Mental health stigma is shifting. So why are adults, especially men, less likely to seek treatment?

Though more people are receiving counseling, not everyone is sitting on the proverbial couch equally; the number of men, older people, and people of color seeking mental health services tends to be lower than the general population. The reasons why these groups are missing out crossover greatly among these demographics.

Despite the CDC declaring racism as a contributor to poorer health outcomes, Black Americans and Hispanic or Latino people continue to receive little institutional support. In 2018, nearly 7 in 10 Black Americans and Hispanic adults received no mental health treatment in the previous year compared with half of the overall population, according to the Substance Abuse and Mental Health Services Administration.

For decades patients have expressed feeling more comfortable with therapists of the same race or ethnicity, but not everyone has that luxury. For example, in 2021 only 5% of U.S. psychologists identified as Black and only 0.13% as American Indian or Alaska Native, according to the APA. Mental illness has also been historically stigmatized in Black communities.

"For many in the African American community, our story is one of perseverance and resilience. After all, we survived slavery; surely, we can survive 'sadness' or 'anxiety.' In this mindset, anything less would be considered spiritual or moral weakness," Victor Ray Armstrong, vice president of Behavioral Health Services for Atrium Health, wrote for Policy Research Associates in 2019.

Race plays a role in seeking treatment, but age is a factor as well. Older people are also impacted by stigma and negative beliefs about mental health treatment. A 2021-2022 national survey by the SAMHSA showed that, among older adults, 95% who might benefit from treatment said they did not think they needed it. Baby boomer women were more likely to seek and receive treatment than men, accounting for half and a third of the survey respondents, respectively.

Structural issues like accessing transport to attend appointments, difficulties navigating the health system, isolation, and cost are also deterrents.

Gender can also be a predictor of whether patients choose to seek help. In 2022, 2.3 million male patients received mental health treatment versus 2.8 million women. Feeling pressure to act tough or "man up" is a key reason why men are underdiagnosed, according to the Anxiety and Depression Association of America. Yet more than 1 in 10 men experience depression and anxiety and are also four times more likely to die by suicide every year than women. 2023 state health figures from the KFF also show that men are less likely to be uninsured than women, and that gap has increased in the past decade.

According to a 2012 synthesis of 51 qualitative studies in the International Journal of Men's Health, the top reasons men were not seeking support when under duress were social stigma, unease toward medical professionals and medications, challenges in expressing emotional problems, and a desire to handle their own issues. Unfortunately, not much has changed since then.

Writing for Psychology Today, Rob Whitley, professor of psychiatry at McGill University, said men are more comfortable talking about their physical than mental health. Whitley points out that men are also averse to getting help if it means taking time off work, which may put them at risk of looking unreliable and putting their jobs on the line. Research interviews with men also show that when they disclosed their depression, they were not met with support: instead, they were criticized and called names.

On the other hand, researchers for Lived Experience Australia, a nonprofit that works on mental health policy in that country, found through a 2023 study that men are more likely to address their psychological issues when someone they trust in their community encourages it or when the condition starts to impact them physically.

In the U.S., scientists have begun to focus more on the structural and systemic drivers of mental health illness. "We should place less emphasis on whether Black men are resistant to therapy, and more on understanding the contexts in which they already feel comfortable talking about their feelings and traumas," Howard C. Stevenson, executive director of the Racial Empowerment Collaborative at the University of Pennsylvania, told the APA.

To overcome their mental health afflictions, research shows men benefit from community support. Interacting with other men experiencing similar things through activities in nonclinical spaces like sporting venues also helps men change their perceptions of mental health. This way, they can also see themselves in others and be motivated by role models to care for themselves. In therapy, men can benefit from clinicians who reinforce their strengths, provide opportunities to connect, and encourage them to discard the negative traits of traditional masculinity. Fortunately, there are increasing opportunities to do just that.

During the pandemic, the prevalence of anxiety and depression triggered a 25% increase in prevalence. This contributed to a greater awareness of mental health issues and helped spur changing cultural norms. This also fast-tracked the adoption of telehealth services, which increases accessibility with no need to travel to a therapy appointment, combined with more discretion which may lessen the feelings of shame or stigma. During the first year of the pandemic, telehealth services increased between 16- to 20-fold, and as USA Today reported, now nearly every provider offers online therapy.

Story editing by Carren Jao. Additional editing by Kelly Glass. Copy editing by Sofía Jarrín.