When we think about vulnerability, Australian men aren’t the first group that spring to mind. But the facts are, they’re three times more likely to die by suicide than women and are twice as likely to die as a result of substance abuse.

These frightening statistics point to a deadly cultural taboo about help-seeking behaviour in boys and men. And it’s not until we begin to reframe what constitutes courage that men’s emotional health and wellbeing will improve, says Dr Cate Howell, OAM, who works extensively with at-risk men.

In Dr Howell’s book, co-written with her son Alex Barnard, she explores a range of issues affecting men’s mental health and provides tools to prevent them from suffering in silence.

“We called the book The Changing Man: A Mental Health Guide because change is desperately needed to reduce the impact of mental health issues.

“And men are changing and wanting more information and tools to use in their day-to-day lives.”

The high rate of suicide in men can be attributed to many factors, including shame around help-seeking and the general stigma that’s still associated with mental health issues in Australia.

“Experiencing emotional issues might be perceived by men as being weak or lead to feelings of vulnerability.

“These perceptions can also trigger shame. However, the shame is not based on truth, as mental health issues are a common occurrence in life, and it takes great courage to identify and deal with them.”

Men are also more likely to experience physical symptoms of emotional distress before emotional ones, explains Dr Howell, and may not attribute this to their mental health.

“This is because they are often socialised to suppress emotion and be strong, no matter how they feel.

“Men also have greater difficulty than women in recognising or identifying emotions.”

Substance-related issues are also higher in men, especially alcohol abuse, and unfortunately, this can lead to impulsive behaviours.

“Sometimes, suicide is an impulsive act, triggered in part by substance use.”

Alcohol abuse can be attributed to a toxic culture of self-medicating and binge drinking, which are often more accepted in men.

“In Australia, using alcohol to relax and socialise is very much part of the culture, and in some cultures, intoxication is more accepted in men.

“Binge drinking may be viewed as masculine. And parents may model substance abuse to their sons.”

Alcohol or other substances can be used to self-medicate when there is emotional distress.

“Difficulty identifying and expressing feelings can contribute to substance use, and the substances can be seen as a way of changing how men feel.”

But it helpful to see substance use as the tip of the iceberg, says Dr Howell. 

“Under the surface, there may be a history of stress, trauma, depression, disconnection from other people or meaningful roles in society, or lack of confidence and self-worth.

“The man may lack skills to cope with these and turn to substances as a way of coping.”

Men’s mental health issues and the alarming rates of suicide are a national crisis, says Dr Howell. 

“What we hear currently is that mental health has been significantly impacted by COVID-19, especially in young people, and that suicide rates have risen in some groups.

“So, let’s consider the impact of COVID-19 on young men, their work, relationships and their futures.

“I know of a young man who recently died by suicide, and the first-responders reported that they are being called out more often to young people who have taken their own lives.

“This is tragic, and we need to wake up as a society and recognise that we are losing too many young men this way. We all need to be doing more.”

While there have been positive developments in the mental health space, says Dr Howell, such as online and phone services and greater access to mental health professionals, the system is still lacking, fragmented and hard to navigate.

“Programs are set up, do a lot of good, and then disappear when funding is lost. And rural and regional areas often come off second best.

“We have to get messages out into the community that men, like women, experience a range of mental health issues and that these issues are part of life and can be successfully tackled.

“We need to invite men to increase their skill in recognising the issues and learn tools to manage them.

“We have to focus more on prevention, especially suicide prevention, as well as making it very clear where help can be accessed.

“Streamlining services and access would also assist.”

Mental health nurses are critical to improving men’s mental health, supporting a cultural shift that encourages help-seeking and promoting a holistic approach to treatment, explains Dr Howell.

“I have worked with mental health nurses in a range of hospital and community settings, including in primary care.

“I have seen mental health nurses assist in many ways, such as assisting the man with identifying the issues, including diagnosis, providing information, support, advocacy, counselling and taking steps towards treatment and recovery. They also assist the man at times of crisis or risk.

“In terms of anxiety and depression, it is helpful to take a holistic approach, recognising that there may be physical health or lifestyle issues which are contributing, as well as social, cultural, occupational issues or spiritual issues.

“Helping the man to identify strengths that will aid recovery and help them develop a range of coping skills will also assist.”

We all have a responsibility to be educated on mental health issues, rethink courage, and encourage help-seeking in boys and men.

“We can continue to develop our knowledge and be aware of the range of issues that can affect boys and men.

“These can include trauma such as bullying or abuse, anxiety, depression, eating disorders, substance-related issues and psychosis, to name a few.

“We can be aware that mental health issues may reveal themselves in several ways, some not so obvious.”

Symptoms of mental health issues

• Disturbed sleep or tiredness
• Low mood or anxious feelings
• Poor concentration or memory
• Pessimistic thinking
• Social withdrawal
• Irritability and anger
• Addictions

“We can develop our understanding of how men experience and manage emotions and the barriers to expressing emotions or seeking help.”

Admitting a problem may trigger feelings of vulnerability and shame, so being empathic is important, explains Dr Howell.

“We can approach the man and have a conversation, perhaps asking them how they are going in themselves, and encourage them to talk about what they are experiencing.

“We can offer support, information and assistance, and help them get in touch with community and professional supports.”

We can also prevent mental health problems in boys through teaching coping skills and encouraging social connectedness.

“Central to this is developing a range of coping skills to aid prevention and build resilience, or the ability to adapt to stress and change in life.

“It is useful to help children and young people find meaningful activities to engage in and build their sense of self-worth and social connections.

“We need to spend time interacting with our young ones and encouraging them to understand different feelings and learn to name them, and to be able to talk about the feeling rather than turning to an unhelpful behaviour.

“This is how we help them develop emotional intelligence over time.”


12 tools to identify and take action on mental health (from The Changing Man: A Mental Health Guide)

1. Identify the key issue(s).
2. Set goals – these need to be achievable and tackled in small steps.
3. See a doctor and have a physical check-up: This is vital as some underlying physical health issues can trigger anxiety or depression.
4. Focus on lifestyle
5. Gather information about anxiety and / or depression.
6. Reach out to others
7. Consider counselling or talking therapies
8. Utilise work and other meaningful activities in recovery.
9. Consider complementary therapies (e.g., supplements) if appropriate.
10. Work on prevention, including strategies for preventing relapse.
11. Consider whether medication has a role.
12. Practice and more practice!

Prevention strategies

• Stress management
• Developing optimistic thinking
• Utilising gratitude
• Putting energy into what is important or valued in life
• Investing in relationships
• Practising more mindfulness
• Engaging in meaningful activities
• Building self-belief and self-confidence

Prevention also includes reducing stigma around mental health, advises Dr Howell.

“We can continue to work on this by having conversations about mental health at all levels in society and raising awareness about the issues.

“We need to have conversations about vulnerability and to educate about ways to reduce shame.”