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'We鈥檙e known by a 21-year-old practical joke.鈥� I鈥檓 on the phone to Dr Zac Seidler, clinical psychologist and Global Director of Men鈥檚 Health Research at . It strikes me how fitting the origins of this now billiondollar philanthropic organisation are. It may have been born out of banter and be synonymous with growing comedy moustaches, but from the start its motivations have been deadly serious. Sometimes what is obvious about a thing can disguise its depth and potential.

In the spirit of Movember, I talked to therapists, researchers and campaigners about ways in which mental health services need to adapt to better meet the needs of male clients. A recurring theme is that there are prevalent misconceptions about male engagement with therapy, about male presentations of distress, and about men and boys in general. Most therapists are probably aware of the bleak statistics around men鈥檚 mental health, but are we looking closely enough at the reasons why they exist and how we can better address them?听

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Seidler is particularly interested in how we can change systems to better meet men鈥檚 needs. 鈥榃e need to understand how to reach, respond and retain them in care, moving away from a narrative that men just need to adapt to a healthcare system that is not actually built with them in mind,鈥� he says.

75% of deaths by suicide are males, and they are three times more likely to die by suicide than women

This is a key issue 鈥� as therapists, what we often expect from men runs in opposition to the conditioning they have received throughout their lives. 鈥楾here is an inherent desire in many therapists for open vulnerability and emotional communication which is fundamentally contradictory to masculine socialisation,鈥� says Seidler. 鈥楢 framework of care that is at odds with the way in which men and boys are brought up to describe and express what鈥檚 happening for them.鈥櫶�

Movember was initially focused around prostate and testicular cancers, but since 2003 it has grown to include work around mental health and suicide prevention. 鈥楽ixty per cent of men who die by suicide have been in touch with the mental health system or other services in the year prior,鈥� says Seidler. 鈥楾he idea that everything happens out of the blue is incorrect 鈥� there is contact, there is willingness, openness and motivation for change. It is up to the workforce and the system at large to start to consider how it sets men up to fail and then blames them for it.鈥櫶�

Therapy Today, November 2024

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While responsibility for breaking down the barriers to men engaging well with therapy certainly lies within the counselling profession and service providers, as well as within men themselves, we also need to accept the wider systemic context. This may require us to focus on the subtle ways in which male socialisation can impact our clients.听

I spoke to Dr Dwight Turner about his experiences of working with male clients. 鈥楢t the very least there is an awareness that something is wrong and that they need to speak up and speak out about their experiences, and at the other end there is a willingness to engage with what it is to be a man,鈥� he says. 鈥業鈥檝e found in doing work with men over the past 20 years or so, I am encountering men who have hidden behind the stereotype and found it doesn鈥檛 work for them anymore. And in rediscovering their gentleness or just that they are very kind, friendly men, they have discovered more of themselves and gone on to live some pretty well-fulfilled lives.鈥櫶�

He adds: 鈥楳en are realising that they have been co-opted into a way of being that has led to problems with mental health and so on. As they start to stretch beyond those systemic boundaries and rediscover what it is for them to be men 鈥� be they men of colour, be they men from the LGBTQ+ community, whoever they might be 鈥� they start to stride out and become their own types of men, broadening out masculinity.鈥櫶�

Dr Zac Seidler

Limited masculinity听

A theme, however, that comes through from many who work in this area is that, despite increased public awareness campaigns, there are few spaces where men can ask questions about what it is to be a man. I spoke to Dr Georgia Philip, Lecturer in Social Work and Sociology at the University of East Anglia (UEA) who, along with colleagues, has carried听out two longitudinal, qualitative studies of fathers involved in child protection and in local authority care proceedings, each involving talking with fathers over the course of a year. The result was a collection of 鈥榩owerful, challenging and humbling鈥� narratives that, alongside the usual academic reports and papers, were used to create composite characters for a play called How鈥檚 Your Father?, written by Simon Floyd in conjunction with UEA and the campaigning organisation Dads Matter. The play toured local authority social work teams in Norfolk, Suffolk and Essex as a way of developing practice with fathers.

Although the study had a social care focus, Philip told me that participants revealed much about their struggles with mental health issues and the service response they received. 鈥楾he profiles of the mums and the dads involved in care proceedings are actually very similar. They are often younger, they have had very harmful early lives, they are experiencing mental health issues and there may be substance abuse. So they are similar, but those things are interpreted differently for women and men in that situation. For women they are seen as vulnerabilities and therefore as needs, but for men they are interpreted much more as risks, and therefore the pathway and service response is different. I think that is really problematic.鈥櫶�

Philip also questioned whether we need to treat men as a service user group that requires specialist training, or whether instead we need to adjust our perceptions of male clients so that we can appropriately apply our existing skills. She identified that often care professionals had 鈥榣ess confidence and willingness to work with men and hold听the tension between both the potential they have and the problems or dangers they may pose鈥�.

One consequence of this lack of confidence in professionals was a sense in male service participants of 鈥榥ot knowing how to be鈥�. If they became emotional, they were viewed as 鈥榯oo difficult鈥�, but if they stayed quiet, they were perceived as unco-operative or uncaring.听

32% of men offered treatment by NHS Talking Therapies will not complete their allocated sessions

In the context of parenting, men are also consistently seen as secondary 鈥� another deeply embedded stereotype related to gender and care. This creates a problem in two directions, in that fathers are often not held accountable to the same degree as mothers, yet nor are they validated or supported as parents in their own right. In other words, their privilege can serve to other them when the context changes.听

Dr Georgia Philip

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Another ongoing area of development in our profession, says Turner, is awareness of the impact of intersectionality in clients, including men. 鈥楾here is always a danger in placing privilege or otherness on one homogenous group as opposed to another because it takes us away from actually looking at what the individual experience is like for people within those groups. Who are they really, beyond these sorts of labels?听

鈥楾here is this common perception that if you are the man, then you have all the privilege in society, which makes it very binary. It鈥檚 not as simple as that. I work with men around this and they find themselves othered into playing out a role or being seen as only one way of being. Actually, what often comes up when you take a more intersectional lens into their identities as men, and as many other things, is that there may be one area in which they hold privilege, but there are many other areas where they don鈥檛. Only by acknowledging the fullness of our human experience do we then start to recover who we are. When a person is seen as having male privilege, we sort of deny that they have a story to tell about that experience.鈥櫶�

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If we are to allow our clients the space to engage with what masculinity means to them, we may first need to challenge some of the prevailing narratives around masculinity. There is no doubt that feminism has changed our sector and society at large for the better 鈥� I believe that our practices and our clients鈥� experiences have benefitted significantly from feminist insight, and on the whole it has made psychotherapy far more inclusive and equitable. Efforts to tackle male aggression and violence are ongoing and fundamental to ensuring safety within our society. An unfortunate outcome of these efforts, however, is that masculinity has become synonymous with the word 鈥榯oxic鈥�. Seidler describes this as 鈥榬eductive and often stigmatising language鈥�: 鈥楾here are plenty of things about traditional masculinity that I believe are toxic. There is a difference between saying that and putting a descriptor in front of masculinity 鈥� it is stifling, and it ends up becoming a self-fulfilling prophecy.鈥�

Dr Dwight Turner

Role models听

Alongside challenging our own assumptions about our male clients, it is essential that men are offered modelling of healthy masculinity. I spoke to therapist and author Joshua Fletcher about 鈥榦wning鈥� his mental health issues publicly. Through his use of social media Fletcher has been able to use self-disclosure to model authenticity. 鈥業f they see me, a confident, funny, accessible person who is doing OK after not doing OK, people who can relate to what I鈥檝e been through find that inspiring,鈥� he says.听

Many of our male clients will not have had vulnerability modelled to them, and yet it is what we are expecting of them. Fletcher summed up his experiences at school as 鈥榠f you cried, you would get beaten up鈥�. Within the male socialisation he experienced, vulnerability posed a significant risk to social status and safety. He soon learned that the 鈥榗onsequences of emotional processing鈥� were negative.听

He told me that many men who contact him want to 鈥榯est the waters to see if I鈥檓 legit鈥� in response to him presenting a different type of male role model. His self-disclosure offers men 鈥榚vidence of improvement鈥� through therapy, and answers the question, 鈥業f I talk does this lead to good places?鈥櫶�

As therapists we may take for granted the route between talking and mental health benefits but for many male clients, socialised to mistrust emotional vulnerability, they may question why that would work.听

鈥業f I can conceptualise me talking about stuff, opening up, as a step towards fixing myself and feeling better, then I鈥檓 more likely to do it,鈥� says Fletcher. 鈥楢s opposed to every year simply being told it鈥檚 OK to talk, it鈥檚 OK to open up. Why? Why does that benefit me? I think a lot of men need to know why it is good.鈥櫶�

This approach acknowledges the common desire among men to solve problems, to fix things, to do rather than to be. Instead of challenging their existing way of being, it moves towards it.听

Joshua Fletcher

Creating space听

Research by Georgia Philip and her team at UEA confirms what many practitioners know from experience 鈥� it鈥檚 a myth that men don鈥檛 talk. As she says, 鈥楾hey do if space is created.鈥櫶�

So how can we create this space effectively? If we want to contribute to undermining the existing, limiting socialisation of men, we may need to first accept it in clients and move towards where we find them. This often means both metaphorically and physically.听

I spoke to Nick Little, Director of , a campaigning group to help men talk about mental health. From his experiences working in mental health services, he came to recognise that 鈥榓 lot of the events we were setting up, we wouldn鈥檛 come to鈥�.听

Through talking to hundreds of men about their mental health it became clear that men often preferred a more doing rather than being approach. 鈥業t鈥檚 about doing an activity, and the last activity that they seem to want to do is to go into a room that is set up with two chairs and start talking about their feelings. But get them to ride a bike together and after 20 miles they are talking. Go for a haircut and they鈥檙e talking,鈥� he says.听

12th Man creates links with spaces where men already congregate, such as barbers, gyms, working men鈥檚 clubs and tattoo parlours, and provide mental health first aid training to staff at these venues. Little told me that his focus was less on crisis though and more on 鈥榯rying to make mental health part of everyday conversation鈥�. On the ground, this means encouraging men to discuss ways to maintain positive mental health.听

36% of all NHS referrals for psychological therapies are for men

Traditional responses have been to normalise crisis by focusing on getting men to seek help when they are at risk. Little says that 12th Man鈥檚 approach differs from this: 鈥極ne in four people at any given time is experiencing a mental health problem, but three in four people aren鈥檛. They all have 鈥渕ental health鈥� as well, they are either in a good place, an average place or starting to move towards being the one in four. They are completely ignored in the way mental health is talked about, and that, we think, is a significant problem.鈥櫶�

Although not a sports charity, the name comes from football 鈥� that when a team is struggling on the pitch, a supportive crowd of fans can act like a 鈥�12th man鈥� to the team, and 鈥榯urn everything on its head鈥�. Values of unconditional support, loyalty and expression of emotion are all available to men within this environment. Little describes the 鈥榚levated status鈥� of a man crying at a match because it is seen as passion and commitment rather than weakness.听

So perhaps one way of approaching the problem at hand is to try and identify ways in which masculine socialisation can work in our favour? Seidler emphasises the importance of recognising and building on the positive aspects of masculinity that already exist, the 鈥榮kills and strengths and abilities that are deemed unnecessary or unimportant rather than trying to leverage those to our advantage鈥�.听

Christian Chalfont

Groupwork听

Men are social and respond to the behaviour of those around them just as much as anyone else. Another way in which healthy masculinity can be modelled to people in real life is within a group environment. Christian Chalfont runs , an organisation that seeks to help men 鈥榗aught in limbo between who they think they should be, and who they really are鈥�.听

鈥榃e don鈥檛 intellectualise what guys are going through, and we very much speak from our own lived experience. We model that vulnerability and how to witness and receive each other without the need to diffuse the situation with banter or diminish what someone is going through. We are not offering advice or trying to fix somebody, we just teach men presence and silence, and that is enough. Simply to be here and witness one another without the need to have a solution,鈥� says Chalfont.听

鈥楾his is a platform where they are just tentatively trying something which isn鈥檛 as confronting as one-on-one stuff. They might not end up sharing that much through the weekend but as soon as they see other men sharing from a place of modelled vulnerability and appropriate behaviour, they always respond in kind. Once they can see that level of acceptance, that humanity, that mature masculinity that we bring to something, then that allows them to consider other options.鈥櫶�

This actively counters the socially constructed notion among men that 鈥榬eliance on others admits defeat and failure鈥�, and allows participants to engage in the 鈥榝ull spectrum of experience鈥�. is another organisation using groupwork to help male clients. The social enterprise was started by 香港六合彩精准资料 registered therapist Mike Richard and runs three men鈥檚 groups a week in Salford. Richard is passionate about getting men from different backgrounds into therapy and told me, 鈥榗ounselling can learn a lot from peer support鈥�.听

鈥楲oads of aspects of masculinity are great. Helping others and being part of a team, when you tap into that the guys feel very connected with each other. They are more likely to achieve their individual goals when they are part of a supportive group. We are missing out on giving these guys what they deserve. They can take the skills that we give them and the knock-on effect is that it helps their families, their wives, their children,鈥� says Richard. 鈥業 just think that if we hold back on the knowledge we have as counsellors, that鈥檚 such a shame isn鈥檛 it? If they can鈥檛 access it because they can鈥檛 afford it we have to be creative in the ways that we get that knowledge across.鈥櫶�

40% of men won鈥檛 talk to anyone about their mental health

Mike Richard

Action听

Twenty years ago, the social critic and scholar bell hooks wrote that the 鈥榝eminist movement created a socially sanctioned space where girls can create a sense of self that is distinct from sexist definition; the same freedom has not been extended to boys鈥�.¹ Through talking to the people who have generously contributed to this article I have learned about some of the spaces where this is currently possible for men. But there is still work to do. These spaces need to be amplified and replicated.听

We find ourselves currently in what Seidler calls a 鈥榗omplex inflection point鈥�. If our men and boys have nowhere to turn for this form of expression, the听loudest voices from the manosphere, offering simple solutions to complex problems, will win out. Seidler calls this 鈥榤ake or break from a social cohesion perspective鈥� and says that it is 鈥榦n the care workforce to be a connector, not a disruptor here鈥�.

I asked Seidler what Movember鈥檚 answer was. 鈥楪o to where men are and try to co-design solutions. We don鈥檛 talk at men, we talk with men,鈥� he says. 鈥榊ou need to be willing to listen to all opinions, you need to not offer confirmation bias. My call-out constantly to counsellors and therapists is to find ways to challenge the orthodoxy, to consider the notion of best practice and what is actually working. Try to engender a room and a space that allows for honesty and transparency in response.鈥櫶�

If we want to encourage a broader change of narrative around masculinity then a good place to start is within our existing skills base. We can listen to our male clients. We can find out what their particular experience of masculinity is. We can attempt to move beyond common perceptions of it as simply 鈥榯oxic鈥�.听

If male clients feel unable to be honest and transparent in response to us, we may have already lost them. 鈥楾hat鈥檚 the greatest risk here,鈥� says Seidler. 鈥楧isconnection and detachment. My main aim across the board is to find ways to call men in, not call men out.鈥櫶�

Nick Little