Evidence for a gender-based approach to mental health programmes: Identifying the key considerations associated with “being male”

Aims The aim of the evidence check was to find out what the evidence base is relevant to testing the proposal that “being male” is a key consideration for understanding mental health outcomes and service development i.e. that a gender-based approach to mental health programmes is defensible, especially for prevention, early intervention and stigma reduction. Methods Four electronic databases were searched for journal articles, as well as relevant websites and specific journals. Studies were selected if they were about being male, mental health, and inclusive of a broad array of programmes, campaigns and public health initiatives, and not limited to clinical interventions on referral. Once the main themes had been identified, supplemental searches were carried out where themes were felt to lack depth. Two researchers selected studies for inclusion, and one researcher coded the included papers for key information and collated the evidence. Key Findings • It is important that programmes take a gender-based approach to working with men because there is a strong relationship between adherence to traditional masculinity and poorer MH help-seeking, higher levels of MH stigma, suicide attempts and body image concerns • Programmes should pay particular attention to approaches that help men to become emotionally expressive because difficulty in expressing emotions is the element of masculinity most linked to negative MH help-seeking, endorsement of MH stigma and likelihood of suicide. (This holds true amongst different groups of men, including ethnic groups of men and gay men, where discrimination may increase the impact of these negative aspects) • Programmes should also pay attention to approaches that help men develop or sustain feelings of self-esteem, control and responsibility (for example around work and family) as these are linked to more preventative self-care behaviours and to positive coping with stressful life events • Programmes should ensure they view men as positive assets and use male positive approaches (e.g. presenting help-seeking as ‘rational’ and as a strength) and language (e.g. using ‘regaining control’ rather than ‘help-seeking’) as this helps engage and sustain involvement in interventions (though caution should also be taken that these approaches don’t act to reinforce negative traditional male views) • Part of using male positive approaches includes involving men in ‘doing’, in action-based approaches, especially doing traditionally male activities. Such approaches act to create a safe space that generates trust and thus facilitates talking and ‘opening-up’ emotionally. • Furthermore, such action-based interventions also act to facilitate positive male social engagement which affects, and is affected by, the ability to be emotionally open and helps improve self-esteem through feelings of enjoyment and having a valued male identity