We’re talking about men’s mental health more than ever now, but the LGBTQ+ community and those from lower incomes are still not getting the support they deserve
Welcome to Behind The Masc: Rethinking Masculinity, a campaign dedicated to exploring what ‘masculinity’ means in 2019. With photo stories shot in Tokyo, India, New York, and London and in-depth features exploring mental health, older bodybuilders, and myths around masculinity – we present all the ways people around the world are redefining traditional tropes.
My first encounter with mental health was on a train in 2014. I was coming back to uni during my final year. The walls of the carriage started to close in like if I didn’t concentrate then gravity would snap. My hands were tingling and the strangers next to me were staring intensely at point-blank range, so I got off early, breathing heavily, and escaped to the station cafe of a nameless satellite town. It felt like the safest place on earth.
I learned later to label the experience a ‘panic attack’. After telling some of the people closest to me in the days afterwards, I was surprised by how warm and familiar their reactions were. What had seemed like an otherworldly event to me became something shared with others, as I heard stories of other panic attacks, 3am anxieties, and intense bouts of random sadness, from men I’d never known to not be okay.
It’s impossible, in any meaningful way, to correlate my personal experiences with the men around me to the wider and increasingly louder conversation that’s going on around male mental health – but I couldn’t help but relate the two. Call it what you like, but the restrictive attitudes towards men and their emotions that dominated my formative years (the 90s and 00s) – that we now refer to as ‘toxic masculinity’ – meant lots of men suffered in silence for too long.
“The restrictive attitudes towards men and their emotions that dominated my formative years – that we now refer to as ‘toxic masculinity’ – meant lots of men suffered in silence for too long”
It’s difficult to pinpoint when that process started, but you couldn’t do worse than in 1997. The disproportionate representation of men in suicide rates was brought into sharp focus by a spike in the number of young men taking their own lives in Manchester. Seeking to make some kind of change, the Department of Health commissioned a pilot scheme from social justice campaigner Jane Powell: a grassroots movement that young men could culturally connect with. It became the Campaign Against Living Miserably, otherwise known as CALM, which has been raising awareness about the crisis in male suicide ever since.
“There are many incredibly complex reasons for the gender bias in suicide, which has been present since the 90s,” the organisation’s CEO, Simon Gunning, tells us. “More than four in 10 men under the age of 45 in the UK have contemplated taking their own lives – it’s more common than you’d perhaps think.” Gunning points to a “cultural problem rooted in the damaging masculine stereotype that conflates strength with silence” as a major part of the issue. To combat this, CALM has spearheaded the now refreshingly familiar tactic of having men in the public eye break down these barriers.
Whether it’s irreverent campaigns, like the time Chris Hughes from Love Island bottled his tears in a perfume called L’Eau de Chris; or testimonies from ordinary guys in the media, celebrity roundtables, Prince Harry in conversation with Bryony Gordon or high profile strongmen like Tyson Fury opening up about depression, the idea that men don’t talk enough about their mental health is being gradually and consistently eroded. In fact, Google searches for ‘men mental health’ increased tenfold between March 2008 and March 2018.
“I think it’s pretty clear that the conversation around mental health, particularly the crisis of male suicide, is garnering more attention,” says Cecelia Knapp, a poet, playwright and performer. “When I lost my brother to suicide seven years ago, I was shocked by the statistic of suicide being the biggest killer of men under 45 in the UK. By which I mean it wasn’t until I had been directly affected by it that the fact came to my attention. I struggled to talk to anyone about it because it still felt like such an alienating and stigmatised subject. Nowadays, it seems that people are a lot more tuned into the topic of mental health. They’re more willing to talk about it. It feels like more of a comfortable conversation.”
As time has worn on, the one size fits all ‘Time to Talk’ narrative has been expanded to include notions of intersectionality. The charity Stonewall found in 2014 that 52 per cent of young LGBTQ+ people had, at some point, self-harmed, and around 2016, the growing sense of a crisis in LGBTQ+ mental health began to impact the conversation on men’s mental health more generally. Attitude magazine editor’s book Straight Jacket released that Summer addressed issues of depression and suicide in the LGBTQ+ community, and the July issue of Attitude had Prince William on the cover, pictured for a cover feature that discussed bullying and mental health.
Further research from Stonewall has since emphasised how crucial it is to centre the experiences of men in the LGBTQ+ community in the conversation about men’s mental health, reporting that two in five GBT men (46 per cent) have experienced depression in the last year, and more than half of bi men (56 per cent) and gay men (53 per cent) have dealt with episodes of anxiety. “Issues including experiences of hate crime, discrimination and abuse, along with stereotypical assumptions about masculinity can have a hugely negative and long-lasting impact on the lives of GBT men,” confirms Josh Bradlow, policy manager at Stonewall.
“We need to understand that mental health disproportionately affects the LGBTQ+ community and people on low incomes,” Knapp agrees. “I grew up in a single-parent, low-income family and the support we needed just wasn’t readily available. We need to support our friends in the LGBTQ+ community of which Leo my brother was a part. He was alienated and bullied because of his sexuality and gender non-conformity and this had a radical impact on his mental health.”
“We need to understand that mental health disproportionately affects the LGBTQ+ community and people on low incomes. I grew up in a single-parent, low-income family and the support we needed just wasn’t readily available” – Cecelia Knapp
But is merely talking about these issues – intersectional or otherwise – really enough? “The conversation around opening up and talking has gone a long way but we need to push more,” says Knapp. “Talking is obviously great and removing the stigma is important but we need to support the people who are opening up.”
According to Hilda Burke, psychotherapist, couple’s counsellor and author of The Phone Addiction Workbook, the national conversation around men’s mental health is indeed filtering down to have an impact on real men’s lives on the ground. “Not only am I receiving more enquiries from men, but those who are coming to therapy will disclose it more readily to friends and family then maybe they did in the past, I also work as a volunteer at a men’s prison, Wormwood Scrubs, which can be quite a macho environment. But even in that space, there are many inmates seeing the value of speaking to a therapist.”
Simon Gunning agrees, reporting a higher usage of services at CALM. “Without a doubt we are seeing the positive effects of a national conversation around mental health and suicide,” he says. “In 2018, we saw a 52 per cent increase in demand on (our) free and anonymous helpline and webchat, and our highly-skilled trained helpline staff directly prevented 675 suicides in this period.”
However, Dr Jay Watts, a Consultant Clinical Psychologist, psychotherapist, writer and activist, sees room for improvement. “Many people who repeatedly ask for help or are stuck on long waiting lists feel maddened by the message that people are there to listen should you but ask,” she says. Progress with services for people with mild mental health problems through the Improving Access to Psychological Therapies (IAPT) initiative has been positive, but Watts is firm that this is not enough: “people who need long-term help or therapy, inpatient care or rehabilitation have lost out”. It’s also worth noting that even in the case of IAPT, only 36 per cent of referrals are men.
Indeed, this vital, life-saving first contact needs to be shored up by an infrastructure of robust mental health services across the board, from the clinical to the informal, and there are multiple fronts on which mental health services can improve. Initiatives such as the Men’s Sheds Association which lays on community spaces for older men to socialise, or A Band of Brothers which mentors ex-offenders, point the way to the kind of supplementary support networks and positive male role models that can act as a vital preventative support. These kinds of initiatives should be expanded.
Care should be joined up too, so while support networks should be established, healthcare should be provided near to them. For men with serious and complex mental health problems, that means enough beds need to be made available locally, as opposed to 49km away from home, which the Care Quality Commission has reported many independent sector patients are being accommodated in.
While government promises of growing NHS mental health budgets are welcome, more is needed to ensure proper care can be provided before crisis point. The NHS Constitution should enshrine a commitment to treatment within a maximum of 28 days of referral, as recommended by Mind. More cash should be provided to schools to have counsellors on-site, to ease the burden on external NHS youth mental health service CAMHS which has been shown to turn one in four children away. NHS funding for mental health must continue to be properly accounted for so that we can properly back-up claims that there are record amounts being spent on it (while spending is increasing, there are no comparable figures before three years ago, according to FullFact).
The Government’s National LGBTQ+ Health Adviser should makes mental health a key priority, as recommended by Stonewall, and NHS mental health services staff should receive training on the needs of LGBTQ+ people. Stonewall also recommends “consistently monitoring patients’ sexual orientation and gender identity to identify gaps in provision and areas for improvement, before targeting services to meet these needs”.
Employers and educational establishments need to actively advertise their mental health services, like Birkbeck, University of London has with its counselling scheme, which it has marketed internally through posters and podcasts. Services need to be brought to homeless people and those without the means to access pastoral resources, too. “Having effective, connected services across the UK is vital and unfortunately, as a society, we have much to improve on here,” Gunning confirms. “While great strides have been made in regard to the way we view mental health and suicide, we must continue to push for better service provision across the board.”
When it comes down to it, beyond talking, we also need to men to engage in a range of behaviours that have traditionally been out of bounds. It’s all very well telling men to talk to their mates about mental health, but we also need to equip men with the tools to deal with being on the receiving end of the conversation too. This is a process CALM and TV channel Dave has started in its Be The Mate You Want campaign that advises men on how to listen to a friend in need. De-stigmatising self-care is necessary too: it needs to be normalised for men to take time off work for therapy, to shake off the old fashioned breadwinner mentality that keeps many struggling on in silence.
Until these changes happen, there’ll be no room for slowing down. Foregoing toxic masculinity to open up and seek help remains a vital step, but no one should ever settle for conversation alone. We must demand robust services to meet the need, and a cultural revolution to normalise access to them. It’s literally a matter of life and death.
Read more from Behind The Masc: Rethinking Masculinity here.