The opportunity sits inside the interaction itself. For many men, the usual process of talking about problems, admitting you need help and naming what you're feeling can feel like a test of masculinity. Mental health is where the double bind hits hardest. The behaviours that lead to a diagnosis are the same behaviours he's been taught to resist.
This is part of why distress can turn up in your appointment. He hasn't booked in for a mental health reason. He's there for a health assessment, a care plan review, a wound check, a routine appointment. But somewhere in the conversation, he mentions he hasn't been sleeping. He mentions the headaches. He mentions his stomach has been off for weeks. The presenting reason is the safe version of the conversation. The real one is hiding in plain sight.
There was a young boy that I saw, he was only about 20. A really fit, healthy, young guy. And he started talking about how he struggled a lot mentally.
I knew he was a very stressed and anxious person, and health anxiety was always a big thing for him. And I started asking him, "Why does the idea of being healthy matter so much to you?" And he started talking about binge purging behavior, and started expressing concerns about eating disorders. And so I was actually able to work with him and get him involved into some eating disorder counselors, which otherwise wouldn't have happened.
There are manifestations of mental health that we probably aren't as attuned to. It presents differently in males. It might present very differently, like not wanting to leave their room, being online all the time, not getting out of bed, not grooming themselves, not talking in the household.
The monosyllables, the grumpiness, and even eating disorders. They tend not to present as crying all the time, but rather feeling flat, disinterested, avoiding social interaction. I had a gentleman close to 80 during COVID, and he was British.
He was a British expat. He had this uneasy feeling. And the reason he had an uneasy feeling, he hadn't felt it for many, many years.
And so we dived into it and, "What do you mean? Tell me, when's the last time you felt like this?" "During the Second World War, when I was a little boy and I was in England or in London at the time, and the planes all flew over." And so it's picking up on those little moments and recognizing that that was quite a traumatic experience for him. You need to have open eyes, and you need to be listening.
Active listening is key because we need to pick up on those moments. And sometimes it's just a little bit of breathlessness. "I've got a little breath.
I'm feeling tired." That can be the start of another conversation. But if we're not listening, we miss those opportunities. You don't know what you don't know, right?
So if you're not asking about it, you'll never have it pop up. If you're not doing it every day, you're not going to know it intimately, but you need to know it well enough to be able to pull it out and to be able to escalate that care just like you would any other abnormal sign, right? You never want to walk up to a doctor and say, "Here, your patient's got a blood pressure of 160, sort it out," and walk away.
You want to be able to walk up to them and say, "Hey." Do a proper handover. As the nurse, we're not necessarily the ones that are making the treatment decisions, but we're still the ones that are responsible for escalating appropriate concerns.
