Just Telling Men to ‘Open Up’ Is Not Enough

This year I’ve taken part in a few online talks, including one with Kate Mabbett from Man Up Man Down Campaign on Noods Radio, and overall, these talks have helped to cement my ideas on men and mental health, somewhat.

So, in an effort to summarise those thoughts on International Men’s Day 2019, I’d like to talk about them here, and to do so with frankness.

Some men need a different mental health approach

My experience working with young people in mental health services over the last ten years is that, for whatever reason, a large proportion of men just don’t engage in standard counselling and psychotherapy approaches, and even mental health services in general, as much as women do.

The ratio when it comes to such engagement is usually 70% women, 30% men. This, frankly, just isn’t good enough when men account for 75% of all suicides. But, what’s going wrong exactly?

Asking men to ‘open up’ is not a silver bullet

In the last ten years, I can’t count how many times I’ve seen mental health services call on men to ‘open up’, only to see their services continue to maintain poor engagement ratios with men. I mean, yes, it’s good to make it clear that men can express their feelings too, if they want to. But, this doesn’t seem to be working as a silver-bullet approach, so what else can we do? Well, simple: instead of asking men to change for mental health services, by asking them to open up to standard, intensively emotional and relational approaches to mental health, perhaps we can think about changing mental health services to better meet the unique needs of men.

‘Ah, yes,’ I hear you say. ‘But what do men want?’ This one would be easy to avoid, and in a sense it would be right to. I mean, we don’t yet fully understand what men want and need from mental health services, and so we need to ask them, which is what OTR Bristol, myself, and others are beginning to do.

But we’ve a long way to go. And, at the same time, there are some services that are already having some success in engaging men, such as JourneyManUK, Empire – Fighting Chance, and ProRealVR. Though on the surface these services are very different from each other, they do show us some of the ways we can work that increase the chances of men engaging support.

Three approaches that seem to work

Less emotional/relational approach

Firstly, some men do not wish to engage in direct, one to one, emotionally-focused, relational work. Maybe the method is group tasks, exercise, or a VR/gaming-style environment – whatever it is, men seem to gravitate towards ways of working that don’t involve intensely emotional and relational work. That’s not to say men won’t explore such emotional intensity – they will – just that the method to explore needs to not be primarily emotional/relational.

So, for example, I’ve worked with young boys who found it far easier to play around in ProReal’s 3D, minecraft-like environment, and show me what their family is like, by placing down objects and people. They would have found it far more uncomfortable just to talk to me, and tell me how they felt, especially as they’d have to look directly at me, instead of a screen, where things aren’t so intense.

Mentorship

Secondly, some men seem to gravitate towards mentoring relationships, relationships within which they build trust, learn a task, and look up to another person, usually an older male that models qualities and skills that they would like to learn themselves. These can be physical skills, like boxing or bush-craft, but also psychological skills, like empathising and emotional regulation.

This is where Empire – Fighting Chance excels, by helping men to practice key character traits and psychological skills, like commitment, respect, and communication, while teaching boxing. Again, as above, it’s less relationally-intense, and also, here, has a mentoring aspect, in the trainer.

Externally-focused

Finally, I think there is something in the ritual-, group-, community-, and task-focused approach these services take that suggests men like something pragmatic, physical, and external to them, something outside themselves that they can focus on – something to do together. Maybe because of nature, maybe nurture, maybe both – but it seems men are more comfortable at least starting with external and action-, task-focused activities.

This is something that JourneyMan UK is really focused on, as they create rites of passage rituals for young men, and use the group to perform key practical tasks, through which young men, and their old male mentors, learns interpersonal skills and find a sense of purpose.

Next steps for men and mental health

So, I think we’re faced with a choice, going forward. We can continue to bash away at the ‘open up’ approach, which will have good, but limited results. Or, as well as continuing to offer men that option, we also focus, as some have, on starting where some men very much already are – by offering supportive services that involve task-oriented activities, mentoring relationships, and approaches that are less primarily emotional/relational in their format. In this way, we might meet more men where they are at, and in so doing, support the men who often most need it.

Not all men are the same, and some men will continue to seek out more relational approaches, and that is great. It’s just, given the above, we need to expand the diversity of our approaches if we are going to reach all men who are struggling with their mental health. And that means services, not men, will need to change.

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This article was published originally in John In Bristol.

John McGuirk is a  psychotherapist based in Bristol. He has worked in mental health for over a decade.