Some young people are significantly more susceptible than others to mental health problems. They include those living in poverty, young carers, refugees, and those with chronic physical health conditions. Young people are also at increased risk simply by dint of being male. This is not to suggest, of course, that girls are not also vulnerable, but the overall prevalence of mental health problems is higher in boys (Green et al, 2005).
Research suggests that many of the vulnerabilities men feel in midlife, when the risk of suicide is at its highest, are established in childhood and adolescence, and that the needs of boys and young men need attention to prevent difficulties in later years (Wyllie et al, 2012).
Suicide is the biggest killer of men under-45 in the UK, a fact that continues to shock and disturb. It also, of course, demands that as a society we work assiduously to try to understand why this should be the case and to address the causes.
Clearly, there are no simple answers and, in the face of such daunting statistics, it is easy to feel powerless. However, there is evidence that, when depression and other mental health problems are addressed early, outcomes are good.
Teachers and school staff are in a position to make to make a positive difference to the wellbeing of boys, not in a way which places on them an undue burden of responsibility, but to the extent that they can often provide a first line of support and signpost pupils to further help.
The Charlie Waller Memorial Trust’s Stella project focused on the needs of vulnerable learners. During the project, I spoke to Dr Andrew Reeves, director of the Trust’s programme for universities and further education, about his work with boys and young men.
When do boys and men seek help?
With more than 30 years’ experience as a social worker and therapist with children, young people and families, Dr Reeves is passionate about male mental health. He told me: “The mental wellbeing of boys and men is still overlooked and not talked about enough and it’s often not easy for them to seek help.
“My experience,” he continued, “is that they often leave it to the point at which they feel they have no choice. They’re desperate; sometimes they’re feeling suicidal, or they’re drinking too much, taking drugs or getting into fights. Or they’re irritable and people are starting to point that out, and they notice they’re behaving differently from usual.”
Although they may notice that their behaviour has changed, Dr Reeves believes boys and men often experience a lack of connection to their feelings.
“It’s a generalisation, but boys and men may notice they’re acting differently without necessarily recognising that they feel different; I think one of the things that can go with men’s mental health is a kind of disconnecting.”
I asked Dr Reeves what he felt was most likely to prompt young men to seek help: “Men will look online but typically to search out answers, rather than support,” he suggested. “Then they will get to the point when they’re feeling a bit desperate and go to a service they feel maps onto their experience, and where they’re not going to be judged.
“Another route is a suggestion from someone they trust. That could be a friend, parent, sibling or teacher who might say ‘I think you should do this,’ or ‘Why don’t you go to that?’, then they’ll make the choice.”
What’s affecting boys’ mental health?
When boys and young men do seek help, what sort of problems are they presenting?
“The biggest change I’ve noticed,” Dr Reeves explained, “is the increase in boys and men with issues around self-esteem, body image and eating. When I first started working in this field, men talked about depression, anxiety, relationship and sexual problems, rarely about body image per se, or their sense of self, or self-esteem.
“I’m now noticing the sheer number of boys and men coming through the door worried about body shape, about being inadequate, about their sense of being male. Some have issues around steroids or regulating their eating to lose weight or build muscle mass, and getting caught in a real trap with it.
“Women have struggled with these issues for years and now there is research suggesting that the muscle culture perpetrated by media aimed at men and boys is linked to eating disorders and body image problems.”
We hear a lot about increased use of pornography. Has that had an impact on what Dr Reeves encounters as a counsellor? “There’s a big debate as to whether pornography addiction exists. All I can say is that I see a lot of young guys who are using porn sufficiently excessively that it’s profoundly damaging their capacity to relate. So potential sexual partners become objectified; their expectation of how they should be in a sexual relationship is distorted.
“It further compounds notions of body image and inadequacy, increasing concerns around sexual performance, so the real world experience of sexual intimacy with another person becomes completely corrupted by these artificial notions. Increasing numbers of older boys and young men find it really hard to step out of that. I see loads of guys who say, ‘I’ve been lying to my mates for years that I do this and this and this, but I don’t, and actually I’m frightened of relationships because I don’t know how to do them’. I think that’s a major issue.”
Culture: making it easier for boys to talk
At the Charlie Waller Memorial Trust, we take a whole-school approach to mental wellbeing. In addition to providing one-off training sessions, we forge longer term relationships with schools to help them build a culture in which all pupils, staff and parents can learn to articulate and meet their mental health needs.
An important part of that is raising awareness of mental health issues among male staff, as Dr Reeves explained: “It’s not that male staff have to carry the whole responsibility for boys’ wellbeing, but they can play a key role in setting a culture where mental health is talked about in a positive way. One way of doing this is to promote mental wellbeing as having equal status to physical wellbeing.”
This is, of course, a live issue in society generally, the present government having committed itself to parity of esteem between mental and physical health. Funding is obviously at the centre of this debate, however, educators can play a significant role in encouraging young people to think about taking care of their minds in a clear and objective way, unobstructed by stigma.
“There are practical ways of doing this,” Dr Reeves added, “such as linking mental wellbeing sessions to sport. Use the school gym as a location for getting across simple, clear messages about mental health. Male staff and older pupils can be good role models in these settings if they can talk openly about mental health, using positive language.”
The importance of language
In Dr Reeves’ experience, the words used to describe services and support are crucial: “When boys and young men do seek help, they rarely come because they like the look of a service, because – and this is my personal point of view – most helping services tend to use what would be described as typical female language. I appreciate I’m buying into gender stereotypes here, but boys aren’t brought up to talk about growth and support, care and love, talking and sharing. They should be, but they’re not.”
Dr Reeves illustrates this with an example from his own practice: “I once ran a group for men struggling with anxiety and called it an ‘Anxiety Group for Men’. No-one ever came. Then I changed the name and called it ‘Developing a Toolkit for Success’ and I had a waiting list. I think we need to ensure our counselling and wellbeing services are not always described in deficit terms. Rather than asking, ‘are you having problems, do you need support?’ we could ask, ‘do you want to cope better with aspects of your life?’.
“It can be a big cultural leap for a young man to acknowledge that there are times when he is not coping. Another choice of words can make the same service feel like something altogether different, which boys and young men are more comfortable accessing.
“I make sure my materials promoting mental health and services are written in male-friendly ways. Boys and men respond to clear communication – when they know what they’re getting and it does what it says on the tin.
“I positively reinforce the fact they’ve sought help. I want to normalise it and to deal, very early on, with the notion that being in the same room as me is in itself a weakness. I want to reframe that as a strength. Surely it is a sign of strength if I notice something about myself I need to attend to and take action?
“I deliver a very pragmatic service; it’s honest and respectful. I put on the table what I’m thinking, I’m interested in what the guy I’m working with is thinking and how he wants to work and I stress that it is collaborative – I’m not doing something to them, we’re working in partnership.
The myth of men and feelings
It is a commonly held belief that men are reluctant to, and unskilled in, talking about their emotions.
“There’s a persistent myth”, Dr Reeves said, “that, even if you get men through the door of mental health services, they don’t know what to do and they’re not very good at talking about feelings.
“I’ve been in practice for many years, working predominantly with boys and men. It’s been my experience that, if they’re given an opportunity and a safe, respectful space, if you’re honest with them and ask clear questions, they are very good at expressing themselves.
“They know what’s right for them and what’s not. Let them use the language that is right for them. If you’re constantly asking a man ‘what do you feel about this?’ they don’t really know how to answer. Ask them what they think and they’ll tell you what they feel. Don’t be precious about your language.
“I cannot think of a single boy or man I’ve worked with who hasn’t been able to make some use of the support that’s available. So my key message would be, these guys are really good at it – we just need to give them the opportunity, get them through the door.”
Case study: Boys in Mind
The Charlie Waller Memorial Trust has helped partner organisations in Bath and North East Somerset, including the local authority, public health, CAMHS and four schools, to develop and deliver their “Boys in Mind” strategy. The strategy identifies ways to support schools in meeting the mental health needs of boys and young men. It aims to:
- Raise awareness of the effects of gender-conditioning and stereotyping on behaviour.
- Reduce stigma around mental illness and poor wellbeing among boys and young men.
- Explore ways of encouraging boys and young men to seek and give help.
- Ultimately prevent suicide.
Activities have included meetings with school leadership teams, training for parents and staff, focus groups for boys and young men, and using local young male ambassadors. Early successes include:
- Development of the “Anger Volcano”, a tool to help staff explore anger-related issues.
- A film – Letter To My Younger Self – to help young men who may be struggling with their mental health. This was a collaboration involving young people and voluntary agencies, funded by Into Film and malikfund.org (see http://bit.ly/2LU5ybQ).
- Involvement of local schools in reviewing their policies and practices through a “gender lens”.
- The Boys in Mind conference, attended by 55 school staff, young men and partner organisations.
Five tips: Supporting boys’ mental health
• Make sure boys and young men know what support is available in school for mental wellbeing.
• Use clear, positive language to promote it, e.g. “A toolkit for dealing with...”.
• Create safe, respectful spaces for boys to talk.
• Promote mental wellbeing as having equal status to physical wellbeing.
• Use locations such as the gym for posting clear, simple messages about mental health.
- Clare Stafford is CEO of the Charlie Waller Memorial Trust, a charity that provides fully funded mental health training to schools. Visit www.cwmt.org.uk
Further reading
The Charlie Waller Memorial Trust’s Stella Project has been working with professionals to provide mental health training in order to better support vulnerable learners. This series of articles is part of the legacy the year-long project hopes to leave. For more information, see The Stella Project: Supporting vulnerable learners, SecEd, February 2018: http://bit.ly/2qY0FFV. To read previous articles in this series, go to http://bit.ly/2JSreYn
References
- Mental Health of Children and Young People in Great Britain 2004, Hazel Green et al, Office for National Statistics.
- Men and Suicide: Why it’s a social issue, Wyllie et al, Samaritans, 2012: http://bit.ly/2sUimbc