routine you’re familiar with, you’re part of that camaraderie.
“And then after school, there’s this new place, a big open world and they have to find themselves. They’re at risk, trying to find their place, and they can get information that is maybe toxic or takes them on that path.
“They’re bombarded with information, then algorithms come in and that narrows it down to say three or four influencers, and they may not be the right ones.”
To that end, Dr Evans has taken steps to be a positive influencer, creating a podcast titled In My World. It is the antithesis of the manosphere approach, with subjects such as ‘Men need to feel safe to talk’ and ‘Learning to be honest’.
Dr Stephen Adams, a semi-retired GP formerly with West End Medical and Integrated Sexual Health in Fremantle, said the increasingly complex situation for men now was unprecedented.
“I’ve worked in the field of men’s health for many years now, and there have been different crises or problems over the years. But this one I think is quite unique,” Dr Adams said.
He said that toxic social media content, the advent of the #MeToo movement, COVID-19 limiting people’s social and academic interactions and the rise of the ‘manosphere’ – where some men seek to reclaim traditional masculine roles – have all combined to create a perfect storm for men young and old.
“Young men are described as ‘lost’, dealing with biological drives, confusing societal expectations and inconsistent role models,” says Dr Adams.
How GPs can help
When it comes to the role of GPs and men’s mental health, it is fundamental.
“GPs are vital in identifying and supporting mental health issues among young men but system barriers still exist, including bureaucracy around the ability for more direct referrals by a wider group of professionals,” Dr Adams said.
Healthcare providers generally “should be encouraged to initiate open, empathetic conversations with men about mental health at every opportunity”.
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For example, Dr Adams said, healthcare providers – and not just GPs – should be able to refer people to mental health services.
“It could come from a social worker, a school nurse or a counsellor. The mental health plan is there as a barrier to over-servicing, but instead it ends up adding to the whole problem with unnecessary bureaucracy.”
In Dr Adams experience, anxiety and depression remain the most common diagnosis, often presenting through physical symptoms like panic attacks, erectile dysfunction and unexplained tiredness, rather than clear declarations of mental distress.
He also stresses the importance of communication when it comes to the role of GPs, with more welcoming and easier access to care also needed.
“It’s important that we have systems in place. GPs need to instil trust and an environment that men are comfortable to walk into, maybe with more flexible hours and even weekends, or video consults.
“I worry that there’s young men who don’t even know how to book a GP, or the name of their local practice. They don’t build that trust with their doctor.
“We need to make GP practices more welcoming for men. They see their mechanic regularly, but not a GP.”
As for mental health specifically, Dr Evans is a great believer in the close relationship between physical and mental health. That is, looking at the whole man – is he getting enough sleep, is he eating well?
“I can’t emphasise enough how much that impacts mental health. There are more complex conditions that can’t be dealt with by eating better or sleeping more, but good physical health can really help with good mental health,” he said.
By creating a safe space for men without judgement and asking the right questions, GPs can then better delve in and ask about relationships, drugs and pressures.
“In my day-to-day life as a GP, I see so many guys with issues that need to be discussed but they book 10 minutes and they want a quick fix. I can tell they need more,” Dr Evans adds.
“We need to offer follow-up appointments and go out of our way to recognise that this guy needs to talk about it. It’s about the whole man.”
Male mentors needed
For Leighton Bradfield, co-founder of mental health charity 20Talk, the rise of social media ‘masculinity influencers’ and their impact on young men is the result of a lack of relatable mentors for younger people.
“I feel that a lot of men have felt pushed away by third wave feminism, in that they feel they’ve been targeted, and that’s why these Andrew Tate figures have come to light, and that’s been quite destructive,” he tells Medical Forum.
“We’re seeing that a lot of men don’t really have mentors or community anymore to give them direction. They feel victimised, they’re given a direction by influencers – which is not the right direction – and that’s why it’s amplifying.”
Leighton believes that lack of mentorship stems from men being put in the “bad box”, even good men, so they feel discouraged from standing up and tackling the narrative of poor role models.
He believes many middle-aged men in his community don’t want to stand up, for fear of being criticised.
“They feel their voice doesn’t mean anything anymore, and then the destructive influencers step in and fill that void.”
Further funding
The good news is, change is afoot, and there are some wonderful charities and initiatives, such as Movember, Lifeline, ManUp WA and Menshed, that are dedicated to supporting men’s mental health.
During Men’s Health Week, Movember launched Men in Mind, a workforce training program for healthcare practitioners to transform the way that men experience mental health care.
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According to the charity, Men in Mind helps practitioners better grasp the complexities of men’s health and masculinity to deliver care that engages, motivates and connects with male clients.
Movember – among other groups – has also lobbied governments for increased funding to support and promote men’s mental health initiatives.
In April, the Federal Government made a $1 billion mental health commitment, which includes:
- $225 million for 31 new and upgraded Medicare Mental Health Centres
- More than $200 million for 58 new, upgraded or expanded headspace services
- $500 million for 20 Youth Specialist Care Centres for young people with complex needs
- $90 million for more than 1200 training places for mental health professionals and peer workers.
However, specific funding packages targeting men’s mental health were lacking.
Prevention is key
For Leighton and Lockie’s organisation, it’s all about prevention.
“To give you some context, only 2% of government funding goes into preventative mental health. So, our whole thing is how do we connect this existing, evidence-based education to young people in a way that they actually want to learn about and understand?” Leighton said.
20Talk is now expanding into the Eastern States, and its ‘20 Hours for 20Talk’ challenge, where participants raise a minimum of $1000, is a key fundraising component that Leighton said is “blowing up” in terms of signups.
A bit like the 40-hour famine concept, participants spend 20 hours in a two-by-two metre space with no talking or technology, symbolising the challenges of mental health and the need for support.
Such initiatives and programs can’t come soon enough. It was reported in June that more than one in three Australian men (35%) aged 18-65 years have used intimate partner violence in their lifetime, according to data from Ten to Men – the Australian Institute of Family Studies longitudinal study of boys and men.
Of those, men with moderate or severe depressive symptoms were 62% more likely to use intimate partner violence, compared to men without these symptoms.
There is no doubt that there is now more awareness and conversations when it comes to men’s mental health, but actioning that as a society is the next major step.
As Dr Adams concludes: “Everyone is talking about it and that is definitely a good thing, a good way to make change. People need to discuss it, and they’re now realising this is an issue.”
ED: More information on 20Talk can be found at www.20talk.com.au
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