Strategies to Address Treatment Barriers

Addressing men’s mental health has persistently posed a formidable challenge for physicians and health care providers. Although there have been major strides in recent years toward destigmatizing mental health, the pervasive culture of “traditional” masculinity often complicates the treatment landscape. The societal pressure to conform to traditional gender norms has wide-reaching effects on help-seeking and coping behaviors among men.

For health care providers, navigating these multifaceted challenges demands a nuanced understanding of the intersections between masculinity and psychological distress. To address this health care disparity, Psychiatry Advisor spoke with experts to further elucidate the underlying issues affecting men’s mental health and provide physicians with strategies aimed at achieving more effective and inclusive mental health care for all patients.

Men’s Mental Health – Prevalence, Presentation, and Pressures

Although mental illness is more prevalent among women than men, 1 in 8 men report experiencing symptoms of mental health problems¹ and about 1 in 10 men experience depression or anxiety daily.² Troubling, only half of men who experience depression or anxiety will receive treatment in their lifetime and men are approximately 4 times as likely to die by suicide than women. Furthermore, boys and men are disproportionately more likely to develop certain mental health conditions such as attention-deficit/hyperactivity disorder (ADHD), schizophrenia, and substance use disorder, relative to girls/women.²

Although the causes of and contributing factors to mental health are multifactorial, the societal and systemic pressure to abide by traditional, rigid masculine ideals can negatively influence men’s mental health and prevent help-seeking behavior.³ “My colleagues and I have studied men who score high on a ‘hegemonic masculinity’ scale – meaning they say they believe in a number of traditional masculinity norms such as needing to be the breadwinner and feeling it is appropriate to solve conflicts with their fists,” explained Dena T. Smith, PhD, associate professor of sociology in the Department of Sociology, Anthropology, and Public Health at the University of Maryland, Baltimore County. “The higher these men score on the masculinity scale, the worse their mental health tends to be,” she told Psychiatry Advisor. When these men experience perceived challenges to their masculinity, such as a decline in health or wealth, these issues are further exacerbated – especially depression, she added.

“While many mental health disorders, particularly mood disorders, occur without any external cause, when men experience stress that is beyond their ability to manage, this can increase the risk that they may have a major depressive episode or some other mental health event,” said Derek M. Griffith, PhD, founder and co-director of the Racial Justice Institute, founder and director of the Center for Men’s Health Equity, and professor of health management and policy and oncology at Georgetown University in Washington, DC.

Dr Griffith’s statement was supported by a recent survey that assessed men’s mental health, as men reported the top 3 issues that negatively affected their mental health were work-related pressure (32%), financial pressure (31%), and health concerns (23%).⁴

While there are many commonalities in the presentation of mental health conditions across gender identities, there are certain symptoms that may present differently among men. Previous research suggests that gender differences in socialization, coping, and help-seeking contribute to higher rates of “internalizing” disorders (ie, depression and anxiety) among men and more “externalizing” behaviors (ie, aggression and substance misuse) among men.³ Additionally, men are more likely to engage in high-risk activities when their mental health is affected, relative to women.⁵ In addition, Dr Griffith explained that excessive work can be a sign of a mental health problem among men, as it may represent an effort to focus on an area of their life they feel they have some control over. 

Study findings also indicate that mental health issues among racially minoritized groups, including Black Americans, may be overlooked or inadequately treated.⁶ “So, there are ways in which these issues can cut across gender, race, class, sexuality, etc., so that some people may be more or less likely to have their symptoms captured by diagnostic instruments,” Dr Smith said.

“Beyond individual idiosyncrasies, mental health issues are ones that affect how someone functions, cares for themselves, interacts with others, and performs in key roles and responsibilities,” Dr Griffith noted. For any population, notable impairment in some or all of these areas – such as persistent anger or irritability, marked changes in mood, sleep or energy level, or misuse of alcohol or drugs – may indicate the presence of mental health issues.⁷

Diagnostic and Treatment Barriers

Despite higher rates of issues such as substance use disorders and suicide among men compared with women, studies have consistently shown that men are significantly less likely than women to seek mental health treatment and to remain engaged in treatment.⁸ Compared with women, substantially fewer men received any type of mental health treatment (25.7% vs 13.4%), medication for their mental health (20.6% vs 10.7%), and mental health counseling or therapy (11.7% vs 7.2%), according to 2019 data from the Centers for Disease Control.⁹

In a survey of 1000 men, 40% of respondents had never spoken to anyone about their mental health and 40% of men reported that they would only seek professional help if they developed suicidal thoughts.⁴ When asked why they had never spoken about their mental health, 29% of men indicated they were “too embarrassed” and 20% cited “negative stigma” surrounding men’s mental health.

 “While we assume that men do not seek help for reasons that have to do with how they think about being a man, we must recognize that men often learn that others tell them to ‘get over it’ or ‘suck it up’ or otherwise dismiss their expressions,” Dr Griffith told Psychiatry Advisor. “Men also may feel that nothing can be done to fix the problem, and certainly talking about it cannot help, so why bother?”

Dr Smith echoed these sentiments and noted that there is still stigma among men discussing their problems and seeking help from mental health professionals – especially in certain cultures.¹⁰ Men are also typically socialized to avoid talking about emotions other than anger.³

Even when men do engage in mental health treatment, their symptoms may be overlooked or misdiagnosed.¹¹ “My colleagues and I argue that [Diagnostic and Statistical Manual of Mental Disorders] (DSM) symptom sets do not always accurately capture mental health troubles for everyone, and men in particular can be overlooked,” Dr Smith stated.

Using the example of depression, she pointed to research showing that men with mental health concerns may be more likely to experience anger and physical symptoms and to mask their psychological symptoms with substance abuse.¹² “If a clinician is not careful and sticks closely to DSM symptom sets, it is possible to miss the diagnosis or increase the risk of misdiagnosis with men,” she cautioned. 

Strategies to Improve Men’s Mental Health

“It’s crucial for clinicians to go beyond diagnostic categories and checklists and make sure to assess context and a patient’s life situation, resources, and any behaviors or experiences that may not fit neatly into DSM categories,” Dr Smith said.

Although many men are solution-oriented and only want to express a problem if they believe it can be solved, this is “not true of every man, so do not go into problem solving mode when you hear a concern,” Dr Griffith advised mental health care providers. When men reach out for help, clinicians should validate how difficult this step can be and ask if they are seeking someone to listen or to help find a solution, he suggested. “If the latter, do not get discouraged by their skepticism of the strategies that you brainstorm together. Remind them that you cannot predict the future and trial and error may be necessary. Remind them that if it were easy, they would have solved the problem already.”

He emphasized the importance of helping men feel they are still respected and loved even when they express fear, vulnerability, and personal concerns.  

More broadly, Dr Smith emphasized the need for ongoing efforts to destigmatize mental health treatment for men and to challenge rigid, traditional masculinity beliefs to help improve mental health and help-seeking among men. 

“We have to move past the stereotype and assumption that men will not seek help or share their concerns or feelings with others,” Dr Griffith said. “It is important to help them find someone that they can talk with and let them share as they feel comfortable.”

Pharmacotherapy and behavioral therapy are effective treatment options for patients managing their mental health disorders. However, some men may be reluctant to engage in these forms of treatment right away. Accordingly, Dr Griffith recommended the following general strategies to improve men’s mental health:  

• Encourage patients to be proactive about taking care of both their physical and mental health.
• Incorporate physical activity, which naturally helps to improve mood. 
• Recommend relaxation techniques or meditation to help relieve stress.
• Encourage men to engage in hobbies and activities they look forward to doing in their free time. 
• As men move into middle age, it is not uncommon for them to become isolated and no longer engage with friends. Make sure that patients schedule time for social engagement and encourage their partners and loved ones to let them know it is okay if they take time for themselves to do something fun and enjoyable.

Addressing men’s mental health requires a holistic approach that considers the complex interplay of gender dynamics, societal pressures, and biological susceptibilities. However, breaking down stigma, promoting help-seeking behavior, and providing tailored support services are essential steps in improving men’s mental health outcomes.

If you or someone you know is struggling or in crisis, help is available. Call or text 988, chat 988lifeline.org, or contact the Crisis Text Line by texting TALK to 741741.