Absolutely Mental

By Harald Breiding-Buss

Men in their 20s and 30s are killing themselves at unprecedented rates. Where suicide was once a problem of men approaching the end of their “useful” working lives, it is now ravaging amongst fathers with young children. But daddy doesn’t feature in the government’s mental health strategies, writes Harald Breiding-Buss

“One of the biggest health inequalities that exists is between men and women.” This quote by UK Public Health minister Hazel Blears summed up their National Men’s Health Week in June.

Men are four times more likely to develop heart disease, die from accidents or take their own lives than women, and they also lead in strokes, cancer and respiratory diseases. Blears’ predecessor as Public Health minister, Yvette Cooper, also pointed out that “when it comes to life expectancy there is no greater inequality than that between men and women”.

The statistics in New Zealand are not any different. Suicide rates for men under 35 skyrocketed in the mid eighties. Every year more than 40 out of 100,000 men in this age group take their lives, compared to less than 15 twenty years before. While in the mid seventies it was men over 55 most likely to kill themselves, the age factor has swung right around: these days, suicide is a problem of the young.

Men don’t see their doctor as often as women – and are being blamed for a supposed indifference to their health. But researchers both in the UK and in New Zealand are not so sure men’s attitudes are the problem.

In Nelson, researchers have found that health services geared towards children and their caregivers are not seen by men as also including them. And innovative approaches with health clinics in pubs and at work places in the UK have shown that men do not shy away from seeing a doctor and talking about their health issues, if these don’t shy away from bringing the service to them.

What was probably most worrying in those trials was the sheer number of health problems that were picked up during those random health checks, indicating that a large proportion of the male population is suffering from a condition that requires immediate attention.

Yet the men rather tolerate that than subject themselves to treatment in the mainstream health system.

“[It is] not surprising that men’s health needs are not being addressed if the service appears hostile” says the “Community Practitioner”, a professional UK health publication in its July issue.. “For health professionals, empowering individuals to make healthy decisions is a primary objective. How can empowerment and improved life styles be achieved if our service is non attainable for its male users?”

Mental Health is an area that has received increased attention in previous years, and much attention and money is channeled towards reducing the stigma that comes with mental illness.

What with multi-million dollar TV campaigns featuring celebrities and sports stars, depression is a now a health condition that everyone knows something about. The NZ government has put extra funding specifically towards mental health, and strong lobbying by providers has ensured that it is a priority in both national and regional health strategies.

In addition to “more” mental health services, “better” services are a priority in the government national health strategy. The “Blueprint”, a medium-term strategy for mental health services in New Zealand, specifically wants to “improve the responsiveness of mental health services to consumers.”, and “to improve responsiveness of mental health services to families and caregivers”.

The Mental Health Commission’s most recent progress report outlines an increase in staff numbers working in these areas especially in the last two years. This includes a fair amount of staff in non-governmental organizations.

But this increase does not seem to have translated into any more or better services for men. Men and women are about equally likely to suffer from depression, although reliable statistics are hard to come by. Men’s greater reluctance to visit doctors also means depression in men is more likely to go unnoticed.

Male suicide rates, however, are several times that of women’s. But is this simply a gender difference—or another indication that health intervention is not as effective for men as it is for women.

Perhaps the surge of suicide rates in the mid and late eighties had something to do with economic and social changes that left some men not only without a job, but also without a family? Changes that have seen men becoming more housebound, without receiving any support for it.

Two years ago the Father&Child Trust in Christchurch began working more intensively with families that have been struggling to make the change from childless couple to parents.

Early this year we also started working with teenage fathers on another, unrelated project. But we found that the two groups have a big health issue in common: depression that is rooted in fatherhood and relationship issues.

With Canterbury Plunket’s Postnatal Adjustment Programme, we started working with partners of women who suffered from postnatal depression. The primary aim – perhaps symptomatic of the wider approach to men’s health – was to help the men to support the women.

If the woman was healthy, the male would usually not be referred to the programme and come to our attention.

Once we started working with some men one-on-one we discovered some serious mental health issues. And the idea that men find health services, especially family health services, hostile, manifested itself in our practice as well: the most seriously depressed men were those, who were the most reluctant to talk to anyone, and who most often failed to let themselves be dragged along to “partner evenings” which were part of the programme.

One such man was Vincent*, a father in his mid-thirties and primary caregiver of a six months old boy. His partner underwent the group programme for postnatally depressed women, and when it came to attend the partner evening, Vincent didn’t want to go.

“We had a big argument over it”, he says. “I just didn’t want to go.” But finally he did go, and “it was one of the best decisions I’ve ever made.”

Fathers’ mental health problems are not a primary focus of the partner evening, in which the men get at least part of the evening to themselves, while the women get sent outside. However, it is indicated that such support is available through the Trust, and postnatal depression is discussed as an issue for the whole family, not just for the women.

Vincent indicated in the session that he might feel “a bit down” himself every now and then, especially now that his partner is recovering. That in itself has been a common experience with the programme: the men quite capably hold the family together while their partners are suffering, and then decline as their partners recover.

Vincent got a phone call a few days after the group on the strength of this statement and was offered a one-on-one session at a place of his choice, which was his home.

The worker who was on his case found him deeply depressed and often barely functional. Vincent sometimes had to leave his baby crying in his cot by himself and walk away, because he could not cope. He dreaded every day, got into frequent arguments with his partner, and longed to be alone.

He was too far down to find the energy to engage in exercise or anything at all that he knew to be fun.

For Vincent it took a combination of medication and one-on-one support to send him on the road to recovery. Most of all, it took a health worker who knew about symptoms of depression in fathers. What would have happened to Vincent’s family, to his son, to his relationship, if his partner hadn’t presented with mild postnatal depression?

In other circumstances, someone like Vincent would perhaps have been shrugged off by the person working with his partner as simply another unsupportive husband, or as another example that men aren’t cut out for the job of raising children.

His reluctance to attend the partner evening would have been seen as evidence of his unsupportiveness, his lack of understanding for his partner, when it was a symptom of his own ill health.

As the primary caregiver of his son, Vincent probably belongs to a high risk group of men in danger of developing mental health problems. “Probably” because we only have anecdotal evidence. But depression after the arrival of a baby is by no means restricted to primary caregivers.

John*, for example, was always a rather happy fellow according to his friends and partner, with a job that he liked and that carried some responsibility. But two months into fatherhood this began to change.

Even though John did many “nightshifts” with his baby boy, this was more out of a sense of duty rather than true bonding. He got into frequent arguments with his partner and at work, started talking about quitting his job and taking one that would take him away from home for weeks at a time. He lost enjoyment in life and his favourite pastime became long, lone walks by himself.

John started improving once he was counseled on relationship changes after the birth of a baby, and having a close look at his role, importance and needs as a father.

The transition from man into father, and the changes that that brings about between the parents, looms features large in the Trust’s day-to-day work with fathers.

But the picture of men’s mental health turned bleak when the Trust began its teenage fathers project and came across a group of young men harbouring frequent suicidal thoughts. Many of these young men shouldered a significant, or even the major part of the care of their babies.

Others were struggling with the provider role, toiling away fulltime at rates that ensured their partners an income equal or less than they would receive on the domestic purposes benefit. Indeed, when it comes to teenage mums, WINZ, IRD, health and community workers automatically assume that the father is out of the picture.

Darryl* is one such young dad. At 17 some would consider him still a child himself. Rejected by his own mum he fled home two years before. After a short stint of living with his dad, he got a girl pregnant.

He has had a history of depression ever since that feeling of rejection began, and at age 12 he tried for the first time to take his life. “The knife wasn’t sharp enough”, he says, thinking back to that day. Just another thing that went wrong.

But when he met his girlfriend he was happy at least for a while. The two of them moved in with each other, and Darryl started providing for a family, doing overtime on the minimum wage. Until one day he was told by a neighbour that his girlfriend was sleeping with his workmate.

Things fell apart, but Darryl found himself looking after his son often more than the half week that the two had agreed on. “There’s no way she’d have him Friday or Saturday nights”, he says, and finds the boy dumped on him, whenever she wanted to go out. Having lost everything, Darryl once more started thinking about taking his life, and he says he would, if not for his son.

His ex, aided by her social worker, then tried to use his depression to cancel the access agreement altogether. The Trust successfully intervened, but it was a close call. “There were absolutely no concerns for his ability to care for his son – although he is sometimes barely functional on days when he is without him”, says the Trust worker involved with him.

Being able to perform a proper fatherhood role seems to be a key component in the mental health of men of all ages. But it is one unrecognised by the mental health system. The Trust’s files are full of stories of men, whose depression after separation was used to deny them access to their children altogether.

It is a different story for women. In Christchurch there is a facility for mothers with severe postnatal depression, the Mothers and Babies Unit at Princess Margaret Hospital, where mothers can receive residential care without having to be separated from their babies.

It is recognised that mother and baby need each other, that the mother needs the baby to help her healing process. But is it really any different for fathers?

The newly formed District Health Boards, who fund most of the country’s health services, went through the exercise of finding a health strategy earlier this year, each on their own. The Canterbury District Health Board, for example, made children’s and mental health two of its five top priorities for the next five years.

But the same DHB told the Father&Child Trust in writing that father’s mental health is “not a priority”, ignoring two of its own top goals. Despite comprehensive submissions by the Trust and another fathers group, only the issue of support of fathers for their partners suffering from mental illness made it into the final document.

The depth and importance of the father-child relationship for both, the father and the child, is not recognised in the health system, and as a result men’s accessibility to health services both for themselves and their children is not addressed.

The health inequalities between recipients of family health services are mirrored in gender differences in the provision. Frontline staff looking after health needs of the families in the community are overwhelmingly female. The DHB’s and other health authorities are also predominantly female staffed. The family health system is essentially a service of women working with women.

This ensures that women’s voices as service recipients are heard when decisions about funding are made. But because very few people are working with men, and because even fewer of those are men themselves, men’s mental health issues go unrecognised.

Men’s health may not be a priority simply because it is not in the face of those who make decisions. They do not see it on a day-to-day basis in the same way as they do with women, and they interpret it in different ways.

And so suicide is treated as just another gender difference between men and women. Men, it is said, are more likely to kill themselves because they are men.

The statement implies that we cannot do anything about it. But as long as we blame men’s failure to be more assertive about their health as solely the men’s own problem, we won’t find out if we can.

Next: Fathers Day In Dunedin