One in five.
This represents the prevalence rate of mental disorders and addiction problems in Canada. By the time they celebrate their 40th birthday, 50% of Canadians will have experienced or will be experiencing varying degrees of mental illness.
Beyond the unquantifiable weight on every individual’s life, mental disorders have an extensive, readily measurable financial impact. Mental health problems cost society $51 billion every year and prevent 500,000 employees from going to work every week. Simple empathy aside, one would expect that these figures alone, would raise concern, prompt discussion, and promote research to best support people with mental health problems.
Unfortunately, research is still wholly insufficient, especially with respects to studies that explore the impact of social identity on access mental health care. On a personal level, these factors impact an individual’s willingness to seek out treatment. On a systemic level, these factors go as far as affecting diagnosis. If, or when, one seeks out mental health care professionals – and only after a 6-month to year-long waiting period – patients are still not ensured an accurate diagnosis. Even when patients present the same symptoms, professionals will diagnose proportionally fewer men with depression than women, which serves as the first indications of a deeply rooted gender bias shaping doctors’ diagnosis.
The prerequisite to adequate diagnosis and care is comprehensive research on the disorders themselves. Thus far, gender disparities have been demonstrated in numerous areas, including, very pertinently, in prevalence rates. As an example, addiction problems have been found to be more common among men than women, while women are more likely to develop mood and anxiety disorders.
There are also noted gender differences in root causes of disorders. For example, it is more common for men to develop mental health problems following a physical injury because it directly impacts their sense of strength. Finally, gender also influences the way symptoms are expressed. Depression in men is characterized by irritability, fatigue, and loss of interest while women express overwhelming feelings of sadness and worthlessness, which has a marked impact on how depression is effectively diagnosed.
It is evident that gender impacts mental health issues in profound and far-reaching ways. However, this differential effect has yet to be taken into account systematically in research. In the area of eating disorders, for example, study participants are overwhelmingly female. While this reflects the real-world prevalence of these disorders, it begs the question: how do you go about treating the men that do have eating disorders if all the available research on the most effective treatment offer findings skewed towards females?
Gender differences in mental disorders must be explored further. In order to enable doctors and mental health professions to adequately care for patients, we must also focus on gender’s impact on treatment efficacy. Mental health research focused primarily on these differences is still insufficient, and thus far there are no governmental policies is in place to encourage this type of research.
It’s also important to consider that gender is not the only limiting factor of access to healthcare. Characteristics such as race, age, socioeconomic status, and geography, to name a few, also greatly influence the end result. In their paper published in 2016, Memon et al. divide factors preventing access to mental health care into two categories. They coined the first one “personal and environmental factors.” Gender falls into that category, along with the recognition of mental health problems, social networks, cultural identity and stigma, and financial factors. The second category is called “relationship between the service user and healthcare provider” and encompasses waiting times, language, communication, responding to needs, power and authority, cultural naivety, insensitivity and discrimination, and awareness of services. These factors are intrinsically linked to social identity.
Take belonging to a minority racial or ethnic group. This facet of one’s identity is by definition social. And it impacts mental health, the stigma attached to it as well as stereotypes held by professionals in mental health care. This, in turn, affects the likelihood of an individual seeking treatment and the quality of care they will receive.
Memon et al. looked at access to mental health care in Black and Minority Ethnic (BME) communities. One of the factors they found to be relevant to one’s access to health care is what they call “cultural identity and stigma.” Participants pointed out that mental disorders were highly stigmatized and often taboo in their community: “a mental health diagnosis could stigmatize the whole family, affecting employment prospects and standing in the community.” According to the paper, belonging to the BME community also impacts “cultural naivety, insensitivity, and discrimination.” Many of the practitioners that BME community members encounter are typically Caucasian who do not understand their experience within and in relation to the world. This also has a resounding negative impact on the likelihood of pursuing treatment as well as the quality of the care likely to be received.
One’s racial and/or ethnic background clearly impacts the likelihood of both seeking treatment and receiving adequate care. To entrench the issue further, this part of their identity then intersects with gender. In their paper, Memon et al. also points out this intersectionality of identity. Several of their participants alluded to the fact that men are less likely to talk about their problems, especially to mental health professionals, with one of their participants stating “Men, we tend to keep things to ourselves. We do not think that by exposing our own insides to outside will bring any solution at all […] I am a man, I can sort it out.”
More than adequately grouping men separately in order to better assess their different context and experiences, we also cannot just dump all men into one category. Many other factors including socioeconomic status, age and geography will influence any one person’s treatment. As Jeanne Miranda, a Professor of Psychiatry and Biobehavioral Sciences points out: “Minorities are often more likely to be poor, less likely to be treated by doctors of their same race and, in many cases, less likely to know they have a condition that requires professional care.” The factors individual have their own distinct impact and their intersection creates its own resounding effect. This means we cannot have a blanket solution to address the disadvantages of intersecting identities, as was shown by the disappointing impact of the Medicaid expansion of the Affordable Care Act in the United States in 2004. State health insurance increased access to treatment for mental health and substance abuse patients but failed to reduce racial disparities. Addressing a mere financial factor without looking at other facets like identity that contribute to the problem of access and how the two interact means these sort of policy changes will be a limited impact.
The intersection of a person’s identities must be taken into account in both research and treatment of mental disorders. Mental health research, despite its best efforts, needs to move away from focusing on general population approaches to accommodate more specific subgroup explorations of mental disorders and how to face them. To do so, the provincial and federal government need to review their funding and policies. In Ontario, mental disorders represent only 7% of the province’s medical funding, despite representing 10% of its medical burden. How can we expect to cater to specific groups when the current budget barely allows us to support the general population?
Canada’s meager budget allocated to mental health care is behind most OECD countries and members of the Common Wealth, including New Zealand, Australia, and the United Kingdom. As of right now, demand for mental healthcare far exceeds Canada’s ability to provide adequate treatment. As a result, certain groups’ access to mental health care is inevitably going to be much more limited than others. This has to be recognized and addressed at a systemic level and thus requires politicians to get involved and push for bills and budgets that address existing disparities in men’s access to mental health care, as well as other subgroups within that broad category.
Sadly, the topic of mental health care remains largely outside of political debates. In the Quebec provincial elections that took place on October 1st 2018, mental health care and the budget allocated to it was far from being a central issue. When Mouvement Jeunes et Santé Mentale, a group of youth mental health advocates voiced their concerns, Jean François Lisée of the Parti Quebecois reiterated his commitment to an increase of the mental health budget by $60 million per year. Quebec Solidaire made the vague promise of hiring more staff, including social workers and psychologists. Neither of these commitments are sufficient to address the intersection of disadvantages that impact the wellbeing of Canadians every day.
Resources for men battling with mental illness:
DUDES Club – serving First Nations
