Men’s Mental Health: Why staying silent comes at a cost
- 2 days ago
- 5 min read
While women are more likely to be diagnosed with mental health conditions such as depression and anxiety, psychiatrists warn that men are far less likely to seek help, often delaying support until symptoms have already escalated into crisis.
On average, one in eight men will have depression and one in five men will experience anxiety at some stage of their lives[i].
However, men’s mental health struggles often go unrecognised, untreated or are masked through anger, withdrawal, substance abuse, risk-taking behaviour or aggression rather than the more commonly recognised signs of depression and anxiety.
Globally[ii], men consume nearly four times more pure alcohol and account for 80%, 75%, and 69% of deaths due to homicide, road traffic injuries and suicide.
Dr Gagu Matsebula, member of the South African Society of Psychiatrists (SASOP), says men as a demographic are significantly less likely to engage with healthcare services, including mental healthcare, even when services are available and accessible.
“Men are less likely to attend preventative healthcare visits, less likely to seek help early and more likely to present when their condition has already progressed significantly,” says Dr Matsebula.
“What we often see is that men only seek assistance in the very late stages of the condition. This contributes to poorer health outcomes, higher mortality rates and a greater burden of untreated mental health conditions.”
He explains that this reluctance is deeply rooted in social and cultural expectations around masculinity.
“Society expects men to be strong, in control, dependable, rational, fearless and emotionally contained. Men are taught from a young age to ‘man up’, to suppress vulnerability, and to avoid appearing weak. The problem is that these same expectations prevent many men from speaking openly about emotional distress.”
According to Dr Matsebula, one of the biggest barriers is what mental health professionals refer to as “restrictive emotionality” - the tendency for men to suppress or inhibit emotional expression because vulnerability is viewed as incompatible with masculinity.
“Men are human beings and experience the full range of emotions, but society tends to only allow men to express certain emotions such as anger, frustration or confidence. Emotions like sadness, fear, distress, worry or hopelessness are often discouraged or judged negatively,” he says.
“This creates a situation where men struggle to develop the language, confidence, or practice needed to express what they are feeling.”
As a result, mental health conditions in men may look very different from the stereotypical symptoms people expect.
“The tools traditionally used to diagnose depression and anxiety do not always account for how these conditions present in men,” says Dr Matsebula. “Men may present with irritability, aggression, substance abuse, emotional withdrawal, reckless behaviour, poor impulse control or overworking instead of openly expressing sadness.”
He says untreated mental health conditions can significantly affect relationships, work performance, parenting, physical health and quality of life.
“When anxiety and depression remain untreated, men often turn to unhealthy coping mechanisms that temporarily dull distress but ultimately worsen it. Alcohol abuse, gambling, drug use, emotional withdrawal, aggression, and risk-taking behaviour can all become coping strategies.”
Research continues to show that men are disproportionately represented in high-risk behaviours and preventable deaths.
“These patterns are not isolated from mental health,” he explains. “Poor emotional regulation, untreated trauma, substance abuse, chronic stress, and social isolation all contribute to these outcomes.”
The economic impact is also substantial. According to a 2023 analysis[iii], South Africa loses an estimated R161 billion annually due to unaddressed mental health conditions through lost productivity, absenteeism, presenteeism and reduced workforce participation.
“Mental health is not only a healthcare issue. It is also a workplace issue, a family issue, and an economic issue,” he says.
Dr Matsebula says one of the most important steps in improving men’s mental health is normalising conversations around emotional wellbeing long before a crisis develops.
“We need to create environments where men can speak openly without fear of judgment or ridicule. Families, workplaces, social groups, schools, sports clubs, faith-based organisations, and communities all have a role to play in changing how society understands masculinity and emotional health.”
He adds that loved ones should avoid interrogating or trying to immediately “fix” someone who appears emotionally withdrawn.
“If a man has become quieter or more withdrawn, instead of asking ‘What’s wrong with you?’, rather say, ‘I’ve noticed you seem quieter lately. Do you want to talk about it?’”
He says support often comes through small but consistent gestures.
“Listening without judgment, validating feelings, sitting quietly with someone, helping with daily tasks or simply reminding someone that they are not alone can make a meaningful difference.”
Dr Matsebula emphasises that seeking help should never be viewed as a weakness.
“If a man develops chest pain, severe headaches or an injury, nobody tells him to simply toughen up and ignore it. Mental health should be treated no differently,” he says.
“Experiencing anxiety, depression, emotional distress or burnout does not make a man less resilient, less capable or less masculine. It simply means he is human.”
He encourages men to pay attention to ongoing emotional or behavioural changes, especially when symptoms begin interfering with daily life, relationships, work or sleep.
Common warning signs can include:
persistent irritability or anger
emotional withdrawal or isolation
changes in sleep or appetite
loss of interest in hobbies or activities
increased alcohol or substance use
feelings of hopelessness or numbness
ongoing anxiety, worry, or panic
difficulty concentrating
fatigue or loss of motivation
reckless or risk-taking behaviour
Dr Matsebula says professional support may include counselling, psychotherapy, cognitive behavioural therapy, lifestyle interventions, support groups, and in some cases, medication.
He also stresses the importance of preventative mental wellness habits.
“Regular exercise, healthy sleep, strong social connections, stress management, reduced alcohol intake, proper nutrition and meaningful social support all play a significant role in protecting mental wellbeing.”
At a broader level, SASOP believes greater investment in mental healthcare, public awareness campaigns, and community-based support services is urgently needed in South Africa. Currently, South Africa allocates roughly 5% of the public health budget to mental health services – significantly lower than the 10–15% recommended for lower- and middle-income countries.
“Mental health awareness campaigns have successfully reduced stigma around conditions like HIV over time. The same sustained effort is needed for mental health, particularly men’s mental health,” says Dr Matsebula.
“The message men need to hear is simple: speaking up is not weakness. Reaching out is not failure. Mental health conditions are treatable, and seeking support early can change and save lives.”
For mental health support, contact the South African Depression and Anxiety Group (SADAG) Suicide Crisis Helpline on 0800 567 567 or SMS 31393 for assistance.
