Where is the witch doctor?: Men and Mental Health

I was reading an article in the New York Times on the alarming rate of suicide in the native population of Alaska when it struck me that mental health was an issue that kept popping up in my own research work and that most of the people whom I encountered that had serious mental health problems were men. From a wife dressed head to toe in black recounting how her husband, recently retrenched from the South African mines, drank rat poison in front of her and killed himself to an elderly and frail old man locked in his bedroom and tied to his bed, the toll of depression, schizophrenia, and a whole host of other mental health problems was disturbing. But all of these problems were swept under the rug, hidden away, discreetly taken to the local healer, or just not recognized by family members and medical staff burned out by the tsunami of HIV/AIDS. Even at the hospital that I worked in, mental health problems, especially depression related to HIV/AIDS, were encountered by doctors on the wards and in the outpatient department on a daily basis but there was little that they could do for their patients except refer them to the psychiatric nurse on staff or district mental health services which were woefully inadequate. The same held true for patients in Ghana where mental health services were primitive at best (only 12 psychiatrists in the entire country) and most mental health patients who could no longer be cared for by their families were referred to one of the three rather frightening psychiatric hospitals that existed in the country.

Of course, all of this got me thinking, so I did a bit of digging around and came across some alarming statistics for global mental health:

- Over 154 million people suffer from depression;
- 25 million people suffer from schizophrenia;
- Over 877,000 people per year commit suicide;
- Less than 1% of the health care budgets for most middle and low income countries is spent on mental health (WHO 2002)

What is even more alarming than these statistics are the ones on male suicide where men are two to three times more likely to commit suicide than women. Men’s poor social and emotional support systems, cultural models of masculinity which force men to suppress emotions and not seek help, and higher rates of substance abuse (i.e. alcohol, drugs as self-medication) are partially to blame for these grim statistics. Naturally, the question which next comes to mind is how do we address these mental health problems, particularly in men who are less likely to seek health services in the first place, and in many countries (high, middle, and low income) where mental health is still deeply stigmatized and typically put on the budget and policy backburner?