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Tough enough to talk about it: honing in on stigma and culture helps address men’s mental health and addictions

rural community pic

Livinus Numfor, health promotion specialist in Yarmouth, Nova Scotia. (contributed)

By Andrea Frydl

Livinus Numfor is no stranger to stigma or discrimination.

He is Black, an immigrant, has an accent and is one of three men on the health promotion team at Nova Scotia Health’s Mental Health and Addictions Program.

Given this lived experience with stigma, he is empathetic and understands that men in his community, province and country often face similar stigma when dealing with personal mental health and addictions issues.

Numfor is aware of the disparity between men and women in help-seeking behavior.

“For mental illness awareness week, I believe we should hone in on the idea that the world we live in creates a great deal of challenges for men who want to address mental health and addictions issues,” said Numfor. “Rather than focusing exclusively on the barriers to treatment, we should seek to make a change in society that facilitates discussions about men’s mental health and addictions in general.”

There is a disparity between men and women in how they communicate about mental health and addictions and how and when they seek care. This disparity is problematic as men often see higher rates of substance use disorder and suicide.

Numfor participates in various community health committees including the topic of men’s mental health. His connections and inroads with the community has helped him take a deep dive into the challenges’ society faces when addressing men’s mental health and addictions.

Numfor did independent research, spoke to mental health providers and people with lived experience and created a list and of challenges and proposed solutions.

He believes there are seven challenges that need to be overcome when fostering a culture of inclusivity for men’s mental health and addictions. They are:

Cultural and environmental influences

The social determinants of health that impact peoples’ overall physical health also affects their mental health. These are poverty, racism and discrimination, inequity and adverse childhood experiences.

Traditional masculine ideals

Toxic masculinity makes it difficult for men to accept that they need support. Often, boys who experience anxiety and depression are told to ‘man up’ and ‘not cry.’ Toughness and aggressive behavior are admired as a masculine trait. Asking for help is considered a sign of weakness. These beliefs can extend into adulthood. Media depictions of male ideals often reinforce these beliefs.

Lack of acceptance from peers

Many people feel that speaking up about mental health is perceived as being weak. This could lead to discomfort, embarrassment, shame and potential rejection by peers.

Of the men who do seek help many often do so in private and do not tell their friends due to the stigma.

Lack of family support

Numfor stated that one of the people he spoke with said that his family was afraid of him when they found out that he was seeking care.

The patient mentioned that his family thought he may become violent or dangerous.

“If this is what a lot of families with men who seek care think, then overcoming mental health challenges would be extremely difficult,” said Numfor.

Personal challenges and family dynamics

Men may be afraid to seek out or use prescribed medication such as selective serotonin reuptake inhibitors due to their common side effect of erectile dysfunction. Many men feel hesitant to seek mental health support due to denial of emotions and the long-held belief that men should be the leaders in their family units.

Often this leads to ignoring symptoms or issues until they are very severe. In addition, if someone else in their family has a mental health issue, men may feel less inclined to seek care for themselves so that they can appear to be the bedrock for the family.

Self-medicating with alcohol

Instead of seeking mental health support, men may rely on alcohol to self-medicate and reduce feelings of anxiety, depression or pain.

Additionally, some men seek to become inebriated to facilitate talking about mental health issues, when they feel they can be more open with others about their problems and emotions.

Distrust and fear of discrimination by health care professionals

Some men have low health literacy and may be intimidated about seeking help because they don’t understand or are confused by the language and terminology being used in mental health and addictions.

Just as is expected in other service industries, if a client has a bad experience with a professional anywhere in the health system, they will be less inclined to trust or seek it out again.

In addition, men may fear that their personal information will not be kept confidential and as a result will be reluctant to be open and honest about their personal situation. Men who fear discrimination by the health system may not choose to engage with it at all. For example, gay men who feel their doctor discriminates against them may not continue with care.

Although this list seems grim, Numfor says that there are solutions to these challenges.

“We can do better and make a lasting impact,” he said. He recommends the proposed approaches to creating change:

Adopting an environmental approach

Numfor recommends addressing the high-level social determinants of health first, which can help prevent future mental health issues in the long run.

However, for the men who are managing mental health and additions issues now, or who are hesitant to ask for help, Numfor recommends that governments adopt a comprehensive mass media campaign that employs multiple tactics and dissemination strategies that target men who adhere to long-held beliefs that men have to be ‘tough’ and not express their emotions.

“It would be great to see something focusing on mental health during football or hockey games instead of just beer and doritos commercials,” said Numfor.

Focusing on cultural changes

To get at the crux of cultural change, communities need to normalize the idea of men talking about mental health and seeking care when they need it.

In addition to the mass media campaign mentioned previously, society should seek to root out myths about toxic masculinity and help identify adopt a zero tolerance of misogyny and gender stereotypes through advocacy and the setting of guidelines in professional and public spaces.

“Although we’re still working on it, health promoters have helped make smoking uncool,” said Numfor. “We should do the same thing with the belief men shouldn’t talk about their problems --- that’s also uncool.”

Developing new language

To address the literacy issues mentioned earlier and to make the language around mental health and addictions more accessible to a male audience, Numfor recommends changing the way we speak about it.

For example, he mentions changing “mental illness” or “mental health” to “mental strength” to avoid stigmatizing language.

“Mental health” is too inclined to the direction of discrimination and the new terminology “mental strength” could give a new meaning and reframe the language.

Numfor believes that if you need to see someone about your “mental strength,” it gives the idea that you don’t have a problem, instead, you are seeking to improve something – to build your mental muscle, so to speak - and it will be easier to speak up.

“If a man has cancer, he would be much more willing to talk openly about it with his doctors, his family and his friends,” said Numfor. “It should be the same with mental health and addictions. It’s not weakness to need help. It’s not weakness to seek care or talk about your problems with friends and family. Even superman probably talked with a therapist or to Lois Lane once in a while about the pressures he was dealing with.”

There are thousands of mental health and addictions professionals who provide support, programs and services to Nova Scotians across the province.

You are not alone. We are here to help.

Provincial Mental Health and Addictions Crisis Line is available 24 hours 7 days a week at 1-888-429-8167

Mental Health and Addictions Intake Line is available weekdays from 8:30 a.m. to 4:30 p.m. The toll-free number is: 1-855-922-1122

For other program and service information and additional resources, please visit: http://MHAhelpNS.ca