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MENTAL HEALTH AND CARIBBEAN MEN by Dr Kadisha Douglin Isn’t everyone at risk for mental illness? Aren’t women more likely to be diagnosed with common mental illnesses like depression and anxiety? Why single out men’s mental health? While it is true that women are statistically more likely to be diagnosed with depression than men, and more likely to attempt suicide, men are more



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Dr Kadisha Douglin

Isn’t everyone at risk for mental illness? Aren’t women more likely to be diagnosed with common mental illnesses like depression and anxiety? Why single out men’s mental health? While it is true that women are statistically more likely to be diagnosed with depression than men, and more likely to attempt suicide, men are more likely to be hospitalised for a psychiatric reason, and men are 3.5 times more likely to die by suicide.

Global statistics consistently show a higher suicide mortality rate for men in every country except China. Globally, suicide is the second leading cause of death among 15–29-year-olds reveals World Health Organisation (WHO) – we are losing YOUNG men!

In the Caribbean, Guyana has consistently been in the top three countries in the world with regard to suicide mortality (WHO), with suicide rates of 44.9/100,000 and 14.2/100,000 for males and females respectively, according to Pan American Health Organization (PAHO) statistics of 2016. Although Barbados has generally had a low mortality from suicide (0.8/100,000 males, 0.3/100,000) (PAHO 2016), there has been an apparent increase in media reports of deaths of young men either suspected or confirmed to be by suicide, since the beginning of the pandemic.

Why are Caribbean men killing themselves?

Stigma surrounding mental illness and mental help seeking is rife throughout the Caribbean and is compounded by harmful gender stereotypes. Globally, men are less likely to maintain regular checkups and screening with their primary health care provider. They are also less likely to report psychological distress to their primary health care physician. Unfortunately, when they do report symptoms of depression or anxiety, they are also less likely than women to be diagnosed despite presenting with identical symptoms (WHO).

In most paternalistic societies, men are expected to be breadwinners, independent, strong and stoic. Emotions such as sadness, grief, fear, and anxiety are judged as effeminate, weak and crazy. The stereotype of the rigid, independent male, who deals with distress through avoidance or violence, is upheld in our music, media, and social interactions.

The reality is that the “traditional” man will not reach out to a friend when heartbroken; he will not tell his doctor he had a panic attack; he will not admit to feeling overwhelmed. There will be no “opportunity for vulnerability”. Their friend groups, similarly indoctrinated, will provide distraction, but no deep support. And so, our men suffer in silence.

In the Caribbean, unhealthy methods of coping are glorified: use of alcohol to manage “tabanca” or a “horn”; use of cannabis to “cool ya head”; interpersonal violence to avoid the appearance of being “soft” and to displace anger.

Homophobia, prevalent in our society, contributes to superficial, distant friendships.

What are mental health warning signs for men?

• Changes in sleep pattern and appetite

• Changes in energy levels

• Sadness, hopelessness, feeling “numb”

• Loss of interest in activities

• Restlessness, “feeling on edge”

• Increased irritability, anger, aggressiveness

• Increased/excessive alcohol consumption

• Inappropriate use of drugs (including prescription medications)

• Aches, pains and physical symptoms without any clear cause

• Difficulty focusing

• Difficulty functioning at work

• Engaging in risky activities

• Intrusive, repetitive, unwanted thoughts/images

• Compulsive thoughts/behaviours

• Thoughts about death and suicide

• Plans about suicide

Are some men at greater risk for mental health problems?

There are some factors and situations that may increase the risk for suicide and mental illness in men. These include, but are certainly not limited to the following:

• Men who have experienced trauma

• Older white men – studies consistently show this demographic die by suicide every year more than any other group

• Unemployed and retired men

• Legal and financial problems

• Marital breakdown – being a single male is associated with increased suicide risk; depression is more common among divorced men

• Substance use – use of alcohol and other drugs increase the risk of mental illness

• Other major life challenges – e.g. loss, significant physical illness

How do we dismantle harmful gender stereotypes and promote mental health awareness and well-being for men?

A multisectoral approach involving government, private partners, community leaders and the media is necessary to achieve a paradigm shift in men’s mental health. While making detailed multisectoral recommendations is beyond the scope of this article, I think it is important to consider strategies that target the youth and prevent suicide.

There must be policy change that allows targeted education in schools, and community engagement of young boys.

The existing mental health services and programmes within the community and primary health care clinics must be bolstered. There must be a national suicide prevention strategy.

While we advocate for systemic change, there are some measures men can implement for themselves and their friends: Prioritise self-care – self-care is not something “girls” do. Self-care is not selfish. Self-care is self-compassion. It is prioritising all the factors necessary for maintaining wellness –




•stress management and relaxation

•regular health screening

•creative/pleasurable and mastery pursuits

•social and spiritual connectedness.

• Journal – for many, sharing intimate thoughts and worries is challenging.

Journaling is an excellent way to gain some catharsis, and to gain the distance that allows for objectivity.

• Reach out if you are struggling!

Call/text someone you trust. That conversation may provide some relief, or the reprieve needed for you to examine your options. Maybe that person can connect you with additional help.

• Reach out to someone you suspect is struggling! Ask directly about feelings of hopelessness, thoughts of selfharm and suicide. (No, you will not encourage suicide by asking/talking about it!)

• Talk to your family doctor – primary care physicians are your first port of call when there is a problem and can refer you for specialised intervention.

• Seek psychotherapy – there are many private, public and Internet-based options.

• Create safe spaces for you and your friends to talk openly and deeply.

• Use your influence – take a moment each week to post about men’s mental health on your social media pages.

Mental health problems are treatable, and suicide is preventable. Let us keep talking about men’s mental health. Let us work together to save our men and boys.

Dr Kadisha Douglin is a general adult psychiatrist and member of the Barbados Association of Psychiatrists.