Pre-coronavirus, one in two consultations at my doctor’s surgery were about mental health.
But while we’ve made headway in reducing the stigma around this topic, there is still a big challenge ahead, as most of the patients I saw were women.
Despite many high profile male mental health campaigns over the years, sadly men continue to be hesitant to talk about the issue.
Guys of all backgrounds are, on average, a third less likely to seek medical help than women – and BAME men even less so. With so many in denial about their emotional wellbeing, coming to us only when it’s nearly too late, GPs like myself often feel like men’s mental health is a ticking time bomb.
It’s a worrying trend, given the leading cause of death in men under 50 is suicide.
Numerous factors contribute to why they won’t open up, including concerns about confidentiality or the implication of mental health disclosures staying on ‘the permanent record’.
Studies also demonstrate that racism and discrimination, experienced more by BAME populations, can lead to the development of long-term emotional issues.
For young males, ongoing values of machismo play a big role too. Some BAME cultures endorse harmful ideals of traditional masculinity – of the importance of stoicism, of being seen as the unbreakable provider without weakness.
Even BAME faith communities can hold dangerous traditional views – for example, some believe depression is caused by weak faith or incurring God’s anger.
There’s also the thinking that because depression isn’t visible it simply isn’t real. It speaks volumes that the word ‘depression’ doesn’t exist in many South Asian languages. The closest equivalent phrase means ‘long-term psychotic type condition’.
I recently had an Asian man calling my GP practice every few weeks without any obvious reason. We discussed London lockdown life, the postponement of the Premier League, even our shared concerns around toilet paper shortages – anything but actual medical issues.
The frequency of his calls didn’t feel right, so I reached out and had a frank discussion about my concerns and my patient told me he was ashamed to say he had significant anxiety and depression symptoms. He said he didn’t feel like a ‘real man’.
I was able to reassure him that the real shame would have been in not speaking up at all and together we were able to put a plan in place to support him. This example highlights the complexity of addressing mental health in BAME men – there are so many challenges.
Covid-19 has added an extra hurdle for doctors trying to diagnose mental health issues.
Video consultations have reduced our ability to read between the lines and interpret body language, and use our GP spidey-senses to work out whether something’s not as it seems.
Lockdown and social distancing have also put financial pressures on BAME households and husbands, who often hold traditional breadwinning roles, have had to deal with a great mental health burden.
Covid-19 has also removed – albeit sometimes unhelpful – male coping mechanisms like escaping to the office, exercising at the gym or watching sport, and has cut us off from our social support networks.
These changes, combined with a pre-pandemic resistance to seeking help, make BAME males particularly vulnerable.
Research also shows that matching patients with therapists of the same ethnicity, language or cultural background improves outcomes with mental health therapy
The good news is there has been progress in supporting men’s mental health in general, such as the Heads Up campaign, which has focused on male-dominant activities like football.
As part of the campaign, the start of third-round FA cup matches were delayed by 60 seconds to successfully encourage 87,000 fans to fill out online mental health quizzes and create personalised ‘Mind Plans’ to improve their mental wellbeing.
Then there is the well-known Movember movement, which encourages men to grow their facial hair to raise money and awareness for men’s physical and mental health causes.
Innovative ideas like this are needed to target the challenging problems facing BAME men. For instance, men respond well to activity and exercise-based therapy, especially with peers. Perhaps we should move towards group-based therapy to help BAME men better engage with mental their health.
Research also shows that matching patients with therapists of the same ethnicity, language or cultural background improves outcomes with mental health therapy – and I truly believe that a tailored approach like this could prove hugely beneficial.
Getting cultural and religious centres to start a dialogue and normalise mental health can be powerful tools too, as well as training community members to provide support from within. Enlisting the vocal support of religious scholars and revered community members, for instance, may encourage stoical elderly men to seek help.
Meanwhile, the support and endorsement of prominent UK BAME figures could ensure the younger generations feel emboldened to speak up about their struggles.
We have to bring mental health into the 21st century, utilising technology to mitigate the male challenge of verbally communicating their problems.
It’s great to see some organisations addressing this, such as the Shout Crisis Text Line, the UK’s first 24/7 text service, which is free on all major mobile networks for anyone in crisis, anytime, anywhere.
To anyone reading this who is suffering, rest assured that we, your GPs and allied healthcare professionals, are always here to support you with whatever you need – mental health or otherwise.
I’ve seen the tragic consequence of what happens when BAME men don’t speak up about their problems and the heartbreak it causes the families they leave behind – and I promise you it’s not worth it.
Whatever you do, don’t bottle it up – there are solutions, but we can only help if we know there’s a problem in the first place.