Dr Simon Yam (PhD) shares lessons learnt from helping the mental health of men with diverse identities and backgrounds.
In the past 18 years of my professional life working with men, one thing that has consistently prevented them from accessing help is their inherent belief of what ‘being a man’ or ‘masculinity’ means.
This is a deeply embedded construct that stems from various facets of human life – gender definitions, social and cultural expectations, religious doctrines, peer influence and pressures.
As such, men are known to have greater vulnerability to various health disorders across their lifespan. They are more likely to experience serious health problems and have higher rates of substance misuse, suicide and mental health problems. Male suicide in Australia has reached tragically high levels, accounting for seven in nine suicides every day, and men are more likely to engage in risk-taking behaviour.
I have worked with men who struggle with sexual and gender identities, who misuse alcohol and drugs, and who do not have the tools to address issues with their sexual health, mental health and suicidal ideation. Men in general are conditioned by societal expectation of hegemonic masculinity, and fears being judged or ridiculed for being weak if they access help or support services.
During my years of providing peer outreach, sexual health, drug awareness education and mental health support to men who identify as gay, bisexual, or just ‘a straight fella who has sex with other men’, I have realised that social, cultural, economic or religious self-identities can affect the willingness of men to seek support services, including diagnosis and treatment for medical conditions.
When it comes to a targeted cohort such as gay men, setting up gay-friendly sexual health clinics is a good step forward, as the peer-based setting allows for a common ground for these men to identify within a non-judgmental space, and to take a step closer to understanding the importance of addressing their personal sexual health.
However, as we move along the sexual identity continuum, bisexual men, straight-identifying men who have sex with men, and straight men find it more challenging to access services.
This is not about whether the services are available. This is about fear and disclosure for these men – fear of being ‘outed’, being judged, and being positively diagnosed of a disease. In fact, these aspects of fear stems from the overall fear of vulnerability which may compromise, threaten and devalue their perceived masculinity.
This fear is consistent across my work with men in the mental health space. I have experienced the levels of resistance from my clients to seek professional help.
What works within a life coaching setting is the informality, the peer-connection between the client and the professional, and the process-driven approach – like the process of fixing a car. There are no endless chats based on intangible concepts. It must be easy, clear and results-focused.
However, when I advise some of them to access help from their GP for a Mental Health Treatment Plan, there is often a level of unwillingness due to their fear of being seen as weak. An Asian client expressed that it would bring a level of shame to his family if they ever found out he was seeing a psychologist. In this instance, the mental trauma of ‘coming out’ as an Asian man with mental illness exacerbated the triggers that were already present.
It is essential that health service providers are continually upskilled in three areas: understanding the barriers to men seeking help; making services more male-friendly; and recognising the layers of complexity when it comes to identities for men.
Understanding the resistance that usually accompany male patients’ visits to the GP is a first step in applying motivational interviewing to get a deeper level of information. Refrain from asking ‘why’ questions, as this often makes them feel judged, and obliged to justify their actions.
For example, when a guy finds the courage to see his GP regarding his depressive state, the better option is to ask, “How are you feeling lately? When did you realise you had these feelings? What have you tried to do to address this issue?” This is a more positive approach than “Why are you feeling depressed? Why do you let these things affect you?” Questions like these will shut the male patient down and he will most probably never return.
Be patient with your patient. Listen to what they have to say with a non-judgmental mindset. Empathy plays an important part in building rapport and trust. Validate their existence as a human being, first and foremost, because mental health does not discriminate. It is vital to help the patient understand having a mental health trauma does not compromise their masculine identity.
Providing referrals or developing a Mental Health Treatment Plan is a good way forward, especially when it is framed within the intent of helping him address the issue. Men usually want to ‘get on with it’ once the issue is confronted, so even though it is not a quick fix, providing a clear and objective line of action often helps adherence to the treatment plan.
GPs can also engage in marketing campaigns or outreach targeted at men, highlighting some of the more serious medical conditions that can affect men, such as prostate cancer, depression and suicidal ideation. And consider changing how the GP clinic offers help to men, rather than expect men to change their help-seeking behaviour.
Ensure that the clinic has promotional materials that addresses men’s health issues and thought-triggers for male patients in the waiting room, such as “Do you know you can access 20 private and confidential subsidised mental health treatment sessions per year if you have a Medicare card?”, or “Australia loses seven men to suicide every day. You are not alone mate. Talk to your GP if you are struggling mentally.”
GPs can also promote their services through outreach targeted at men in barber shops, golf courses, gyms, construction sites, sporting clubs, men’s social groups (i.e. men’s sheds) and other locations where men tend to congregate.
I run the SafeBROSpace program at barber shops, imparting knowledge and tools with barbers to conduct mental health brief interventions with male clients, and to provide referrals to health service providers, crisis care or personal development services.
One golden principle when we undertake with men and their health is to continually affirm men’s positive strengths and allow emerging masculine virtues to thrive.
Concurrently, we need a sustainable, integrated, and clear blueprint approach to supporting men across the public, health professionals, researchers, community groups, academics and policy makers if we are to ensure every man and boy in Australia is supported to live a long, fulfilling and healthy life.
ED: Dr Simon Yam was formerly the CEO of Men’s Health and Wellbeing WA. He is a life coach for men, founder of BROS GLOBAL and an accredited mental health first aid instructor.