Samuel, a 27-year-old artist and gay man living in Australia, is telling me about his partner’s first and only experience seeking treatment for mental health issues. “Last year, he was in a really bad place and needed help,” he says. “He’s struggled with depression and anxiety his whole life, but small-town mentality has always told him to internalize.” Samuel explains that the Australian health-care system offers patients with a diagnosable mental illness six subsidized sessions with a psychologist, so he coaxed his partner into seeing a general practitioner for a diagnosis. “The doctor proceeded to tell my partner not only that his depression was likely linked to his sexuality,” he continues, “but that his sexuality could have been caused by pesticides used on fruit and vegetables.”
The experience was understandably unbearable for Samuel’s partner, who burst into tears at the end of the appointment. “Getting him to take that first step took a lot of coaching and years of encouragement,” Samuel says. “It was all ruined by one male doctor’s ignorance.” He hasn’t approached another medical professional about his depression and anxiety since.
Mental-health campaigns, especially those aimed at men, are often centered around the theme of “reaching out.” That’s based on an understanding that mental-health problems are stigmatized, and that a key barrier to treatment for men is a belief that it’s unmasculine to ask for support. For example, HeadsUpGuys, an online resource from the University of British Columbia for men struggling with depression, encourages men to “reach out to others for support” if they’re having suicidal thoughts; the New Zealand government’s online resource about depression notes that “men are less likely to reach out for help” and provides a helpline for doing so; and the Movember Foundation, a worldwide men’s health organization, explains in a video on its website that “talking saves lives,” underneath the tagline, “To be a man of less anxiety, I had to be a man of more words.”
It’s true that men are significantly less likely than women to seek mental-health treatment, and that the stigma surrounding men asking for help partly explains why. However, framing a reluctance to reach out as the key barrier between men and better mental health misses a crucial part of the picture — namely that health-care systems tend to be ill-equipped to deal with those who do ask for help. In fact, people who seek mental-health treatment are often met with intensive insurance requirements or the significant costs of private treatment; under-resourced helplines staffed by overworked volunteers; mental-health crisis teams so overburdened they outsource their function to the police; and therapists who cannot accept more patients or who don’t call back at all.
Henry, a 26-year-old marketer in the U.K., says that when he called a suicide helpline in his third year of university after he realized he “just didn’t want to keep going,” the person he spoke to was unhelpful. “The man on the other end told me to ‘man up’ in a vaguely pitiful yet encouraging way,” he explains, adding that this response infuriated and humiliated him. “I understand that being on-call for that kind of job is high-stress, but these situations can be critical.”
Helplines are often recommended as a first port of call by government agencies and included underneath articles about mental health, but often the organizations running them receive little to no government funding and rely on charitable donations and voluntary labor. Therefore, the level of training provided to staff and the quality of the care and advice given to callers is variable.
For those who would prefer (or need) to see a doctor or therapist, this can be costly, and depending on the health-care system, may involve Kafkaesque levels of paperwork and bureaucracy to navigate insurance requirements, requiring a level of patience and perseverance most mentally ill people can barely summon. Aly, a 23-year-old digital lobbyist in Washington D.C. who struggles with depression, tells me that she’s been searching in vain for a therapist for almost a year. “Of the offices I’ve called, most don’t respond,” she says. “The ones that do don’t have room for another client, and don’t immediately provide other referrals.” She adds that the four providers her insurance company recommended are “AWOL — they haven’t responded to a single email or phone call.”
It’s worth noting that for African Americans and working-class people, this problem is exacerbated. A Princeton University study showed that therapists are significantly more likely to turn down prospective clients if they’re black or working class, even though all of the test subjects were covered by private insurance. In other words, “reaching out” for them might not cut it.
Things aren’t necessarily much better on the other side of the pond, either. Olly, a 25-year-old actor based in the U.K., managed to see a general practitioner after he attempted suicide twice, but he was then put on a six-month waiting list to see a therapist. “Every month you have to fill out the same questionnaire to confirm you’re still waiting,” he says. “It was a perpetual disappointment.”
Even after accessing an appointment with a doctor or therapist, some patients will receive insensitive or ineffective treatment — a la Samuel’s partner being told his sexuality was caused by pesticides. Or consider Angie, a 41-year-old university worker in Illinois, who has had a string of terrible luck finding a good therapist to help with her depression and anxiety. “The first therapist I tried in college latched onto the fact that my father hadn’t been around,” she says. “He told me, ‘From now on, you can think of me as your father,’ and I never went back.” She tells me that another counselor didn’t get back to her after she contacted them, and that a second therapist she saw “suddenly announced during our third session that he needed to cleanse my chakras.”
Or take the case of Niles, a 29-year-old pharmacist from Australia, who went to see a general practitioner about his mental health problems. “He asked me all the standard questions to test my anxiety and depression, but threw in comments along the way about what a difficult task I had brought him and how it had disrupted his work day,” he says. “I later found out that the referral he had given me was to a physiotherapist — the wrong kind of therapy.”
People who don’t have medical insurance are left to either pay for private care or rely on whatever free community services might be available in their location (if they exist). Ada, a 26-year-old retail worker and trans woman in San Jose, says that after her latest birthday, she was no longer covered by her parents’ insurance plan, which meant she had to pay $800 out-of-pocket for her antidepressants. She found herself homeless and unmedicated, eventually admitting herself into an outpatient program after she had a violent breakdown in which she punched a mirror and injured herself. “It was basically, show up around 10 a.m., talk about feelings, eat a mediocre lunch and then do more talking in a group setting,” she says. “It ended up putting me $18,000 in debt.”
Unfortunately, while medical professions working in mental health are generally competent and compassionate, when health-care systems are strained by a lack of funding and an unsustainable ratio of providers to patients, these cases aren’t the rare outliers they should be. The King’s Fund charity reports that in the wake of budget cuts, the number of mental health nurses in the U.K. has fallen 13 percent since 2009, while one in 10 of all posts in specialist mental-health services are currently vacant. The problem, then, isn’t so much the competence of frontline mental-health workers (although a few are patently unsuited to the profession); it’s the funding crisis that leaves them so thinly stretched.
Since the late 1970s in countries like the U.S., U.K. and Australia, successive governments captured by neoliberal logic have underfunded their health-care systems, slashing budgets and privatizing key health-care resources at the same time mental health problems have burgeoned among their populations. After the Great Recession, austerity measures further widened the funding gap, leading politicians like Theresa May and Donald Trump to pay lip service to the importance of improving mental health as they actually cut funding for services.
In light of the crumbling health-care systems that have followed, it’s reductive to suggest that the primary barrier between men and better mental health is a failure to ask for help that results from a fear of seeming unmanly. While stigma is certainly a barrier to treatment, a lack of access to robust mental-health care caused by deliberate underfunding is the real problem that mental-health organizations, advocates and media outlets should be challenging. Because it’s cruel to encourage men and others to “reach out” if there’s little help at hand when they do.