A Policy Approach to Rewiring the Narrative on Mental Health & Education Outcomes for Boys & Young Men

Michael J. Wilson, Ray Swann, Zac E. Seidler, & Simon M. Rice

Abstract

Rigid adherence to traditional masculine norms typified by self-reliance and restrictive emotionality is associated with poor mental health and education outcomes for boys and young men. Existing approaches to encourage more flexible, positive expressions of masculinity have largely been focused on achieving individual behaviour change. Here we discuss the need for a policy lens on efforts to reduce the influence of restrictive gender role norms for boys and young men. Examples of current solutions span the sensitisation of mental health care for boys and men, alongside embedding of positive masculinity programming into educational policy. In all, applying a policy and systems lens when promoting positive masculinities does due justice to the structural nature of restrictive frameworks of masculine self-expression.

Background - The need for structural change

Gender socialisation processes and normative behavioural expectations grounded in gender are profound determinants of mental health.^1,2 Feminist movements have achieved significant and essential progress towards the liberation of girls and women from restrictive behavioural scripts assigned based on their gender. Yet the crux of patriarchy – the valuing of ‘masculine’ characteristics over those coded ‘feminine’ – has also exerted harms for boys and young men.^2-5 Traditional masculine norms prize rigid self-reliance, emotional restrictiveness, and toughness.⁶ Socialisation into this rigid archetype of masculinity can lead to boys’ and men’s avoidance of expressing emotions or behaviours that indicate vulnerability, alongside the self-stigmatisation of culturally feminised, but realistically human emotional experiences.^3,7 Research supports the connection between traditional masculine norm adherence and poor mental health outcomes for boys and men,⁸ including greater risk of suicidal ideation.^9,10 This also extends to educational outcomes, where endorsement of traditional masculine norms is associated with school disengagement.¹¹ Critically, restrictive gender role frameworks with negative psychosocial outcomes are structural problems demanding structural solutions.¹² The need for change here is perhaps best justified by evidence that suicide is the leading cause of mortality in young men worldwide;¹³ males die by suicide at three times the rate of females.¹⁴ The adoption of policy and system-level strategies to reduce the influence of rigid traditional masculinities in advance of positive expressions of manhood is essential for the promotion of boys’ and young men’s mental health.¹⁵ Existing interventions focused on promoting young men’s wellbeing,¹⁶ including preventing suicide (e.g.,¹⁷), commonly encourage boys and young men to reflect critically on the extent to which their expression of masculinity might be inhibiting help-seeking. Yet it is important to also embed the promotion of positive masculinities into the fabric of mental health and educational systems and policy. A 2019 Lancet review of programmatic, legal and policy approaches to ameliorate restrictive gender norms identified 87 program evaluations, of which 7% measured mental health as a dedicated outcome, and only 15% adopted a focus on boys and men.¹⁸ Moreover, existing gender-focussed policy approaches to health promotion have largely aimed to advance gender equity via targeting women’s and children’s health.¹⁹ As Smith and colleagues¹² have noted, a select few nations worldwide have developed national policies focused on men’s health (e.g., Australia, Brazil, Iran, Ireland, Malaysia, and South Africa). Yet broader acknowledgement of gender socialisation (i.e., masculine norms) as a determinant of mental health in boys and men is limited in global health policy.²⁰ A focus on policy and systems-level approaches to reduce the hold of restrictive gender norms on boys and young men, commensurate to the poor mental health and educational outcomes experienced by this group, is needed. A critical component of this should be greater prioritisation of strategies across research, systems and policy that amplify diversity and difference within men as a group. The continued comparison between boys and girls represents a cul-de-sac that systematically obfuscates the modern-day reality of increasingly diverse expressions of masculinity.^21,22 Moreover, greater recognition of gender as a social health determinant that intersects with other categories of social identification, such as race, class, and sexual identity, is essential to advance men’s health equity.^23,24 Boys and young men possess agency in their capacity to shape their own gender development,⁷ yet simultaneously, social pressure to conform to traditional ideals of manhood are strongest during adolescence.^25,26 Connections between rigid expressions of traditional masculinity and poorer mental health could explain the emergence of gender disparities in health and wellbeing outcomes surface during adolescence.²⁷ As one example, whilst young women are much more likely to be diagnosed with depression, especially in adolescence,²⁸ young males are consistently over-represented in other mental health and impulse control problems including substance use disorders, interpersonal violence, and risk-taking behaviours.^29-31 Young men are also found to express greater reticence towards health-promoting behaviours such as professional help-seeking relative to young women;³² a pattern which is often implicated in explaining young men’s disproportionate vulnerability to suicide.¹⁷ Disparities are also evident in educational outcomes for boys and young men: meta-analytic evidence suggests young men exhibit poorer academic performance than young women, particularly in language courses.³³ The aim of any successful reform in this space is not to privilege young men’s needs over other genders, but rather to seek out and respond to very clear systemic disparities that will lead to true gender equity and benefit men, women, and whole communities. Systems and policy approaches should look to enable the promotion of mental health and positive educational outcomes that: (i) are sensitised to the ongoing influence of traditional masculine gender role norms; and (ii) liberate boys and young men (and in turn girls and women) from outdated archetypes of masculinity towards positive expressions of masculinity grounded in connection, motivation, and authenticity.³⁴ Examples of promising policy-level approaches will be outlined across mental health and educational systems below.

Boys’ and young men’s mental health promotion

A policy and system level approach to mental health promotion benefits boys and young men in myriad ways. Firstly, there is a growing emphasis on the need for mental health services and systems to adapt to provide therapeutic approaches appropriately tailored for the complex influence of traditional masculine socialisation on engagement with these services. Existing approaches include Kiselica and Englar-Carlson’s,³⁵ positive psychology/positive masculinity model of psychotherapy. This encourages mental health practitioners to amplify the positive and mental health promoting elements of traditional masculine norms as a conduit to boys’ and men’s engagement with therapy. Much of this thinking has been codified in the American Psychological Association’s guidelines for psychological practice with boys and men,³⁶ representing essential recognition of the role of mental health systems and policies in adapting to support service engagement among men via leveraging strength-based masculinities. Furthermore, Seidler and colleagues’ Men in Mind is an online intervention aiming to upskill mental health practitioners to best engage and respond to help-seeking boys and men, via tactical adjustments to therapeutic engagement practices in line with masculine socialisation to reach and retain help-seeking boys and men.^37,38 Enacting mental health services that amplify diversity and difference within and between men is a core tenet of Men in Mind; an intervention exemplar that adopts a systems-level approach to shifting gender norms towards healthy and positive enactments of masculinity.

Schools as a vehicle for promotion of positive masculinities

Schools occupy a position of far-reaching potential concerning both mental health promotion,³⁹ the establishment and norming of positive expressions of masculinity to help reduce rigid reliance on traditional archetypes of masculinity.¹¹ Indeed, recent work has aimed to specifically operationalise positive masculinity across domains of connection to others, motivation to enact a meaningful societal contribution, and authenticity in one’s vulnerability and sense of self, with a view to directly informing strength-based programming for boys’ and young men’s wellbeing and intrinsic motivation.³⁴ As described above, mental health promotion programs delivered to boys are young men in schools commonly encourage them to engage in reflective discussion around the potential role of traditional masculine role norms in their psychosocial experiences. A 2019 systematic review identified a range of promising programs in this domain.¹⁶ Notwithstanding this, the review identified a notable lack of ‘gender transformative’ programs that aim to shift adolescent masculinities towards the embodiment of adaptive qualities. As schools are a near-universal touch point for boys and young men, a critical opportunity exists to embed promotion of positive masculinities into school policy and curriculum. Examples of such programming exist in Australia, such as Brighton Grammar School’s +M initiative: this represents a program of curriculum and resources for students, parents and teachers dedicated to the cultivation of positive masculinities in boys and young men.⁴⁰

Conclusion

Rigid adherence to traditional masculine norms is associated with a range of negative mental health and educational outcomes for boys and young men. Existing approaches to positively shift masculinity norms alongside mental health promotion often focus on individual or group behaviour change in specific contexts. A notable gap concerns top-down policy and/or systems-level approaches to the promotion of positive masculinities. Promising examples exist in terms of tailoring and targeting mental health services for boys and young men, alongside the embedding positive masculinity as a priority in school-based wellbeing programming. Evaluation and scaling of effective approaches is needed. Greater prioritisation of policy initiatives is essential if we are to assist boys and young men to move beyond restrictive masculinity norms and help them to reclaim aspects of their humanity as a vehicle for improving their mental health.

About the authors

Michael J. Wilson^1,2 (BA Hons) is a researcher based with Orygen at The University of Melbourne, as part of the Gender and Social Psychiatry team with his research focusing on gender and masculine socialisation as a social determinant of mental health in boys and men, including risk of suicide, alongside promotion of positive masculinities in boys and men. Dr. Ray Swann^3,4 (PhD) is Head of the Crowther Centre and completed his PhD in medical Education at the Austin Hospital, Department of Surgery, University of Melbourne and his Masters by research at the Melbourne Graduate School of Education. Dr. Zac E. Seidler^1,2,5 (MPsych, PhD) is a clinical psychologist, researcher and leading men’s mental health expert and currently holds dual roles as Director of Mental Health Training at Movember and Senior Research Fellow with Orygen at the University of Melbourne. Associate Professor Simon M. Rice^1,2 (Dip Ed, Grad Cert Clin Epi, MPsych, PhD) is a Principal Research Fellow and Clinical Psychologist and currently leads Orygen’s research programs into Elite Athlete Mental Health and Forensic Youth Mental Health.

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