COMMENTARY

Is It Time to Treat 'Male' Mental Health?

Drew Ramsey, MD

Disclosures

April 02, 2018

The great reckoning taking place in America about male behavior and men in general leads to a question: What is male mental health and what can we, as a profession of mental health clinicians, do to promote better mental health in men? I am Dr Drew Ramsey, reporting for Medscape Psychiatry. I am an assistant clinical professor of psychiatry at Columbia University in New York City.

In my clinical practice, I see a lot of men. I found this somewhat surprising in my early days of practice because we [mental health care professionals] often think of the therapeutic room as a place where we see more women. After all, the statistics tell us that twice as many women as men become depressed,[1] but maybe one of the reasons for this disparity is that we have not focused on male mental health at all. Think about it. We have female mental health care centers at every major academic institution in America, yet I could not find a single male mental health care center. This is very concerning when you look at some of the mental health statistics. For example, of the 40,000 annual suicide-related deaths in America, roughly 78% were white males.[2]

Maybe part of the reason for what is happening to men in America is our lack of focus on their unique mental health challenges. So often we think of development as something that just happens in adolescence; however, my own experience as a man and experiences with my patients tell me otherwise—as I am sure you see with your patients.

There are challenges we face at each stage of life: developing identity in our 20s; managing a profession and, for many of us, fatherhood in our 30s and 40s; and looking back on what we have done with our lives in our 50s and 60s as we face our own parents' aging and demise. These are all challenges that really deserve our attention and a conversation [with male patients to help them] better understand themselves.

As I thought about what constitutes male mental health, a concern I had is how men can assess their mental health and how we can help them access care. I created a little scale looking at several factors that interfere with male mental health, such as substance abuse. The lifetime prevalence of a substance-use disorder in men is quite high—about 40%.[3] I also thought about conditions that often go untreated in men, one of which is depression, because it presents a little differently in men than in women. For example, men who are depressed are often a little bit more irritable, angrier, and can have more insomnia.[4]

My concern is that there is a notion that men do not really present to mental health clinicians or have mental health problems. This notion discourages treatment and does not encourage people to seek preventive treatment. One of the interesting things about psychiatrists is that so many of us have been in psychotherapy to understand ourselves, our emotional world, and our work.

I think the more that we can spread the news of the care we have to offer, the more we can help men access treatment. It is my hope that psychiatrists in our profession can help with overall male behavior and how we relate to one another and to women.

I am Dr Drew Ramsey from Medscape Psychiatry. I am really curious to hear your comments and how you consider male mental health issues in your practice—what you feel are unique aspects to it and what you feel we can do to help men better understand themselves and their behavior.

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