Download Title here - Men's Health Forum Scotland

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
11-13 Cavendish Square
London W1G 0AN
Mobile: 07989459643
Web: www.mentalhealthequalities.org.uk