Men and health

Home: K to 12: Respect Protect Connect Program: Information for educators

This is an extract from the Respect Protect Connect workshop manual, by Timothy O'Leary and Russell Pratt.

Some young men are affected by serious illness, creating anxiety about facing death at a young age. Throughout the rigours of treatment they see their celluloid heroes overcome huge odds, whilst personally experiencing feelings of helplessness and weakness. It is important to help them to rethink their ideas about being a man and allow them to acknowledge their strengths in facing the illness. Young men deserve to receive support without negative interjects telling them to tough it out on their own.

Men's health in general continues to suffer due to unhealthy lifestyles and preventable diseases. Men make up more than two thirds of patients admitted to Australia's largest intensive care unit (ICU) at Melbourne's Alfred Hospital. 1998-99 hospital records showed:

• 70% of patients admitted to its intensive care unit were males;
• Men comprised 76% of the cardiovascular admissions; and
• Men made up 74% of the trauma ICU admissions.

Dr James Cooper of the Alfred Hospital Trauma Centre stated that the higher proportion of male patients aged between 25 and 35 years reflected a propensity for high-risk behaviour (Saltau, C: The Age, Men at risk of trauma 13.9.99). Saltau (1999) also cites Heart, Stroke and Vascular Diseases, a report published by the Heart Foundation (1999) revealed that 50% of all forty-year old men would develop coronary heart disease in later life, compared to 33% of women. The report attributed this to higher levels of alcohol and cigarette consumption by men.

Connect:

Men's Health and Wellbeing Association web; http://mhwaq.org.au/
Centre for Adolescent Health.

Return to top

1.8.1: Young men, mental health and violence

"The vast majority of people with schizophrenia are no more prone to violence, or homicide, than the rest of the community." (Professor Paul Mullen, cited in Hawley, 1999.)

People suffering mental illness may experience high levels of violence and discrimination in their daily lives. Presently, there are concerns for the care and protection of those suffering mental distress. Bracken and Thomas suggest that there is a "real increase in the violence, threats and discrimination against people with mental health problems. There is increasing intolerance, stigmatisation and rejection" (1998: p.16). Whilst there are concerns that those suffering mental illness will be the victims of violence, others in society have misconceptions that those with a mental illness will be the perpetrators of violence. Research in the UK suggests that between 1957 and 1995 there has been a 3% annual decline in homicides by people with a mental illness (Taylor & Gunn, 1999).

The issues of young people suffering mental illness are complex, and different for a range of illnesses. For the purpose of this exercise, it may be worthwhile to talk about one group within the spectrum of mental illness - schizophrenics.

Young men with a diagnosis of schizophrenia are some of the most highly misunderstood and stigmatised groups of young people.

Schizophrenia affects 1 in 100 people. Its causes are not known. However treatment mainly centres on the use of antipsychotic drugs. In parts of Europe and the UK, sufferers of schizophrenia refer to themselves as 'voice-hearers', in response to the long-standing myth that schizophrenia describes a split personality.

During a psychotic episode it is common for sufferers to experience visual hallucinations as well as a sense of paranoia or persecution in relation to others.

• 25% of people with schizophrenia will suffer one or two psychotic episodes, but will recover and live free of any further symptoms;
• 25% will use medication and supports to cope very well with the condition;
• 25% cope reasonably well;
• 15% are chronic sufferers; and
• 10% commit suicide (Hawley, 1999).

Respect:

Deal with the myths about schizophrenia - for a great read, try John Watkins, 'Living with Schizophrenia'.

Protect:

"People are most violent through fear - so don't escalate fear." (Mullen: in Hawley, 1999).
If you urgently need help contact the Psychiatric Team at your nearest hospital or alternatively contact your doctor.

Connect:

Sane Mental Illness Helpline www.sane.org

Return to top

1.8.2: Young men and depression

"Many of us grow up believing there is some terrible flaw at the centre of our being, a defect we must hide. Feeling unlovable and condemned to loneliness if our true selves be known, we set up defences against sharing our innermost feelings with anyone."
(Bernard Siegel.)

"Depression is one of the most acute, painful diseases you can have",
(Rob Moodie, VicHealth.)

As with youth suicide, there is much literature available regarding depression. Unfortunately, there is still a common myth that depression is something you just have to "get over". As the 20th century progressed into the 21st, rates of depression in western, industrialised countries continued to grow. Mental health disorders are now more prevalent than all other diseases, except heart disease and stroke. Unfortunately, 60% of the one million Australians with a mental health disorder do not have their problem diagnosed. (Australia's Mental Health; cited in Gray, 2000).

It is estimated that in 20% to 40% of cases, the onset of depression begins in, or before, teen years (McKay, 2000). In 1998, Dr Bret Hart estimated that almost one-in-ten children experience depression before the age of 14. He said the depression often extended itself into adolescence leading to antisocial behaviours.

Less than 40% of people with depression seek help, and 20% of those who do are misdiagnosed (Kennett, cited in Toy, 2000). As depression is a high-risk category for suicide, it is obvious that this situation is a dangerous one.

Respect:

It is important to give all men permission to be sad, to grieve, and to realise that a lack of tears does not indicate a lack of pain. Remove the stigma attached to depression and substitute understanding.

Protect:

Duty of care includes challenging the dangerous macho notions of toughing it out alone. Encourage help seeking behaviour. Treat all suicide threats seriously.

Connect:

Community Health Centres & Psychiatric Services, Beyond blue http://www.beyondblue.org.au/, Lifeline http://www.lifeline.org.au/, Suicide Prevention Australia http://suicidepreventionaust.org/
(Note: Over 50% of outreach grief services clients are under 29 years of age. Children under the age of 10 comprise the largest age group of clients assisted).

Return to top

1.8.3: Young men and substance abuse

Substance abuse may be viewed as 'normal' behaviour to protect one's self against painful and damaging internal self-images. It also makes sense when viewed within the framework of a male culture that does not encourage help seeking behaviour. This same male culture rewards high-risk behaviour with invisible toughness medals pinned to secretly sad chests.

The practice of 'splitting-off' from emotions is often supplemented with numbing behaviours like drug and alcohol abuse - both of which are often condoned by peer groups. Also, harm minimisation programs that encourage safe sex and safe injecting, clash with the harm maximisation/high-risk ethos of the dominant male culture. (Kimmell, 1991)

Substance Use:

• The number of people who had tried heroin increased by 50% between 1995 and 1998 (Marino, 2000);
• The number of heroin arrests rose by 38% between 1997/98 and 1998/99. (Marino, 2000).
• Young men account for 80% of all overdose fatalities;
• One-in-ten deaths among Australians aged 15 - 44 is due to heroin use;
• The typical overdose victim is likely to be an unemployed male who has used for 10-15 years (Michelmore, 1999);
• In Victoria in 1998, there were 212 alcohol-related deaths and 4500 tobacco-related deaths compared to 268 heroin-related deaths and two amphetamine-related deaths (ABS, 1998: cited in Toy, 2001).
• Marijuana is the most frequently used illegal drug in Australia.
• Although there were no deaths in Victoria clearly related to marijuana use in 1998, there is growing concern regarding marijuana as a risk-factor for psychosis in susceptible young people (Toy, 2001).
• In 1996, the Australian School Students Alcohol and Drugs Survey found that 36.4% of 12-17 year old students had smoked marijuana at least once during the previous week. About 4% of the young men surveyed reported use of the drug on at least six occasions during the previous week (Source: The Age, 20/1/01, "Marijuana: The not so happy herb".).
• It is estimated that in more than 85% of cases, offenders in the Melbourne Juvenile Justice Centre were charged with drug-related offences (Saltau, 2000).

Far from being rehabilitative for young offenders with drug-related offences, jail can be traumatic. A NSW study found that 1 in 4 prisoners aged 18-25 years is sexually assaulted during their term of imprisonment. One in two of these young prisoners will be physically assaulted (Caruthers, 1998).

Former Supreme Court Judge, Mr. Kep Enderby, stated that in 90% of cases prison was counterproductive: "It doesn't help anyone. If it does anything to anyone it makes people worse." Faced with difficulties finding employment upon release, and grappling with the effects of institutionalisation, the likelihood of young men re-using substances or re-offending is very high. Without access to condoms, and clean needles, they may be infected with HIV. Currently, the Federal Government is backing the introduction of a national drug-diversion scheme for 17-25 year olds which could put up to 7500 people into treatment programs rather than jail.

Return to top

1.8.4: Substance abuse: getting help

When substance abuse is a problem for a young man, he may have difficulty accessing help. The 'dominant masculinity' so pervasive in Australian culture may get in the way of the person receiving help and making changes to his behaviour.

The impact of hegemonic masculinity can be found in young men who deny, dismiss, minimise and mask their feelings, needs and issues. To support their drug use, these young men may have engaged in activities requiring them to use violence, manipulation and crime. These behaviours may also serve to prove their 'manliness', both in their own minds, and in front of others. They may not have developed skills in reflection and self-awareness, or in coping with strong emotions. Using help seeking behaviours and conflict resolution strategies may also be alien concepts to them.

Prochaska and DiClemente (1986) suggest that behaviour change is a six-stage process:

1. Pre-contemplation
2. Contemplation - awareness of costs of drug use;
3. Determination/Preparation - motivation for change;
4. Action - taking steps to change;
5. Maintenance - sustaining and consolidating the change;
6. Lapse/Relapse?

From the above model, it can be seen that major behavioural change is certainly not going to occur in a short time. Anyone working with young men who need behaviour change work needs to understand this, and to allow themselves the time and space to cope with the length of the work involved, and the possibilities of setbacks in the work.

Respect:

Young men may be abusing substances as a way of avoiding troubling issues or painful effects of abuse. They will require ongoing support to face these issues upon detox or decreased substance use.

Protect:

Drug injecting users are at an extremely high risk of HIV and Hepatitis transmission: Clean using is vital to protection from these diseases. Young people need good, clear information on safe usage without being made to feel guilty about their usage. This will only serve to drive them into unsafe behaviour.

Connect:

Centre for Adolescent Health

Find a drug or alcohol treatment program in your area at info exchange http://www.serviceseeker.com.au/

Return to top

Sponsor

SECASA

Disclaimer Copyright Updated: 22 Sep 2009