Skip to main content

Men’s Health

Volume 448: debated on Wednesday 28 June 2006

The evidence of men’s and boy’s poor mental well-being is all around us. Some 75 per cent. of people who kill themselves are men, most of them young men, among whom suicide is the commonest cause of death. One man in eight is dependent on alcohol and 72 per cent. of male prisoners suffer from two or more mental disorders, while boys are five times more likely to be diagnosed with attention deficit hyperactivity disorder than girls.

Alarming numbers of men are unhappy, anxious, stressed and depressed. The results of a recent YouGov survey for the Men’s Health Forum show that more than 18 million men in the UK could be affected by common mental health problems. The survey found that men in the UK experience very high stress levels, with nearly half—46 per cent.—suffering from moderate or extreme stress in a normal week. Just over half— 51 per cent.—said that they felt down, stressed, depressed or anxious at least once a month, while one in 10 felt that way a few times a week or even every day. Up to 76 per cent. of men have experienced depression or anxiety in their lives. The study also shows that while mental health is a major problem, nearly one fifth of men suffer in silence and do not turn to anyone for help.

What causes such men to feel stressed, depressed and down? Some 48 per cent. of men blame work or study as the key trigger for mental health problems, while 44 per cent. blame financial worries. Fast-paced living was mentioned as the cause by 27 per cent. of men, and relationship problems by 25 per cent.

Earlier this month, during national men’s health week, the all-party group on men’s health, which I chair, held a meeting with the all-party group on mental health. We heard from experts in the field of men’s and boys’ mental well-being. David Wilkins, from the Men’s Health Forum, presented a new report on the issue, “Mind Your Head: Men, boys and mental well-being”, which argues that although women are more likely to be diagnosed with a mental disorder, problems in men are massively under-diagnosed.

According to the report, in many cases that is simply because we do not fully understand the differences between how mental health problems manifest themselves in men and women. The report concludes that

“men’s mental well-being as a whole is poorly understood and seriously undervalued.”

That conclusion is at odds with the importance given to mental well-being by the general public. The publication of the White Paper, “Our health, our care, our say”, followed an extensive consultation programme, in which a focus on mental well-being was ranked second on the general public’s list of priorities for the NHS. Only regular preventive health checks were considered more of a priority.

Specialists recognise that importance too. The National Institute for Mental Health in England is explicit about the benefits to the nation of working to enhance mental well-being. In “Making it possible: improving mental health and well-being in England”, the institute wrote:

“The skills and attributes associated with positive mental health lead to improved physical health, better quality of life, reduced crime, higher educational attainment, economic well-being and personal dignity.”

At the meeting of the all-party groups, we also heard from Dr. Phil Timms of the Royal College of Psychiatrists, who told us that men tend to like being in control, which can prevent them from seeking help. However, if that can be turned around so that men see that they are taking control of their own health, it might be positive.

Men’s mental health problems are often missed by GPs and friends because they are covered up. Dr. Timms also spoke about a friend of his who committed suicide while at medical school and had not spoken to anyone about his feelings. He also noted that that is not uncommon. Instead, men start drinking, take risks and become angry or complain of headaches, rather than admitting that they are feeling distressed or depressed.

National men’s health week looked at men’s mental well-being. At national level, the Men’s Health Forum worked closely with 40 other organisations to make the week a success and to show what can be done to improve men’s mental well-being. I shall not list all 40 organisations, but partners in the week included the Royal Mail, which is the country’s biggest employer of men, the TUC, and charities such as the Mental Health Foundation, the Samaritans and the Afiya Trust. The Department of Health and NHS organisations were also partners. They all did some great work, showing what can be done to improve men’s mental well-being.

The partners also worked with Haynes Publishing to produce the “Brain Manual”, which was compiled by a good friend of mine, Dr. Ian Banks. He is not only president of the Men’s Health Forum, having done a huge amount of work in support of men’s health, but has recently been appointed as one of only two professors of men’s health in the country. About 2,000 local events took place in national men’s health week too. These events—run by NHS professionals, voluntary groups and occupational teams—undertook an extremely broad range of activity in an even broader range of settings. Activities ranged from display stands and father-and-son days to a five-a-side football competition and everything in between.

In my constituency in Dartford, the primary care trust health promotion team worked with pharmacists on a leaflet that they could either give to clients as a takeaway or use to prompt conversations on health issues. The overall aim is to engage men in promoting activities in ways that are local and flexible. Pharmacists, as we know, are both local and flexible. I am delighted that my local PCT and local council were able to get involved in men’s health week.

I had the good fortune to chair a recent men’s health supported conference on men’s mental well-being, at which the Minister also spoke. That conference and the “Brain Manual” received financial support from the Government, for which I know the Men’s Health Forum was extremely grateful. The Government were also supported by the Mental Health Foundation and the Football Association.

The wide range of factors that positively and negatively influence a man’s mental well-being were explained and discussed at the event. The Football Association highlighted how sport can help to improve mental well-being. It has announced that it has appointed former England captain Tony Adams as a new football for all ambassador, with specific responsibility for mental health.

The FA’s Simon Johnson also called on the mental health practitioners at the conference to become involved in the new football for all project, which uses football as a tool to help service users. That is clearly a welcome development. As the conference was supposed to have taken place in the new Wembley stadium, the FA could have spoken also about its experience of managing workplace stress.

Many gay men in particular face challenges to mental health well-being. There is still widespread homophobic bullying in schools, for example, and many mainstream religions regard homosexuality as sinful. Homophobia results in depression, anxiety, fear, apathy, mistrust and other mental health problems. There is also an impact on heterosexual men who might fear being labelled gay. That limits personal expression and creates fear of closeness with other men.

The conference held workshops run in London by PACE, which is London’s largest gay and lesbian organisation. Evaluation shows that 96 per cent. of participants found the workshops useful, 71 per cent. felt more assured and 40 per cent. felt less unhappy about being gay.

Many of the lessons of that work could be used to help men in general. The “Mind Your Head” report from the Men’s Health Forum is heavily influenced by Professor Richard Layard’s work on happiness. A key area here is the effect of work on well-being. Far more men than women work full-time, and experiencing satisfaction at work is an important predisposing factor for positive mental well-being in men.

We usually associate higher earning power and higher status for men at work as representing a disadvantage for women, but this is a double-edged sword. The traditional role of breadwinner brings its own stresses, and long working hours can harm good family relationships, which are crucial for the mental well-being of future generations.

Lack of job satisfaction, work-related stress, the pressure to work long hours and unemployment are all damaging to mental well-being and, for numerical reasons, more likely to affect men than women. Men in the UK work the longest hours in Europe; 27 per cent. of men with full-time jobs in the UK work more than 48 hours a week, and 11 per cent. do more than 60 hours a week.

According to the TUC, 5 million people work more than seven hours of unpaid overtime every week. Most of those are likely to be men. The TUC work on this suggests that almost half the UK work force want to work fewer hours, with 10 per cent. willing to accept a pay reduction to do so.

Perhaps that has an influence on some of the other statistics highlighted by the YouGov survey published during men’s health week. For example, stress, anxiety or depression are causing a third of sufferers to drink more alcohol. A further 18 per cent. start or increase smoking, and 4 per cent. admit to using illegal drugs in a bid to make themselves feel better. Nearly a fifth say that that makes them feel more aggressive.

We also know that 73 per cent. of adults who go missing are men. Let us remember that the reverse of that issue—unemployment—is also a common factor in poor mental well-being. Last year, the Health Development Agency reported that

“there is a strong association between unemployment and psychological and psychiatric morbidity... Upon re-employment, there appears to be a reversal of these effects.”

Just last week, the Journal of Occupational and Environmental Medicine reported that the stress caused by job loss in the over-50s doubled their chances of suffering a stroke or heart attack.

As I have said, understanding and valuing of men’s mental well-being are low, but the position is even worse when it comes to ethnic minority men. There is little awareness among health care professionals of how to engage effectively with black and minority ethnic men. Young African-Caribbean men are much more likely to receive a diagnosis of schizophrenia, more likely to be detained under the Mental Health Act 1983 and less likely to be offered psychological treatments. Asian men have high incidence of compulsory admissions to psychiatric institutions and low uptake of aftercare services. Irish men have a particularly high suicide rate, while Chinese men are generally reluctant to express emotions or to seek help with emotional problems.

Black and minority ethnic organisations, including Destigmatize and SIRI Counselling, were also partners in national men’s health week. I am particularly pleased that the Men’s Health Forum is continuing to work with those organisations and others on a project on the mental well-being of BME men. It is good news that the Department of Health is providing the majority of the funding needed for the project, and I hope that a sponsor can soon be found to provide the remainder.

I know that the forum has had a long relationship with Professor Kamlesh Patel, chair of the Mental Health Act Commission and director of the ethnicity and health unit at the university of Central Lancashire. In fact, I would like to congratulate Professor Patel on his recent appointment to another place, and I look forward to welcoming Lord Patel of Bradford to meetings of the all-party group on men’s health.

There are isolated examples of innovative work going on in Kilburn. Brent council, the local child and adolescent health service, and the charity Corum Family run the boys2MEN project, which aims to give young African-Caribbean men healthy relationships with men when many do not have a father figure in their household. Last year, they won an award for that work.

Another groundbreaking project is CALM, the Campaign Against Living Miserably. CALM has been successful in working with the music industry in clubs and local radio. Its telephone helpline and website also allow young men to talk about problems and find local support.

I urge the Minister to ensure continuing and increasing support for such projects. Those charities, councils and local NHS bodies are helping young men to avoid alcohol abuse, suicide and aggression. Others have had success too. Dr. Phil Timms has noted that in New Zealand, 10 to 12-year-olds are taught about mental well-being. That is proving very successful.

The Men’s Health Forum survey identified relationship problems as troubling a quarter of men. It is often claimed that men will not seek help for such problems, but the national Mensline scheme in Australia shows that that is simply not true. By offering a male-friendly, male-specific service, it has attracted 400,000 callers since 2001 in a culture internationally known for its macho men. That suggests that with a little encouragement and by respecting men’s maleness, we might help large numbers of men suffering marital breakdown. That would have knock-on effects, helping men and women to tackle some troublesome problems of relationship breakdown that can be so damaging for children.

I think I have shown that on a range of measures men’s mental well-being is poor, and that despite the successes of isolated and small-scale initiatives, no one really knows how to tackle things comprehensively. As the Men’s Health Forum told the all-party groups on men’s health and on mental health:

“Men are less likely to be diagnosed with depression because male specific symptoms may not be taken into account.”

We need to understand that. We need to tackle it. We need to stop men’s physical health, those in relationships with them and society at large suffering through men’s poor mental health.

The first step must be a detailed investigation of levels of male psychological distress in all its manifestations. I believe that the Government should fund and start that work now. Specialists at the National Institute for Mental Health in England should examine the key risk factors, establish good practice and make recommendations for new and more flexible male-friendly services. They should also consider how we deal with the significant inequalities such as those affecting gay men and those from BME communities.

I hope that the Minister can announce progress on that important work. Such a gender-sensitive approach will soon be mandatory, when the new gender duty, introduced by the Equality Act 2006, becomes operational next April. I am also concerned that the public sector as a whole, not least the NHS, is not yet preparing for its new responsibilities, even though they have the potential dramatically to improve service delivery for men and for women.

We must avoid at all costs a society in which chronic poor mental health, as well as its effect on other areas of health and society, is endemic in men and repeated from generation to generation.

I start by congratulating my hon. Friend the Member for Dartford (Dr. Stoate) on securing this extremely important debate and on all the work he has done with the all-party group on men’s health. It is vital to use whatever platform we can to raise these sensitive issues with the wider public and in Parliament.

My hon. Friend is right to say that there is increasing focus, certainly in Government, on well-being and mental health. If we are to tackle some of the basic problems, it is important to consider how mental health issues can affect different parts of society. We have talked about issues in men’s mental health, but as my hon. Friend said, there are additional mental health issues in respect of people from black and minority ethnic communities.

If we are to tackle the overall issues in dealing with mental health problems and mental well-being, it is vital to ask why certain groups suffer disproportionately and why some people do not come forward and access services. I was pleased that there was a national men’s health week and that the Men’s Health Forum put together a conference on mental health where the “Brain Manual” was launched. I am delighted that the Department was able to support it. I spoke at the conference and I was incredibly impressed by people’s commitment and dedication in raising the issue, and I asked for feedback from the conference.

We want to look in even more detail at other comments, but one issue, especially, that was raised was that of opening hours for GPs’ surgeries, as men find it difficult to take time off work to go to the GP. We must ask whether there is a barrier at that first stage and find out how to make it easier for people to gain access to health care services.

My hon. Friend set out some of the very real challenges in men’s mental health and drew attention to some shocking statistics: three-quarters of those who kill themselves are men; 73 per cent. of adults who go missing are men. Too high a proportion of men suffer from mental health problems, and instead of seeking help they are more likely to turn to drugs, alcohol and smoking to try to alleviate those problems.

It is important to raise awareness of men’s mental health problems and to have programmes to tackle in a broader sense some of the stigma and discrimination that goes with mental health in general, but especially in men who perhaps feel that they have some kind of weakness that cannot be talked about. How do we overcome that and say, “No, this is a common health problem that we need to be open about”? People should not feel stigmatised if they have to seek help.

As my hon. Friend said, we must assist men to acknowledge mental health problems and encourage them to seek help and support. The conference had the support of the Football Association, which appointed Tony Adams as its ambassador with specific responsibility for mental health. That will promote mental health issues positively. Too often, coverage of such issues is completely negative. We have to talk about the positive aspects of the services available and the advantages of coming forward and, with the Football Association, emphasise the importance of physical exercise in helping mental health problems, and in particular reducing the stress that my hon. Friend talked about.

The Department has set up the shift programme to help to tackle the way in which the media and the wider public approach and perceive mental health issues. It is heartbreaking sometimes to see how the media deal with some of these issues. Sometimes they do so in a deeply unsympathetic way. We have to bring home to people the fact that mental health problems are a common health problem and it is important that they are approached constructively and positively. We also want to develop an anti-stigma code that can be adopted by employers.

Creating an understanding of mental health issues and promoting mental well-being are vital. As my hon. Friend said, the Men’s Health Forum’s policy report considered six aspects of that. It may be common sense, but mental health promotion strategies need to address the aspects of life that impact most on how people feel about themselves, including those that my hon. Friend talked about, such as bullying, homophobia, racial discrimination, family conflict, employment and feeling isolated. We need good partnership working at national and local level to tackle some of these issues. This relates to the whole public health agenda. We are bringing together at local level—through, for example, local area agreements—local government, health care, trusts, voluntary organisations and Jobcentre Plus to consider what all the aspects of an individual’s life are and what impact those are likely to have on their mental health.

My Department is working closely with the Department for Work and Pensions and the Health and Safety Executive on our health, work and well-being strategy. The aim is to get employers engaged in the debate and considering what they provide and what support they give. How can we ensure that Jobcentre Plus is working closely with employers? This is not only about helping people to remain in work. Too often, people feel that they cannot go to work because of the stigma and discrimination and because others do not understand how to deal with the issue. Managers and work colleagues are frightened of it. How do we say, “No, that is the wrong approach”? I have seen many good examples. My hon. Friend mentioned Royal Mail, and BT is another good example of a company where I have seen good support given to people. It is not just about helping people back into work, but about helping people to remain in work.

My hon. Friend is right to talk about giving men control of their own health. That is what the direction that we take in the White Paper towards the individualised care approach is about. How do we ensure that care is more convenient for people, that it is closer to their homes? We are talking about more choice and information, and simple positive steps that people can take to improve their own well-being. He is right to say that that is one of the keys, particularly when it comes to mental health issues.

My hon. Friend talked about problems, particularly in the BME communities. This year, we conducted the count me in census. We asked people to consider in particular racial background in mental health in-patient care. That means that we now have a baseline whereby we can measure progress, which we have set out through the delivering race equality programme. I believe that that will make a real difference, particularly in terms of reaching out to BME communities.

As my hon. Friend said, it is important that we understand the reasons behind some of the statistics that we have discussed today. The overall suicide rate is now at its lowest recorded level, but until recently the suicide rate among young adult males had been rising. The death rate in this group is still far too high and is much higher than in the general population. We have introduced measures through our national suicide prevention strategy that are starting to have an impact, but we certainly need to redouble our efforts in that direction to ensure that we encourage young men to look after their mental well-being and, crucially, to seek help when they need it. We need to understand the reasons why men are unwilling to engage with services and to admit problems, and we need to devise policies to tackle them.

My hon. Friend mentioned some of the risk factors associated with young men. They include psychological factors such as depression, low self-esteem, and substance misuse, as well as social factors such as unemployment and family problems, but when we began to develop our suicide prevention strategy, there was little evidence about what works in promoting good mental health with young men. We wanted to find out why men find it more difficult to talk about their problems, why they are more likely to resist health promotion messages, and why they are reluctant to ask for help when they are in distress.

That will become even more important as we consider how to expand some of our programmes. My hon. Friend mentioned Richard Layard’s work. In our manifesto and in the White Paper we said that we would extend access to psychological therapies. That is vital and is something that might help men who are reluctant to come forward. We need to get behind those issues and to extend our programme of psychological therapies.

That is why at the conference it was pleasing to be able to launch the evaluation report of the reaching out pilot scheme, which examined how we can encourage young men to seek help earlier and identify some of the barriers that discourage them from seeking it. The evaluation report set out the lessons learned by those pilots. One lesson was that involving service users in designing the care required is vital. Yes, this is a message that goes across all the health care services. It was particularly important in this area. Young men responded much more positively if we talked about mental well-being as opposed to mental health problems. That is an interesting lesson. All the evidence will help local providers to improve the way in which they engage young men and develop their services.

As my hon. Friend pointed out, it is vital that local organisations think about this, as they will have a duty under the Equality Act 2006 to tackle these issues. We need to lead this from the centre and to ensure that the message is going out loud and clear. I hope that we will continue to work with the all-party group on men’s health, the Men’s Health Forum and all the other organisations that are contributing to building the momentum around this area. I hope that we will be able to work closely together. Frankly, if we can engage in such partnership at national and local level we can do a lot to improve men’s mental health, which is vital to the future of our society.

Sitting suspended until half-past Two o’clock.