1.1. In the UK today, one man in five dies before the age of 65 – and with suicide being the biggest cause of male death up until the age of 50, poor mental health – and inadequate support for mental health is a major contributor to that. The key challenges we face are that:
1.1.1. The mental health of boys and men is under diagnosed and under treated. Mental health is gendered - symptoms and diagnoses tend to take account of women’s signs of poor ill health rather than men’s. Too often men’s symptoms are not considered as such but as problems in their own right.
1.1.2. The disproportionate number of men facing challenges such as homelessness, contact with the criminal justice system, self-medicating with alcohol and drugs and higher rate of exclusion in schools further indicates that there is a level of male mental distress that is not adequately addressed using conventional methods of assessment.
1.1.3. Men are less likely to seek help for mental health problems. While this is in part a reflection of traditional mindsets and masculinity, a major contributor is that stigma and self-stigma are real psychological and social forces that influence behaviour – and can be reflected in lower income, status and damage to careers.
1.1.4. Not all men face the same degree of mental health challenge. There are gross inequalities in the experience of mental health associated with different deprivation, employment and unemployment patterns – deprivation, age and ethnicity.
1.1.5. Good practice for supporting boys’ and men’s mental health is materially different from supporting women – but this is not always reflected in how services are delivered.
1.1.6. Experience from other countries such as Ireland and Australia is that clear leadership, as exemplified by adoption of a Men’s Health Policy, can be a critical way to address this.
2.1. The Men’s Health Forum was founded by the Royal College of Nursing in 1995 and has been the leading charity in the field of men’s health since 2001. In the specific field of men’s mental health, the Men’s Health Forum has been instrumental in the publication of the following papers, reports and documents:
2.2. In addition, as preparation for this response, we asked our network for their views and opinions and a further 42 people and organisations responded.
3.1. Women are more likely to experience a common mental health disorder (CMD) than men when measured by survey responses[5] and by treatment rates[6]. When viewed through different lenses, however, there is significant evidence that men’s mental health might be misunderstood, misrepresented (specifically as matters of criminal justice, poor education outcomes and social matters) and undiagnosed.
3.2. One adult in six (17.0%) has a common mental disorder (e.g. depression, anxiety, phobia, obsessive compulsive disorder and panic disorder) using traditional mental health scales. One woman in five has CMD (20.7%) compared with about one man in eight (13.2%). (Adult Psychiatric Morbidity Survey 2014, Executive summary: Adult Psychiatric Morbidity Survey)
3.3. From the same source - the Adult Psychiatric Morbidity Survey 2014 - it is also known that men are almost three times as likely to report being alcohol dependent (4.4% of the population compared to 1.5% of women) and more than twice as likely to report being drug dependent (4.3% of the population compared to 1.9% of women).
3.4. In 2017, men constituted 75% of the total of registered suicides, though the registered suicide rate (15.5/100 000) was the lowest recorded since the time-series began – this still leaves suicide as the biggest cause of death in men under 50[7].
3.5. Under diagnosis and even un-diagnosis of men’s depression levels may be the result of implementing diagnostic tools that are not representative of men’s experience of depression. Professor White and Professor Branney in ‘Big boys don't cry: Depression and men’ (2008)[8] posit that women’s symptoms of depression, typically, but not limited to, worry, crying spells, helplessness, loneliness, suicidal ideas, appear more frequently in the diagnostic criteria than symptoms that might be more associated with men’s depression, typically, but not limited to, slow movements, scarcity of gestures, slow speech and alcohol dependency. The paper highlights that when the Gotland Scale of Male Depression[9] is applied, there was no discernible difference in the depression rates of men and women.
3.6. The Men’s Health Forum has further argued that the following might provide a better picture of the state of men’s mental health than the number of clinical diagnoses:
3.6.1. Over three quarters of people who kill themselves are men (Reference: ONS). 3.6.2. Men report significantly lower life satisfaction than women in the Government’s national well-being survey – with those aged 45 to 59 reporting the lowest levels of life satisfaction (Reference: ONS) 3.6.3. 73% of adults who ‘go missing’ are men (Reference: University of York). 3.6.4. 87% of rough sleepers are men (Reference: Crisis). 3.6.5. Men are nearly three times more likely than women to become alcohol dependent (4.4% of men are alcohol dependent compared to 1.5% of women) (Reference: APMS 2014). 3.6.6. Men are three times as likely to report frequent drug use than women (4.3% and 1.9% respectively) (APMS 2014) and men constitute more than four times the number of drug-related deaths in England and Wales (ONS 2017)). 3.6.7. Men make up 95% of the prison population (Reference: House of Commons Library). 72% of male prisoners suffer from two or more mental disorders (Reference: Social Exclusion Unit). 3.6.8. Men are 10% more likely than women to be detained under the Mental Health Act (Reference: NHS Digital, 2017-18). 3.6.9. Men have measurably lower access to the social support of friends, relatives and community (References: R. Boreham and D. Pevalin). 3.6.10. Men commit 86% of violent crime (and are twice as likely to be victims of violent crime) (Reference: ONS). 3.6.11. Boys are around three times more likely to receive a permanent or fixed period exclusion than girls (Reference: gov.uk). 3.6.12. Boys are performing less well than girls at all levels of education. In 2017 only 62.3% of boys achieved C/4 or above, compared to 71.4% of girls (Reference: Department for Education). 3.6.13. Though only 5% of those suffering with anorexia and bulimia are male, that represents thousands, making it an important health problem for males. This is compounded by a tendency for eating disorders in males to go unrecognised or undiagnosed, due to reluctance among males to seek treatment for these stereotypically female conditions (National Centre for Eating Disorders) 3.6.14. Members of the GBT community are more likely to experience a range of mental health problems such as depression, suicidal thoughts, self-harm and alcohol and substance misuse (Mental Health Foundation)[10]. |
3.7. While it might be possible to argue the extent to which these figures indicate undiagnosed common mental health disorders, it is unarguable that for some men life is very difficult and that there is a tendency for some to rely on ‘coping’ strategies that become problematic.
3.8. Some men may have discernibly lower levels of personal mental health literacy, which could impact recognition of their own signs and symptoms and those of other men their interact with. The impact of this could be that early warning signs and not acted upon, thus increasing the time to seeking appropriate support.
3.9. Research conducted by the Men’s Health Forum commissioned by the National Mental Health Development Unit, published as ‘Untold Problems: a review of the essential issues in the mental health of men and boys’ (2010)[11], detailed that:
3.9.1. Men are more likely to lack some of the known precursors to good mental health
3.9.2. Men appear less likely to recognise or act on warning signs
3.9.3. Men seem less willing to seek professional help
3.9.4. Men are more likely to adopt poor coping strategies when experiencing psychological distress
3.10. These findings indicate potential issues to further understand and tackle at the level of the individual, socialisation and, in conjunction with the above statistics, how the wider system views and understands men and their presentation of poor mental health. According to Angie Giles, a private counsellor, responding to a call put out by the Men’s Health Forum for responses to the broad questions in this inquiry, “Men are still more prone to thinking of mental health as a weakness, despite the best efforts of many organisations to change this”
4.1. Across all of society, mental health problems cost UK economy £34.9bn last year, according to the Centre for Mental Health[12]. From data provided by Advisory, Conciliation and Arbitration Service the total figure can be further divided, with sickness absence costing £8.4 billion each year, plus another £15.1 billion in reduced productivity. A further £2.4 billion is lost replacing staff who leave work because of mental ill-health[13].
4.2. While this analysis did not provide a gender breakdown, other work indicates that the economic impact of men’s mental ill health is significant:
4.2.1. In 2011, the Department of Health estimated[14] that economic impact of a single suicide to be at £2.1 million-£3 million – with 30% of the cost accounted by lost output and 70% accounted for by the distress suffered by the relatives of the person who died from suicide. This would suggest that the 4,382 male suicides in 2017 would have an economic cost of more than £9 billion.
4.2.2. 2016 research by the Equality and Human Rights Commission[15] indicated that men see a much sharper drop in income as a consequence of mental ill health. Men with conditions such as phobias or panic attacks earn 42% less than their non-disabled peers, and men with anxiety or depression earn 26% less. The equivalent reductions in income for women were only 10%.
4.3. This latter issue suggests a very significant incentive for men to avoid making problems widely known and to prefer to seek help in confidence – and our own research suggests that men with mental health issues are likely to feel this pressure more strongly. The Men’s Health Forum commissioned a survey in 2016[16] conducted by Opinion Leader, finding men with mental health issues were more likely to report feeling ‘concerned’ that their employer would think badly of them for taking time off to attend an appointment (52%) than the general male working population (41%). 48% reported felt ‘embarrassed’ for taking time off work for a mental health appointment, which was greater than the general male working population (35%) according to the same survey.
4.4. The figures are likely to segment by race as according to the Mental Health At Work Report 2017[17], only 43% of BAME employees feel comfortable discussing mental health, compared to over half (54%) of white employees.
4.5. The aggregated evidence lends weight to the position that some men feel a pressure to be ‘breadwinners’, are highly represented in full-time employment leading to a predominantly male culture and that those experiencing poor mental health are paid significantly less.
5.1. There are major inequalities between boys and between men – and different boys and different men face quite different levels of risk of mental ill-health.
5.2. As a group, boys are rate of permanent school exclusion (0.15 %) was almost four times greater than that for girls (0.04 %) in the academic year 2016/17 and the fixed period exclusion rate was almost three times higher (6.91 compared with 2.53 %)[18] over the same time period.
5.3. Among boys, certain groups are over represented. Pupils known to be eligible for and claiming free school meals (FSM) had a permanent exclusion rate of 0.28 % and fixed period exclusion rate of 12.54 % - around four times higher than those who are not eligible (0.07 and 3.50 % respectively)[19]. Black Caribbean pupils had a permanent exclusion rate nearly three times higher (0.28 %) than the school population as a whole (0.10 %)[20]. Pupils of Asian ethnic groups had the lowest rates of permanent and fixed period exclusion.
5.4. The impact of exclusion from school can negatively impact the psychological health of both boys and girls, according to Professor Ford[21] however it is possible that the over-representation of boys in school exclusions can contribute to the psycho-social phenomena in men identified above, especially as 75% of mental health issues are established before the age of 24[22].
5.5. In addition to school exclusion being shown to negatively impact the mental health of young people, there is evidence of more severe social and criminal justice outcomes. For those young offenders with knife possession offences at some point in their childhood (aged 10-18), who reached the end of Key Stage 4 in the 2012/13 academic year, a higher proportion had been persistently absent and/or excluded from school[23]. In response to our survey, Clinks stated, “People in contact with the criminal justice system are overwhelmingly men and there is a higher prevalence of poor mental health amongst men in prison than the public. We are also currently seeing historically high levels of self-harm and suicide amongst men serving sentences in prison and the community.”
5.6. While it could be argued that school exclusion does not necessarily lead to poor long-term outcomes, according to Forgotten Children (2018)[24] 94% of Year 11 pupils (i.e. post GCSE level) from a mainstream or special school go on to a sustained education or employment or training destination, compared to 57% from alternative provision.
5.7. Over the course of life, these challenging beginnings can compound. In 2017, Samaritans published a report entitled “Dying from Inequality”[25]. The report aimed to look at the connections between socioeconomic disadvantage and suicide, among other aims. A high level statement perfectly encapsulates the compounding risk factors, “Men in the lowest social class, living in the most deprived areas, are up to ten times more at risk of suicide than those in the highest class, living in the most affluent areas.” Data published by Public Health England in 2017 furthers the evidence base. Males working in the lowest-skilled occupations had a 44% higher risk of suicide than the male national average; the risk among males in skilled trades was 35% higher. Individuals working in roles as managers, directors and senior officials – the highest paid occupation group – had the lowest risk of suicide. Among corporate managers and directors the risk of suicide was more than 70% lower for both sexes[26].
5.8. To put it in more striking terms, the difference in suicide risk between a man in an unskilled occupation compared to a man who is a “manager, director or senior official” is as great as the difference in suicide risk between men and women.
5.9. The difference in risk for men living in the most deprived areas compared to men in the most affluent areas is even greater.
5.10. The impact of unemployment is also particularly significant for men. The Department of Health report “Preventing suicide in England: One year on” published in February 2014 suggested that there were an extra 800 male deaths from suicide as a consequence of the 2008 economic crisis between 2008 and 2010, compared to 155 female deaths.
5.11. According to Dr O’Connor and Dr Kirtley (2017) “Socioeconomic disadvantage exerts strong pressures upon individuals, including their risks of suicidal thoughts and behaviours. Socioeconomic disadvantaged individuals are more likely to have experienced childhood adversity and other stressful life experiences”.
5.12. The past 10 years have seen a growing focus on the possible link between some of the poor outcomes highlighted in this submission and how boys and men are socialised. Professor Robertson writes “There is an existing evidence base that confirms the assertion that ‘being male’ (masculinity) should be a key consideration in understanding mental health outcomes and in shaping approaches to improving the mental health and wellbeing of men” (2014)[27]. This statement when combined with the various data points above, key in the notion of intersectionality across multiple characteristics in analysing the outcomes of men and groups of men.
6.1. The critical priority is to recognise that men’s mental health issues will often be displayed differently, and that services to address those challenges will need to be designed differently. For maximum impact, services also need to be targeted towards those men at greatest risk.
6.2. Design principles have been a research area of particular interest for us – and we have collaborated on two reports consolidating research in this area:
6.3. ‘Delivering Male: Effective Practice in Male Mental Health’ (2010) a collaborative publication with Mind, used a mixed methodological approach to gather data on the experiences of men and professionals working with men around mental health. The findings were distilled into seven areas for further examination that would likely promote the outcomes for men with mental health:
6.3.1. Treating men as individuals: while gender is perhaps the most fundamental determinant of an individual’s sense of self it is not the only determinant. It is, therefore, necessary to see men as individuals primarily and respond to their individual needs.
6.3.2. Inter-agency working in the early years: As David Wilkins, formerly of the Men’s Health Forum, states, “There is significant scope to prioritise the development of happy, well-adjusted children, and a very strong case to be made for taking the gendered needs of boys into particular account”.
6.3.3. Stigma: throughout this response, areas where men may experience specific forms or degrees of stigma have been highlighted. Further research is required to better understand the gendered experience of stigma, in relation to acknowledging a need and seeking support.
6.3.4. Promoting services: It is probable that a more sophisticated and nuanced approach to the promotion and delivery of services could improve male uptake. Men who find help-seeking difficult are not going to change in the short term – but mental health services can.
6.3.5. The role of third parties: men are known to have fewer and less profound social connections, even those who are married. Engaging those close to men experiencing mental distress, could result in improved outcomes for men’s mental health.
6.3.6. Joined-up approach: referring back to statements made elsewhere about the multiple and varied ways in which men shown distress, it is probable that responding to various presentations with a view to a man’s mental health could be of particular value to them.
6.3.7. Professional training and an improved knowledge-base: Supporting professionals to have a deeper understanding of the needs of men and groups of men could improve the delivery of support. Equally, embedding the practice of working with men in particular ways could result in a deeper evidence base of what works.
6.4. In 2014, the Movember Foundation commissioned the Centre for Men’s Health at Leeds Beckett University with the support of the Men’s Health Forum to carry out a review of the academic literature relating to male mental health and a detailed examination of the practical learning from existing initiatives. In addition to the literature review, an extensive investigative network was built and interviews held to gain insights from tacit understanding of working with men. Finally, a symposium was gathered of professionals from various backgrounds to share the findings, discuss wider issues for men’s health and provide consideration as to where further work could be done to support the mental health of boys and men. It is probable that working at both the levels of systems and agents is required in order to change the perception some men may hold regarding mental health. Professor Robertson et al (2014)[28] states:
“Part of using male positive approaches includes involving men in ‘doing’, in action-based approaches, especially doing traditionally male activities. Such approaches act to create a safe space that generates trust and thus facilitates talking and ‘opening-up’ emotionally”. |
The overall body of evidence was then condensed into 10 good and best practice tips for working with men regarding mental health:
6.4.1. Start by understanding what the obstacles are: Barriers to accessing services will likely be different for different groups of people. They may be real, for example opening hours, or they may be perceived, for example a person feeling they won’t be understood. In either instance it is important to understand what the barriers are and how the impact groups and individuals.
6.4.2. Communicate with men in a way that respects the way they see their maleness: Communication is highly important in engaging any group and men are no different. From the evidence above, stigma is a very real thing for some groups of men. It may take a person significant strength to acknowledge they have concerns regarding their mental health, particularly where they have to overcome the barrier of stigma. It is highly important they do not feel a “lesser man” when seeking support and, therefore, communicating in a manner that respects those obstacle is key to making that person feel welcomed. Our recent report – “Mind your language: how men talk about mental health” indicates that the words used may need to be tailored to men as well.
6.4.3. Be positive about men and boys: The statistical evidence depicts some men as marginalised, aggressive and anti-social. Seeing all men in this light could influence the relationship that is built between the individual and the support.
6.4.4. Ensure that the intervention has clear objectives that its users understand: evidence from the ‘How to …’ guide points to men’s preference for solution focussed support. Making sure the support is goal oriented is good practice as a starting point for working with men.
6.4.5. Consider basing social support interventions on shared activity: Activity-based interventions have proved consistently successful at engaging men. Evidence suggests that, by and large, men prefer coming together to ‘do something’, also known as an ‘action-oriented- approach. Further, there is suggestion that men like to ‘give’ support and experience and ‘take’ advice.
6.4.6. Make sure the setting is right: In general, men appear to not engage with clinical spaces, therefore, other settings such as sports venues, schools or the workplace may be a more appropriate space for engaging men.
6.4.7. Incorporate peer support: Peer support shows promise for effectively engaging men. It may be this is because peer groups reduce the sense of isolation and stigma associated with help-seeking.
6.4.8. Publicise positive examples: Giving permission to men to speak about their mental health and reduce the impact of stigma and self-stigma is important to the wider work of men’s mental health. Sharing examples where other men, particularly men in positions of influence, can support the reduction of stigma.
6.4.9. Look beyond the intervention: Successful interventions strive to make positive social change and engage in constructive challenge to mainstream services where necessary. They also often act to challenge stigma and exclusion. These objectives are particularly important in the drive to improve male uptake of services.
6.4.10. Plan evaluation from the outset and make your results known: Improving the knowledge-base of good and best practice requires commitment to robust evaluation that is widely publicised, even where the intervention has proven not to be effective. Doing so will embed good practice and further the collective benefits to men and sub-groups of men.
6.5. Establishing the right support for workplace mental health is also critical – although this needs to go well beyond awareness raising to include:
6.6. Finally, given the strong link between inequality, deprivation and mental health, it is essential that support, including prevention activities, are focused on those in greatest need and tackle the root causes of men’s mental health issues. Inequality has received strong recognition in the NHS England Long Term Plan: it will be essential that the NHS takes an ‘deprivation plus’ approach, ensuring that gender and other inequalities are reflected as the plan is implemented.
7.1. In general, services do not yet reliability assess and act on the reach and impact of services by gender – or design their services to address the distinct needs of each gender.
7.2. There are exceptions, and it has been encouraging to see the recent downward trend in male suicide rates.
7.3. On a wider level, targeted activity to support men has been done on an ad hoc basis and we don’t yet see it deeply rooted in policy – or the level of system ownership to tackle men’s mental health issues.
7.4. This starts with inadequate measuring and reporting: our 2015 report ‘The Gender Data Deficit’ highlighted shortfalls in the local JSNAs used to assess health need in each local authority area. The headline finding from the research was that of the 147 JSNAs researched and analysed only 18% adequately recorded information by gender.
7.5. In addition to up front analysis, it is also critical that the scale of support for men matches the scale of the problem. There is a question as to whether IAPT is reaching enough men. Even though recovery rates and improvement rates are very similar for men and women, in 2017/18, for example, men were only 35% of those referred to IAPT.
8.1. Our principles for addressing men’s health in general – laid out in our ‘Men’s Health Manifesto’ – apply also to the departmental response needed on the mental health of men and boys:
8.2.1. Ensure all data at all levels are fully and relevantly disaggregated – including access to psychological therapies (IAPT) – by gender – cross-referenced also vs. deprivation and other protected characteristics – age, ethnicity, sexuality etc. – and male-relevant measures such as work status
8.2.2. Fill gaps where data are not collected or where men under-report, such as sexual violation and mental health
8.2.3. Inspection bodies (e.g. CQC) to assess outreach & access as well as service delivery by gender – and report by gender
8.2.4. More measurement and reporting against inequalities to tackle ‘hidden Failure’
8.3.1. National Institute for Health Research and other national research funders to invest in research into knowledge ‘gaps’ on causes, good practice and health economics
8.3.2. Men’s mental health & wellbeing – especially for those with a dual diagnosis of substance abuse and mental health problems
8.3.3. Engagement with primary care, mental health, preventative services and screening – including trials of men’s drop-in clinics
8.3.4. Self-management of long-term conditions
8.4.1. Continue to focus on male-tailored interventions to tackle the primary causes of mental health problems – including:
8.4.2. Reduction in excessive drinking and in drug taking – recognising that these may by maladapted coping strategy for mental distress
8.4.3. Tackling social determinants such as unemployment, deprivation, educational underachievement and poor housing
8.5.1. Remove the barriers to using health care, mental health and preventative care – especially for men of working age
8.5.1.1. Fix opening times and access for full-time workers
8.5.1.2. Improve online access, booking and other interaction – ensuring that men can access confidential, anonymous services
8.5.1.3. Avoid using drug or alcohol problems as a barrier to mental health treatment – with greater support for integrated care for dual diagnosis
8.5.1.4. Tackle stigma and discrimination, especially in the workplace and especially for men with stigmatised problems such as mental health, eating disorders and sexual violation – with strong work-place protections for people with poor mental health
8.5.1.5. Greater use of self-help groups and peer-led services
8.5.2. Reach out proactively
8.5.2.1. Take services to where men are: workplaces, online, pubs, sports grounds, betting shops, prisons etc.
8.5.3. Make the most of it when men do engage with health services:
8.5.3.1. Include mental health in health checks
8.5.3.2. Special focus on high-risk infrequent attenders
8.5.3.3. Ensure that new services are co-designed with men
8.6.1. Male targeting – esp. higher risk groups and stages of the life course – with particular focus on areas and transitions where groups have higher risk
8.6.1.1. Unemployed men
8.6.1.2. Men experiencing relationship breakdown
8.6.1.3. Men in the criminal justice system
8.6.1.4. BAME men
8.6.1.5. GBT+ men
8.6.1.6. Male carers
8.6.1.7. Homeless men
8.6.1.8. Isolated older men
8.6.1.9. Young dads and new dads
8.6.1.10. Excluded boys
8.7.1. Support Personal, Social, Health & Economic (PSHE) education to include:
8.7.1.1. Diet, activity, sexual and mental health, first aid and self-care for men and boys
8.7.1.2. Understanding and using the health system
8.7.1.3. Development of empathy and emotional intelligence and healthy sexual behaviour
8.7.1.4. Tackling mental health stigma
8.7.1.5. Male-tailored information and education – for men and boys
8.7.1.6. Support men’s desire for information about their conditions
8.7.1.7. Invest in building symptom awareness – esp. for depression – and social marketing to support lifestyle change
8.8.1. None of the change needed will happen unless it is strongly embedded in the system:
8.8.1.1. National Men’s Health Policy (as in Australia and Ireland) – incl. a national strategy for improving the mental health of men and boys
8.8.1.2. Support change on the ground – training, leadership, incentives, process and policy
8.8.1.3. Assign responsibility for men’s health & set up men’s health champions in local & national organisations
8.8.1.4. Include men’s & boy’s mental health in all health professional, psychology and PSHE teacher training
8.8.1.5. Include mental health in legal, policing and other front-line service training
8.8.1.6. Support professional development re men’s health incl. communication, targeting and service design
8.8.2. On the question of leadership, we would like to thank the Women & Equalities Committee for their leadership on this issue – and welcome it as a critical first step to the change that is needed.
March 2019
[1] https://www.menshealthforum.org.uk/best-practice-delivering-male-mental-health-guidelines
[2] https://www.menshealthforum.org.uk/best-practice-delivering-male-mental-health-guidelines
[3] https://www.menshealthforum.org.uk/best-practice-mental-health-promotion
[4] https://www.menshealthforum.org.uk/mind-your-language-how-men-talk-about-mental-health
[5] Adult Psychiatric Morbidity Survey 2014, Executive summary: Adult Psychiatric Morbidity Survey
[6] https://digital.nhs.uk/data-and-information/data-collections-and-data-sets/data-sets/improving-access-to-psychological-therapies-data-set/improving-access-to-psychological-therapies-data-set-reports
[7] https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/suicidesintheunitedkingdom/2017registrations
[8] https://www.researchgate.net/publication/247801286_Big_boys_don't_cry_Depression_and_men
[9] https://www.sundhed.dk/content/cms/67/83367_gotland-male-depression-scale-april2015.pdf
[10] https://www.mentalhealth.org.uk/statistics/mental-health-statistics-lgbt-people
[11]www.menshealthforum.org.uk/sites/default/files/pdf/untold_problems.pdf
[12] https://www.centreformentalhealth.org.uk/news/mental-health-problems-work-cost-uk-economy-ps349bn-last-year-says-centre-mental-health
[13] http://www.acas.org.uk/index.aspx?articleid=3915
[14] The economic case for improving efficiency and quality in mental health, Department of Health 2011
[15] “UK’s ‘hidden disgrace’: mental health problems can lead to 42% pay gap”, The Observer, Aug 6, 2016
[16] The survey was completed by a representative sample of more than 1200 men in 2016
[17] https://wellbeing.bitc.org.uk/system/files/research/bitcmental_health_at_work_report-2017.pdf
[18] https://www.gov.uk/government/collections/statistics-exclusions
[19] https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/726741/text_exc1617.pdf
[20] https://www.ethnicity-facts-figures.service.gov.uk/education-skills-and-training/absence-and-exclusions/pupil-exclusions/latest
[21] https://www.exeter.ac.uk/news/featurednews/title_595920_en.html
[22] https://www.mentalhealth.org.uk/statistics/mental-health-statistics-children-and-young-people
[23] https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/716039/examining-the-educational-background-of-young-knife-possession-offenders.pdf
[24] https://publications.parliament.uk/pa/cm201719/cmselect/cmeduc/342/342.pdf
[25] https://www.samaritans.org/dying-from-inequality/report
[26] https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/suicidebyoccupation/england2011to2015
[27] https://cdn.movember.com/uploads/files/Our%20Work/evidence-for-a-gender-based-approach-to-mental-health-program-movember-foundation.pdf
[28] https://cdn.movember.com/uploads/files/Our%20Work/evidence-for-a-gender-based-approach-to-mental-health-program-movember-foundation.pdf