Keeping it real – Reimagining mental health care for all young men

Overview

Adolescent and young adult males are an underserved population relative to their mental health needs. Targeted research is urgently required to deepen our understanding of how young men experience mental ill-health, and the kinds of next-generation service systems they will be likely to engage with. Novel initiatives are required to:

• (1) develop services that young men find relevant, and
• (2) take services to young men, rather than waiting for them to walk in the door. Involving young men in the design of these initiatives will be essential to increasing the acceptability of mental health services for them.

Suicide is the leading cause of death among young men (aged 15-24 years) and the life expectancy of men with a mental disorder is 15.9 years less than their peers. A lower incidence of mood disorders yet higher rate of suicide among young men suggest that depression may be underdiagnosed. Differences in symptomology have been identified as masking the true incidence of mood disorders, in particular depression among men. Young men also continue to access mental health services at a lower rate than young women.
Key issues shaping the potential risk and experience of mental ill-health by young men include the symptoms they express being missed, the potential barrier that adherence to traditional masculine norms may exert on help‑seeking and the influence of identity and background on their health related behaviours.

There is growing recognition that for young men, symptoms of mental ill-health manifest through externalizing behaviours including anger, alcohol and other drug use and risk taking rather than affective symptoms such as feelings of worthlessness or hopelessness. As such, their symptoms can be missed as they do not readily
fit with existing diagnostic criteria.

Traditional masculine norms, such as being tough and self-reliant mean that many young men learn to avoid expressing emotions or behaviours that show vulnerability. These dominant social norms have also been identified as a barrier to health professionals recognizing mental health problems in young men.

The experiences of young men can be shaped by their identity and personal context. Mental health risks can be exacerbated for young men from non‑ Western cultural backgrounds, who identify as sexuality diverse or experience learning difficulties for example.

Experiences of anger, when disproportionate and repeated, can be a signal of mental ill-health in young men and may trigger a need for mental health care. Aggression, however, can be a barrier to service access. A new approach is needed that facilitates young men’s engagement while ensuring the safety of health workers.