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Reviewed research
Authors Harding C & Fox C
Review Date June 2016
Citation American Journal of Men’s Health 2015; 9(6): 451-463
Background
Research suggests that reduced rates of mental illness in men compared to women is largely the product of under-diagnosis. This is thought to be partially due to reluctance to seek help among men and the increased use of harmful self-management strategies such as excessive alcohol consumption and drug taking. Four decades of research in men’s mental health help-seeking has focused primarily on perceived barriers to seeking care with little attention paid to enabling factors.
Aim
The aim of this study was to identify enablers to mental health help-seeking in men.
Methods
Semi-structured interviews were used to examine participants’ experiences and perceptions of mental health help-seeking. The interview questions considered men’s intentions to seek counselling, family and friends’ experiences of counselling, and other enablers. Men were recruited through selected clinics of psychologists and counsellors in Melbourne, Victoria, and were eligible to participate if they were (voluntarily) currently receiving counselling or had received it in the previous 12 months.
The interviews were transcribed and analysed thematically by both authors. Codes were developed in two ways: 1) with the use of concepts predetermined from previous research such as ‘opportunity to reciprocate help to other men’ and social norms, and 2) as emergent ideas evolved (i.e. a data-driven approach).
Results
Nine men aged 23 to 65 years volunteered to participate in the study. All had completed at least 5 counselling sessions in the previous 12 months. Two men identified as gay and the remainder as heterosexual. Four men were in long-term relationships while another four were single; one man did not disclose his relationship status. Seven themes were identified within men’s interviews:
PRECIPITATING EVENT: For some participants there was an acute event prior to seeking care but for others it was a chronic condition with debilitating consequences for their everyday lives. Three participants explicitly described “domestic troubles” or “relationship breakdown,” and two participants spoke of severe anxiety and panic attacks.
SIGNIFICANT PERSON: Some men acknowledged the role of a significant other in the decision to seek mental health care. Three men described their female partner as being the main influence on their decision and stated that, if not for their influence, they would not have otherwise sought counselling. A further two men reported a close female friend as having influenced their decision to seek care. One man sought counselling upon the advice of his ex-male partner as their relationship was ending. Seeing the benefits of counselling for their partner or friend, if they had previously received it, was an additional motivating factor for some men.
GENERAL PRACTITIONER REFERRAL: All participants consulted a GP or clinician prior to commencing counselling. For some men this consultation provided comfort and assistance but for others it was a daunting or discouraging experience. Three men spoke of their disappointment at having a GP initially dismiss their symptoms as warranting referral to a mental health professional: one was told he had a physical health problem, another was told he would be fine as he was not in any physical danger, and one was given a DVD to watch instead. Men were satisfied with GPs who they perceived as being positive and helpful, and who quickly referred them to an appropriate mental health professional.
ONLINE RESOURCES: All participants reported using the internet to search for a counsellor, to search psychologists’ websites after being referred, or to join online forums. After being dissatisfied with information provided by his GP, one participant used the internet to help understand his symptoms and to “share knowledge and experiences” in online forums. Once a referral was sought, using online resources was effective in reinforcing the decision to seek counselling.
SOCIAL NORMS: All participants reported social norms pertaining to masculinity as influencing their decision to discuss their mental health help-seeking with friends. Men tended to share their experiences more so when it was known that others had sought counselling or had mental health issues. High-profile sporting identities publicly discussing their mental health was reported by some men as assisting them to identify and normalise their own issues. It was noted by participants that mental health help-seeking was more normal for the younger male generation.
MENTAL ILLNESS DEFINITION: All men reported ignorance of what defines a mental illness among themselves and their peer group. Some men stated that they believed mental illness to be a ‘female condition’ and that this was a bad thing for men. The media’s depiction of mental illness as only ever being severe or life-threatening was mentioned by participants. Some believed a more accurate depiction would include common disorders and that this may enable men to seek assistance. All men identified counselling as increasing their understanding of mental illness and as reducing the associated stigma.
MENTAL ILLNESS TREATMENT: After receiving a referral, some men were reluctant to make an appointment due to fears about the nature of mental illness treatment such as having to take “personality changing” drugs or having a psychiatrist “picking at your brain.” All participants reported their experience to be more positive than they were initially expecting.
Conclusion
The findings of this study support a strengths-based approach—where enabling factors and positive influences are acknowledged—to mental health policy for men. Campaigns to dispel social norms around masculinity and health, and to counter negative stereotypes around mental health, directed at both the public and GPs may assist men to better manage their own mental health.
Points to Note
- Little is known about the factors which facilitate men’s mental health help-seeking. This study aimed to identify these factors through semi-structured interviews with nine men who had voluntarily received counselling.
- Men reported a significant other—usually a woman—in their lives as often enabling their access to services, particularly if they had also previously sought mental health help. GPs who facilitated access to care were seen as enablers while those who dismissed men’s symptoms and concerns inhibited access.
- Men reported ignorance among themselves and their friends around mental illness definition and treatment; this was reduced after receiving care for their own mental health.
- Little information is provided to assess whether the interviewed group of men represent diverse sociodemographic backgrounds and experiences; a key component of quality assessment of qualitative research.
- The findings of this study support the development and implementation of campaigns that dispel social norms around masculinity and health, and to counter negative stereotypes around mental health, directed at both the public and GPs to assist men to better manage their own mental health.
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