MENS HEALTH
The mental health of men
and boys: an overview
Ian Peate
M
ens health, according to Baker (2002),
is a contradiction in terms. He makes
this statement against the stark reality that
mens health is in danger; consider, for
example, that men typically live 5 years less than women,
and that men are disproportionately expected at all ages
to suffer from almost all of the major forms of disease
and injury, such as cancer and trauma (Mens Health
Forum, 2009; National Cancer Intelligence Network,
Cancer Research UK, Centre for Mens Health at Leeds
Metropolitan University, Mens Health Forum, 2009). In
some instances, inequalities have worsened since the first
health profile was carried out in 2006 (Department of
Health (DH), 2007).
There may be many reasons for the worsening inequalities,
and an emphasis is placed on mens apparent negative
health behaviours and the provision of policy that guides
health and social care from a broad perspective (Williams
et al, 2009).
Current health policy may be restraining and restricting
the development of innovative and creative ways of
providing a gender-sensitive service.
Some men live unhealthy lifestyles. However, caution
must be taken when suggesting that men live unhealthy
lives. It is unacceptable to suggest that all men behave in
one way and all women in another. Such an approach
would reduce lifestyle to a non-complex phenomenon,
and lifestyle and lifestyle choice is far from non-complex
(Wilkins, 2010). Men must be viewed as individuals who
engage in a range of complicated relationships, personal
and social, as opposed to being categorized by a set of
behaviours collectively associated with men.
Alternative public health models are required, which
build on earlier successful activities, pay more attention to
gender, and consider the gender equality a legal duty; the
Equality Act 2006 requires public authorities to ensure
that they promote gender equality. This may lead to the
production of an approach that takes on board the needs of
the different genders (and differences within genders), and
the inequalities that exist.
The role of gender in mental health needs to be
understood in greater detail if men and boys are to be
valued and cared for effectively. There are differences in
the ways in which men and women view the world and, as
such, policy response should acknowledge this, taking these
differences into account.
This difference was recognized by the government
in 2003, in its production of the UKs first national
British Journal of Nursing, 2010, Vol 19, No 19
Abstract
This article provides insight and understanding into important issues
of which nurses need to be aware when caring for men and boys with
regard to their mental health. Inequalities in health care are discussed,
and suggestions made concerning how all nurses can help redress
these inequalities. The mental health of men and boys concerns all
nurses; not just those working in mental health settings. The article
focuses on a recent review published by the Mens Health Forum
(Wilkins, 2010), and considers a number of gender-specific mental
health issues that affect the health and wellbeing of men and boys.
The role of the nurse is to protect and promote the health of people
in their care and this article makes clear that this extends to and
includes the mental health of men and boys. Labelling people and
categorizing them into homogenous groups is not often helpful or
strategically wise; this article does not wish to categorize, but merely
attempts to explain.
Key words: Male Mental health Policy development
Inequality
gender-specific health policy guidance, Mainstreaming
Gender and Womens Mental Health (DH, 2003). To date,
mens mental health needs have not been paid the same
attention as womens.
The Nursing and Midwifery Council (NMC) (2008)
makes it clear that all nurses and midwives must work with
others to protect and promote the health and wellbeing of
those in their care, their families and carers, and the wider
community. This clause in the code of conduct applies to
men and boys for whom nurses and midwives care. It could
be suggested that the failure to protect and promote the
health and wellbeing of men and boys is tantamount to
professional misconduct.
Men, mental health and inequality
Inequalities in mental health outcomes in men are evident.
People who engage in positive, sustainable relationships
are likely to experience good mental health. Social
participation has the ability to reduce the chance of an
Ian Peate is Professor of Nursing and Head of School,
School of Nursing, Midwifery and Healthcare, Faculty of Health
and Human Sciences, Thames Valley University
Accepted for publication: October 2010
1231

Table 1. Some indicators associated with poor mental
health in males
75% of people who commit suicide are men
Men are more likely to become alcohol dependent than women
Men are twice as likely than women to use class A drugs
Male psychiatric inpatients are twice as likely to be detained and treated
compulsorily
Men commit more violent crimes and are twice as likely than women to be
victims of violent crime
The majority of children permanently excluded from school are boys
Adapted from: Wilkins (2010)
onset of common mental illnesses. Furthermore, those who
receive poor or reduced social support are less likely to
make a good recovery.
Branney and White (2010) note that the social support
men receive is generally inferior to that women receive, and
that women report higher levels of social support than their
male counterparts. Typically, women often engage in more
reciprocal and confiding relationships than men and tend to
depend more on family and friends for support.
The prevalence of psychotic illness (for example,
schizophrenia and bipolar disorder) in the population is said
to be equally distributed between men and women at 0.4%
(Saddler and Bebbington, 2009). Common mental health
disorders include anxiety, depression, phobia and obsessive
compulsive disorders, and are more frequently diagnosed in
women than men. One in five women compared with one
in eight men is diagnosed with a common mental health
disorder (Deverill and King, 2009).
If such data is to be produced, the disorders have to be
diagnosed by a health professional. It could be tentatively
suggested that mental health problems in men are less likely
to come to the attention of health professionals, therefore
an appropriate diagnosis may not be made.
Common mental health problems for men are significant.
Wilkins (2010) notes that the estimate of one in eight with
regard to common mental health problems is the same
proportion of men diagnosed with cardiovascular disease
an important cause of premature death in men. Table 1
provides an overview of some of the indicators associated
with poor mental health in males.
Some men experience emotional and psychological
distress. This is complex and often does not appear as
clearly as it does in women. These forms of distress can
fall outside conventional approaches to diagnosis; they may
be missed or men may be given inappropriate diagnoses
(Wilkins, 2010).
There are a number of issues that must be considered by
nurses and policy-makers to ensure that the mental health
needs of men and boys are adequately provided for, and that
the inequity of health outcomes between men and women
is addressed. These issues include the way in which society
views the male role, male behaviours and mental health,
and the needs of specific groups of men and specific mental
health issues.
1232
Men, masculinity and society
It could be cautiously suggested that, if the needs of men
were better understood, service provision and development
could be more effective.
Understanding the role of the male in society and
discourse surrounding masculinity is essential in beginning
to understand the needs of men and boys. Gender roles,
masculinity and the different societal expectations of the
sexes are complex; these expectations change over time and
are different for each person.
Socialization, which takes a sociological perspective
the way in which an individual has been brought up and
learned to inherit unchallenged normsis an important
issue that may explain the cultural and societal differences
in the gender roles (Brody, 1997). This approach implies
that it is social interaction and social construction that
determine individual behaviour.
Social determinism, it could be suggested, would
establish that the man acts in accordance with his social
conditioning, as opposed to any genetic predisposition.
Socially constructed gender difference is responsible
for determining whether a person can realize
their potential for a long and healthy life (Annandale and
Hunt, 2000). (See Table 2 for some familiar socially
constructed features of masculinity and femininity. These
are generalizations.)
The dichotomies highlighted in Table 2 are the result
of the widely shared beliefs of what it is to be feminine
or masculine within society. Society agrees with these
stereotypical beliefs and takes on the norms associated with
them. Conforming and playing out the stereotypical beliefs
results in and strengthens a self-fulfilling prophecy of how
men and boys are expected to behave.
Biological perspectives are related to how males are
viewed with regard to their biological differences from
females, for example structural differences within the brain,
hormonal complement and physical differences (Doyal,
2001). Biological determinism is powerful, and has the
potential to undermine how men and women behave. If
taken to it its logical conclusion, biological determinism
dissociates the environment and social factors associated
with human nature.
A combination of social and biological perspectives
the sociobiology perspectiveis the third system that
can be used to begin to explain gender role differences.
Baron-Cohen (2003) explains that, from this perspective,
adaptation and natural selection are key, whereby women
Table 2. Socially constructed descriptions
of masculinity and femininity
Masculinity Femininity
Strong Soft/gentle
Powerful Weak
Rational Emotional
Self-reliant Dependent
Breadwinner Child-raiser
Adapted from: Laws (2006)
British Journal of Nursing, 2010, Vol 19, No 19

are said to have developed behavioural patterns that are
different from mens.
The male role confers a number of responsibilities. Men
are required to live up to these responsibilities, which
can bring with them both advantages and disadvantages.
Their outcomes can result in a negative impact on health
and wellbeing.
Work that men undertake often has a higher salary than
their female counterparts, and men frequently assume
higher positions in work than women (Equal Opportunities
Commission, 2005). Usually, work brings with it satisfaction
and this, in itself, can contribute to positive mental health.
Nevertheless, sometimes work can be unsatisfying
and unmanageable. It can be physically demanding and
unpleasant, and can be unreasonably demanding of time,
which can result in mental distress. It is probable that men
are twice as likely to work full-time and more likely to
work longer hours than women, as well as assuming the
breadwinner role (Wilkins, 2010).
The negative impact associated with unhappiness at
work can have damaging consequences for the man and
his family, potentially affecting the future positive mental
health of new generations. Therefore, fatherhood and a
fathers involvement are important for the consequential
wellbeing of boys. Fathers Direct (2001) report that
adolescents who have a strong parental bond with their
father are less likely to become involved in petty crime,
and the children of supportive fathers are more likely to do
better in school.
While work can bring advantages, leaving work for any
reason can be stressful. Unemployment can have devastating
effects on the man and, of course, his family. Employment
can have an important role in defining a mans place in the
community, and unemployment can lead to alienation from
the rest of society and peers.
In the current economic climate, uncertainty about
work is ever-present for all. The unemployment rate for
men is three-times that of women. One in seven men who
become unemployed will develop a depressive illness in the
following 6months (Royal College of Psychiatrists, 2010).
When an opportunity to work is no longer there, this will
affect the health and wellbeing of men, boys and families.
Work and societys perceptions of who should be doing
it places more pressure on men to act as the breadwinner.
For some men, working and providing are associated with
being masculine, and working allows men to undertake and
act out the male role.
Job satisfaction and positive mental health are closely
correlated (Faragher et al, 2005), and failure of a job
to provide satisfaction has the potential to predispose a
person to anxiety and depression. However, it must also
be remembered that, no matter how satisfying the job
is, overburdening a person can damage his/her health
and wellbeing.
Men and their risk-taking behaviours
Behaviour, both male and female, is a complex concept and
a number of factorssocial, biological and sociobiological
influence the way in which people behave.
British Journal of Nursing, 2010, Vol 19, No 19
MENS HEALTH
Men and boys differ from women with regard to risk.
Whether paragliding, driving too fast or posing on a
skateboard, the male engages in risk when carrying out these
activities. Not all men engage in risk-taking behaviours, so
generalizations must be avoided. Nevertheless, there are some
men who take one or a number of risks that jeopardize their
mental health.
Gray (2005) notes that risk taking and risk-taking
behaviours are largely associated with adolescents and young
men. Orford et al (2001) suggest that risk taking involves a
number of behaviours that are associated with alcohol use:
taking drugs they would not have taken usually; engaging
in unprotected sex; becoming caught up in an argument or
fight; and drinkdriving.
Men are the perpetrators of most cases of violent crimes;
most crimes are committed by men on men. Men commit
(Kershaw et al, 2008):
79% of woundings
77% of domestic violence
79% of violence against strangers
86% of muggings.
Being violent does not bring with it a diagnosis of mental
illness. It is, however, associated with personality disorders,
and drug and alcohol misuse, both of which are more
common in men.
These issues are often associated with a number of societal
factors and include being from a lower socioeconomic group,
and being single, separated or divorced, and having had a
dysfunctional upbringing and adverse childhood experiences
(Wilkins, 2010).
Societal expectations and the hegemonic model of
masculinity seem to encourage men to take physical
and psychological risks. Lee and Glynn Owens (2002)
suggest that physical risk-taking provides individuals with
the ability to demonstrate their competence and courage.
Courtenay (2000), also on this theme, suggests that men
take health risks by refusing to take time off work when
they are sick, by being adamant that they need little sleep
to function, and stating that alcohol does not impair their
ability to drive.
1233
 These behaviours may reinforce masculine status for the
man and society, but they also bring with them possible harm
to his both mental and physical health.
Specific groups of men
It is important to note that there are specific groups of men
who may be particularly at risk of mental health problems.
Young men
The high rate of suicide in young men is well acknowledged.
The National Institute for Mental Health in England
(2008) notes that men are, on average, three-times more
likely to commit suicide than women, with the peak
relative difference occurring in the 3039-year age range,
during which men are four-times more likely to end their
own lives.
Black and minority ethnic men and boys
Men from some black and minority ethnic (BME) groups
are admitted to psychiatric hospitals more often than white
men (Wilkins, 2010).
In some population groups, psychiatric hospital admission
rates are higher to a very significant degree. Black men,
according to Wilkins (2010), are up to three-times more
likely than other men to be treated as inpatients. Nearly one
quarter (23%) of inpatients in psychiatric settings in England
and Wales belong to BME groups (National Mental Health
and Learning Disability Ethnicity Census, 2010).
Gay men and boys
Gay men have higher rates of common mental health
disorders than the general male population; this group of
men are also at a greater risk of attempting suicide and
completing suicide.
The attitude of the public can have a significant impact
on the mental health of gay men. Men who have sex with
men may suffer from stigma, prejudice and discrimination.
For example, they may be blamed for the spread of HIV
and AIDS (Peate, 2007). Some gay men may face isolation,
negativity associated with sexuality, both self and societal,
difficulties at school and with school work, and homophobia
in the workplace.
Adolescence for some may be a difficult period of
time. An American study (Cochran and Mays, 2000) has
KEY POINTS
Positive male mental health begins when the man is a boy
All nurses, regardless of their sphere of practice, have a duty to ensure they
promote the health and wellbeing of all men and boys
There are a number of determinants that have the potential to affect the
mental health and wellbeing of boys and men
Nurses and policy-makers must ensure that policy development is creative,
innovative and responsive to the distinct needs of men and boys
There is an urgent need to develop new and creative ways of offering
gender-sensitive services
1234
demonstrated a greater prevalence of depression among
gay adolescents.
Armed forces personnel
Another specific group of men that Wilkins (2010) discusses
are men who experience post-traumatic stress disorder
(PTSD) in the services and as ex-service personnel.
The majority of people who experience frontline service
are males.
There are a range of symptoms associated with PTSD,
which include depression, anxiety, irritability, shame, guilt
and violence (National Institute for Health and Clinical
Excellence, 2005).
Kapur et al (2009) report that ex-servicemen aged under
24 years are between two- and three-times more likely than
young men in the population, as a whole, to end their lives
by suicide. The risk is persistent but may be at its highest in
the first 2 years following discharge. The risk of suicide is
greatest in males who have served in the army, those with a
short length of service, and men of lower rank.
Implications for practice
Nurses working with the populations considered above
must ensure that they are aware of the potential threat to
their mental health.
Awareness can help nurses become alert to the potential
and actual problems that may be associated with belonging
to one of the specific groups discussed. It must be
remembered that a man may be a member of one or
several groups. For example, he may be a BME man and an
ex-service man.
Conclusions
Generally, men are frequently unable to recognize that they
may have a mental health problem. They are often unaware
or have limited understanding of services available, are
hesitant to ask for help for mental health problems, and find
a number of the services offered unsuitable, unacceptable
or unappealing.
Healthcare providers may be misdiagnosing the mental
health issues of men and boys in their care. Mental health
problems may go unrecognized, such as eating disorders and
self-harming, which are often associated with females; 10%
of diagnosed cases of eating disorders occur in young men
(Eating Disorders Association, 2010).
Among the BME male population, mental health problems
are exacerbated. This group may feel that there is a particular
stigma associated with the development of mental health
problems. They also believe that mental health services will
discriminate against them.
To reduce inequality and ameliorate partnership working,
nurses and policy-makers must make broader policy
responses that address the mental health needs of men and
boys. Current mental health policy and practice fails to take
into account the importance of gender and this inequality
must be redressed by all of those people who influence
policy and provision of services for men and boys. There is
a need for the development of a national strategy for mens
mental health to help guide and form future practice. BJN
British Journal of Nursing, 2010, Vol 19, No 19

Acknowledgements:The author would to thank Mrs Frances Cohen
for her help and support.
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