Understanding and responding to remote mental health help-seeking by gay, bisexual and other men who have sex with men (GBMSM) in the U.K. and Republic of Ireland: a mixed-method study conducted in the context of COVID-19

Figures & data

Figure 1. The sequential mixed-methods design employed in the current study.

Figure 2. Analytical steps taken to address RQ1, RQ2 & RQ3.

Table 1. Demographic characteristics for all SMMASH-Pan Participants.

Demographic Variable (N total)	N (%)
Age (n = 1368)
16–25 years	175 (12.8)
26–35 years	345 (25.2)
36–45 years	299 (21.9)
46 + years	549 (40.1)
Sexual Orientation (n = 1368)
Gay	1170 (85.5)
Bisexual	178 (13.0)
Straight/Other	20 (1.5)
Country (n = 1368)
Scotland	650 (47.5)
Wales	103 (7.5)
Northern Ireland	63 (4.6)
RoI	262 (19.2)
England	287 (21.0)
Other	3 (0.2)
Ethnicity (n = 1368)
White	1327 (97.0)
People of colour	41 (3.0)
Education (n = 1368)
None/ secondary	163 (11.9)
Post-secondary	1205 (88.1)
Living situation (n = 1368)
Alone	516 (37.7)
With company	852 (62.3)
Remote MH Resources (n = 1368)
Yes	297 (21.7)
No	1071 (78.3)
MH Diagnosis (n = 1358)
No	838 (61.7)
Yes	520 (38.3)
Recent Depression (n = 1309)
None/mild	839 (64.1)
Moderate/severe	470 (35.9)
Recent Anxiety (n = 1292)
None/mild	983 (76.1)
Moderate/severe	309 (23.9)
Self-perceived Physical Health (n = 1358)
Good/Very Good	1249 (92.0)
Poor/Very Poor	109 (8.0)
Self-perceived MH (n = 1354)
Good/Very Good	991 (73.2)
Poor/Very Poor	363 (26.8)
Recent anxiety/depression or self-perceived poor MH combined (n = 1298)
No	715 (55.1)
Yes	583 (44.9)
Accessed remote MH resources for men who report recent depression/anxiety or self-perceived poor MH (n = 583)
No	400 (68.6)
Yes	183 (31.4)

Table 2. Constant only & final logistic regression model – coefficients of the model predicting MH help-seeking behaviour among GBMSM in the SMMASH-PAN study.

				95% CI for Odds Ratio
Predictors	B	SE	Lower	Odds	Upper
CONSTANT MODEL
Age	0.10	0.06	0.99	1.01	1.02
Post-secondary education (no)	0.19	0.23	0.77	1.21	1.90
MH (good)	0.17	0.20	0.80	1.18	1.74
Ethnicity (white)	0.11	0.41	0.50	1.12	2.47
Physical health (good)	−0.40	0.26	0.58	0.96	1.58
Recent Depression (none/mild)	0.11	0.19	0.76	1.12	1.64
Recent Anxiety (none/mild)	0.74***	0.20	1.41	2.09	3.11
MH diagnosis (no)	0.45**	0.15	1.16	1.56	2.10
Living situation (alone)	−0.18	0.16	0.62	0.84	1.14
Sex orientation (gay/bi)	−0.61	0.66	0.15	0.54	1.97
FINAL MODEL
GAD (none/mild)	0.91***	0.16	1.83	2.48	3.36
MH diagnosis (no)	0.49**	0.15	1.22	1.62	2.17

***p < .01, **p < .05.

Table 3. Key barriers & facilitators to GBMSM’s MH help-seeking from GBMSM-facing Organisations & Online Resources.

MH help-seeking – GBMSM-facing organisations
Barriers	Facilitators
Lack of knowledge around GBMSM-facing organisations Lack of confidence to search for GBMSM-facing organisations Focus on sexual health Counselling perceived as lacking benefit Lack of motivation to seek help	Inclusivity of trans (including non-binary) men Socialisation chances with other gay men Counsellors with empathy Same sex identity counsellors/ freedom to select counsellor with diverse race characteristics or based on men’s individual needs Safe, inclusive, & comfortable environment Services discreetness
MH help-seeking – online resources
Barriers	Facilitators
Lack of person-centred approach Attitudes towards self-resourcefulness Lack of perceived benefit Looking for ‘quick fix’ not ‘long term investment’ in MH	Referral by a trusted person Clear, concise, & discreet content and function Provision of individualised care Positive effect on MH

Table 4. Short, medium & long-term recommendations to improve MH help-seeking among GBMSM in the U.K..

SHORT TERM RECOMMENDATIONS

Mass & Social Media – Advertise existing resources to improve MH (e.g. apps, websites, helplines, counselling) for GBMSM. Mass & Social Media – Raise awareness of simple/useful MH promotion techniques (e.g. exercise, social interaction, reduce alcohol/drugs, mindfulness etc.) for GBMSM. GBMSM & MH services to raise awareness of success of existing resources to help improve MH (for GBMSM). Since those with longstanding MH issues already know how to seek help, GBMSM and MH services should focus on those with new MH problems. Ensure GBMSM-facing organisations advertise MH services they offer within wider promotion of their services. GBMSM & MH services to raise awareness of existing MH resources. Working with national, regional, and local stakeholders to consider the cocreation of a GBMSM population targeted mass and social media intervention to reach diverse GBMSM. Ensure ‘branding’ is inclusive and visibly welcome to all – celebrate diversity of services users and, where possible, staff.

MEDIUM TERM RECOMMENDATIONS

Develop GBMSM-facing/tailored resources to help men with poor MH. Frame MH help seeking as normative for GBMSM and positively endorsed. Consider innovative ways by which these men already seeking help for MH can share their experience to enable others to also do so. Promote MH maintenance as a long-term commitment (i.e. Ruby Wax ‘deposit in saving bank’) not a ‘quick fix’ (i.e. one session of meditation unlikely to make you feel better). Communicate these issues via a webinar and linked short briefing in order to ensure consistency across the sector. Primary focus is to embed good practice within service delivery. Important to think of social and discrete spaces for both physical and digital services. Contemporary research needed to further understand what factors affect the MH of GBMSM (e.g. impact of minority stress, homophobia, disproportionate substance us) and, critically, how they interact with other health inequalities to produce syndemic ill-health among this group. Mass & social media advertise testimonials of use and demonstration of how to access services. Work with GBMSM and lobby boards for MH inclusion. Peers, partners, friends & family can play a role in enhancing GBMSM confidence and self-efficacy in help-seeking for (online) MH resources – ‘help a friend’. Run webinar so GBMSM MH ambassadors describe how they successfully searched for, and used, services for the first time. GBMSM Ambassadors can operate at the organisational (e.g. THT, Waverley Care-SX), community (e.g. BearScots, FrontRunners, gay/straight alliance in educational settings), professional (GPs, STI clinician), celebrity (Lady Gaga) and individual (e.g. Jimmy MacDonald) level. GBMSM MH Ambassadors frame MH as an issue for GBMSM, endorse and promote (i) MH help-seeking, (ii) MH resources and organisations, (iii) high-quality MH apps, using personal testimonials. GBMSM and MH organisations coproduce MH materials with GBMSM community Connect MH with SH and service use more broadly (holistic health). Research, MH and GBMSM organisations and communities work collaboratively to identify those high-quality MH apps (already identified in systematic reviews) most suitable for GBMSM. Research, GBMSM/MH Organisations and GBMSM community work together to design GBMSM-tailored MH resources (e.g. meditation programme) using existing modifiable apps (e.g. InsightTimer). Local GBMSM services / community ambassadors provide support in using the apps (LGBT MH app support group, training intervention). After quality appraisal, GBMSM and MH services advocate relevance and utility of specific GBMSM-appropriate MH resources. MH services should be proactive to reach GBMSM. NHS/GBMSM-facing organisations devise strategies to ensure digitally excluded GBMSM are included when services are delivered remotely. Rebranding of GBMSM-facing organisations to include MH issues. Moving away from GBMSM-facing organisations due to ending HIV. GBMSM-facing services develop and deliver GBMSM staff training package for generic MH and wider services. GBMSM-facing organisations endorse and promote those high-quality MH apps suitable to GBMSM, via outreach work, social & mass media. GBMSM-facing organisations should adapt outreach activities to promote MH and Wellbeing and ensure their MH services are promoted as widely as possible.

LONG TERM RECOMMENDATIONS

Create community-development initiatives, drawing on assets-based co-creation approach to enhance mental health. Advocate importance of MH awareness and maintenance for all. Advocate importance of MH awareness and maintenance for GBMSM population given their unique multiple vulnerabilities (syndemics). Collaborative research with GBMSM communities, MH & GBMSM organisations and app designers to coproduce MH app tailored to GBMSM. RCT to evaluate the efficacy of MH app tailored to GBMSM. Create new identity of MH maintainer (like exercising, 5-a-day etc.) for GBMSM as someone who actively engages in activities to maintain their mental health (e.g. exercise, meditation etc.). Work to ensure generic MH organisations dealing with specific issues (alcohol, drugs, abuse, eating disorders, MH etc.) are gay friendly. High-level work is needed to make sure that commissioners and service-level agreements achieve coherence and clarity around who delivers what and to whom. National level service provision (e.g. Scotland-wide, U.K.-wide) could enable celebration of diversity of service provider staff more realistically.