The male mental health crisis has escalated during the pandemic, but teen boys and young men aren’t receiving the diagnoses and care they need to heal. Males are four times more likely than females to die by suicide, despite lower recorded rates of depression and anxiety. In this Q&A, Kristin Wilson, MA, LPC, CCTP, Newport Healthcare’s Vice President of Clinical Outreach, explains why the statistics don’t match with the reality, and describes what can be done—within families, school systems, and societies—to reverse these trends.
Q: Why are the recorded rates of anxiety and depression among males so much lower than among females?
Kristin Wilson: For girls, it’s much more acceptable to talk about being sad. For teen boys and young men, it can feel like a sign of weakness to admit that they’re struggling with their mental health. Talking about being sad doesn’t fit what society views as acceptable male behavior. As much as things have shifted in recent years around gender norms and the ability to have open conversation about mental health, it’s still really hard for males to add the word “I” to the sentence “I’m not okay.”
We know boys can tend to confuse sadness and anger, they repress feeling sad and instead express it as anger, which feels much more socially acceptable to them. When asked about how they are feeling, boys will often not report being sad. They’re also more likely to abuse substances as way to self-medicate, engage in high-risk behaviors, become defiant, or to withdraw from family and friends. Because these actions have such a behavioral implication on the people around them, the underlying depression can be tricky to see. The good news is that once boys realize they need help, they are just as able to access and accept mental health services as girls.
Q: So it’s likely that just as many young men as women are struggling with their mental health, and the statistics don’t accurately reflect that because men tend to underreport their symptoms. What, then, accounts for the fact that the suicide rate among males is so much higher than the rate for women?
KW: Although it has been shown that women have higher rates of suicidal thoughts and non-fatal suicide attempts, when men make a suicide plan, they often take more deadly measures. With girls, their attempts tend to leave an opening for living. When boys decide that they will make an attempt, it feels much more final to them. They internalize so much, because of their fear of speaking the truth, that it gets to a point where they just can’t hold it anymore, and that feels like the only way out. Then the suicide gesture is the statistic that’s recorded, rather than the feelings leading up to it. Regardless of gender, suicidal thoughts and actions are serious crisis moments and need to be addressed by professionals.
Q: What can parents do to support their sons who may be struggling but not talking about what they’re feeling?
KW: It comes down to noticing how your son is acting. If he is shut down and not ready for conversation, shifts in behavior are the red flags to watch for. Parents need to be aware of how those feelings could be manifesting in substance use, arguing with teachers or fighting with peers, changes in sleep or appetite patterns, problems in school or slipping grades.
It’s also essential for families to create a safe space for open communication and authentic connection. Make time every day for meaningful conversations with your kids—it doesn’t have to be at the dinner table, it can be driving to school or to the store. You don’t have to make eye contact; it doesn’t always have to be intense. Ask questions that elicit more than one-word answers, really listen to what they say, and reinforce the idea that it’s okay not to be okay. It’s about staying in touch with your kids on a daily basis, creating a relationship foundation so that they know they will be supported and heard if do have something they need to say. And that means parents have to commit to putting down their phones and fully engaging in those conversations.
Q: Speaking of phones, what role do screen time and gaming play in male mental health, particularly over the past months when there’s been much less in-person social interaction?
KW: We see a lot of isolation and addiction that occur as part of gaming and other online activities. Kids will withdraw into their rooms or the basement to play, and be there for hours. They might say they’re gaming with somebody else who’s also online, but that connection is a lot different from being in a room interacting with peers. Online connections within the context of competition don’t always have the same benefits as face-to-face human connections.
Often parents feel they have no control over screen time, and that’s been especially true during the pandemic. For many families, all the rules went out the window because everyone was just trying to survive. Many kids were home during the day while parents were working, which created a loss of boundaries and structure. Parents may need to pause and consciously reestablish limits around screen time and gaming, and also build in time together as a family, particularly as we head back into the school year with so many additional stressors and moving parts.
Q: What can schools do to help reverse the mental health trends among males?
KW: As a society, we’ve done a good job checking temperatures and other COVID symptoms before going into school buildings, but we’re not checking mental health temperatures. Schools need to do emotional check-ins so they know what’s happening with teens and with staff, and work toward creating trauma-sensitive environments. More education is needed about trauma responses, especially those that are being normalized right now, like substance abuse, disordered eating, and difficulty concentrating. Building in key protective factors can help school communities enhance resilience and insulate against trauma—things like emphasizing supportive relationships, creating safe places to talk about mental health, mentorship programs, peer advocacy.
In a recent 4H–Harris Poll survey on the impact of the pandemic on youth mental health, seven out of 10 teens reported increased depression, anxiety, and stress, and 79 percent said they wished there were safe spaces in school to talk about mental health. They want to talk about it—they just don’t know where to go. A single school counselor who may be dealing with their own stressors cannot be the one point person for everyone who is struggling. We have to shift that model and do a better job of cross-training and providing education to all staff in the building so they become more aware of how pandemic is impacting their community and how to help them.
Q: Once teen boys and young men do get into treatment, which approaches tend to be most effective for them?
KW: Engaging boys and young men on a physical and creative level is very effective. It takes the need to have all the right words or to say all the right things off the table. They can be hiking in the woods with a group and an Adventure Therapist, and all of a sudden they’re talking about their feelings, doing an activity such as putting rocks in their backpacks for every trauma they are carrying and feeling burdened with. Music therapy is another modality that can be very powerful for boys—writing lyrics to songs often allows them to put their feelings into words more easily. It’s about finding ways for them to feel comfortable in their bodies, so that self-expression can happen.
Science may also help provide insight into the most effective ways to support male mental health. For example, there appears to be a neurobiological foundation for the differences in how males and females respond to the chronic stress associated with mental health issues. Studies done by researchers at Virginia Commonwealth University have found that mitochondria in male and female mice react differently to stress, producing different impacts on the brain.
Q: As a larger society, how can we work toward supporting teen boys and young men to feel safe talking about mental health and to get the care they need?
KW: We all need to work together to destigmatize mental health issues and create safe spaces for those conversations to happen—both nationally, through digital platforms, and within families and communities. We need to reinforce the understanding that, regardless of gender, it’s okay not to be okay, and that asking for help is not a sign of weakness but rather a sign of strength.
Kristin Wilson, MA, LPC, CCTP, has been working in the treatment field since 1997. During the past 20 years, her leadership roles have included clinical supervisor, executive director, and clinical outreach representative, as well as senior regional director of marketing for a major behavioral health network. Kristin is a licensed clinician who has worked in a variety of mental health treatment settings, including inpatient, residential, and outpatient levels of care for chemical dependence, process addictions, and eating disorders. She holds a Master’s degree in psychology and Creative Arts Therapies, is a Certified Clinical Trauma Professional and a certified yoga teacher.