'The fewer male psychologists we have, the more the stigma persists'

As a 24-year-old mixed-race assistant psychologist, my journey into the world of psychology has been quite an eye-opener. From day one, I noticed something striking: I was often the only male in the room. Whether it was my undergraduate classes or the Enhanced Psychological Practitioner programme, for the first time in my life, I was in the minority as a male. This trend continued when I landed in a Child and Adolescent Mental Health Service (CAMHS) setting – yup, I was still the lone male psychologist.

But it was during my time in CAMHS, amidst the challenges and opportunities of my coursework, that I had a revelation. I was tasked with a research project focusing on my service, and in a casual chat with a colleague they mentioned a 'young boy who could really use a male clinician'. That got me thinking.

As a male in this field, I often feel like an outlier.

But for the young men coming into our service, finding someone who looks like them must be even more challenging. What must it be like for the young males searching for someone who reflects their own experiences and struggles?

So, I dove headfirst into a burning question: What are the barriers for young males accessing our service, and how do we make things better for young men in CAMHS? I embarked on a mission to unpack the complexities of male help-seeking behaviours and advocate for a more inclusive and supportive mental health landscape.

Norms, expectations and stigma

As psychologists, we're all about creating environments where everyone has an equal chance at getting the support they need. But here's the kicker: despite all the talk about equality and diversity within mental health, there's still a big gap between men and women when it comes to asking for mental health support. Studies keep showing that young men are way less likely to speak up about their mental health issues compared to young women (Radez et al., 2021; Staiger et al., 2020). Why? Well, it's a messy mix of gender norms, expectations, and stigma.

When I started digging into this topic, the theory of Social Identity arose. See, society has this idea that young men should be tough, strong, and never show any weakness. So, admitting you need help with mental health stuff? That's like waving a red flag at your manliness. A recent study in the UK backed this up – many young men are struggling, but most of them keep it to themselves because they're afraid of being seen as weak (McKenzie et al., 2018; Priory, 2022).

But here's where it gets even more interesting.

It turns out that the lack of male psychologists in the field is making things even harder for young men who want to reach out for help (Johnson et al., 2020). Think about it: if all you see are women in the mental health field, it can potentially be tough to relate as a young male. Social learning theory says we learn from role models around us, so when you walk into a space and all you see are females, it reinforces the idea that this is a female space, and as a young male, you might start to question if it's really a place where you belong (Addis et al., 2010).

When reading research and articles on this it reminded me of a theory I learned in my undergrad – Gender-Role Congruence. Basically, feeling more comfortable talking to someone who gets where you're coming from. If you're a young man struggling with mental health, you're more likely to open up to another male due to the belief that they have been through similar experiences and challenges (Parmenter et al., 2019).

Research with my service

I decided on a mixed-methods approach – both numbers and stories to get the full picture. I started by diving into the data from our electronic systems to see what the numbers had to say. I wanted to know all about the referrals – who's coming in, what their difficulties were and, crucially, whether there's any difference between boys and girls seeking help in CAMHS.

But numbers only tell part of the story, right?

So, I also sat down with a bunch of staff members. I wanted to hear straight from the people on the ground – what are they seeing, what are they hearing, and what are they experiencing when it comes to young males accessing mental health support? These interviews were key to getting a deeper understanding of the barriers these young men face.

Although I initially aimed to interview staff of different genders, I encountered a challenge. There were no male psychologists available for interviews within the CAMHS team. However, I made the most of the opportunity by speaking with other male members of the CAMHS team, including mental health nurses and family therapists, to gain diverse perspectives on the issue.

Let's dive into what I found.

First things first – the numbers. When I looked at the referrals into CAMHS based on gender, something interesting popped up. It turns out that more young men are being referred than young women. Now, at first glance, you might think that's a good thing – more males seeking help, right? But when I dug a little deeper, I found that these referrals for young males were mostly for issues like behaviour regulation, often followed by queries of neurodiversity.

This observation was supported by the clinicians I interviewed. For example, one shared that males often present with difficulties viewed as 'behavioural' or pathologised as 'attention-hyperactivity', and are more likely to engage in drug and alcohol abuse. Additionally, they mentioned that young males often get into trouble with education and the police.

We can understand this predominance through the lens of the Two-Factor Model of Psychopathology. This model basically looks at two main types of behaviour – externalised and internalised. Externalising behaviours are the ones you can see – think disruption, aggression, impulsivity, or rule-breaking. These behaviours are often indicators of behaviour dysregulation or forms of neurodiversity. On the other hand, internalising behaviours are more inwardly experienced and less visible. These might include emotional distress, withdrawal, or inhibition, and can present symptoms like anxiety, depression, or low mood.

Studies have shown that when males face challenges or difficulties, they often tend to express themselves through externalised behaviours (Liddon et al., 2017). Now, why is that? Well, it's believed that societal norms and expectations play a big role here. You see, our society has this idea of what it means to be a 'man' – tough, stoic, not showing any emotions. So, when males are dealing with anxiety or low mood, which are often associated with mental health issues, they might feel pressure to keep it all bottled up inside (Chaplin, 2014).

This idea is backed up by Social Identity Theory, which suggests that males are more likely to exhibit externalised behaviours because it fits with their idea of what it means to be 'masculine' (Amin et al., 2018). And the interviews I did with staff support this. They discussed about how the young men they supported struggled to open up about their emotions because of the stigma and gender norms surrounding masculinity. It's like there's this unwritten rule that as a male we aren't supposed to show vulnerability, and that can make it really tough to reach out for help when it is needed most.

Externalised behaviours aren't just random outbursts; they're often a way for young males to express themselves when they're struggling to put their feelings into words (Bazhydai et al., 2018). Research has shown that males aren't taught to talk about their emotions from a young age the same as females are, which means they might not have the tools to express what's really going on inside. Combine that with a society that tells boys to 'man up' and not show any vulnerability, and you've got a recipe for frustration.

So, instead of talking about what's bothering them, males might act out or lash out as a way to cope with all that pent-up emotion.

Beneath the surface

And here's the kicker: because externalised behaviours are more obvious and disruptive, they tend to get a lot of attention from parents, teachers, and other adults (Liu, 2004). That usually leads to referrals for assessment and support, which sounds like a good thing, right? Well, not necessarily.

You see, these referrals often focus on the behaviour itself, rather than what's causing it. Issues like anxiety or low mood might get overlooked or downplayed, which could make it harder for young males to get the help they really need. It's like they're stuck in this cycle where they're only seen as 'troublemakers' or 'dysregulated teens', instead of getting the support they need to deal with what's going on beneath the surface.

When I talked with the staff during my research, they mentioned a real shortage of male psychologists in our service, and they said that from their experience some young males would feel more comfortable opening up about their issues if they were able to talk to another male.

One female member of the CAMHS team shared that, 'As a clinician working in CAMHS, I've noticed that the lack of male psychologists may send a subtle message to young men seeking support. I imagine it's like a signal saying, "This isn't really your space". It's something that we need to address to ensure all young people feel comfortable accessing the help they need.'

A male member of the CAMHS team said, 'I imagine stigma and toxic masculinity already play a role in reducing the number of males we see in CAMHS for mental health support. However, the lack of male psychologists in places like CAMHS reinforces the stereotype that mental health issues are primarily a concern for women. It's like a cycle – the fewer male psychologists we have, the more the stigma persists, and the fewer young men feel comfortable seeking help.'

Think about it: if you're struggling with mental health issues as a young man, wouldn't you feel more comfortable talking to someone who's been through something similar, who can feel that same pressure? But here's the catch. Some studies have actually found that young males tend to prefer having a female clinician (Liddon et al., 2017). However, when they were asked why, it all came down to one thing – they worried about seeming weak or vulnerable in front of another male. Talk about feeling the pressure of societal expectations, right?

So, what's the solution?

It's not as simple as just hiring a bunch of male psychologists and calling it a day. I think there's a deeper societal role here too. Society needs to stop reinforcing this idea that psychology and caring professions are only for women. That's a stereotype we need to break. By challenging these stereotypes, we can encourage more men to consider careers in psychology, gain more male psychologists and make it easier for young males to engage better in mental health services.

As I reflect on everything I've shared about my experiences as a male psychologist and the research findings, there's another layer to this whole discussion that's been on my mind. It's about diversity, not just in terms of gender but also ethnicity, religion, sexual orientation, physical appearance, including body shape and more.

Here's the thing: when I look around my psychology team, I realise I'm the only one from an ethnic minority background. That got me thinking even more. The young people we serve come from all walks of life with diverse backgrounds and identities. But our team doesn't always reflect that diversity.

And that's a problem.

See, it's not just about having more male psychologists to support young men. It's also about ensuring our teams are diverse and inclusive so that everyone feels represented and understood. Whether you're a young man struggling with mental health or someone from a minority background seeking support, it's important to see yourself reflected in the professionals and services who are here to help.

So while my focus has been on young men and their mental health journey, let's not forget the bigger picture. It's about building teams that embrace diversity in all its forms – that's how we truly make a difference in people's lives.

Adam Boyle is an Assistant Psychologist working in the NHS