When ‘manning up’ harms instead of heals

As part of Men’s Mental Health Week (14th – 20th June 2021), Mark Pitts, Social Worker and Operations Manager at Bush & Co shares his experiences of working with young men following catastrophic injury and trauma.

I am sure that many of us have worked with men, of all ages, who have struggled with their mental health and for that reason you’ll be only too aware of the shocking figures published on suicide rates within men; with those aged between 45 and 49 being the most at risk.

The Office of National Statistics published that across England and Wales, in 2019 there were 16.9 deaths per 100,00 people which was the highest rate since 2000.

When looking at the data following injury, a study in Denmark* followed a cohort of clients (male and female) for 15 years post-injury and reported a 4.1% higher risk amongst males during that time compared to the general, uninjured population and within the study cohort, 77.8% of the suicides were men.

Working with catastrophically injured men

So what particular issues does this raise for us working with catastrophically injured men and how does it affect our approach?

It is clear that the causes for such high figures of suicide are multiple and complex, they also do not record the numbers of those regularly self-harming, placing themselves in high risk situations and struggling to get through each day.

In my opinion, I would suggest that the factors affecting the general population of men are present with our clients too, including but certainly not limited to: Social Constructs about what a ‘man’ is or should be; sense of worth; loss of role and status; loss of income and lack of access to appropriate support.

In my experience of working with men after severe brain injuries, the symptoms of poor mental health can emerge at any point after injury (if not present pre-morbidly). Sometimes behaviour that challenges is recorded as a direct result of organic damage to the brain, but emerging awareness of loss and traumatic change can promote anxiety and depression leading to those same observable behaviours.

The double edged sword that is insight

Insight really helps in the planning and implementation of rehabilitation packages and programmes. It also gives these men an understanding of their new reality, lost horizons and future plans.

This new reality very often consists of change or loss of career, change or loss of relationships, loss of status for example; the list is extensive.

For men I believe the expectations they hold of themselves as ‘bread winners’, providers and protectors, although somewhat outdated in many people’s view, still hold extreme power for the individual.

The honest picture

Statutory services are more stretched than at any time and the problem not only lies with mens’ reluctance to access services, it lies also with the fact that those services are often hard to access, not geared to the needs of many men in the services and their settings that they do provide.

I believe a large proportion of men find the prospect of sitting down in a clinical setting and talking about ‘feelings’ to be a deeply unattractive proposition.

In my own practice as a brain injury social worker and as a previous case manager I have worked with many men, of all ages, who have struggled to accept either the need for help or to engage with support even when they agree they would benefit from it.

Empower through conversation

An example from my time as a case manager was a young man of 24. He had been involved in a road traffic incident as a passenger and had an acquired brain injury.

I became involved 18 months after his injury and after his relationship with his previous case manager had broken down. There were lots of complexities in family history, educational attendance and achievement and lack of employment record. He simply would not talk about the incident other than to say the friends also involved had “dropped him”.

He was very unwilling to have a ‘support worker’ and when I visited him we would invariably go straight into his garage or driveway where he had a couple of cars one of which was being renovated.

My ‘in’ with this young man was to try to empower him in our conversations as much as possible. The car was a great subject, he knew much more than me about the mechanics and it was a subject where he could assume to role of ‘teacher’ and I the role of ‘pupil’.

This simple device enabled our conversations to flow in a ‘usual’ way. It also gave opportunity where he would be able to say, “I sometimes forget how to do a simple job or remember where I was up to with a task” or how he could be distracted by a telephone call and struggle to re-engage.

This was an opportunity to talk about him having an ‘assistant’. Someone who would support him with his car work, but also make sure he got up, planned his day either round the car, buying parts etc, which leads on to budgeting activity, planning, use of a diary etc.

With this young man we were able to utilise a different medium to facilitate discussion about how he was struggling, his injuries and to begin to plan for a future route into employment.

Don’t get me wrong it was not always a smooth path, there were many challenges. However, I do think that some lateral thinking and approaches can be useful and avoid the stigma and fear that many men can experience. In this case the recruitment of a male support worker who was age appropriate, spoke the same language and was able to pick up on cues was central to the success we did have.

I do also personally believe that as a case manager giving something of yourself to clients is enormously helpful. I always believe that sharing some of your own vulnerabilities can be empowering. We are often seen as problem solvers and our clients don’t imagine that someone like ‘us’ might have struggles. Obviously we all have our own limits to what we share and how comfortable we are with it, but for me, when we encourage men to talk about their mental health we should not be afraid to be a role model for that advice within the professional boundaries.

Imagine the smiles, the rebuilt lives and the hopeful futures

Men’s mental health challenges won’t go away and will certainly always be part of the trauma men deal with post-injury; men’s mental health is a crisis that continues to be talked about but rarely tackled in a co-ordinated or resourced fashion. We have the power to make a small difference to a small number of men individually but if we can all do that, and put men’s mental health front and centre of their rehabilitation pathway, imagine the smiles we could back on faces, the lives we could rebuild and the future we can help carve out for those struggling.