Written evidence from The Centre for Male Psychology for the inquiry into men's health by the UK Parliament

Dec 15

Background
1)    This is a submission from the Centre for Male Psychology, an independent organisation, founded in 2021, dedicated to advancing the academic discipline of male psychology and communicating findings to the wider society. The topic of men’s health – in particular mental health – is our key area of interest. An important issue within this topic is masculinity, mainly because so much is said about it which is based on weak evidence. Although we are a new and small organisation, we feel that our perspective is one that needs to be heard. This document was prepared by Dr John Barry, and I am happy to give oral evidence for this inquiry.

Executive summary and recommendations
2)    In recent decades it has become increasingly popular to attribute men’s health problems and relative lack of help-seeking behaviour to deficits in masculinity. Despite the popularity of this explanation, the evidence base for this notion is weak, and improvements to men’s health based on this deficit view of masculinity have not been apparent. We suggest that men’s health issues and help-seeking are likely to be better explained in other ways, and that future efforts focusing on these might be more beneficial. A government strategy for men’s health would be useful to help steer this topic.

1/ What factors drive lower, and falling, male life expectancy and what action would have the biggest impact on addressing this?
3)    A recent review suggested “men's infirmities are complex and multifaceted, contributing to increased morbidity and mortality rates and decreased life expectancy”.[1] These contributory factors are said to be biological and genetic factors (e.g. weaker immunity than women), social deprivation, ethnic differences, lack of health education, and masculinity. The inclusion of masculinity on this list demonstrates – we argue in this submission – the undeserved dominance of the notion that masculinity has a significant negative effect on men’s health. This popular misconception exists despite evidence that masculinity is either unrelated to preventative health behaviour [2] or even has a beneficial effect on general health and mental health for men.[3]

4)    As will be seen in our answers to other questions in this inquiry, there are other more valid explanations for men’s health inequalities than masculinity, such as a lack of information for men, and a lack of perception by men of health problems.

5)    If masculinity (also referred to as gender role socialisation) is related to health at all, there is good reason to focus on how it might be harnessed to improve men’s mental health, rather than seeking deficits. For example, the masculine roles of provider and protector can be invoked by encouraging men to seek help because their families rely on men being healthy. It should be noted however that more research is needed on the potential benefits of masculinity, and that harnessing masculinity might not be the best strategy for men who reject traditional masculine norms.

2/ What is known about why men have a higher risk of dying from cancer and how can this risk be reduced.

a) What action is needed to improve early detection of cancers specific to men, for example around awareness of symptoms, issues with screening and encouraging men to come forward?

6) A failure to seek help due to not wanting to appear weak is the default explanation for men’s ill health these days. However there are more obvious barriers to men seeking help, such as financial restrictions, but even though some of the proponents of the deficit view of masculinity recognise these types of barriers,[4] their importance tends to be minimised.

7) There are other male-typical issues that are typically overlooked. For example, it is seldom mentioned that men are 16 times more likely than women to be colour blind, which can impact their ability to recognise colour-related symptoms of medical conditions e.g. blood in faeces (bowel or colon cancer), blood in urine (bladder cancer), or skin discolorations (skin cancers).[5] In addition, older men - who are more likely to have these conditions than younger men – are more likely than younger men to be socially isolated through being widowed or divorced, and thus have nobody who can point out these symptoms for them. Rather than blame masculinity for being a barrier to help-seeking, we need to devise ways help the one in 12 men who are colour blind to recognise medical symptoms in a way that won’t require recognising colour. Better screening programmes (e.g. being called to attend a clinic annually) are one obvious way.

b) With nearly half a million men living with or after prostate cancer, how well does aftercare support ongoing symptoms of male specific cancers and how could this be improved?

[No answer given]

3/ What is driving higher rates of suicide amongst men and how could this be addressed?
8) Although it has become popular to blame masculinity for men not seeking help, the evidence for this as an important factor is limited. One often-cited example is the paper claiming that masculine ‘self-reliance’ (i.e. not seeking help) is linked to suicidality.[6] However upon inspection of this paper, it can be seen that the link between self-reliance and suicidality was not only weak, but there were several other issues which call into question the credibility of the conclusions of the paper.[7] Nonetheless, the title of the paper was ‘Masculinity and suicidal thinking’ and the paper has been very influential in promoting the deficit model of masculinity to a wide audience of academics, clinicians and the general public, thus diverting attention away from more credible explanations that would lead to more effective solutions.

9) Another factor is similar to the barrier of colour blindness noted in paragraph 7 above. It is generally assumed that men and women show similar symptoms of mental health issues, and not widely recognised that men may express symptoms of depression, trauma and suicidality differently, for example, with depressed men being more inclined to be angry and to engage in substance abuse. This means that not only might family and friends not recognise that a man they know is suffering from a mental health condition, but the man might not himself recognise it either. Similarly, if a man thinks that eating disorders only impact women, then he might not recognise when he is showing symptoms of having an eating disorder.[8]

10) A solution to this issue is to give men more information on what symptoms they should look out for, whether related to mental health, eating disorders, or medical issues. This information should be presented in a way that will be accessed and used effectively by men.

4/ What factors contribute to men using health services, like general practice, less often than women and what impact does this have on men's health outcomes, for example from cardiovascular disease?
11) Many of the barriers to men using mental health services apply equally to women.[9] Predictably, masculinity is often said to be a barrier to help-seeking. A paper that has been cited many times and been very influential said “masculine gender norms, such as emotional stoicism, may make it more difficult for some men to recognize the severity of [mental and physical health] problems.”[10] It is interesting to note that stoicism is the cornerstone of Rational Emotional Behaviour Therapy (REBT), which is known to be a very successful form of psychological therapy.

12) Although certain expressions of masculinity might be problematic for some men in some cultures, in general the UK is not a particularly strongly masculine culture (rated 66 out of 100)[11] and the trend in the social sciences, media, government and NGOs to warning men about the dangers of masculinity probably don’t help and might even do harm. There is little research on the potential harms, but what exists should incline us to be cautious. For example, a study of 2000 men in the UK and 2000 in Germany found that believing masculinity is bad for your behaviour - including preventing men from engaging in covid health behaviours, and stopping them talking about their feelings - was associated with worse mental wellbeing.[12] Further research on this topic is needed, but at this point it is already reasonably clear that there is more at risk than to be gained by blaming health issues on masculinity.

5/ What role do community and sport-based projects play in reaching men at high risk of isolation or poor mental health, and how can it be ensured that this support is spread equitably across the country?
13) There is some promising evidence that Men’s Sheds are community-based projects that can improve wellbeing and reduce social isolation.[13] Adding a sports and exercise aspect to interventions has the potential to increase socialisation and improve mental health.[14] There is also evidence that men are more inclined to seek action-orientated interventions over ones that require them to talk about their feelings[15] and evidence that men tend to like activities such as weight training more than women do.[16]

14) Anecdotally, men say they don’t want to seek help for no clear reason because it wastes the time and resources of others. However there is an opportunity to harness this selflessness; for example, men will join a therapy group when it is to support other men rather than for themselves, indicating the potential usefulness of the masculine ‘protector role’.[17]

6/ What are the challenges in delivering health equity across different population groups among men and how best can they be addressed?
15) A meta-synthesis of 144 studies into health and help-seeking found that only 35% of studies disaggregated their data by gender; in other words most research can’t tell us much about how these issues relate to men or women separately.[18] In the same way, it is important that studies disaggregate their findings by ethnicity where possible. This is in order that the needs of all groups is taken into account. For example, in some cultures and religions certain health conditions might be highly stigmatised, and reaching out to men of these demographics may present particular difficulties. In the same way that we respect the values of people in those demographics, we should respect that men in general, or older men, or younger men, might view health differently to women in general. Instead of blaming men for not coming forward for treatment, we should investigate how we can be more effective in reaching these men. It is too easy to write off groups as ‘hard to reach’ when the real problem is that solutions, which should come from service providers, are just ‘hard to imagine’.

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References

[1] Abualhaija, N. (2022). Men’s health disparities: Causes and interventions. Nursing Forum, 57(5), 785–792 (p.785) https://doi.org/10.1111/nuf.12764

[2] Levant, R., & Richmond, K. (2007). A Review of Research on Masculinity Ideologies Using the Male Role Norms Inventory. The Journal of Men’s Studies, 15(2), 130–146 (p.141) https://doi.org/10.3149/jms.1502.130

[3] Levant, R. F., Jadaszewski, S., Alto, K., Richmond, K., Pardo, S., Keo-Meier, C., & Gerdes, Z. (2019). Moderation and mediation of the relationships between masculinity ideology and health status. Health Psychology, 38(2), 162–171. https://doi.org/10.1037/hea0000709

[4] Mansfield, A. K., Addis, M. E., & Courtenay, W. (2005). Measurement of Men’s Help Seeking: Development and Evaluation of the Barriers to Help Seeking Scale. Psychology of Men & Masculinity, 6(2), 95–108. https://doi.org/10.1037/1524-9220.6.2.95

[5] Barry, J. A., Mollan, S., Burdon, M. A., Jenkins, M., & Denniston, A. K. (2017). Development and validation of a questionnaire assessing the quality of life impact of Colour Blindness (CBQoL). BMC Ophthalmology, 17(1), 179. https://doi.org/10.1186/s12886-017-0579-z

[6] Pirkis, J., Spittal, M. J., Keogh, L., Mousaferiadis, T., & Currier, D. (2017). Masculinity and suicidal thinking. Social Psychiatry and Psychiatric Epidemiology, 52(3), 319–327. https://doi.org/10.1007/s00127-016-1324-2

[7] Barry, J. A., & Liddon, L. (2023, May). Introduction to Male Psychology and Mental Health (Module 4) [Educational]. The Centre For Male Psychology.

[8] Räisänen, U., & Hunt, K. (2014). The role of gendered constructions of eating disorders in delayed help-seeking in men: A qualitative interview study: Table 1. BMJ Open, 4(4), e004342. https://doi.org/10.1136/bmjopen-2013-004342

[9] Liddon, L., Kingerlee, R., & Barry, J. A. (2017). Gender differences in preferences for psychological treatment, coping strategies, and triggers to help-seeking. British Journal of Clinical Psychology, 57(1), 42–58. https://doi.org/10.1111/bjc.12147

[10] Mansfield, A. K., Addis, M. E., & Courtenay, W. (2005). Measurement of Men’s Help Seeking: Development and Evaluation of the Barriers to Help Seeking Scale. Psychology of Men & Masculinity, 6(2), 95–108 (p.104) https://doi.org/10.1037/1524-9220.6.2.95

[11] Hofstede, G. (1984). Culture’s Consequences: International Differences in Work-Related Values. SAGE.

[12] Barry, J. (2023). The belief that masculinity has a negative influence on one’s behavior is related to reduced mental well-being. International Journal of Health Sciences, 17(4), 29–43. PMID: 37416841

[13] McGrath, A., Murphy, N., Egan, T., & Richardson, N. (2022). Sheds for Life: Health and Wellbeing outcomes of a tailored community- based health promotion initiative for Men’s Sheds in Ireland [Preprint]. In Review. https://doi.org/10.21203/rs.3.rs-1501458/v1

[14] Abotsie, G., Kingerlee, R., Fisk, A., Watts, S., Cooke, R., Woodley, L., Collins, D., & Teague, B. (2020). The men’s wellbeing project: Promoting the Well-being and mental health of men. Journal of Public Mental Health, ahead-of-print(ahead-of-print). https://doi.org/10.1108/JPMH-03-2020-0014

[15] Holloway, K., Seager, M., & Barry, J. A. (2018). Are clinical psychologists, psychotherapists and counsellors overlooking the needs of their male clients? Clinical Psychology Forum, 307, 15–21. https://doi.org/10.53841/bpspsr.2019.1.63.50

[16] Nuzzo, J. L. (2023). Narrative Review of Sex Differences in Muscle Strength, Endurance, Activation, Size, Fiber Type, and Strength Training Participation Rates, Preferences, Motivations, Injuries, and Neuromuscular Adaptations. Journal of Strength and Conditioning Research, 37(2), 494–536. https://doi.org/10.1519/JSC.0000000000004329

[17] Shields, D., & Westwood, M. (2019). Counselling Male Military Personnel and Veterans: Addressing Challenges and Enhancing Engagement. In J. A. Barry, R. Kingerlee, M. Seager, & L. Sullivan (Eds.), The Palgrave Handbook of Male Psychology and Mental Health (pp. 417–438). Springer International Publishing. https://doi.org/10.1007/978-3-030-04384-1_21

[18] Clement, S., Schauman, O., Graham, T., Maggioni, F., Evans-Lacko, S., Bezborodovs, N., Morgan, C., Rüsch, N., Brown, J. S. L., & Thornicroft, G. (2015). What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychological Medicine, 45(1), 11–27. https://doi.org/10.1017/S0033291714000129

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