By Dr Lucy Wright, Optima Health’s Chief Medical Officer
I was thinking the other day about mental health issues in the workplace. They make up the majority of the cases that I see in clinics these days. Unwell and unhappy people who are not coping in work or in life, or in both. Most of the people I see are female, but in many of the companies I work with men predominate in the workplace, so surely I should be seeing more men? Are men more psychologically robust than women?
I started to investigate and this is where things get really interesting. In England, women are more likely than men to have common mental health problems and almost twice as likely to be diagnosed with anxiety disorders. But in 2017, 5,821 suicides were recorded in Great Britain and of these 75% were male. Suicide is the most common cause of death for men aged 20 to 49 in England and Wales. Males working in the lowest skilled occupations had a 44% higher risk of suicide than the national average; the risk among men in skilled trades was 35% higher. Low skilled male construction workers are almost four times more likely to take their own lives than the national average and the number of suicides in construction is now six times higher than deaths from falls from height.
Only 50% of men feel comfortable discussing mental health issues and 28% of men have not sought help for the last mental health problem they experienced, compared to just 19% of women. Some 34% of men admit they would be embarrassed or ashamed to take time off work for mental health concerns, compared to 13% who would be self-conscious about doing so for a physical injury.
A third of women (33%) who disclosed a mental health problem to a friend or loved one did so within a month, compared to only a quarter of men (25%). Over a third of men (35%) waited more than two years or have never disclosed a mental health problem to a friend or family member, compared to a quarter of women (25%).
Detention rates under the Mental Health Act are higher for males (83.2 per 100,000 population) than females (76.1 per 100,000 population). Men have higher rates of drug and alcohol usage; 31% of men drink at a level indicating increased or higher risk of harm (more than 14 units per week) against 16% of women. Men make up 77% of the estimated alcohol dependent prevalent population. Figures reported in 2016-17 Crime Survey for England and Wales indicate that 11.5% of males aged 16 to 59 had taken an illicit drug in the last year, compared to 5.5% of females.
This makes me think that maybe I just don’t see as many men because they are not coming forward for help and not getting help for mental health problems throughout our health care system. Tragically, this is ending in suicide for some. This is a societal issue; we know, from the usage statistics for General Practice, that men attend their GP less often than women and their medical conditions are diagnosed later because of that. Overall, males still die at a younger age than females and they are more likely to die in every age group.
What can we do in occupational health (OH) about this; how can we help the men in the organisations we work with? Firstly, having access to occupational health would surely be an advantage – especially in construction where transient workforces and self-employment make this difficult. Sadly, the Fit for Work service did not attract the volumes expected (the review of that project will make interesting reading). People need OH and we are here to supply that need, how can we meet up? Perhaps we should have an online platform to enable people to find suppliers, the equivalent of an OH dating service? “Self-employed man, 46, non-smoker, GSOH WTLM competent DTE OH practitioner for assessment and RTW advice”?
For those who have OH services we need to consider how do we deliver any health message including mental health messages in a way that men feel enabled to access? Some organisations target the female partners, mothers and sisters who work for the organisation – how about the ones who don’t; can we still get in touch with them somehow, so they know their man has access to support? And what do we do for the male partnerships where maybe both partners don’t feel enabled to access health care? 3% more gay men attempt to take their own life than straight men and half of gay and bisexual men said they felt that life was not worth living, compared with 17% of men in general.
But we realise in health promotion that one message and style of delivery doesn’t fit the IT enabled generation and the older people. We understand the need to stratify our health message accessibility by gender and sexual orientation as well as literacy and age. This is complicated, but Amazon can make a pretty good guess at what I would want to buy, it isn’t impossible and there is much more available now for the IT enabled generation and perhaps that lack of a personal touch is what some men need to feel comfortable. Online CBT is as effective as personally delivered CBT but may be more accessible to those who won’t or can’t talk to another person.
EAP services are available in many companies that have OH provision and there are significant advantages when OH and EAP cooperate to make sure that the employee is being seen in the right service at the right time. I know there are lots of OH practitioners delivering in innovative ways and we need to continue to share ideas and good practice because people need health services they feel able to access, and the OH service is where men work and is the easiest place to get help and support.
With more and more male celebrities, sportsmen and even royal princes talking about mental health issues in men, hopefully the tide is of society is turning and I will soon be seeing more men in the OH departments asking for help earlier.