Comment on Could we improve men’s mental health?

quixotic120@lemmy.world ⁨1⁩ ⁨year⁩ ago

I am an actual licensed therapist and while there are a number of real actual creating barriers specific to men pursuing mental health treatment there are a few factors I’ve consistently seen that are ubiquitous across gender, race, sexuality, class, etc

Money, time, availability

Therapy is inaccessible. I am a therapist who mostly works with insurance companies. They pay me about 100-115/hr. My clients will often have a high deductible health plan which means they need to pay this $100-115 per session until they hit their deductible, which can be 5,000+ dollars. It’s a lot to ask someone to pay $100+ weekly. On top of that they still usually have a responsibility afterwards of (typically) 10-30% so $10-34.5 per meeting which is still a notable weekly cost for many people on the high end especially after shelling out $400+ a month for months on end.

Other clients have PPO insurance which is a fixed cost per meeting but this can vary wildly. More affluent clients have excellent PPOs where they might pay $10-20 per meeting which is not terrible. But that’s rare. We are often covered under the “specialist” copay and many PPO plans have tiered provider coverage now. So a copay for me might be $50 or more per meeting (the worst I saw was $125 which was absurd because it was actually $27 more than I’d get from the insurer in question).

So you have this on top of these plans taking hundreds of dollars out of each pay check. “Well budget for it”. Hard to do because the need for therapy can be inconsistent and many of these people are coming in fo(and specifically symptoms like poor money management). Then on top of that even if you do budget for it you have the inherent issue that the need for outpatient therapy is often not dire/acute so if something more pressing comes up (eg a serious dental/medical issue, car breaks down, short on rent) therapy might be the corner to cut if it’s already established because in the overwhelming majority of cases you won’t die without it; it will just lower your quality of life (sometimes significantly so)

Then comes the time portion. Even if you can get past the cost barrier you have the availability of the therapist and yourself. I’m a night owl and I work late but many of my colleagues don’t. I’m pretty nontraditional though, no kids and my partner is very career oriented themselves whereas many of my peers tend to value the traditional 9-5 much more so they can be home for their children and such.

So when you go to schedule with someone it’s often that you can only get seen during business hours. It’s one thing when it’s a doctors appointment that you have once every few months that you need to duck out of work for but a weekly hour long engagement is much harder to explain. This brings back in the masculinity issues - many men find this basically impossible to disclose to the workplace and basically wouldn’t even try to get an exception for weekly therapy. Even without explicitly saying so asking for 1 hour open a week consistently for a doctors appointment is going to be perceived as therapy by many. But stigma aside many of us simply can’t do that. I’m on the practitioner side and I know I’ve ignored my own physical health at times because it was inconvenient to schedule doctor appointments during my workday.

Our systems of employment (at least in the USA) simply do not provide or protect for medical leave, even when it’s very brief and especially when you are a low level employee (executives and admins tend to have less of an issue ducking out for doctors appointments in my experience at least). There is no legal right to paid or unpaid time off for medical appointments in the USA and that is completely disgusting in 2023.

The final piece is practitioner availability. I have a waitlist through October at the moment and am not accepting new clients. All of my colleagues are in the same boat. The old practices I used to work at constantly call me to see if I’ll take any referrals because their waitlists are so overloaded. The hospitals and clinics I have referral relationships with email me every week for updates. It’s extremely stressful. Every new client, especially adolescent, complains that they are happy to finally have someone after waiting 3-6 months. Even if someone wants a therapist they have to wait ages. It is not uncommon that I get someone and when I call them to start they say they don’t even remember why they called in the first place.

We need more people doing the work. Or ideally we need to make societal reforms so that there are less people experiencing mental health issues. I’ve been doing this almost 15 years now. I, and anyone who doesn’t exclusively work with the rich, can tell you that a significant degree of what we work with is people who lack resources and not proper mental illness. I mean, it is depression and anxiety, but it’s because they have been paycheck to paycheck for years or theyre under a mountain of student loans or credit card debt and the stress is just too much to bear. And their jobs won’t give them raises and there aren’t any other jobs out there that pay more. Not everyone is a software developer or investment banker that can jump ship to another 6 figure job with cushy benefits. Most people work jobs that pay 40-60k with shit benefits and little upward mobility.

To answer your question more directly:

In my opinion it’s a systemic issue based around that super fun phrase everyone loves, “toxic masculinity”. I personally do not subscribe to gender labels but I am amab/male presenting and get a lot of male clients as a result. Many of them tell me they hide the fact that they are in therapy from everyone but their partner. This is indicative of the problem; that being in therapy is weak. That being in therapy makes them a bitch, a wuss, all kinds of pejorative terms. It’s bad, is my point.

So part of the answer imo is not in having doggies and cool dude stuff in the office. Its far more complex and involves redefining masculinity to still including things like being a lumberjack or carpentry or whatever. From there though you need to shed the part where it means you have to be emotionally numb to everything, constantly display strength, embrace the fucked up misrepresentation of stoicism that has you shove all your feelings into your stomach, and glorify anger, rage, and violence as the only appropriate means of emotional expression.

this could also be extended to the stigma surrounding therapy itself and the tendency to associate therapy need with weakness. This is an issue that goes beyond therapy though; there are people who won’t see medical doctors for the same reason even though they’re in physical pain. Our pride is our downfall.

Tldr make therapy cheap and accessible, make protections for workers to seek medical care, increase the amount of practitioners (or decrease the need for them), and systemic reform to the societal concept of masculinity and pride. So probably gonna take awhile

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