Mental health problems occur in both men and women, but they present in slightly different ways. From my own experience seeing patients there were some things that stood out to me. For instance, I found myself often reflecting on how many men I was seeing whose depression was linked to their retirement. I remember a particular 65-year-old retired architect—let's call him Jim. Jim told me that he had been very much looking forward to his retirement. He had projects for both his home and his garden and he was going to really enjoy himself travelling the world with his wife. Within a few months he started losing interest in these projects. He struggled to find things to do with his time. His wife had retired more or less at the same time, but she seemed to be always doing things with their daughters, the grandchildren and local friends. Jim reflected that he felt useless and that he had lost touch with most of his friends as he knew them through work. Even when he saw them he found it hard to talk to them as often they would be talking about work and he would feel excluded. He realised that he had lost a big piece of himself, the bit that was Jim the architect. He reflected that retirement did not mean the same to his wife who had other roles, such as mother, grandmother and community member. He realised that he had not built a world outside of work like she had. He felt useless.

Mental health issues for men are a major public health concern, but it does not seem to get people's attention. This takes me to the first thing you did not know about men's mental health.

1. Mental health problems are just as common in men as they are in women but they are missed in men 

The patterns of mental health complaints are quite different in both groups across the world, but the rates are virtually the same according to the World Health Organisation. Men engage less than women in mental health services, which is also a big part of the problem.

Going back to Jim he presented with a very typical male picture of depression. He was angry, resentful with his wife and daughters, irritable and a tendency to shut himself off. His guilt, lack of appetite, the sadness and the crying went completely undetected.  It took a very diligent family doctor to spot what was really going on.

2. Suicide is the biggest killer of young men in the developed world 

For those who think depression is not real, here is this chilling fact: the leading cause of death for 15 to 35 year old men is suicide. The second one is having an accidents. Bearing in mind many suicides are still recorded as accidental deaths due to stigma, this statistic is even more worrying. 

3. Trying to live up to being the model man affects men's mental health

Jim, like many other men, had his sense of worth—his very identity—linked to his career. Many men identify who they are based on what they do or how successful they are in the eyes of their peers or society. Some have their self-worth closely tied with how much money they make or whether or not they are the breadwinner. With Jim this resulted in sacrificing everything in his life to being as successful as possible in his professional life. For other men this can be even more tragic, as they set unrealistic goals making it impossible to ever achieve 'success'.

4. Some men focus on issues rather than emotions

A lot of men tend to struggle to describe their emotions when they are experiencing mental health problems. This could be due to pressures put on them by the male and female roles that society defines. It may also be due to the way men view themselves and the stigma they attach to mental health issues. Whatever the reason men with a mental health complaint to focus on other things, like having trouble at work or with their families. Sometimes they focus on their physical symptoms such as tiredness, headaches, stomach cramps or poor sleep. This is part of why men's mental health problems are missed. Sometimes they get a lot of investigations for various health problems before the real problem is identified.

 5. Men find mental health services difficult to accept

The way some men are brought up causes them to think that they are weak if they seek help. Particularly when it is about their emotions, a lot of them have been taught that they should just 'man up' and pull their socks up. Men tend to believe that mental health services are 'for women'. In particular, some feel that the way depression, anxiety or other common mental health problems are described does not fit them. Some men feel that therapeutic activities frequently offered, such as art therapy or talking therapies, are not for them. Projects that have used male role models, changed the language to fit the way males are brought up and that use activities men traditionally find more appealing—such as woodworking or engineering—have been more successful with men.

Jim was able to make a full recovery. We succeeded thanks to his family doctor who spotted his depression early. He also benefitted from an understanding family that was able to see past his anger and irritability. The occupational therapist was able to successfully engage him in activities such as carpentry and model building. He never found therapy acceptable and preferred medication. The lesson for me was to be flexible and to adapt what we were doing to what Jim found acceptable. Hopefully greater awareness of how mental health problems can present in different people will enable more people to be diagnosed and be offered the right treatment for them.

 

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