There’s something you should know about Josh*. He never experienced depression, anxiety, or other mental health concerns before 2013. Until then, he firmly believed he was in control of everything in his life.
Josh is a well-rounded person—he’s working on his PhD at McGill, loves to travel, listens to The Velvet Underground, runs yearly marathons, and is a wine connoisseur. Despite the stressful environments and transitional periods of academia, he did not have any serious struggles with mental health. That changed in his second year of PhD.
He started his thesis around this time, becoming isolated from his colleagues and professors. Anxiety emerged with his studies; questions such as, What am I going to do later? and Am I going to have a good job? plagued him. In the same year, he had a sudden death in the family and broke up with his girlfriend.
That was when the panic attacks started.
“When I was doing nothing specific, and was just working at home, I would get a panic attack,” Josh said. “One time, I called the ambulance because I was sure I was gonna die. I was at home and I couldn’t breathe [....] I was sure I’d had a heart attack [....] That’s really when I started to look for help.”
There’s a mental health epidemic across Canadian university campuses. In 2011, the Centre for Student Development and Counselling in Toronto’s Ryerson University saw a 200 per cent growth in demand from students in crisis situations. At McGill’s Mental Health Service (MMHS), there was a 30 per cent increase in demand in the last five years.
Robert Whitley, assistant professor in the Department of Psychiatry at McGill, wrote in an op-ed for the Montreal Gazette, that the life transitions, economic stressors, and psychological stressors associated with university may have a large influence on students’ mental health; however, efforts to improve student mental health should expand throughout campus.
“A better solution would involve a change in campus culture, with universities making strident efforts to enhance well-being at every opportunity,” Whitley wrote at the time. “This could involve dedicated courses on personal and social development, with a focus on enduring life-skills and self-improvement, [...] implementation and expansion of ‘buddy’ programs that match students together. There could also be a greater role for chaplaincy, peer support programs, and closer student-faculty relations.”
Mental health requires more attention on Canadian campuses, as stressors of post-secondary educational environments may breed mental illnesses. Over the past five years, national and international organizations—such as the Canadian Mental Health Association (CMHA) and Healthy Minds—have emphasized that academic institutions have a responsibility to enhance students’ psychological health.
McGill has expanded initiatives in response to the growing demand of its mental health services. To accommodate the reported demand, MMHS increased low-intensity interventions, using peer and group support to address students’ needs as soon as possible instead of having them be placed on wait-lists that result in treatment delays.
MMHS partnered with campus groups such as the Peer Support Centre and McGill Students’ Nightline to expand this support network. MMHS also undertook the Wellness Action Recovery Plan (W.R.A.P), a mental health recovery program providing support and psychoeducation at McGill. Having received $500,000 from Bell Let’s Talk, a national program designed to promote conversation on mental health in Canada, MMHS created an online mental health hub to use technology to expand it’s services.
But there is a large gender gap among those seeking mental health assistance, both at McGill, and across Canadian and American post-secondary institutions.
Despite the higher demand for campus counseling services, a report from the Association of University and College Counseling Center Directors estimates that only 34 per cent of clients at centres are male, although men represented around 44 per cent of the student population.
In 2013, MMHS saw a 60:40 ratio of females to males seeking its service. McGill’s enrollment figures were 56 per cent female and 44 per cent male students, indicating that while the gender gap is relatively small, it exists.
A study from the U.S. National Library of Medicine found less stigma associated with mental health services for females versus males—a possible reason for this gender gap. Researchers suggest that stigma largely stems from traditional gender roles and social norms, which stress male characteristics of strength, and therefore, place less emphasis on emotional expression.
“Standards of masculinity are messed up, whether it’s in the food that men are supposed to eat, the way they are supposed to dress or act, or their expected physical appearance,” Evan Berry, U3 Geography, said. “Yet this is what the media tells us, what our peers perpetuate, and how we are raised from an early age. Our social code for men means they cannot be emotional or [ask for] help if necessary because it’s not a manly’ thing to do.”
According to Josiah Ahn, U2 Management, the assumption that gender influences a person’s ability to cope with difficult times is presumptuous, as nothing is black and white when it comes to the way our minds work. However, he recognizes that there is societal pressure stigmatizing men’s mental health.
“Have you ever seen a picture of He-Man?” Ahn asked. “He’s built like [Arnold Schwarzenegger] and somehow always comes out on top, and his name represents the epitome of what being masculine should mean. As children, boys are taught that winning a competition or a fight of some sort distinguishes being a man from being a boy. However, the truth is that there is no single human on this Earth that isn’t flawed, and at one point or another, we all need some help.”
Men might also be less likely to realize that their mental health is at risk, or feel as if they should cope with it alone, which delays recovery.
“It’s so funny, well—it’s not funny, but [when I described my problems to my family], they said, ‘You know, I never thought you would have these kinds of problems. You seem to be doing so well—you seem to be succeeding,’” Josh mused. “[Before 2013], I truly believed that I was in control of everything in my life. I was never depressed, or whatever, so [after], I felt like I was not invincible anymore [...] I could not control it.”
For Ahn, talking about mental health means admitting that we are flawed and that we need help to win the battle, which is something that lots of boys and girls are never taught to do.
“Therefore we try to carry these burdens on ourselves, thinking that our ability to cope with these things are somehow related to our value as a person,” he said.
Anxiety and depression were the two most significant mental disorders observed in students, both in the national and McGill results for the NCHA 2013 study. Since women, on average, are more likely to experience anxiety and depression than men, these issues are often overlooked for males. But in Canada, one in six men will experience at least one anxiety disorder in the course of their life, and one in ten will experience major depression.
Zach*, U3 Arts, struggled with depression in his second year at McGill. He identified stressors coming from areas such as relationships and school.
“I didn’t tell anyone about this—I would just kind of go about my life and see my friends, and my roommates would think it was normal and that was it,” Zach said. “[Dealing with this issue] was more in terms of blaming myself, like, ‘You just need to get out of this funk; you need to be able to just pick it up—you’re in university.’”
It got to a point where Zach realized that he needed to talk to someone and take the initiative to seek help.
“I was in bed all day and still just felt like I couldn’t find anything that I wanted to do or be happy about,” he said. “I know a few people at McGill that have been like that, and are like that, and some have gone to seek help and some haven’t; and some have gotten out of it, and some are still experiencing it.”
According to the CMHA, around six million American men suffer from depression—half the estimated figure for women. This gender gap is in question around the world: Men might not show symptoms of mental illness in ways that are easily identifiable for mental health service providers.
“Our understanding has expanded, and now we see that certain groups of men have been conditioned in different ways than other groups, meaning they exhibit signs of depression in different ways,” Berry, also a member of McGill Students’ Nightline, said. “Not everyone might have a loss of interest in once pleasurable activities or low energy, for example. Instead, people might be hyper productive or have outbursts of anger. Other signs can point to someone being depressed, but they’re exhibited in different individuals in different circumstances, especially because of gender.”
Another concern is that men are not aware of varying symptoms of depression. In focus groups assessing depression awareness conducted by the National Institute of Mental Health (NIMH), “men described their own symptoms of depression without realizing they were depressed.” They did not know that physical symptoms such as chronic pain, headaches, or digestive problems, could be linked to depression.
“We’ve known for decades that women are more apt to recognize illness of any sort and go to their doctor,” Dr. Michael Myers, a psychiatrist and clinical professor in the Department of Psychiatry at the University of British Columbia, said. “This doesn’t mean women are healthier, but that some men just repress it. We believe a lot of somatization [symptoms] in men, for example, migraines, back pain, irritable bowel syndrome, is rooted in depression.”
Josh loves bars and he loves to drink. This is a characterization he shares with many other McGill students. But somewhere along the way, the line between ‘normal’ and substance abuse became blurred. Josh calls his inclination towards substance abuse as ‘self-destructive behaviours.’
“I would go to bars and drink a lot—I was never violent or anything, but still, there’s no other way of describing these behaviours,” he said. “You drink, drink, and party for two to three days in a row [....] Alcohol consumption was a big part of [my depression].”
Studies show that men experiencing transitional stressors associated with post-secondary education are vulnerable to substance misuse in order to alleviate anxiety, depression, or stress. This may increase likelihood of further development of mental health problems, substance abuse disorders, or even suicide.
“I’ve seen a lot of things like that in fraternities, whether it be problems with drinking, or it be problems with girls [...] or with school,” said Zach, also a member of Phi Kappa Pi. “[Guys] just treat themselves in an unhealthy way […] Smoking weed […] those are the kind of things that kids turn to. Drinking is the same thing [....] That’s a classic university problem.”
In March 2010, a first-year Queen’s University student, Jack Windeler, committed suicide. Maclean’s reported that he was struggling with depression and isolation from friends. In the months following Windeler’s death, three male students at the university also committed suicide.
“One of the predictors of suicides is life transitions, especially when they don’t go very well,” said Whitley. “Entering university is a big life transition.”
According to Whitley, a university environment and the concept of masculinity might impact how students adjust to these life changes.
“That ties into how universities would value a lot of competition, pressure, conformity, and conditioning,” he said. “Concepts of masculinity especially emphasize competition […] whereas concepts of femininity might be more about cooperation […] some men may internalize that sense of competition […] of having to prove themselves to a higher extent than women [...] and if they sense they are failing, things can happen.”
A strong indicator of male vulnerability to mental health is in suicide statistics. While females attempt suicide at higher rates, males die by suicide more because they are more likely to use lethal means.
Following the deaths of students in 2010, Queen’s University released a report in 2012 titled, “Towards a Mental Health Strategy for Queen’s: A Discussion Paper,” which found that between the ages of 15 to 19, 12 out of 100,000 males commit suicide, and 5 out of 100,000 females commit suicide. The suicide rate increases for Canadian males between the ages of 20 to 24, rising to 19 out of 100,000, but stays stagnant for women.
Windeler’s family created The Jack Project in 2012, partnering with Kids Help Phone, to open up about Jack’s mental health issues and encourage students to seek mental health support before it’s too late. The Jack Project became Jack.org in 2014— a Canadian network of young leaders transforming societial perceptions on mental health.
“With suicide being the leading cause of death after motor vehicle accidents for youth, it’s clear that this age group is particularly vulnerable to mental health issues, and [...] concerning that this number is so much higher for males,” said Laura Herbert, U3 Psychology and lead of the McGill Students’ Chapter of Jack.org.
McGill Students’ Chapter of Jack.org runs activities to reach individuals who are not as interested in conversing about mental health and to make the topic feel relevant to all, including briding the gender gap of mental health access.
“What we’re trying to do is make sure that everyone feels able to speak up, reach out, and care for themselves and for each other,” Herbert said. “This includes trying to educate people about the signs and symptoms of mental health problems and when to seek help, as well as reducing the stigma against seeking help, both of which may be particularly relevant for males.”
The high rates of suicide and untreated depression among men is concerning. For Berry, masculinity can be damaging when it prevents men from receiving the emotional support they need.
“In our society, men fear being too ‘girly’ [...] meaning straight guys need to call ‘no homo’ if they’re too physically intimate with a guy, Yankee Candle needs to make man scents for men because candles are too feminine, and a guy who is too scrawny can get a ‘Do you even lift, bro?’ from their man friends,” said Berry. “Masculinity is fragile because it is merely a social code that men use to maintain their status.”
Whether it’s a result of stigma or perceived barriers, university mental health services and support networks should expand to include prevention and intervention methods that target male university students. One factor to consider might be the female-oriented configuration of mental health services.
“One of the arguments in the literature is that psychological services are feminized in some ways,” said Whitley. “A substantial majority of psychologists are women. Men might rather talk to another man [...] These [arguments have] varying levels of evidence.”
This argument is supported by the Ohio State University’s Office of Student Life Counseling and Consultation Service. According to the Wall Street Journal, many schools in the US are recruiting more male therapists. A survey by the Association for University and College Counseling Center Directors (AUCCCD) showed that only 28.3 per cent of college counseling center professional staff were men. At MMHS, women staff double that of men, with a ratio of 16 to eight.
But hiring male professionals in campus mental health services may not be enough in bridging the gender gap.
At McGill, the standard protocol for assessing a student who tries to access MMHS is scheduling an appointment to meet one-on-one with a clinician for 60 minutes to talk. From there, clinicians at MMHS will work with students to decide what is best in terms of treatment, peer support, and outside resources.
But according to Whitley, for men, the idea of talking to a stranger about their problems for 60 minutes once a week might not be an appealing way to respond to their psychological distress.
“Traditionally, if you look at human history of cultures, the way men go through psychological problems or through transitions [is] they often respond by playing sports, conducting traditional rituals, [or] starting a new project in life […] these are more practical-oriented solutions to problems,” he said.
Ohio State changed its group therapy recently to cater to more male students. Where it used to begin with ‘intense’ conversations, the group now starts with around 15 minutes of casual talk before moving towards a group therapy session, finished by a group game like cards. Male clients to the center increased 16 per cent in the 2013-2014 academic year.
Mental health services must reach out to male students in places that they are comfortable in, such as clubs, sports teams, and fraternities. For example, juggling commitment to a sports team and academics can add stress for students.
“The more consumed you are about sports, the less time you have to yourself,” said Matthew Tse, U2 Sociology and member of the varsity men’s lacrosse team at McGill. “Personally, I find my time on the field as a leisure—it actually destresses me. But there definitely are people who are very stressed out because of their lack of time, because of how consumed they are.”
To target athletes on campus, Colgate University in upstate New York expanded initiatives within its counseling center, by offering problem-oriented workshops centered on stress, sleep, and nutrition.
According to Tse, every McGill sports team goes through a general health session before each season—mental health is included.
“It’s definitely something that’s brought up and people know how to talk to you and listen,” Tse said. “[The session] mentions that you have your trainer, or you have your big brothers on the team. I know some teams—not all teams—do have sports psychologists designated [...to speak with] as well.”
Despite these sessions and support systems in McGill athletics, Tse agrees that stigmatization of men’s mental health still exists.
“Men are more socialized [towards] this notion of ‘macho man,’” he said. “You can definitely see that distinction in sports. I wouldn’t say it’s restricted to sports, but it’s there [....] The way [mental health is] handled with, especially with guys, is a lot more discreet.”
The value of discretion in mental health issues also extends to fraternities at McGill.
“I know that culturally-wise, we could go tell each other anything, but [mental health] doesn’t really come up, you know what I mean?” said Zach. “That’s not the type of thing that you would go talk about. If you brought it up, people would take you seriously […] but it’s just not something that comes into the mindset of university students.”
But at what cost? Mental health should be discussed as often as physical health. Flu-and-cold seasons arise often on campus—after a quick drop in temperature, during midterms or finals, or in the aftermath of binge-drinking campus events. The symptoms are evident: Wheezing coughs echo in auditoriums and sniffles are perpetual. Students freely talk about how awful they feel from their sickness—it is normal, and okay, to have caught the flu.
But in the same seasons of high academic stress, such as finals or midterms, there’s silence around symptoms of anxiety or depression. One way to normalize men’s mental health issues might be to speak freely about them, in everyday conversation and in casual environments, like sports teams or fraternities.
In 2014, the counseling centre at the University of Missouri in Columbia extended its reach to the school’s fraternities. By working with the university’s Office of Greek Life, the centre held a course on masculinity, covering topics such as respect for women, how to talk about emotions, and substance abuse.
According to Zach, while he has seen substance abuse or individuals struggling with stress in fraternities, it is more a by-product of the university environment in general rather than being in a fraternity.
“Fraternities are a huge source of support,” he said. “As a younger person, I had all these older guys who had [...] seen the ups and downs, and that does help a lot too [...] [for] the pledging process, everyone has gone through the exact same thing […] in a way, that brings you together and brings you that support network that you might not have in other places in your life, which I think is a good thing.”
Further cross-collaboration between MMHS and fraternities will only help the destigmatization of men’s mental health.
For students who want to anonymously speak about their mental health, or anything else, McGill Nightline is another source of support. It provides confidentiality, along with non-judgemental active listening, information, crisis management, and referral service.
“Because seeking support in regards to mental health is highly stigmatized and unfortunately gendered, an advantage of our service is that people can access support in discreet ways,” Berry said. “The fact that our service is confidential, and that the content of the call stays between the caller and the volunteer, means that callers can explore or debrief anything that they’re feeling and not have it shared with anyone else.”
Students, regardless of gender, don’t have to be in the middle of a crisis or suffering from serious mental health issues in order to seek support. For Alex Levesque, U3 Science, the issue at hand is reshaping how students see mental health services, and normalizing access.
“Sometimes just going into counseling to talk to someone every three weeks, using peer support, or calling Nightline can really improve your long-term mental health,” he said. “These services are great for dire circumstances but can also be preventative measures. The first time I went to therapy, back in high school, I waited till things got out of hand and I was basically forced to go by my parents because I wasn’t handling things well.”
Yet whether we like to admit it or not, gender roles largely affect mental health issues, and universities should factor this into their mental health support systems.
“I regret that I didn’t seek out help sooner, and that’s why I continue to use McGill Counseling even though my mental health is much better now,” he continued. “We need to normalize it, and get to the point where everyone, regardless of gender identity, feels comfortable seeking the help they need, whenever they need it.”
Campus-wide involvement in mental health still has a long way to go. McGill’s Student Health Service and Student Assessment office participated in the National College Health Assessment (NCHA 2013) taking a random sample of 4000 undergraduate and graduate McGill students. These students were invited to participate in a survey online, which explored risk and protective behaviours of students, perceived norms, and the prevalence of health conditions that might affect academic performance and retention.
The response rate was 10 per cent, meaning 354 out of 4000 students participated.
Both the national and McGill average response rate to NCHA 2013 had a higher female outcome, the former consisting of 67.6 per cent female to 30.9 per cent male respondents, and the latter, 57.5 per cent female to 42.5 per cent male.
But according to Emily Yung, McGill’s Mental Health Education Coordinator, this gender gap might be because women are just more likely to respond to surveys on mental health. MMHS is conducting a research study examining the difference between stigma and perceived need of seeking mental health treatment, and, oversampling males in the process.
“[MMHS] has more data for women, because [women] want to answer surveys more,” she said. “[For this new research study], we are going to specifically try to get an equal number of females and males to answer [by] actually sending more emails to males.”
This might provide more insight as to how men on campus view mental health, to better understand how differences in how mental health issues manifest for different genders.
“This is tied into a lot of factors, including cultural stereotypes surrounding the idea of vulnerability or ‘weakness’ in males that feeds into a lack of interest or knowledge about mental health issues, as well as stigma against help-seeking,” said Herbert. “It’s clear that there are gender-specific factors that exist in the ways people experience mental health issues, and that we need to better understand how to encourage help-seeking and service use in males.”
Last year, a group of Queen’s researchers, Heather Stuart, Shu-Ping Chen, and Terry Krupa, led the Caring Campus project. Funded by Movember Canada, this initiative targets male university students, by using a multi-level strategy and student-led projects to lower substance misuse of drugs and alcohol. The University of Calgary also has a student-led program, ManUp for Mental Health, which focuses on men’s mental health and safe substance use on campus.
“In terms of different gender identities or sexual orientation, [MMHS] hasn’t done anything explicit to target the very needs,” said Yung. “We trust that all the programs we run […] [will] meet the student where they’re at [.…] In terms of our staff, we’ve invited the [Social Equity and Diversity Education] (SEDE) to come train our staff on better equipping them with language, and how to support someone with the diversity of sexual orientation so that they know how to approach the situation a bit more.”
But does McGill’s neutral approach to gendered considerations for mental health hinder the reach and services it provides?
“I think group-targeted things like that might be something that’s beneficial,” said Zach. “That’s kind of what campus life is. Ideally, campus would be this big social network where people get together, but you end up getting knocked into your groups of people, your demographics, depending on what you join, or who you associate with […] It’s useful to target groups of people and at-risk people.”
Josh had no problem with McGill’s approach, but agrees that gender is a factor worth considering when it comes to mental health services.
“[Males] have differences [with females],” Josh said. “It’s normal. I wouldn’t say we need completely different [gendered] services, but an angle [at MMHS] could be interesting. Something you can start with.”
Josh had a good year in 2015. He runs a lot, tries to see more people, is more open with his feelings, and is vigilant in time-management when it comes to academics. He’s also been drinking less—he’s on a 40-day alcohol cleanse.
Similar to his physical health, his mental wellbeing travels on a continuum—like anyone, it’s affected by his daily environment.
“The transitional [difficulties to my PhD] was a huge one,” Josh admitted. “I’m still in the middle of it actually.”
*Josh’s real name was changed on the request for anonymity. *Zach’s real name was changed on the request for anonymity.