ABSTRACT
Although most societies are evolved with a strongly patriarchal orientation, data suggest that men face a number of burdens related to masculinity that are manifest in a number of troubling ways, including significantly higher rates of suicide, problematic substance use, homelessness and imprisonment. Men’s lives are measurably shorter, and they are more at risk to victimisation by violence and to injury in the workplace. Taking an approach based on the social determinants of health provides a way of understanding these phenomena, revealing that social location is an important predicate of quality of life as well as lifespan for men. Paradoxically, while most treatment programmes are based on a view of the adult male as the index patient, the more progressive and evidence-based approaches to treatment are often found in services for special populations, often guided and informed by holistic values and whole-person approaches. Consequently, therapeutics based on men’s mental health pales by comparison to approaches to women’s mental health and other ‘special’ populations. In addressing the need for a renewed approach to men’s mental health, we propose a model that builds on the biopsychosocial model to include culture and spirituality. We see these five dimensions as interdependent and co-constructed, allowing for a fuller understanding not only of mental suffering, but of pathways to change and ‘recovery’. We advocate for a palliative approach to men’s mental health, which emphasises the long view of wellbeing over the life course over the episodic, curative framing of most current bio-medical approaches to these challenges. Palliative approaches are person-centred and family-focused, based on dialogue and collaboration. We then propose to weave a third thread – a practical model of everyday ethics – together with these two threads to create a renewed discourse on men’s mental health. We apply this interwoven framework to clinical scenarios to illustrate this approach ‘in action’. Through the chapter, we punctuate our commentary with points for the reader to reflect and appraise the material in the context of their own expertise, experience learning needs, and goals. We end with some guidelines to inform practice and policy, and some links to further resources.
