‘Listening without judgment’

Mark Hedstrom’s father suffered through 10 years of depression before he sought help. He was a stoic man, who came from a long line of other stoics. He, like many others, internalized the societal perception that men had to show strength by keeping their struggles hidden.

There's still a stigma for men talking about their issues,” said Hedstrom. “Men often don't have the vocabulary or tools to talk about what they might be going through. That’s a large barrier.”

As the U.S executive director of Movember, Hedstrom is addressing these barriers – for men across the country who are suffering in silence, and for his own 7-year-old son. Movember is a global charity aimed at addressing men’s health issues.

Old shame, new challenges

Experts note mental health issues have long been a complicated topic for many men, who may be hesitant to confide in others and get professional help. Researchers have found disproportionately high suicide rates among men: In 2018, men died by suicide 3.56 times more often than women, according to the Centers for Disease Control and Prevention. The same year, white males accounted for 69.67% of suicide deaths.

Addressing men’s mental health is especially important during the coronavirus pandemic, Hedstrom says, which has cost many people their jobs and their financial security, and has left many feeling more isolated than ever.

According to a report from the CDC, which uses data from 5,412 adults in the U.S. surveyed between June 24 and 30, more than 40% of people have experienced a mental or behavioral health condition related to the pandemic.

“In addition, kids are being virtually schooled, and there are a lot of challenges impacting men’s relationships with family,” Hedstrom said.

Men are far less likely to have reliable confidants, noted Dr. Greg Harris, a psychiatrist and associate medical director for behavioral health at Blue Cross Blue Shield of Massachusetts. Boys are taught from a young age to cultivate relationships through sports and activities that are more casual and superficial, rather than bonding through open dialogue, he said.

“Women tend to be socialized to talk and share more,” Harris said. “Men are taught to trash talk and play sports together.”

Societal pressure for men to suffer in silence is a long-standing problem, agreed Dr. Ken Duckworth, a psychiatrist and senior medical director for behavioral health at Blue Cross Blue Shield of Massachusetts.

“There’s a cultural phenomenon that girls are more likely to seek help as teenagers and young adults,” said Duckworth, who is also medical director of the National Alliance on Mental Illness.

On top of the shame some men may feel about seeking mental health care, and the heightened isolation in recent months, the pandemic has added new complications to seeking professional help. COVID-19 has disrupted or halted mental health services in 93% of countries worldwide, according to the World Health Organization. The survey of 130 countries conducted over the summer is the first look at global data on mental health services.

A need for new tools

Though telehealth has provided a much-needed alternative to in-person treatment in the U.S., not everyone is taking advantage of that. This makes easily accessible tools and prevention efforts even more important, Hedstrom says.

“The real challenge right now is access to care,” Hedstrom says. “That’s why when we look at mental health and suicide prevention, we look for ways to improve what’s happening outside a clinical setting.”

The not-for-profit health insurer Blue Cross Blue Shield of Massachusetts has expanded access to mental health coverage amid rising need. Steps include expanding access to telehealth services, reimbursing therapists at full rate for telehealth or in-person visits, adding 2,000 mental health clinicians to the insurer’s network and creating a new online resource center.

Movember launched a free online tool called “Movember Conversations” – a “conversation stimulator” to help find a starting point when talking to men about mental health. It promotes the use of the “ALEC model,” which stands for ask, listen, encourage, and check in.

That might start with a question like, “How are things at work?” and then listening without judgment, Hedstrom says. The most important thing, though, is the encouragement – a nudge to get men to reach out to friends or get the professional counseling they need.

Movember’s website also offers a resource called “Family Man,” meant to equip fathers and male caregivers with the tools they need to manage parental stress, especially during difficult times.

These online resources make a difference, Hedstrom says. A recent survey from Movember found that 43.5% of those who use these tools said they had confided in a friend about their problems, compared with 18.3% from the general male population. More than 28% have spoken to a health care professional about their mental health within the last year, compared with 16.1% of males from the general population.

“When we look at prevention, we encourage taking steps to stay connected and seek support,” Hedstrom says.

_{PHOTO OF DR. GREGORY HARRIS BY MIKE GRIMMETT}