‘You don’t really want to hide it…’: exploring young working-class men’s mental health literacy

Abstract

Australia’s National Men’s Health Strategy 2020–2030 considers men from socio-economically disadvantaged backgrounds to be a priority population and foregrounds the importance of initiatives focused on empowerment. This article seeks to explore young working-class men’s experiences with mental health in their years immediately following compulsory schooling. Drawing data from a larger study, we explore five young men who openly discussed their mental health. The analysis focuses on where they struggled, how they struggled and what self-care they enacted. Adopting a health literacy framework, we highlight two broad themes: closing yourself off and opening up. While historically working-class manhood has been centred around stoicism and a reluctance to admitting vulnerability, these case studies suggest that the identity work around masculinities and mental health may be experiencing change.

POINT OF INTEREST

1. Historically working-class manhood has been centred around stoicism and a reluctance to admitting vulnerability though this may be changing.

2. This article examines young workingclass men’s experiences with mental health in their years immediately following compulsory schooling.

3. To nuance mental health literacy, we adopt a health literacy framework to highlight two broad themes: closing yourself off and opening up.

4. In exploring mental health literacy, we address where working-class boys struggled, how they struggled and what self-care they enacted.

5. The article makes tenuous links between working-class masculinities, mental health and the effects of social change which has implications for treatment.

Keywords:

• Working-class masculinity
• mental health
• mental health literacy
• social change

Introduction

Contemporary research on men and masculinities indicates that health care systems have struggled with providing ‘engaging, appropriate, and effective care for many men presenting with mental health concerns’ (Seidler et al. 2018, 93). There are significant issues in terms of detection, communication and diagnosis which continue to be persistent barriers in working with and treating men who may be struggling in their mental health. The study of the relationship between poverty, masculinities and mental health/wellbeing remains a burgeoning field (Herron et al. 2020; Mahalik and Dagirmanjian 2019). Today, many boys and young men who are socio-economically marginalised no longer experience a linear transition from school into employment, but instead cycle in and out of short-term, precarious work (Kenway, Kraack, and Hickey-Moody 2006; McDowell 2020). Employment outside the home, as a critical dimension of masculinity (Arnot 1984), remains scarce in the post-industrial economies where this population reside. The scarcity of such forms of labour, amongst other factors, contributes to a reduced capacity to participate in society which may contribute to poor mental health and self-destructive behaviours. Therefore, boys and young men from disadvantaged backgrounds today often face more challenges than their more privileged counterparts which can be detrimental to their wellbeing. As a result, Australia’s National Men’s Health Strategy 2020–2030 considers men from socio-economically disadvantaged backgrounds to be a priority population (Australian Government Department of Health 2019).

While there exist debates over how masculinities are responding to social change (Christofidou 2021), evidence from the study of masculinity in Australia suggests that social pressures around what it means to be a ‘real man’ continue to endure (The Men’s Project & Flood, 2018). These oppressive norms are experienced throughout the life course. Traditionally masculine-coded values of strength, resiliency and toughness – which may be more apparent in working-class communities – can serve as a barrier to how men come to understand their own self-identity, their sense of belonging as well as their social and emotional wellbeing (Mahalik and Dagirmanjian 2019; Mac An Ghaill and Haywood 2012; Smith et al. 2020). Furthermore, research has continued to suggest that boys and young men experiencing socio-economic marginalization and generational poverty are prone to prolonged exposure to loneliness (Seaton 2007), with few opportunities to nurture their emotional literacies without fear of pathologization from others (Keppel 2016). In fact, recent large-scale research in Australia on men’s mental health notes they are ‘prone to protracted and serious episodes of loneliness’ and have ‘unmet belongingness needs’ (Franklin et al. 2019, p. 124, 137).

The article draws on interviews with young men (n = 5) growing up in a disadvantaged suburb who self-identified as struggling with their mental health. While it was not always clear if they saw these struggles as a ‘disability,’ they did clearly articulate the relationship between their mental health and masculine identity norms. This link makes a disability studies perspective useful in framing their experiences of what Timander, Grinyer, and Möller (2015) call ‘mental distress’ because it helps redirect analysis from individual deficits ‘towards a study of discrimination and oppression instead’ (p. 327). We accept that some disability scholars foreground a consideration of mental health problems as ‘social, cultural, historical and political in character’ and, therefore, subject to changing social interpretations (Vandekinderen and Roets 2016, 35). Similarly, Pilgrim and Tomasini (2012) note that ‘ontological and epistemological dispute are a feature of the discourses associated with “mental health”, “mental illness” and “mental disorder” – constant contestation characterises the field’ (632). Aligning with Ringland et al. (2019), we suggest the mental health challenges reported by our subjects – such as anxiety and depression – can be productively ‘categorized as psychosocial disabilities, recognizing the actual or perceived impairment these concerns produce in daily life’ (p. 156; see Aubrecht 2014).

Framing their experiences of mental health as constituting – at least in part – a form of psychosocial disability helps us to emphasise the social, cultural, and psychological structures impacting the lives of these young men, including ‘the functional impact and barriers which may be faced by someone living with a mental health condition’ which NSW Health define as the key element of a psychosocial disability. We recognize psycho-social mental disorders refer to a broad spectrum of diagnoses (e.g. post-traumatic stress disorder, agoraphobia, social phobia, mood disorders, dysthymic depression, etc). Many of these conditions do not interfere substantially with an individual’s social role functioning and, depending on circumstance, many would not be considered disabling.

Mental health can carry a significant social stigma for men, especially for men from disadvantaged backgrounds (Vogel et al. 2011) raised in environments where respectable forms of masculinity are often associated with toughness. In foregrounding the participants’ accounts, we seek to capture where they struggled, how they struggled and what self-care they enacted. We structure our analysis according to scholarship on health literacy defined as ‘knowledge and beliefs about mental disorders which aid their recognition, management or prevention’ (Jorm et al. 1997, 182). An individual’s health literacy has been found to be an important predictor of the use of health services (Milner, Shields, and King 2019). While there are differences in how mental health literacy is theorized, for the purposes of this paper we focus on individual and environmental aspects. Individual health literacy is defined as the cognitive and social skills that determine the motivation and ability of individuals to gain access to, understand, and use information in ways which promote and maintain good health (Nutbeam 1998). The health literacy environment is the infrastructure, policies, processes, materials, people and relationships that make up the health system and have an impact on the way that people access, understand, appraise and apply health-related information and services. We recognize that health literacy and masculinity are complex constructs where both are likely to vary considerably.

In adopting a health literacy framework, the paper analyses data which highlights the diversity of experiences of five marginalized young men and how they access support and what forms of support are effective. We see the research as indicative that some working-class young men are becoming more comfortable with the stigmas around mental health suggesting ‘practices, manifestations, and understandings of masculinity may be changing’ (Christofidou 2021, 81) albeit within certain limits. Debates concerning masculinities and social change have focused on inclusive masculinity (Anderson 2009) and hybrid masculinities (Arxer, 2011) and drawn attention to a softening of masculinity in terms of increasing physical and emotional closeness with male peers. While we acknowledge these debates, we are interested in intersectional factors – specifically how psycho-social disability interacts with social class and gender. This paper is structured in four parts. First, we review literature from the field of masculinities and mental health. Second, we recount the study’s methodology with a specific focus on ethical considerations when researching vulnerable populations as well as rapport building. Third, we present our analysis of the five participants focusing on the broad themes of closing yourself off and opening up, mapping how the participants came to negotiate with their mental health literacy. A discussion and conclusion then address limitations before setting forth recommendations for future research.

Masculinities, social class and mental health

For some time now, research has explored gendered differences in general health and well-being, suggesting that many of the negative health outcomes associated with being a man are linked to normative constructions of masculinity and ‘how cultural dictates, everyday interactions and social and institutional structures help to sustain and reproduce men’s health risks’ (Courtenay 2000, 1388; Evans et al. 2011). The importance of understanding mental health, specifically – and the experiences associated with mental health – as a gendered phenomenon remains highly significant and has implications for how practitioners can better meet the needs of those who may be vulnerable. For men, their mental health is shaped by lifestyle choices and collective social norms about what it is to be a man (Keppel 2016; Vogel et al. 2014). We know there exists a relationship between gender normativity, hegemonic masculinity, and mental health in adolescence (see Landstedt, Asplund, and Gillander-Gadin 2009; Seidler et al. 2018). As previously mentioned, forms of masculinity aligned with strength, control and toughness may serve as a barrier to men coming to understand their own mental health and wellbeing.

Australia’s National Men’s Health Strategy 2020–2030 notes a longstanding concern about the content and context of men’s interactions with the health system. Young men’s avoidance of treatment when experiencing mental health problems or suicidality is well documented (Milner, Shields, and King 2019), often linked to shame and embarrassment due to hegemonic masculine norms. It has been documented that 72% of males do not seek support for mental ill health (Australian Government Department of Health and Ageing 2013). Furthermore, in Australia there has also been a recognition of significant variability in resources to promote health literacy (e.g. health system infrastructure, policies, processes, etc.) (Australian Commission on Safety and Quality in Health Care 2014). Highlighting the intertwined nature of masculinities and mental health in research on the social construction of male suicide, Mac An Ghaill and Haywood (2012) call for educators and counsellors to ‘consider how gender identities may be differently constructed, organized and cohered’ depending on context. However, they also note that this may be paradoxical work because the endeavour to recognize ‘the gendered nature of suicidality’ involves ‘simultaneously questioning dominant explanations of gender identity formation’ (Mac An Ghaill and Haywood 2012, 483).

In the field of public health, large-scale and survey-based research suggests mental health literacy for men is significantly influenced by social class (Milner, Shields, and King 2019). More nuanced qualitative work by Creighton et al. (2017) has used photovoice interviews (Milner, Shields, and King 2019) to explore how men struggle with their mental health. Other research continues to link poverty to negative mental health where a lack of material resources (e.g. stable employment, food security, housing) and very little control over one’s life (e.g. a feeling of helplessness) can lead to chronic stress which, in turn, can be detrimental (Welsh et al. 2015). Mattheys (2015) highlights the dual role of austerity whereby mental health is impacted both by individual financial strain and severely constrained public access to mental health services, noting that research has long established the ‘consequences to people’s mental health from living in poverty, unemployment and underemployment, and from living in areas with high levels of deprivation’ (p. 477). Extending this work, in researching the relationship between poverty and child mental health, Fitzsimons et al. (2017) call attention to how low ‘socioeconomic status creates stress within the household’ (p. 43) where parental mental health correlates with that of their children, even into adolescence.

Mahalik and Dagirmanjian (2019) call attention to how the time working-class men spend in manual and industrial labour, where they are surrounded by primarily male colleagues and traditionally masculine culture, contributes to a narrowing of space where they can feel emotionally open and vulnerable. Furthermore, they contend working-class men often view seeking help as weak, where their participants ‘described stigma through their anticipation of negative judgments from others, and threat to manhood status through failure to meet the masculine ideal of being strong and able to bear up when in pain’ (Mahalik and Dagirmanjian 2019, p. 9). This highlights how working-class men often construct their mental health literacy in limited ways because of stigma and gender norms. Highlighting another dimension, research on masculinities and mental health has outlined several risk factors including social isolation and long-term unemployment (Basbug and Sharone 2017). Based on existing research, it is clear that many men struggling with mental health are not only reluctant to seek support, but they may also not recognize their issues as legitimate (Smith, Richardson, and Robertson 2016). In seminal work, Bandura (1998) indicates that people cannot develop strategies to improve their mental health if they lack an awareness of their issues.

From a social cognitive theory perspective, self-efficacy beliefs determine how long people can persist when encountering difficulties and how much pressure they will experience when facing societal demands (Bandura 1998). Bandura’s view also emphasises the importance of understanding and improving on social systems that contribute negatively toward health for individuals and communities, rather than focusing solely on changing individual behaviours. In this sense, Bandura (1998) argues, a sense of self-efficacy is significant ‘not because of reverence for individualism, but because a strong sense of personal efficacy is vital for success regardless of whether it is achieved individually or by people working together’ (p. 646). Highlighting how social cognitive theory informs understandings of gender, Bussey and Bandura (1999) discuss how gender role development and functioning integrates psychological and sociostructural determinants within a unified conceptual framework, where such a lens focuses on gender stability and traditional gender roles.

Methodology

Context

The data presented in this paper were drawn from a broader longitudinal study – The First-in-Family Males Project – that sought to document the experiences of working-class (and working poor) young men becoming socially mobile during the time immediately following their secondary schooling (Stahl 2020; Stahl and McDonald 2022). Mental health, wellbeing or disability were not the main focus of the study though it arose in questions concerning the changing lifeworlds of the young men. All the participants in the study lived at home during this time in their lives. The Australian Bureau of Statistics’ SEIFA rankings defines the suburbs where the young men resided as some of the most disadvantaged urban suburbs in Australia (Australian Bureau of Statistics, 2015). Highlighting the relationship between structural factors and access to support (Mattheys 2015) – a key aspect of mental health literacy – the neighbourhood where the young men lived was on the peri-urban fringes of an Australian city where it was notably difficult to get access to support services due to long wait times.

Data collection

After securing ethics permission from the university and from educational authorities along with parental consent we tracked the progress of 42 working-class (and working-poor) young men from their last term of secondary school over the course of three years (2017–2020). To be eligible, the young men would have submitted an application for university study and been technically the first in their families to attend higher education. We conducted semi-structured interviews every six months; thus, the research documented the lives of participants from age 17/18 to 20/21. Interviews typically ran about an hour with similar types of questions asked each time though as the participants progressed, certain questions were added based on the previous round of data collection. Students were each assigned a pseudonym and paid in a $AUD 20 gift voucher to a local electronics store.

Data analysis

A professional transcription company was used, though we also reviewed the interview audio files several times and checked them against transcripts to ensure accuracy. This was in addition to the extensive field-notes taken during observations and typed up into fuller reports afterwards. Re-listening to the recordings and reading the transcripts facilitated a deeper interpretation of the data. Also, highlighting another dimension of trustworthiness, the research team conferred in regular meetings about the participants and what was featuring prominently in the data after each round of data collection. These discussions were wide-ranging – struggle, self-care, vulnerability – which allowed for deeper analysis and were integral to how we saw the data in light of the existing literature. These meetings, as regular ‘data discussions,’ also led to the creation of thematic codes where each round of interviews had its own codes (see Creswell and Miller 2000). All data was then thematically coded in the NVivo qualitative software package.

In the following section, we explore five young working-class men’s experiences with mental health in their years immediately following compulsory schooling. Compulsory education refers to a period of education that is legally required of all young people. This education may take place in formal schooling or at another registered place of education. In Australia it may differ across states and territories. The stories presented to us highlight a fragmented journey with mental health literacy and how wellbeing is affective, contextual and sometimes temporal. As previously mentioned, it was not always clear if the young men saw their struggles with their mental health as a psycho-social disability; furthermore, other participants may have been struggling with mental health but could have been uncertain of how to disclose it and/or reluctant given the stigma it may carry. As such, we acknowledge the dimension of critical health literacy posited by Nutbeam (2000) involving the cognitive and communicative skills required to adeptly articulate one’s struggles with one’s mental health. Our analysis focuses on where they struggled, how they struggled and what self-care they enacted and, through adopting a health literacy framework, we highlight two broad themes: closing yourself off and opening up.

Findings

‘Closing yourself Off’

There are many ways to describe how individuals struggle with their mental health. In the first theme we present, we have chosen the terminology of ‘closing yourself off.’ We feel this terminology closely aligns with masculine gender norms which can present difficulties for young men in terms of admitting weakness and vulnerability. This echoes Mahalik and Dagirmanjian (2019) research on working-class men who adopt practices of ‘toughing it out’ which involves enduring suffering under the belief that things will improve (pp. 6–7; see also Smith et al. 2020 and Creighton et al. 2017). In a similar way, ‘closing yourself off’ is a process where there is always an underlying hope that the situation and one’s mental health can be improved (Keppel 2016). For the most part, the young men we look at here also demonstrated a greater degree of willingness to take steps in support of that improvement:

Leo: I don’t like to complain, because I know people have harder lives, have a harder life than I do, and I don’t want to sit here and go, ‘My life is hard, my life is hard.’

Researcher: Yeah.

Leo: I think I don’t deal with it as well as I should more so than it actually being challenging, because other people face these challenges and they come out fine. I’m not fine; I think I just don’t deal with it as well.

Researcher: Okay.

Leo: I’ve got a lot of vices, too many vices I think, and that’s the main issue. I have to go to a psychiatrist and sort all that out.

For Leo, he was comfortable being vulnerable and was open to getting assistance, yet he was often not consistent in following through and booking the necessary appointment. While his family were supportive, our conversations suggested their knowledge around mental health literacy was limited. Leo was eventually hospitalized for his panic attacks which served as a catalyst for him going on medication for his mental health (see Stahl 2020). Leo’s hospitalisation also contributed to changing his family’s understanding of his mental health issues, ‘I think [my parents are] both just more sort of starting to take my mental health a bit more seriously now because they’re sort of finally realizing it [is] actually an issue – not just me being lazy and sad. So they [are] sort of maybe being a bit more supportive about that [rather] than not…’

During the years following compulsory schooling, many young people come to inhabit new spaces of learning whether it be formal education, internships or new forms of employment. These new experiences, while exciting, can be stressful and bring latent mental health issues to the fore (Stahl and McDonald 2022). For example, when we asked Robbie about when he could most be himself, he responded, ‘I would say probably in my room here, just because there’s no one – you don’t kind of put on a front. You don’t change personality. You know how you do it unconsciously when you’re with your friends or something – like family and stuff – you have different personas and stuff?’ These words capture Robbie’s struggle with anxiety which seemed to be linked to both the pressures he felt around the social climate of the university as well as his academic work (see Stahl, McDonald and Stokes, 2020; 2023). In this case, Robbie can be seen as demonstrating a form of psychosocial disability in that anxiety shaped and restricted his interactions with others and, thus, his experiences of functioning in social environments. For another participant, Tobias, who suffered from social anxiety specifically, he described an even more acute impact on his interactions with others, leading to a feeling of paranoia:

… like at uni, and work, I feel like – especially with work, because it’s like a totally new thing […] I feel like, I don’t want to stuff up, sort of thing, like I feel like I’m paranoid that people are judging me, sort of thing, but at home, like you’d just be like, on the couch, selling like, nothing, and like, be relaxed, like not stressing, like no one’s going to be judging me for what I watch or something like that, like I’m more, like relaxed, where like, at work and uni, I’m more stressed. Like, even more stressed of what other people are thinking of me, as well, which is – yeah, which is like a big one … I guess, but sort of, like more stressed of the, like, oh, this person’s dumb, or this person’s a bit weird.

Previous research on masculinities and mental health has emphasised how the home can be a space where men are able to be emotionally vulnerable (Creighton et al. 2017), yet interactions with family can also be ‘fraught with complex emotional entanglements’ (Keppel 2016, 354). Mahalik and Dagirmanjian (2019) research highlights how, while stigma and gender norms affecting mental health disclosure persist, they are also fragmented and informed by experience. Tobias’s struggles with his mental health were exacerbated when his father passed away from cancer, which involved a grieving process that he described in this way:

‘Yeah, and I kind of felt like it was weird, because obviously I was grieving. I kind of felt bad that I was grieving, because I knew my family members were relying on me a little bit, so I kind of… Yeah, it felt weird. I felt a bit selfish, sort of thing, which is a shit way to think of it, but yeah. A bit strange, because I knew they were relying on me, so I had to kind of be around.’

Here Tobias highlights that he was in a process of closing himself off, although ironically the reason for this was his desire to ‘be there’ for his family. That is, he was experiencing feelings of guilt for not measuring up to what he perceived to be his family’s expectations. Complimenting previous research on masculinities, mental health and well-being, he feels his family expects him to be tough and to be able to endure (Mahalik and Dagirmanjian 2019; Smith et al. 2020); moreover, not feeling secure enough in his own wellbeing to be reliable to his family had further implications. For example, in terms of how his father’s death impacted his university studies, Tobias asserted:

So yeah, just with my dad’s cancer that he got the year before, yeah, so it was a bit … I’ve kind of hit the second-year uni blues with work on top [of it]. So yeah, it was kind of a bit challenging, especially … I don’t know, I found that a bit of social anxiety as well around meeting new people and stuff like that. Really I kind of saw it as, yeah, I wasn’t in the best of places, wanting to go to uni and stuff like that, because I kind of saw that I had my core friendship group, and I had my girlfriend, so I kind of looked at that like that stage sort of thing as that.

Tobias’s words capture a cycle of closing off. The demands of university coupled with the grief he felt for his father brought his issues with social anxiety to the fore. As Tobias’s grades suffered, he ended up dropping courses to keep up his GPA: ‘So I dropped one, so I dropped two. I was doing two, and then I dropped another one, so I just did the one, just trying to kind of mentally refresh sort of thing.’ While in the process of closing himself off from the stress of university studies, he also highlighted aspects of hope (see Keppel 2016), mentioning that he was comfortable seeking support and that he found his course coordinators and the university as a whole to be supportive when he asked for a modified schedule. This aligns with research reported by Martin and Oswin (2010), where although ‘just under two thirds of … students who reported mental health difficulties did not disclose this to staff due to fears of discrimination,’ those ‘who did disclose felt supported when staff displayed a respectful attitude and provided appropriate advice and useful strategies for them’ (p. 48). This suggests that ‘closing off’ is not necessarily all encompassing. Unfortunately, Tobias experienced further hardship when his girlfriend ended their relationship:

because my girlfriend broke up with me for another bloke…Yeah, I was like, come on. What else can go wrong now? …Yeah, it kind of hit me, kind of caught up this year, for sure, especially [inaudible] side of things. Just watching that slowly deteriorate sort of thing is a bit … yeah, but yeah, that’s for sure.

In terms of how Tobias negotiated a difficult period in his life, which heightened his mental health issues, we see that when his mental health was negatively impacted in several areas of his life and in quick succession, there were efforts to ‘refresh’ but, ultimately, he struggled to get the necessary traction. During this challenging time Tobias said he did rely on his close male friends – who he was in contact with mainly through sport – but this support was mainly relaxed and he did not explicitly discuss with them what he was going through. Again, this suggests ways in which masculine ‘closing off’ occurs in specific, partial ways – remaining open to and indeed relying on the support provided by socialising with friends, while nevertheless staying ‘closed off’ from them in explicit emotional terms.

During his second year at university Theo, who described himself as an easy-going guy, experienced an onset of struggles with his mental health, ‘When it started to get closer to the assignments, I started to have a couple of anxiety attacks. So it was like, just a panic attack now and all right, something’s clearly not right here…a bit of a shock to me at least.’ When we asked Theo to describe this in a bit more detail, he highlighted how the high-stakes nature of the university course and his long commute were factors contributing to closing himself off from others:

The first semester of university this year I kind of struggled with, because I started off doing a course at [university] which was a French course and that was the stress of actually getting to and from there was a bit rough and then the stress of having to do this even though it was just the one course it was what hinged year two on. It’s like everything hinged on me passing […] it was a bit rough. Went to a doctor and got diagnosed when, okay, I’m going to abstain for now and kind of just see how I go for the second semester. I started up on second semester, kind of went, I’m not really feeling it still yet, so I wanted to give myself a little bit more time to adjust.

In terms of Theo’s mental health, he was open to getting a diagnosis and to medication, ‘The depression and stuff is for like the first two weeks of it where I was just kind of like, I knew about it and I felt a little bit shit because I had to have medication et cetera.’ While he did try to re-start himself at university, similar to Tobias’s ‘refresh,’ ultimately Theo decided not to push himself suggesting a degree of mental health literacy and an investment in prioritising his mental health. Furthermore, Theo was able to recognize his own stagnation (what Tobias described as ‘deterioration’), an integral part of his process of coming to understand his own mental health needs:

And it was a little bit […] where after a while I was kind of sitting in that kind of state for like a good while and what am I doing? It’s like I’m not doing anything. I’m just kind of persisting so I went kind of like suck it up toughen up a little bit, go and do something. Go out, go for a walk. Walk to the supermarket, get something nice to eat. You went out today good on you. All right. Catch a bus, go to the city, talk with [your] mates, chill with your mates, just do what you generally enjoy instead of just kind of closing yourself off.

Similar to other work on masculinities and mental health, the young men we spoke to were aware of the gender norms shaping their sense of mental health. Highlighting the gendered expectations around masculinities and mental health, Theo said:

Yeah, when confronted with any sort of emotion, men are supposed to [inaudible] say culturally, I was expected to kind of just be a bold walk and just go straight for it, just tank it. Just accept it for what it is and be strong about it. And it’s like the issue there is that a lot of the times you tend to forget that A, we are human too. And B, we also have a mind that has feelings. So, while we can put on this façade of yep, I accept that as fact, there’s still that lingering thought in the back, it’s like, but I don’t.

Theo’s words here highlight that he recognized the façade or performative aspect of hegemonic masculinity and how gender norms remain a persistent ‘lingering thought’ regarding how he negotiates his mental health and wellbeing. In this way, Theo is self-reflective about the sociocognitive modes of influence on gender development discussed by Bussey and Bandura (1999) who highlight how ‘gendered roles and conduct involve intricate competencies, interests, and value orientations’ (p. 685), where individuals engage in regulatory self-sanctions, a form of self-policing.

This section has focused on ‘closing yourself off’ and suggests that it is not necessarily a totalizing behaviour, as there are many examples of the participants being agentic and trying to turn their mental health around, recognizing how closing themselves off from potential sources of support is not advantageous. In contrast to Mahalik and Dagirmanjian (2019) research on the mental health struggles of working-class males, Leo, Theo, Tobias and Robbie are comfortable with getting help, suggesting they do not feel threatened by social stigma. Their struggles indicate a quickly developing and relatively high degree of individual health literacy, in terms of cognitive and social skills, which influence individuals to gain access to support during challenging times in their lives (Nutbeam 1998). The other participant, Archie, described his mental health struggle in a different way, describing his journey as ‘every day struggling. I don’t know. Like I said, I have no drive and I’m not striving to anything.’ While he made efforts to seek support, he often cancelled the appointments once they were secured. This stands in contrast to Leo, Theo, Tobias and Robbie who pursued open dialogues with family as well as professional counselling services.

Opening up

We now shift to focus on the second theme of ‘opening up.’ We feel this terminology suggests a comfort with vulnerability and admitting weakness, which is central to establishing a sense of resilience in the face of adversity. To be clear we do not see ‘closing down’ and ‘opening up’ as a binary, but instead as interrelated ‘moments’ or tendencies within a mental health literacy journey. From the outset of the study, Leo struggled with his mental health and was the first to openly disclose being on and off medication for anxiety and depression. Given where Leo resided, it was tremendously difficult for him to seek counselling though, through persistence, he was not only able to get an appointment but also see a psychologist on a regular basis. An important aspect of health literacy is the environment or wider infrastructure and policies which allow for resources to become available (Milner, Shields, and King 2019; Nutbeam 1998) and, as previously mentioned, it could be difficult to secure these appointments. When we caught up with Leo after seeing a psychiatrist for three months, he described the support he was receiving positively:

Leo: Yeah, it’s been good. [The counsellor’s] been helping a lot, but other than that, I don’t know. Just sort of grit my teeth, getting through it and it’s not always going to be this bad. Hopefully it does get back to some sort of normal the next couple of years…Yeah and it’s been good so far. It has been helping. I think it’s going to be a long-term thing, sort of keep working with them, but it’s a good start to have some sort of plan in place.

Researcher: Does he give you like objectives and things?

Leo: He does. Maybe not objectives, he sort of encourages me to set my own goals with that, but he does give me sort of tasks and homework, I guess, and coping mechanisms and sort of exercise and activities to help cope better. Then he sort of catches up with me next time, how’s it been going? Did you do it? Did you not do it? Blah, blah, blah. I do a journal for him and all of that.

Highlighting an increase in reflective practice regarding his own health literacy and capacity to take positive steps, Leo also mentioned reducing his social media intake, saying that ‘it’s just full of negative, toxic crap’ and asserting ‘it is sort of one bad thing after another, after another, after another, that we’re seeing. It is very sort of beats you down and gets you down in the dumps and you feel helpless about it.’

Tobias – who suffered substantial hardship between the death of his father and the breakdown of his relationship with his long-term girlfriend – credits these experiences with what he described as increased ‘self-awareness’ regarding his social anxiety and, we assume, mental health literacy. Highlighting how well-being can be extremely relational for young people in their post-school journeys, Tobias entering back into full-time university studies was challenging for him because he was out of sync with the friends he had made previously. Therefore, he had forged new friendships which he found confronting.

Yeah, it’s life. Yeah. I’ve kind of learned ways to deal with it and stuff like that. It’s pretty good. It’s a pretty big learning curve, and I’ve found that instead of being all doom and gloom, it’s kind of like a big learning curve of how to deal with situations and stuff like that. I feel like I’m stronger mentally because if I can overcome that, I can overcome most things, especially at my age.

Research continues to document not only a lack of proactivity amongst men to seek support (Smith, Richardson, and Robertson 2016) but also an ongoing stoicism which can make speaking about their vulnerabilities very challenging. Theo, who was proactive in seeking support when he suffered attacks of anxiety, compared his journey to that of his wider family.

Yeah. But it’s…I know that a lot of people do bury their head in the sand. I know firsthand that it’s not a good idea to do so because I know that my mum’s had depression before. My sister definitely has something going on like in terms of anxiety, so it’s definitely biological and just from seeing it from my family, I know that the worst thing you can do is not speak about it. So when I go get myself sussed out, I went, all right talk about it with everyone, let everyone know and let it be known. You don’t really want to hide it.

Here, his family’s experiences with mental health may have contributed to his mental health literacy. The importance of family as integral to opening up, fostering resilience and a deeper reflection on mental health literacy, was notable in the data but different for each of the participants. For Robbie, who suffered from anxiety especially around his academic learning, his journey to university was framed by having to contend with this burden in order to be successful. In our conversations with Robbie we asked him about self-care:

I probably – I talk to my mum or my aunty, she’s very understanding and she’s one of my godparents, so she is kind of [there’s a] connection we have. Although she’s the only godparent that I actually feel really connected to and stuff like that. So, I just talk to her and stuff and I feel less worried and also sometimes I play video games and watch movies just to kind of relax and get my mind off what’s troubling me, I guess.

Highlighting how becoming open and vulnerable contributed to a sense of resilience, Theo saw his struggles with mental health as a journey where he was able to change aspects of his personality to become more open, making it possible for him to seek support:

But as I’ve kind of progressed, I’ve kind of learned too that it’s okay to be a little bit more emotionally open in general, out in public, you don’t really need to fear that kind of stigmatism of like, oh, he’s just going off a little bit. Sometimes you could seek support literally anywhere. A lot of people are open to helping you. You just kind of have to show that empathy to them for them to empathize back to you.

Theo demonstrates increased understanding of the cognitive and social skills associated with mental health literacy that determine the motivation and ability of individuals to access, understand, and use information to maintain their own mental health. Furthermore, Theo’s diagnosis led him to read widely about masculinities and mental health:

…it’s a lot more shocking to see the amount of men that go with undiagnosed mental health issues, the suicide rate of men in Australia is more than the death rates on the roads and that’s just one specific gender, like sex of people. It’s really jarring to kind of know that because it’s like you go, oh yeah, it’s just not talked about, it’s being talked about a lot more now, but we’re still in that sort of area where it’s like just starting to, it’s starting to kick up and yeah.

In contrast to Leo, Theo, Tobias and Robbie, Archie did not ‘open up’ at all in our discussions. Over the three years he became more withdrawn, did less artwork, gained significant weight and, for the most part, seemed to avoid confronting his struggles with mental health. Regarding personal goals, he said:

I think maybe just try to apply myself. I think that’s just the biggest… Because right now, I really don’t care about anything. I got all these assignments that I have to do, or had to do, or whatever. I’m nonchalant, I feel nothing about them. I’ve got no compulsion that if I don’t do these, I’ll fail. I know, it’s weird. Weird mental state.

Discussion

This data presented in this paper concerns how a small group of working-class (and working-poor) young men struggled with their mental health and the self-care they enacted. Adopting a health literacy framework, and focusing on two broad themes (e.g. closing yourself off, opening up), the data suggests that stoicism, as an integral aspect of historic working-class manhood is still present but there is also evidence of change where these young men feel comfortable admitting vulnerability. Empowerment is the first objective in Australia’s National Men’s Health Strategy 2020–2030, which aims for men and boys ‘to optimize their own and each other’s health and wellbeing across all stages of their lives’ (Australian Government Department of Health 2019, 7). For boys and young men from marginalized backgrounds, their experiences with health literacy are shaped by culture, gender and age (Smith et al. 2020). These young men, who often see themselves disempowered relative to traditionally dominant masculine norms, may view seeking help as weak and associated with social stigma but the data suggests this was not always the case. In their research, Mahalik and Dagirmanjian (2019) noted their participants ‘described stigma through their anticipation of negative judgments from others, and threat to manhood status through failure to meet the masculine ideal of being strong and able to bear up when in pain’ (p. 9).

The data suggests there may be some sort of relationship between a softening of manhood or masculinity and greater health literacy, though further large-scale research is required to properly understand this relationship. However, while the data presented is far from conclusive, it does speak to debates regarding social change and how masculinities are understood and performed; and, also, how as a society we understand and represent mental health, including its potential impact as psychosocial disability. Christofidou (2021) highlights how research on masculinities and social change needs to carefully ‘explore the underlying conditions that cultivate change among some men’ (p. 82). While the young men discussed in this paper came from working-class (and working-poor) backgrounds with lifeworlds strongly influenced by notions of stoicism and strength, they were often open to and reflective about the importance of going beyond, or challenging, harmful elements of traditionally ‘closed off’ masculinity. Furthermore, there was some evidence of wanting to improve their mental health literacy.

When conducting interviews with the young men, we strove to be open and sensitive to their needs, relying on them to tell their stories. Consistently we found them to be emotionally open, often disclosing difficult and intimate personal details. None of the participants presented in this article ever missed a round of data collection (even Archie) and, over the course of several meetings, we were able to build a rapport with many which may have contributed to them revealing more sensitive details from their lives. Furthermore, the semi-structured interview schedule allowed for a certain flexibility, giving participants the space to discuss what was important to them. We consistently tried not to assume an authoritative position and to maintain a friendly manner. A range of factors contributed to the success of the interviews; we drew on strategies such as humour to establish rapport so that participants were comfortable.

We spoke with participants during a liminal time in their lives as these young men were shifting from adolescence into adulthood. Their journeys were influenced by changing conceptions of how to ‘be a man’ that can vary widely between individuals and families. This confluence of personal and structural factors is precisely what social cognitive theory seeks to explore and, in these terms, Bussey and Bandura (1999) discuss how children must gain predictive knowledge about the ‘likely social outcomes of gender-linked conduct in different settings, toward different individuals and for different pursuits’ (p. 689). Leaving the comfort of their secondary school and entering higher education calls into question the effect of varying gender norms (Stahl and McDonald 2022). In other words, those going through significant changes in the cultural and social contexts of their lifeworlds will face additional challenges regarding how to predict, engage with and measure themselves against those changing social norms, including the gendered norms of masculine identity. This, in turn, can influence the level of self-confidence and agency felt by these individuals. Bandura (1998) argues that such ‘perceived self-efficacy’ is a key factor in promoting health and well-being, with four major elements contributing to a person’s sense of self-efficacy, including: mastery experiences, vicarious experiences, social persuasion, and reduced stress reactions. Furthermore, Bandura indicates people can build their belief in self-efficacy by seeing the success experiences of people who are like themselves and highlights, in scholarship with Bussey, how these processes are highly gendered (see Bussey and Bandura 1999).

Conclusion

As previously noted, the broader study on which this paper is based did not aim to explore the mental health/well-being of these young men. Therefore, the data presented is emergent and exploratory around young men’s mental health literacy. It was also not always clear if they self-defined their struggles as constituting a disability and levels of impairment differed depending on circumstance, though each of the five either left university or took a semester off. We recognize arguments in critical disability studies concerning degrees of impairment and the need for caution in labelling, specifically regarding mental health issues (Vandekinderen and Roets 2016). We also recognize the various issues surrounding medicalisation of mental health, the socially constructed nature of disability and what this may mean for help-seeking (Vandekinderen and Roets 2016).

Given the increased attention to loneliness in Australian men and their ‘unmet belongingness needs’ (Franklin et al. 2019, 124, 137), we are interested in what role the formation and maintenance of affective bonds played as a key support structure for these young men. While our data are limited, the research highlights three main contributions: (1) the importance of familial and peer relationships; (2) understanding mental health literacy in relation to gender norms and; (3) highlighting the need to provide a comprehensive range of services that encourage diversified social structures regarding health, mental health, and disability, rather than focusing solely on the behavioural tendencies or limitations of individuals.

Our data suggest that familial and peer relationships were an integral part of how these men negotiated their mental health. Davis, LaPrad, and Dixon (2011) describes how male bonding ‘can become congruent with inclusive, pro-social, and healthy masculinities’ because young men ‘need a place where they can feel vulnerable, honest, and open with each other’ (pp. 150, 159). This compliments recent research by Wilson et al. (2021), focused on secondary school-based gender-sensitive rite of passage programs, which highlight the importance of male bonding in promoting vulnerability, along with the development of a positive masculinity. According to Wilson et al. (2021), positive masculinity remains difficult to define and scholarship remains limited. While our knowledge of their peri-urban health literacy environment is limited, making it difficult to reach definitive conclusions, we note that some of the participants reported difficulty accessing support services. Therefore, their reliance on friends and family may suggest this was more convenient than accessing formal support.

While our data demonstrate the role played by familial and peer relationships in empowering young men to confront their mental health struggles, future research needs to explore where else they are accessing support and information. One area to build on are recent suggestions that social media play a significant role in promoting mental health literacy (Watkins et al. 2017) and seems to offer a ‘safe space’ for problematising gender norms (Schlichthorst et al. 2019). Further research should also consider the intersectional identity vectors – specifically race and ethnicity – which may be highly influential in how boys and young men approach mental health literacy (Smith et al. 2023).

What is perhaps most important about the small data sample we have presented here, however, is that it underscores the complex, changing ways in which men – and young working-class men, in particular – can and do engage with the concept of masculinity and their own masculine identities. Milner, Shields, and King (2019) draw our attention to how ‘some masculine norms (particularly characteristics such as self-reliance) may be incompatible with communicative and interactive health literacy’ (p. 2). However, within our limited data this was not the case. Amongst this small group, most seemed able to see how masculine norms could be a contributing factor in their own mental health struggles. Therefore, in terms of developing their mental health literacy, the five young men all demonstrated both a willingness and ability to be open, engaging critically with their own mental health and, indeed, masculine identities in ways that give hope (as these young men retained ‘hope’ in various ways) for a more positive future regarding men and mental health.

To conclude, there is a danger, perhaps, that if we continue to assume the ways in which men, or certain kinds of men, will engage with their emotions and mental health – that is, in ‘closed off’ or otherwise dysfunctional ways – we risk simply reinscribing precisely that traditionalist, harmful masculine stereotype as the lived, expected norm for many men. Rather, discussions with young men like those featured here suggest that there is a growing understanding and willingness among men to embrace more open, less damaging approaches to their own mental health. Therefore, the paper makes a useful contribution in continuing to develop our understanding of how discourses around mental health help-seeking and masculinities are changing within male populations. What is imperative is that we continue to provide comprehensive and diversified mental health services; furthermore, creating resources that are accessible and effective is integral to how we encourage greater engagement for populations considered difficult to reach.

Acknowledgements

We would like to thank the anonymous reviewers for their helpful comments and useful suggestions which led to an improvement of this paper.

Disclosure statement

No potential conflict of interest was reported by the authors.

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

We acknowledge funding received by the Australian Research Council (DE170100510).