Written By: Dr. Keith Hariman, Specialist in Psychiatry
A recent survey done by The Mental Health Association of Hong Kong revealed that men aged 35 to 54 require greater attention regarding their mental health. Nearly 60% of respondents are at moderate to severe risk, yet the majority are unlikely to seek help.
Under gender stereotypes, many men may have been taught to suppress their emotions since childhood. As a result, they might ask others for help even in the face of stress and emotional problems. To bring awareness to men's mental health issues as a part of Movember, let's follow the story of Jason to learn more about the potential problems that men can face.
In 2023, the scenario didn't get much easier for restaurant manager Jason despite Hong Kong opening its borders. The bulk of the consumer base that previously filled the seats in his restaurants started diverting their spending across the border to Shenzhen, drawn by a perhaps more vibrant atmosphere and competitive pricing. The allure of a change in scenery after enduring long periods of restrictions in Hong Kong was too tempting for many to resist.
Jason found that easing border restrictions, instead of bringing the anticipated respite, further exacerbated the situation. The revenue stream he desperately needed was now flowing towards Shenzhen, leaving his restaurants in a continuous struggle. The costs remained high, with rent showing no signs of decreasing, and with a thinning customer base, Jason was stressed out by the mounting financial pressure.
This is how he began his journey with alcohol. Jason only intended to use alcohol as a way to help him fall asleep at first. However, he began to drink more and more every night, partly for sleep but also partly to help him drown his sorrows as he worried about his restaurants every single day. Not only did he feel more upset, but he also became rather agitated and irritable. He often lashed out at his staff or wife over minor transgressions and mistakes, only to regret his actions for losing his temper so easily.
As the benefits of alcohol weaned off, he found it more difficult to fall asleep and didn’t eat much due to his lack of energy. He stopped hanging out with his friends, preferring to stay home to drink. He also stopped playing tennis because he lost his willpower and motivation. When things were at their worst, Jason even contemplated harming himself as the psychological pain was too hard to bear.
Jason isn't alone when it comes to alcohol: Alcoholism in Hong Kong is especially prevalent, given the high-stress environment of Hong Kong. According to the Population Health Survey 2020-22, males (14.1%) frequently engaged in alcohol consumption more than females (4%)[2]. The culture of long working hours and the stigma surrounding mental health in Hong Kong can make it challenging for individuals, particularly men, to seek help. They often resort to self-medication with alcohol, which only worsens the situation, leading to a vicious cycle of increasing dependency and deteriorating mental health.
Jason was only brought to medical attention a few months after his mood had deteriorated. This delay in getting treatment was partly because of his reluctance, insisting that he was only going through a low period in life. He also feared the associated stigma of weakness. He was worried that if ‘the lads’ knew that he was in such distress, they would either laugh at him, not understand what he was going through or tell him simply to ‘snap out of it’. When his wife encouraged him to seek treatment, he would often shout back at her and told her to stop nagging. The turning point only arrived when his wife broke down in tears one day and said that she couldn’t bear living with him anymore.
As with many other men, Jason’s story is one we see too often. Both genders suffer from largely similar proportions of mental illness as a whole, with only minor differences in the relative prevalence of certain mental disorders. However, compared to women, men seem to be more reluctant to seek mental health treatment, with women being 1.14 to 1.6 times more likely to look for help in countries such as Australia, the United Kingdom and the USA. Furthermore, though men overall report less self-injurious behaviour, they don’t tell others about their suicidal ideation as much and are thus 3.5 times more likely to succeed in suicide attempts.
Numerous studies have tried to come up with hypotheses to explain this difference in help-seeking behaviour, with suggestions such as the traditional masculinity stereotype of invulnerability and self-reliance, divergent coping mechanisms of relying on self-medicating or alcoholism and poor mental health literacy amongst men. As such, problems of depression, as with Jason, and anxiety often get overlooked and undiagnosed for long periods of time, leading to long periods of suffering for individuals and their family members.
The narrative of Jason outlines a common scenario where mental health issues, exacerbated by societal and professional pressures, spiral without early intervention. Movember, an annual event every November, focuses on men's health issues, including mental health, by raising awareness and funds. Through its campaigns, Movember shines a light on the importance of early mental health intervention, breaking down barriers that prevent men like Jason from seeking help.
The funds raised during Movember are channelled towards innovative research, support programs, and educational initiatives that aim to change the face of men's health. By fostering a broader understanding and acceptance of mental health issues, Movember helps to de-stigmatize the conditions that many men face, encouraging them to seek help sooner. Additionally, by showcasing positive male role models who have faced and overcome mental health challenges, Movember helps reshape societal perceptions, enabling more supportive environments for men to openly discuss and address their mental health concerns.
The bigger problem, however, is the difficulties that mental health professionals encounter in trying to identify individuals like Jason earlier, so interventions may be delivered sooner rather than later. There has been research looking into various behavioural change techniques to encourage men to seek treatment if the need arises, such as the use of role models to convey information, incorporation of content that builds on positive male traits (eg. responsibility and strength), psychoeducational material to bring awareness, and signposting services. There isn’t a single most effective technique, as different people would respond to different cues. Nonetheless, it is hoped that with these strategies, the curtain covering the stigma of mental illness can be torn down and we can have a conversation about men’s mental health.
1. Sagar-Ouriaghli, I., Godfrey, E., Bridge, L., Meade, L., & Brown, J. S. L. (2019). Improving Mental Health Service Utilization Among Men: A Systematic Review and Synthesis of Behavior Change Techniques Within Interventions Targeting Help-Seeking. American Journal of Men's Health. Retrieved November 2, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6560805/.
2. Situation in Hong Kong Population Health Survey 2020-22: Alcohol Consumption. Centre for Health Protection. (n.d.). Retrieved October 18, 2023, from https://www.chp.gov.hk/en/healthtopics/content/25/8798.html
3. The survey shows that men aged 35 to 54 years old need to pay more attention to their mental health, but most of them will not seek help. RTHK.HK. Retrieved October 23, 2024, from https://news.rthk.hk/rthk/ch/component/k2/1728476-20231119.htm