Reducing mental health taboos for men

In this issue we profile Cork Beats Stress, one of the two joint winners of the HMI Inaugural Leaders Award 2014. This is an initiative centred on the delivery of a public mental health intervention through the largest sporting organisation in this country – the GAA.

Jennifer Hayes, Department of Psychology, HSE, Cork, describes how she and her colleagues adapted an innovative approach to the delivery of mental health services within the community in Cork. In collaboration with 2 local GAA clubs.

Cork Beats Stress
Cork Beats Stress

Last year, Cork Beats Stress was announced as Joint National Overall winner of the Inaugural HMI Awards. Cork Beats Stress is a joint pilot project between HSE Primary Care Psychology services in Cork and the GAA. This initiative was set up in an attempt to tackle challenges around the delivery of mental health interventions for people suffering from mental health problems.

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Primary care is responsible for meeting the vast majority of all mental health problems, yet it is inadequately equipped for this remit. Despite the strong evidence-base for the effectiveness and cost effectiveness of clinical psychology, most adults do not have access to any clinical psychology at primary care level.

Research showed that the intervention led to participants acquiring effective mood regulation skills, greater knowledge and understanding of their problems and increased self awareness.

The delivery of mental health services at both primary and secondary levels relies on a service model defined not exclusively, but predominantly, by the provision of individual appointments. In systems where demand outstrips supply this raises questions important questions about best use of scant resources. The World Health Organisation argues that models of best practice are those which are not only evidence-based but which are flexible and have the largest possible reach. An over-reliance on one to one intervention is not always appropriate and can inadvertently fuel stigma by keeping mental health problems, solutions to mental health problems, as well as help seeking behaviours hidden behind closed doors.

Stigma which is closely associated with stereotypes, prejudice and discrimination is a significant obstacle impeding the delivery of effective mental health services, impeding clients in recognising mental health difficulty in themselves or others and preventing clients from accessing effective services. Not only does stigma prevent access to effective services but it also simultaneously makes mental health problems worse thus adding further pressure to the system and hindering access further.

Men accessing and availing of psychology services or health services in general is a challenge. Men are significantly underrepresented in our mental health services prompting the question as to what we can change in how we structure and deliver our services to make them more appealing and accessible to men in general.

Participants also felt that running an intervention through the GAA reduced what participants felt was an even greater taboo about mental health that exists specifically for men.

Cork Beats Stress was set up as a pilot project in Cork in an attempt to circumvent some of the difficulties outlined above. This initiative centred on the delivery of a public mental health intervention through the largest sporting organisation in this Ccountry – the GAA. The intervention programme selected and delivered is called ‘Stress Control’. Stress Control, ((c) Jim White) consists of six psychoeducational classes based on CBT principals. It has a strong evidence base in the treatment of anxiety, depression and stress. These factors along with its suitability to large scale population based interventions made this intervention the obvious choice.

The initiative was run in Midleton GAA and St. Finbarr’s GAA in Cork in conjunction with the GAA Healthy Club Project, with an average of 246 people attending across both sites over the course of the six week intervention. Pre- and post- analysis of levels of anxiety and depression amongst those in attendance showed that over the period of intervention there were clinically and statistically significant reductions in anxiety and depression and a significant increase in perceived quality of life. Research showed that the intervention led to participants acquiring effective mood regulation skills, greater knowledge and understanding of their problems and increased self awareness. Results also showed that participants reported sharing their learning with others, making positive lifestyle changes and increasing participation in new activities. These findings are in keeping with outcomes for Stress Control as an intervention in general.

Stress control as a psychological intervention for anxiety and depression is run in lots of locations in Ireland and the UK and has a strong evidence base. However, what is unique about this initiative is the model of service delivery and the unlikely partnership between psychology services and the GAA. We have been unable to identify any other examples of public mental health treatment programs being delivered through a sporting organisation and we believe this to be the first of its kind nationally and internationally. Our research did show that the content of the programme itself, along with the large numbers present contributed to a reduction in stigma. However, our research also highlighted four ‘GAA related factors’ identified by participants as having a direct and positive impact on the service they received.

Participants reported that the fact that the GAA is a local and community based organisation with a strong community role had an important bearing on the reduction of stigma and normalisation of stress and help seeking behaviours. Furthermore, the fact that the GAA is local had a significant impact because it allowed the delivery of a mental health programme into the heart of the local communities through this local sporting organisation. This was important in reducing stigma and in normalising mental health difficulties and supports and in improving access.

Participants also identified that the fact that GAA membership spans vast swathes of Irish society including people from all walks of life was important. The fact that there are people there from ‘all walks of life’ who are known to participants from their local community was significant in stigma reduction and normalisation, thus reducing barriers and improving access.

The data indicates that delivering a mental health intervention in partnership with the GAA was a critical factor in facilitating men to attend the course because GAA membership is male dominated and as such participants felt that ‘it was targeted towards the male audience’. 25% of those in attendance were male which compares to 11% average male attendance when we run this intervention outside of the GAA. Participants also felt that running an intervention through the GAA reduced what participants felt was an even greater taboo about mental health that exists specifically for men. Participants reported that delivering the course in what is a male dominated environment contributed to reducing stigma for men specifically in accessing a mental health intervention.

Delivering a psychological intervention through the GAA, an organisation associated with fitness, fun and sport, facilitated a positive cognitive shift in the negative associations that people typically hold about mental health and HSE mental health services where people reported holding connotations such as visiting the ‘head doctor’ or ‘shrink’. Negative associations prevent people from accessing services and fuel stigma. Participants reported positive associations with the delivery through the GAA such as being physically and mentally fit. Delivering a mental health service on the back of these positive connotations seemed to have the effect of reducing stigma and thus improving access.

The above project highlights the importance of managers and service developers thinking creatively about the manner in which they structure and deliver services and to think creatively about how best to overcome the challenges we face in not just meeting the needs of clients but in ensuring that services can connect with clients. There is also a need for further implementation research which establishes the best ways or places to deliver services so that service managers can use this evidence to guide their work on service planning, development and delivery. Plans to expand the Cork Beats Stress through Primary Care Psychology in Cork are underway. For further information on this initiative please contact Jennifer Hayes on Jennifer.Hayes@hse.ie.