by Dr Amanda Kinsella and Alastair Pipkin
Research and experience recurrently highlights that Secondary Care Mental Health Services struggle to engage with men. Various theories have emerged which attempt to explain this (e.g. Wyllie et al., 2012) – including that men have a distinct style of regulating emotions; that cultural discourses around masculinity inform a reluctance to help-seek in the traditional sense; and that men tend to suit a problem-solving, action-focused approach prior to delving into their emotional depths. Theory aside – suicide rates remain highest for men aged 40-44, and men are reportedly three times more likely to take their own lives than women (Samaritans, 2017). The case for meeting men where they are, engaging with them on their terms and promoting their use of both mental health services and psychological therapy is clear.
The Halton Recovery Team – a Secondary Care Community Mental Health Team; North West Boroughs Health Care Trust – have recognised a gap in service delivery.
The team piloted a 12-week men’s only transdiagnostic recovery group. Referrals were open to the whole service. The program is based on the concept of empowering men to consider themselves as agents in their own recoveries. An assertive outreach engagement model was used, including an initial joint home visit with the nurse and psychologist who would be facilitating the group. Invitation, transparency and equality were key messages. Additional individual weekly telephone support and a post-course individual psychology session to consider “Where to now” and next steps were offered.
The design integrated relational, third-wave cognitive behavioural therapies, focussing on psychoeducation, relatedness and behaviour change, as well as recognising differences between the help-seeking behaviours of men and women and normalising “men’s emotional processes“.
The aim was not about making men more like women but respecting masculinity and intrinsic differences by specifically exploring the why and how men feel “Dis–Ease” and the behavioural and emotional consequences of shame, isolation and feeling stuck. Concepts of wellness and recovery were explored.
The group prides itself on taking an invitational approach – including sessional and home practice, integrating mindfulness and relatedness skills for regulating affect. Delivery included suicide prevention and transparency regarding high male suicide rates and looking at improving safety net strategies in times of crisis. Group exploration within masculine narratives lead the way to compassion for self and others, helping to support change behaviour and individual recovery.
The pilot group had an 80% completion rate, with the one individual dropping out being offered a place on the following cohort.
Across the two cohorts, self-report measures of readiness to change and difficulties regulating emotions were used. The mean readiness to change score showed an increase pre- to post-intervention, denoting a shift from the ‘pre-contemplative’ stage to the ‘contemplative’. Post mean scores, difficulties regulating emotions also showed a reduction, suggesting a reduction in emotion regulation difficulties. Self-report scales of curiosity about the future, confidence about moving forwards and hopefulness showed increase, while self-report scales of doubtfulness about recovery and self-critical thoughts showed a reduction.
Qualitative feedback was taken from all of the men This was analysed using a thematic analysis, finding five themes; expectations of the group; past experiences of services; positive gains; positive aspects of the group; self-agency.
Some quotes from the men:
“I don’t think any of us realised that when our bodies were doing stuff that our minds would then take over until it was explained … I certainly didn’t realise to the levels our bodies reacted in a certain way and then our minds run off with itself”
“It gives me a chance of thinking I can recover, yeah … it’s gonna take a lot of time, but at least now we know there’s light at the end of the tunnel. Somebody actually understands that we’re not totally messed up”
“[Being in a group with other men] you know roughly the sort of anxieties they’re going to have about certain things, it’s sort of set in stone because you’re all men, so you know where they’re coming from … It puts you at ease”
The group is currently leading into its third cohort, and the team has established a psychological and social pathway for the men following attendance – including being placed straight into individual therapy waiting lists should they choose, and further psychosocial support via an allotment group and newly established football groups. Men from the pilot group have gone on to individual therapy and attending the allotment group together.
The option for men to co-deliver future groups is currently being developed, as is the men co-producing and co-delivering presentations to the Trust regarding exploring commissioning the service more broadly.
The main learning from the pilot is that meeting men where they are enables engagement, empowerment, and overall, the co-creation and delivery of meaningful therapy.
About the authors
Dr Amanda Kinsella is a Senior Psychologist at North West Boroughs Health Care Trust (Amanda.Kinsella@nwbh.nhs.uk). Alastair Pipkin is a Trainee Clinical Psychologist at Oxford Health NHS Foundation Trust (Alastair.Pipkin@hmc.ox.ac.uk). Website: http://www.nwbh.nhs.uk/
You can vote now (7th May 20th June) for a Male Psychology Section of the BPS.
Details are here http://www.malepsychology.org.uk/male-psychology-network/vote-for-a-male-psychology-section/