The Mental Health of Men and Boys Cathy Freese National Project Lead for Gender National Mental Health Equalities Programme - January 2011

“..... men often have mental health needs that are distinct from those of women and which are particularly associated with the lived experience of being male. Some of these needs are not being met as effectively as they might.”

The relevance of gender to mental health: Gender is a basic determinant of our “sense of self” Gender helps define the range of “normal” behaviours Gender colours the way people are viewed by others Gender is an important element in many formative personal experiences Gender is a defining component of some of our most important relationships

The reports Untold Problems and Delivering Male was commissioned by the National Mental Health Development Unit, and written as a partnership between the Men’s Health Forum and Mind. It addresses the following question in relation to service delivery and professional practice: What can be done to make sure we meet the mental health needs of men and boys more effectively in the future? Because the issue of good practice in male mental health is relatively under-researched, a detailed consultation process was established in order to ensure that the document drew on the widest range of expertise.

Consultation Process An expert advisory panel which advised on the developing content of the report and reviewed the various drafts Open access online “Have Your Say” pages which encouraged service users, carers, mental health professionals to express their views on male mental health A series of focus groups which sought the views of men with personal experience of mental health problems A conference at Reading University which invited a mixed audience of service users, carers, representatives from voluntary organisations, and mental health professionals to make suggestions for improved future practice.

NMHDU specialist expertise in priority areas of policy and delivery effective knowledge transfer on research, evidence and good practice translation of national policies into practical deliverables that achieve outcomes coordination of national activity to help regional and local implementation

The Mental Health Equalities Programme (MHEP) Consists of work across the six protected characteristics (as set out in the Equality Act 2010) of age, race, gender, sexual orientation, disability and religion.

The Mental Health of Men and Boys

Men have poorer physical health than women. There are two broad reasons for this: Men tend to take less care of their personal health (they are less knowledgeable about health and tend to have less healthy lifestyles) Men tend to use health services less effectively

Men’s Mental Health 75% of people who kill themselves are men. 73% of adults who go missing from home are men. 90% of rough sleepers are men 1 man in 8 is dependant on alcohol (men are 3 times more likely to become alcohol dependent) 78% of drug-related deaths occur in men (men are more than twice as likely to use Class A drugs. Men make up 94% of the prison population – an 72% of male prisoners suffer from two or more mental disorders (compared with 5% in the general population

Men and boys Mental Health Twice as many male inpatients are detained and treated compulsorily. Men have lower social support from friends, relatives and community. Men commit 87% of violent crime (and twice as likely to be victims). Over 80% of children permanently excluded from school are boys. Boys are performing less well than girls at all levels of education.

Starting point - some assumptions: The mental health of some men is not as good as it might be. Some men may fail to recognise or act on warning signs. Some men may be unwilling or unable to seek help. Some men may choose unwise coping strategies. Men may be more likely to lack some of the known precursors of good mental health.

Men’s mental health and anti-social behaviour Almost all forms of violent and anti-social behaviour are greatly more common in men. A number of the predisposing factors for poorer mental health are also predisposing factors for violent behaviour. Violent behaviour is more common among alcohol and drug misusers, and people with personality disorders. 94% of people in prison are male – ¾ of prisoners have mental health problems

Specific groups and conditions Continuing to address male suicide is important There is a relationship between maleness, mental health problems and other markers of inequality – BME men, gay men Groups needing more attention include: service veterans with PTSD, men with eating disorders, male survivors of sexual abuse

Good practice guide includes chapters on: Male beliefs, attitudes and behaviours Helping men and boys to maintain and improve mental health Identifying and supporting men and boys in mental distress Supporting men and boys with diagnosed mental health problems living in the community Supporting male inpatients

Intended target audience: Planners and commissioners of mental health and wellbeing services Staff in primary care settings Public health and health improvement staff Mental health staff working in community or inpatient settings Social care staff Mental health trainers, educators and students Families and carers of men with mental health problems

Seven “Big” Ideas: Treating men as individuals Gender is perhaps the most fundamental determinant of an individual’s sense of self. Ensuring that mental health service users are treated as individuals will therefore greatly increase the likelihood that their gendered needs as men (or women) are taken into account.

Inter-agency working in the early years Many of the attitudes and beliefs that underpin people’s mental health behaviours are established in childhood. There is much more that could be done to support boys during childhood, especially those boys whose circumstances increase their potential lifetime vulnerability to mental health difficulties and may reduce their capacity for seeking help. Supporting the development of good mental health is not currently a shared objective for health, education and social service providers in any organised way.

Stigma Few dispute that mental ill health is much more stigmatised than most forms of physical ill health. The damaging experience of stigma is commonly reported by mental health service users of both sexes. We believe that, in general, men may feel stigma more strongly than women, and that public attitudes may be more prejudiced against men with mental health problems than women. A greater understanding of the relationship between stigma and gender is needed.

Promoting services The evidence suggests that men tend to under-use mental health services. Structural reasons probably play a part, as probably do stigma and “traditional” male attitudes, which can make the acknowledgement of vulnerability extremely difficult for many men. It is probable that a more sophisticated and nuanced approach to the promotion and delivery of services could improve male uptake. Men who find help-seeking difficult are not going to change in the short term – but mental health services can.

The role of third parties Third parties may have a very particular role in encouraging men to seek help for mental health problems. Particularly life partners, are likely to remain a crucial element in the decision-making process for many individual men. Male friendship groups may have a particular part to play here, as may men prepared to talk about their personal experience of mental health problems.

Joined-up approach Men in mental distress often exhibit difficulties in other areas of their life and functioning. Alcohol and drug misuse – which may have been used as a coping mechanism – are common. Relationship problems, social disengagement, offending behaviour, and difficulties with work (chronic unemployment or work-related stress) also occur. “Whole-life” problems need whole-life solutions. Joined-up approaches which include the involvement of social care, employment, and housing providers may be of particular value for men, who sometimes lack supportive networks of their own.

Professional training and an improved knowledge-base Professional training is an important element in making progress on all equality issues. We would encourage the professional mental health bodies to develop an internal focus on male mental health.

Why did the Mental Health Equalities Programme decide it was right time to develop the reports and guidance for mental health practitioners on working with men?

There was a good case for developing services that take account of men’s needs “as men”. That it is right to do this was noted in the introduction to Mainstreaming Gender and Women’s Mental Health: (2003 DH) “The underlying theme is that gender differences in women and men need to be equally recognised and addressed across policy development, research, planning, commissioning, service organisation and delivery.”

Gender Equality Programme Established in 2004 following the publication of ‘Into the Mainstream’ (DH, 2002) and ‘Mainstreaming Gender and Women’s Mental Health’ (DH 2003). The programme has expanded its focus to include men and people who are transgender.

Gender Sector Public Duty – A proactive approach to the different needs of women & men; In April ’07 all public sector bodies charged with ensuring gender equality; equity of outcome for women & men in all aspects of policy, service delivery & workforce issues. Prohibits discrimination on the basis of gender in undertaking their functions. Places a clear responsibility on organisations to take action to promote gender equality rather than relying on individuals to take action

Equality Duty The Equality Act 2010 brought together all the existing provisions of previous legislation in one unified Equality Duty. This new overall duty includes additional responsibilities in relation to age, sexuality and religious belief but otherwise has precisely the same effect as its predecessor in relation to gender equality. These additional duties will also contribute to addressing the diverse needs of men and boys.

Mental Health Equalities Programme A clear understanding of the legislation, policy and practice implications of equalities in mental health Access to a range of acknowledged experts Existing national and regional networks A profile that allows the team to shape national policy as well as help to deliver it A history of partnership working and an understanding of system wide impact A history of implementing national policies for local benefit taking a whole system approach across health and social care

The Government’s White Paper “Equity and Excellence: Liberating the NHS” sets out how the improvement of healthcare outcomes will become the primary purpose of the NHS. Now that the National Health Service as a whole is changing, the way that we think about mental health should change with it.

Delivering Male: Effective practice in male mental health This guidance will assist in providing the right opportunity to meet service users needs more effectively and successfully. By working towards creating a new approach to the new world of public mental health that reduces inequalities and improves the mental health and well-being of individuals, communities and society as a whole.

Cathy Freese National Project Lead for Gender National Mental Health Equalities Programme Cavendish Square London W1G 0AN Mobile: Web: