COGS 1st International Meeting (2020): Talks

Men’s Mental Health

John Oliffe (University of British Columbia)
January 8, 2020

Thanks for your leadership Jill, and thanks for the opportunity and inclusion.

I’m going to say that means depression and suicide, just in terms of symptoms around depression and some ideas about how they might be externalized…help seeking in context of mental health, but more specifically I want to share a few principles that I think we may have to steal from the community of practice around mental health. And I discuss a few of what are our next steps.

So, we started back in around 2005 around discordant relationship that we believe was very much in response to men being diagnosed with depression.

And so not to suggest that the only root to suicide is depression, but severe depression is known to be a major risk factor.

So we wanted to better understand, so we started with some qualitative work and looked at perhaps the fact that we might be missing depression in how we screen in clinical situations.

And what’s meant by that is sort of this notion that a lot of guys who are experiencing depression were talking to us about aggression, irritability, alcohol overuse, overindulging in sports and work, and things around risk taking.

So it was interesting work because we didn’t sort of rush in and try to change anything about the screening process for depression, but we really wanted to kind of cupid with the idea that now depression might present in certain ways.

The work of Solomon Ross out at Melbourne University of has been really good in moving this forward that’s really looking at mild depressive risk factors. So, he’s done a really nice job of having a look at those issues around irritability, anger and men’s risk taking. So again, starting to help us move and think forward around the idea that men, especially early on in depression, might present in specific ways.

The other thing that we sort of looked at was this idea that men don’t go to the doctor, which now empirically is pretty barren, it’s the story that we most often tell, but I think in text a lot, it really doesn’t represent all men at all, and I like this one out of Huffington’s Post where they actually report 48% of the sample, and the 52% that they don’t report are men that said nothing would stop them from going to see their doctor for an annual visit. So, again, this mixed misrepresentation. And it also applies in the context of men’s depression and suicide.

So, the fact that up to 60% of men have actually been in contact with their health care services in a year prior to their death by suicide, suggests that we need to do a better job with our health care services, and again, trying to debunk this myth that men don’t go to a doctor, because just the essence of it has very much been complained.

Zach Soliba is doing some very great work in trying to work with guys who are in care but potentially being lost to care, so trying to understand that. And Paul, the other biograph here, is a guy who’s doing some really innovative work about looking at general practitioners and their experience of losing a patient to suicide, and story in terms of how clinical can play out.

I put this slide because I wanted to show that I now write with President’s University, just to show that about 20 years ago we did realize that there is a lot of complexity around men’s health seeking, and we pointed to it in qualitative work. So again, trying to think about how we engage men in services, and sometimes it’s not necessarily about building more of the same services, it’s about tying the services to some population that’s at a disadvantage.

Certainly, community-based work has been really helpful in advancing men’s health, especially in terms of interventions and thinking about how we can do a better job of engaging men with their health.

One of the sub-groups that are often disproportionately effected are the homosexual men, and so again, just trying to work with particular groups when we talk about community, are to build services that can engage them.

So some principles that we’ve learnt from that are that men connect by doing. And this is one of the things that’s often spoken about, and the men’s shed’s movement has been interesting. Done really well in Australia, not so well here, hasn’t had the government backing but has opt out, we probably got about 20 sheds across Canada that bring men into a space, on a volunteer basis, and give them some connection. The key idea is that men also connect through talking, as we saw within these particular environments, so when we talk about designing programs, community-based, we talk to them about their pacing and I think that makes shed a really nice example, pacing between activities and the way men kind of naturally connect.

Another principle of community-based approach is that the mission and affirmation of men shifts masculine norms. So cross country support groups, more than 100 are across Canada, similar in Australia, and they operate on volunteerism and they do a really nice job of normalizing the experience of prosthetic cancer in ways that you can talk about the vulnerabilities that accompany that disease and the treatments. The key idea is that there are lots of masculine stereotypes can explain the attrition of some men.

So eventually, the leaders of prostate cancer support groups that it’s okay that guys come once to a meeting, get what they need, and don’t come back, but to maintain the milieu that is changing and transformative in terms of the masculinities that are going on in those groups that allow people to get what they want and go.

The other one is just that men perceive like health issues like heart and stinger, and I think it’s well known, especially around mental health, and the example here is the Veteran’s transition program that operates here out of UBC, and casting psychology, does a really nice job of working with men to help them advance their health literacy, to get past their vulnerabilities and talk about some of the issues that are troubling them in civilian life.

The caveat is that we really need to know and work with the men’s language. Love the example with the Veteran’s transition program is that we talk about dropping your baggage, we talk about releasing, even though what we’re actually doing is counselling psychology in a group-based intervention, wrapping it up in those terms. Probably unethical, but men are accrued to the group by saying “you don’t have a problem, but many men of the group would benefit by your presence in being involved in the group therapy”. Of course it appeals to the militaristic values and the comradery that goes with that, and again, I think values is an important piece to think about too, in terms of masculine values, not just norms and ideals, I think we’re able to bring people into the space.

So, I’ll close up with just a couple of points for next steps. I continuously say this, I’ve been still saying it for a long time, but I’ll say it again is that we really do need to think about men’s health as relational. So, we did a lot of work, and this is from a mother who lost her son from suicide, and just bear in mind that when we make an intervention that impacts men directly, and helps their quality of life and helps them around suicide prevention, the benefits to society are huge. So just to say that we need to think about relational pieces, and we need to remind ourselves, that doing good in men’s health, even if the intervention is focused on men, has many benefits.

The other thing mentioned a lot today, I was on the board for 6 years for generate health, and I think we talked about it a lot then as well, and this utopia of sex and gender. Totally agree, just so important that we kind of collapse these solo’s, and we start talking, so I just shared with you just one experience.

We got a grant and review, so if there’s any reviewers here, you should fund this, it doesn’t matter, I learnt so much from being involved in this particular grant application, because it involved a mass model, and then also a sex comparison, and then some qualitative work in looking at interest and for use of CBD and anxiety. So a really nice experience, so just more of a self-note to say, we got to be open to the things that we don’t know and just engage with the conversation, and once I got past the language I really kind of enjoyed the whole experience of helping to write the grant.

The things I’ve shared with you today, they’re published, the men’s depression and suicide piece are two important parts of it, the full read is available, and it was published just at the end of last year. And the one that’s in press as a community-based men’s health promotional data, 3 of those particular lessons that we learned, there’s 8, so lots of reasons to go to this paper and download it, even if you don’t fully read it, that would just help.

Thank you very much!

Supporting Organizations

Women's Brain Health Initiative logo and website link Women's Health Research Cluster logo and website link Ontario Brain Institute logo and website link Women's Health Research Institute at BC Women's logo and website link Libin Cardiovascular Institute of Alberta logo and website link Canadian Institutes of Health Research logo and website link Women and Children's Health Research Institute logo and website link Elsevier logo and website link Centre for Gender and Sexual Health Equity logo and website Linköping University logo and website link Heart Stroke logo and website link centreDeRecherche logo and website link UMontreal logo and website link Einstein lab logo and website link