Breaking the Silence: Cultural Barriers to Men's Mental Health and Overcoming Them

A couple of years ago, one of our members was experiencing symptoms that he couldn’t explain. Every day, he would break into sweats and chills. His heart would race. Sometimes the symptoms were so scary that he’d go to the emergency department. The physicians and specialists he consulted could not make a medical diagnosis, and the recurring episodes kept him out of work.

Recognizing that this member would benefit from extra support, a Blue Cross NC care manager reached out to him. During the discussion, she asked about his mental health and questioned whether anxiety or stress might be causing the symptoms. But like many men, he was reluctant to discuss his mental health with anyone, let alone get help.

As he eventually discovered, that reluctance was seriously undermining his well-being and costing him his livelihood.

I reflect on this story during Men’s Health Month because it perfectly captures why we, as a nation … and men, in particular … need to stop treating mental health as separate from physical health. We should only think in terms of health.

When It Comes to Well-being, Men’s Health is Family Health

Unfortunately, our member’s avoidance of mental health care is all too common. Across the board, women are much better about seeking out health care in all its forms than men. When it comes to mental health, the disparities are likely even more significant. It’s estimated that 43 million adults (about 1 in 5) experience a mental illness every year, but these illnesses remain untreated in many men because they are reluctant to ask for help. Some studies suggest that 1 in 10 men will experience depression or anxiety in some form. Fewer than half of them will seek treatment.

Men and women display symptoms of mental health differently, too. Whereas women tend to internalize feelings of depression and anxiety, male symptoms are often externalized . They might show up in the form of violence or anger, or they might lead to self-destructive behaviors such as substance use disorder or self-harm. In fact, men are four times more likely to die from suicide.

The negative effects of untreated mental illness extend far beyond the individual. Workers with untreated mental health issues have on average 12 unplanned absences from work per year; their peers lose, on average, 2.5 days. It’s estimated that this loss of productivity costs our economy nearly $48 billion annually. Homelessness and incarceration associated with untreated mental illness add to the social costs.

More tragically, family relationships suffer when fathers and caregivers don’t think about or take care of their mental health. Research suggests that a caregiver’s depression is more likely to negatively affect a child’s socioemotional development; it’s more likely to lead to family quarrels and an oppressive home environment. Most children who wind up in the foster care system are there because of parental abuse, neglect or dependency – factors often stemming from untreated mental illness or substance use disorders.

Family separation, parental concerns about employment, parental substance use disorders, incarceration – these are the sort of adverse childhood experiences (ACEs) that can literally shave years off a young person’s life. This doesn’t just impact one child – it is also likely to impact that child’s children: Someone who experienced childhood trauma is more likely to pass that trauma on to the next generation.

It Can Start with Conversation: Changing the Culture Around Mental Health Care

Our member’s story puts a human face on some of these numbers. It took some persuading, but eventually he agreed to seek out mental health care. Since his first conversation with our care manager, the member has met with a mental health provider once a week … and it has changed his life.

He’s not had another episode since October 2021, and after having spent a year out of the workforce, he’s found a job that he likes. He’s happy to be on his feet once again.

When I read over the care manager’s report, one detail leaps out to me: The member continues to meet with our care manager, and he never fails to thank her for listening. To appreciate someone for listening is to also recognize the value of talking … to share feelings that might be difficult, complicated or downright inexplicable. That recognition is the essence of our member’s transformation.

Unfortunately, we live in a culture that has made the simplest of things – talking – so complicated, especially for men.

As our care manager’s efforts make clear, reaching out and creating a safe space for a man to open up makes a difference. But how can we bring about a more sweeping cultural shift? How do we make sharing details about working through anxiety and depression come just as naturally to men as talking about how many pounds they’ve bench pressed or their personal-best 5k time?

Elsewhere I’ve written about how we have prioritized integrating mental health and primary care. This is clearly a strategy we’ve taken to improve access to care, since primary care providers are ideally positioned to identify individuals with unmet mental health needs and address these needs early before they escalate to a crisis. It’s just as important to think about this integration in terms of how it will gradually chip away at the stigma associated with mental health care. Men who might otherwise be reluctant to start these conversations with a mental health provider might feel more comfortable talking initially with a trusted primary care provider.

Blue Cross NC also invests in community-based organizations that are doing important (and proven) work addressing the unique aspects of stigma as they appear at the local level or as they unfold in specific cultural contexts. Last year, Blue Cross NC committed?$2 million to support 11 community-based organizations ?working to expand pathways to mental health care in rural and underserved communities. Centro Unido Latino Americano received funding to expand its Healthy Minds initiative, a program designed to educate the Latinx community in rural McDowell County how to overcome barriers to good mental health. In addition to hosting a series of community forums focused on breaking the cultural stigma of seeking mental health care, the Healthy Minds Initiative offers evidence-based programming to help individuals improve wellness AND training for peer leaders, educators, organizational staff and community leaders.

The array of programming exemplifies something that’s critical in the work ahead for us all: To build a culture that embraces mental health, it will take community partnerships and coalitions.

Embracing Men’s Mental Health, 12 Months a Year

As Men’s Health Month comes to a close, no one should dust off their hands and assume that the work of advocating for men’s health is complete. It’s a year-round effort, especially when it comes to promoting emotional and psychological well-being.

Our member’s experience is one of those stories with a happy ending. It’s a reminder of the importance of Blue Cross NC’s ongoing work to integrate mental health across the broader system to better treat serious conditions like depression and addiction. Improving just one person’s mental health improves their quality of life. It keeps families together.

It makes our state more robust, one household at a time.