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If it’s a man’s world, why isn’t more being done for men’s mental health on World Mental Health Day?

by John Barry

As world mental health day rolls around again this year, we might wonder how much attention and funding is being allocated to the mental health issues that disproportionately impact men, and what is being done to alleviate them. However rather than innovative new interventions and programmes, we are more likely to find masculinity or patriarchy blamed for men’s mental health problems.

Most of the main players in the world of mental health, such as the World Health Organisation, continue to overlook the fact that suicide and death from alcohol predominantly impacts men.  All too often when these sex differences are identified, men are blamed for not seeking help. However this unfair allocation of blame doesn’t take into account the possibility that much of what is on offer does not appeal to male-typical ways of dealing with distress. This male gender blindness and victim-blaming are aspects of gamma bias, a widespread cognitive distortion that erodes empathy for men.

Although the suicide rates vary across cultures, men are more likely to die by suicide than women in almost every country worldwide. The cultural differences in this ratio suggests an impact of culture on suicide, but the fact that the vast majority of countries have more male cases of suicide than female suggests a deeper influence is at play.

Although male socialisation is often blamed for men’s mental health issues, it could be that male-typical ways of dealing with stress are undervalued in the prevailing mental health narrative. The fact that male suicide and substance abuse are higher in almost every country worldwide might be a clue that despite cultural differences, men internationally have different needs when it comes to dealing with distress. It could be that these sex differences have evolutionary roots, a possibility that is almost universally overlooked by the mainstream health services. By overlooking this influence, alternative interventions – based on harnessing adaptive aspects of coping mechanisms – are also overlooked.

The good news is that some charities and third sector organisations have realised that lots of men find mental health benefits in many activities outside the therapist’s office. For example, Men’s Sheds have – probably without intending to – demonstrated that mental health is not all expressing one’s feelings. Having said that, some types of mainstream psychological interventions can be extremely effective, but their specific tailoring to men’s mental health has been almost entirely overlooked.

The solution to men’s mental health problems will vary from man to man, but it is apparent that many of the authorities in mental health have been less than effective in their approaches to men’s mental health. It could be argued that a one-size-fits-all approach has been applied to patients regardless of their sex, using an approach that happens to fit women in general better than it fits men in general.

It would be very welcome if one year we woke up to find that World Mental Health day had started to recognise important gender differences in mental health and therapy.

Maybe one day.

About the author

Dr John Barry is a chartered psychologist and co-founder of the Male Psychology Section of the British Psychological Society. His new book Perspectives in Male Psychology, co-authored with Louise Liddon, will be published by Wiley around the end of 2020.

If you are feeling under stress, there are people who can offer advice and support. CALM offer advice on issues in general, and can be contacted here. For problems with domestic violence, contact the ManKind Initiative. For problems with family breakdown issues, contact Families Need Fathers.

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New book: Perspectives in Male Psychology

  • Should we believe everything that we hear about men and masculinity?
  • What role do evolution, biology and culture play in men’s behaviour?
  • Do we tend to blame men for their health problems more than is reasonable?
  • What can be done to reduce male criminality?
  • How can the standard approach to men’s mental health be improved?
  • What does gender equality mean for men?

A new book on male psychology will be available in early 2021, authored by Louise Liddon and Dr John Barry, and published by Wiley.

In around 300 pages this book uses evidence from science to shed light to some of today’s heated issues around men and masculinity. A spectrum of the topics – including education, sport and the workplace – are explored, and questions answered.

You can pre-order the book here.

More information will be available soon. To hear updates on this and other news, sign up to the free newsletter

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The other ‘hidden homeless’: autistic men

by Dr John Barry

Around 85% of rough sleepers are men (St. Mungos, 2016). The reasons for homelessness are many and complex, but the most frequently cited reasons for male homelessness are relationship breakdown, substance misuse, or leaving an institution (e.g. prison, care or hospital) (Brown et al, 2019).

At any one time in the UK there are around 5000 rough sleepers (Ministry of Housing, Communities & Local Government, 2017). This isn’t counting the group often called the ‘hidden homeless’, a much larger number of people – at least 250,000 – with no stable accommodation (Shelter 2016). We know that almost half of rough sleepers have mental health needs (Combined Homelessness and Information Network, 2017), but these figures don’t identify the other type of ‘hidden homeless’ – people with autism.

Autism effects 1% of the population (Brugha et al, 2016). Autism exists on a spectrum of severity (Autistic Spectrum Disorder, or ASD). There are some interesting gender differences that might lead to underestimates of ASD in females (van Wijngaarden-Cremers, 2019), but most estimates suggest that more severe cases are four times more common in males, and the less severe form (Asperger Syndrome) is nine times more common in males (Barry & Owens, 2019).

Given the fact that most homeless people are male, we would expect a larger proportion of homeless people to have autism. In the first study on this topic published in a peer-reviewed journal, Churchard et al (2019) found that autism is at least 12 times more common in homeless people than the general population (or probably more, if it was possible to identify the ‘hardest to reach’ homeless people). This figure far exceeds the rate you would expect if autism in homeless people was simply due to both autism and homelessness being more common in men. So if gender doesn’t fully explain the over-representation of autism in the homeless population, then why are so many autistic people homeless?

Well, substance abuse does not explain it, because people with autism are less likely to have problems with substance abuse than other people (Butwicka et al, 2017). However Churchard et al (2019) suggest that the greater levels of social isolation experienced by people with autism might be the key; autistic people often have fewer people to turn to if things go wrong in their lives, such as their housing being threatened. People with autism are also less likely to be employed, so might slip into the poverty trap more easily (Calsyn & Winter, 2002). Churchard et al also suggest that because people with autism are more likely to experience sensory difficulties (e.g. finding noise distressing), this makes living in shared accommodation or a hostel virtually impossible. Also for those with cognitive impairments to abilities such as planning, everyday independent living might become virtually impossible.

Although the current level of knowledge regarding homelessness and autism is very basic, there has been some progress by a group called Homeless Link (2015), who have created practical guidelines on how to identify autism in homeless people, and how to communicate in a way that best facilitates support for the homeless person.

This article only scratches the surface of mental health issues in homelessness. Other issues that impact the general population of homeless people include a history of childhood abuse and neglect, seen in 80% of homeless people (Torchalla et al. 2012). This type of history creates special problems for housing homeless people, because they may have learned to associate home with abuse and neglect (Duffy & Hutchison, 2019). Trauma prior to homelessness is also common (e.g. military-related PTSD), as is trauma as a result of life on the street (Buhrich et al. 2000).

More research is needed to identify the scale of the problem of autism in homelessness, and to develop evidence-based methods of helping these vulnerable people. There can be little doubt that homeless autistic people should be one of the key issues for anyone interested in Male Psychology.

 

About the author

Dr John A. Barry is a Chartered Psychologist and Associate Fellow of the British Psychological Society, Honorary Lecturer in Psychology at University College London, clinical hypnotherapist, and author of over 60 peer-reviewed publications on a variety of topics in psychology and medicine. John is a professional researcher and has taken an interest in improving the teaching of research methods and statistics. He has practiced clinical hypnosis for several years and is a member of the British Association of Clinical and Academic Hypnosis. His Ph.D. was awarded by City University London, on the topic of the Psychological Aspects of Polycystic Ovary Syndrome, which is also the topic of his forthcoming book (Palgrave Macmillan, 2019). He is co-founder of both the Male Psychology Network and the Male Psychology Section of the British Psychological Society (BPS).

 

References

Barry JA and Owens B (2019). From fetuses to boys to men: the impact of testosterone on male lifespan development, in Barry JA, Kingerlee R, Seager MJ and Sullivan L (Eds.) (2019). The Palgrave Handbook of Male Psychology and Mental Health (pp. 3-24). London: Palgrave Macmillan. DOI 10.1007/978-3-030-04384-1

Brown, J. S., Sagar-Ouriaghli, I., & Sullivan, L. (2019). Help-Seeking Among Men for Mental Health Problems. In The Palgrave Handbook of Male Psychology and Mental Health (pp. 397-415). Palgrave Macmillan, Cham. DOI 10.1007/978-3-030-04384-1

Buhrich, N., Hodder, T., & Teesson, M. (2000). Lifetime prevalence of trauma among homeless people in Sydney. Australian and New Zealand Journal of Psychiatry, 34(6), 963–966.

Butwicka, A., Langstrom, N., Larsson, H., Lundstrom, S., Serlachius, E., Almqvist, C., … Lichtenstein, P. (2017). Increased risk for substance use-related problems in autism spectrum disorders: a population-based cohort study. Journal of autism and developmental disorders, 47(1), 80-89.

Churchard, A., Ryder, M., Greenhill, A., & Mandy, W. (2019). The prevalence of autistic traits in a homeless population. Autism, 23(3), 665-676.

Combined Homelessness and Information Network. (2017). CHAIN annual report: June 2015. The Greater London Authority.

Duffy, J., & Hutchison, A. (2019). Working with Homeless Men in London: A Mental Health Service Perspective. In The Palgrave Handbook of Male Psychology and Mental Health (pp. 533-556). Palgrave Macmillan, Cham. DOI 10.1007/978-3-030-04384-1

Homeless Link (2015). Autism and Homelessness: Briefing for frontline staff. https://www.homeless.org.uk/sites/default/files/site-attachments/Autism%20&%20HomelessnesOct%202015.pdf

Ministry of Housing, Communities & Local Government. (2017). Rough Sleeping Statistics, Autumn 2017, England. London: Author.

Shelter. (2016). Green book 50 years on: The reality of homelessness for families today. http://www.shelter.org.uk/__data/assets/pdf_file/0003/1307361/GreenBook_-_A_report_on_homelessness.pdf.

St. Mungos. (2016). Stop the scandal: An investigation into mental health and rough sleeping. http://www.mungos.org/documents/7021/7021.pdf.

Torchalla, I., Strehlau, V., Li, K., Schuetz, C., & Krausz, M. (2012). The association between childhood maltreatment subtypes and current suicide risk among homeless men and women. Child Maltreatment, 17, 132–143.

van Wijngaarden-Cremers, P. (2019). Autism in Boys and Girls, Women and Men Throughout the Lifespan. In The Palgrave Handbook of Male Psychology and Mental Health (pp. 309-330). Palgrave Macmillan, Cham. DOI 10.1007/978-3-030-04384-1

 

 

 

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