Depression is stigmatised. When people know, they treat you differently.Huy, a man with lived experience of homelessness and depression
Many men are hesitant to, and have difficulty talking about, depression and anxiety. A major reason is stigma.
Stigma is a mark of disgrace that sets a person apart from others. When someone is labelled with anxiety or depression, they’re no longer seen as an individual but as part of a stereotyped group. Negative attitudes and beliefs toward this group create prejudice, which can lead to negative actions and discrimination.
Stigma brings experiences and feelings of:
These feelings can be caused by:
Stigma can make it difficult for men to speak about their experiences of anxiety and depression and is a barrier for men seeking assistance.
Other reasons men may not seek help are:
You can challenge these barriers and reduce the impact of depression and anxiety simply by changing the conversation. Here’s how:
Not necessarily. While some men feel comfortable talking about their mental health with a male support worker, others prefer to expose their vulnerability to a female. Either way, it’s important to build a level of rapport.
Recommended by beyondblue, these GUIDE principles will help you start, and follow through with, a conversation:
Before you ‘have the conversation’, make sure you’re prepared by asking these questions:What would I do if this were a physical health issue?
Consider the approach you’d take if the person had a physical illness, as many of the principles will be the same.Have I read the information in Module 2 about depression and anxiety?
Having a better understanding of depression and anxiety can help you identify warning signs or changes in the person.What’s the goal of the conversation?
From something simple like making a connection, to something more detailed like filling in an online depression screening tool, goals will vary depending on the circumstance.Have I prepared actions I might be able to suggest?
These can include:
beyondblue: Telephone counselling 1300 22 4636
Here are some questions you can ask yourself to help you better understand the situation.Am I the right person to have the conversation?
Who’s the best match for this man? Is it a male or female support worker, or someone who already has a rapport with him? It’s worth considering cultural differences too (see below for more information). Be aware that the status of men and women in some cultures may impact on the decision regarding who has the conversation.
Either way, it’s important to build a relationship before talking about depression and anxiety. Mutual respect and trust will help you recognise if a man is struggling with anxiety or depression.What’s the best time and place to talk? How do I create the right environment?
Depending on the circumstances, the best time to talk could be the morning, lunchtime or end of day. Whatever you choose, privacy is important. You could meet at an office, where the person is living or a nearby café. For some, a café may be stressful and intimidating so it’s best to use your judgement.What else is going on?
Are there other issues which need addressing such as physical ill health, substance use/misuse or some other crisis that might add to the challenge of getting him to talk about his mental health.What else should I consider?
Make sure basic needs have been met, like food, clothing and shelter. If a man feels valued and important, he’s more likely to be open to a chat. Also, turn your phone on silent so you can give him your undivided attention.
Men from different cultures may face unique barriers when seeking help for depression and anxiety. There may be a stigma associated with mental health, a lack of knowledge about available services, language difficulties and social isolation.
You don’t need to be an expert, just be culturally sensitive. Get the man to help you understand their culture, and read about their beliefs and traditions. It may shape the way you approach the conversation.Handy tips when talking to men from culturally and linguistically diverse backgrounds
“Do you need an interpreter?”“Can you tell me some things that are important to you about your culture? They could be beliefs, rituals and even important dates.”
Understanding a man’s beliefs and cultural differences means you avoid giving him information that may be irrelevant or disrespectful.“You come from [country]. What major differences would you say there are, if at all, with [country] and here in how people respond to and talk about depression and anxiety?”
It’s important to note that some cultures and languages don’t have words for depression or anxiety. Try talking about emotional distress or emotional wellbeing, as well as physical symptoms of psychological distress.
Once you know the differences, it’s easier to break down barriers about what he may expect from Australia.“Is the medical system in [country] similar to here in respect to getting a good service?”
If he’s had issues getting a good service in the past, ask him if he’d prefer a GP or a worker from his culture.“Can I explain to you how a mental health worker or a GP can help you?”
Sometimes men don’t see a GP or a mental health worker because they’re unsure what to expect.
For more information about depression and anxiety within other cultures, visit the beyondblue website or see the links below.
Talking with a refugee may uncover some trauma. You could refer to an organisation that helps refugees who have survived torture or war-related trauma.
Talking with men about how they’re feeling can help you understand if they’re experiencing anxiety or depression. You’ll gain a sense of how, why and what they’re thinking. The symptoms checklist in Module 2 will help you.
Here’s how you can start a conversation, and keep it going.Don’t make assumptions or attempt to make a diagnosis
Remember, it’s not your role to diagnose depression or anxiety, or to provide counselling. You're here to assist men to access the support they need.Focus your effort on a genuine concern about health
It’s important to let a person know you’re concerned, and why. Try saying: ‘I’m concerned about your health…’ or ‘I’ve noticed you don’t seem yourself…’ Write down what you want to say and how you’re going to say it.
Some men deny depression and anxiety, despite being on medication. Once you’ve clarified their medication, it may lead to a more in-depth conversation.Use open-ended, non-judgemental language
Open-ended questions are a good way to start a conversation. They require more information and can’t be answered with a simple ‘yes’ or ‘no’. To show you’re listening, maintain eye contact and sit in a relaxed position. Let the conversation go at his pace.
"You can tell when a worker isn’t on the ball or not listening. And then I’m thinking, you’re not really helping me so go away."Peter, a man with lived experience of homelessness and depression.
If appropriate, and if you have an example, tell the person about another man who had a similar issue where there was a positive outcome. Just make sure you don’t divulge confidential information.Let him know what support is available
Provide information about organisational support, or direct the person to other self-help resources like these. Men with limited literacy may need help completing forms.
Spend time with him
Be supportive and understanding
Encourage him to talk about his feelings
Listen to his concerns
Be respectful and polite
Allow for silences
Let him take his time
Use clear and simple language
Respect the right not to talk
Learn about causes
Find out about treatment options
Workshop conversation starters with colleagues.
Make assumptions or attempt to make a diagnosis
Judge, blame or criticise
Argue or disagree
Lecture or ‘tell him off’
Ask too many questions
Push him to talk
Dismiss his thoughts and feelings
Give up on him if he doesn’t want to talk – you may get a better response when you try another time
Tell him what he’s ‘feeling’.
Here’s how you can start, develop and strengthen relationships so you can have a conversation about depression and anxiety. To engage men effectively:
The concept of ‘not knowing’. Ask things like:
Stay interested and curious when asking questions. It’s less confronting, keeps the conversation going and is more likely to encourage a person to take action.Conversation starters
Starting the conversation can sometimes be the hardest part. Once you start, the rest of the conversation will often just flow. Try asking about family, relationships, any tension or problems that have, or possibly still are, occurring. By starting a conversation, you’re showing him he matters.
Here are some conversation starters to get you going:
If your organisation has access to the Recovery Star use it to find out where the person is at with their mental health.
I don’t feel like going to the appointment today.
Okay. How come?
I don’t know, I guess I just don’t feel up for it today. I’ve been a bit flat recently and I just want to stay in bed.
Okay. That’s no problem, I’m sure you can get another appointment for next week. How long have you been feeling flat for?
A few days…maybe a week.
Did anything specific happen to make you feel like this or has it just been a gradual building?
Yeah, it’s just sort of got worse I guess. There’s no real reason why.
Has this happened before at all or is this something new for you?
Yeah, it happens quite a lot I suppose. More and more over the last year probably. I just can’t be bothered doing anything and generally just want to stay inside… and not see anyone…
It sounds like it must be quite tough for you at the moment. Hey, have you ever talked about it with anyone else? Have you thought about chatting it over with your GP at all?
Ah, I don’t know if it’s that bad. It usually just passes with time and I just manage to get on with things.
Oh okay, but still, it might be worth just making an appointment and having a chat all the same. It can’t hurt to chat it over with someone who knows what they’re talking about. I’m just thinking that if you’re missing appointments and not seeing people it could be a good idea. How about this… if you make an appointment then I’ll come along with you if that’d help? Anytime that works best for you. Just give me a couple of days notice and I’ll clear the time in my diary to come along.
Making someone believe in their own ability to achieve their goals can motivate them to change. It takes a supporting relationship, open-ended questions and positive affirmations, with no judgement or labels.
Motivational interviewing is made up of three parts:
Motivational interviewing is a useful skill for you to learn. If you’d like to find out more, click here. Training courses are also available.When things don’t go to plan Don’t worry about not knowing exactly what to do. You can:
Men who are experiencing anxiety and depression need positive signs and reassurance they’re not alone. You could provide examples of other men you’ve supported through their anxiety and depression.Persist gently – don’t give up
Some men might not acknowledge the changes you’ve noticed. They might say: ‘There’s nothing wrong, I’m fine’. It’s up to you to be a detective - ask more questions or try a different approach. But don’t give up. Keep trying to have general conversations. It builds trust and rapport.Conversation starters when things aren’t going to plan
“You seem reluctant to talk. Do you find talking about personal issues difficult?”
Don’t try and force a person to talk. Instead, try asking: “Do you mind if I call you in a week to see how you’re going?” If he declines that offer, give him your number and suggest he call you if he changes his mind.
“It’s ok, you can talk about this with me”
If he says he’s fine, you can say: “I’m hearing you say you’re fine, but you’re in your room a lot. Why do you think your housemates might be concerned about that?”
Don’t be annoyed if he doesn’t want to talk. Simply try again another day.Bear uncomfortable silences
Silences may occur in the conversation – don’t rush in to fill the gaps. He may be thinking about what you’ve said and formulating a response.Leave the door open for future discussion
You won’t always have a resolution after one conversation, so make sure you leave the door open for discussion at a later time.
Men who are experiencing anxiety and depression need positive signs and reassurance they’re not alone.
A common & treatable medical illness
Learn to manage their illness
Live a normal life
Can really care
What happens next depends on what you learnt during your conversations and the perceived severity of the depression or anxiety. If appropriate, follow up to see how he’s going and whether he’s ready to ‘take action’.
It’s a good idea to get some support for yourself – more about this in Module 4.