Panos Vythoulkas in discussion with Alex Tsefos and Titian Tam – Men in the Caring Professions

Panos: Hello and welcome to another Keeping Well NCL podcast. My name is Panos Vythoulkas and I’m a clinical psychologist and one of the senior hub practitioners. Keeping Well NCL is a new staff wellbeing service created for NHS and social care employees or for any profession and seniority level with the view to practically and emotionally support staff, teams and organizations during the COVID19 pandemic and its aftermath. Today, we are going to discuss the experiences of men working in caring professions. We will think of the impact on male health care workers emotional wellbeing, gendered stereotypes around mental health and of the importance of seeking help when its needed.  In order to do that, we have invited Alex Tsefos and Titian Tam, both first year Clinical Psychology trainees at Salomons. Titian and Alex are also doing their first year placement in one of the London’s Home Treatment Teams and we will discuss together some of their personal and professional experiences of working in the caring professions and in the end we will share some self-care tips. Before we start our discussion, we want to acknowledge that the use of gender specific language for this discussion is unavoidable, we have made this choice in order to highlight particular difficulties and the harms of gender stereotypes. It is commonly known that the rate of male suicide is higher than women’s – three times more likely in fact. Whilst it’s difficult to pinpoint the exact reason why this is the case, research by Samaritans suggests that societal expectations of the ‘role’ of a male – to be strong, to provide, to support – have a huge impact on mental health. This stigma goes some way in explaining why men are much less likely to reach out for support and access mental health services. Research has shown that only 36% of mental health referrals are for men. These percentages are even higher if specific data are looked into for men belonging in racial minority groups for trans or gay men or non-binary individuals. The statistics also show that 73% of adults who ‘go missing’ are men, 87% of rough sleepers are men and men commit 86% of violent crime. When it comes to mental health, those who identify as men are also so often told to, ‘man up’, ‘grow a pair’, ‘don’t be such a girl’. From childhood, many of us have heard these phrases thrown around, with little or no thought as to the harm this stereotype terminology can cause. So let’s go to Alex and Titian and let’s start with letting people who you are and your relationship with the caring professions. Alex: Hi Panos, thank you for the invite to the podcast today. As you mentioned, my name is Alex and I am currently a first year trainee clinical psychology at Canterbury Christ Church university. Prior to the training, I worked for the NHS for a number of years across various mental health services and I also spent a couple of years working in the third sector. Previously, I worked as a support worker, a psychological wellbeing practitioner in primary care and an assistant psychologist.  I am originally from Greece and I trained there and I moved to the UK 8-9 years ago. Titian: Well thanks Panos for having me here as well, my name is Titian and I’m also a first-year trainee clinical psychologist at Salomons. I would say I have a slightly different background than Alex. I was born and raised on the other side of the world, which is in Hong Kong and I only moved to the UK about four years ago. Yeah, I would say for me it’s quite an interesting journey with the NHS. I started off doing a masters in one of the universities in London about mental health and I had a placement opportunity to work in an inpatient ward specifically for people experiencing psychosis. After that I spent two and a half years working across 2 different inpatient wards, specifically for men before hopping onto the DClinPsych train. It was quite interesting because most of that period of quote “hardship” happened in the midst of Covid-19 Lockdown. And for me it was quite difficult to in a way navigate myself around it, more so when I would consider myself a member of the Black Asian and ethnic minority community. So I think we can have a chat about that in a bit as well. And Well yeah so I am now in the same placement with Alex at a home treatment team in London supporting people going through mental health crisis. Panos: Thank you both you both have a lot of experience in mental health and it is a please having you both here so thank you for accepting and thanks to your university for allowing you to be here. Titian: Thank you for having us here Panos: Let’s make a start. Based on your clinical and personal experiences so far, what do you think can be particularly difficult for male colleagues during this time? Alex do you want to start? Alex: Yes, I guess our male colleagues have experienced a lot of challenges during that period. From my experience working across different services I have kind of noticed how male practitioners are underrepresented in the field of psychology and in the health care professions in general. However, despite the underrepresentation in the field it is quite interesting as you often see men taking more leadership or management roles within the NHS. It is also quite important to highlight how even though I have worked across different services in the NHS I can only speak about my own experiences working for the organisation within psychology services specifically and other people, other male colleagues may have had different experiences depending on their place of work and background as well. So some of the challenges I have noticed that male colleagues have experienced over the past few years is trying to fund a balance between work and responsibilities at home which has become even more difficult during the pandemic. For many male colleagues it was quite hard continuing to work face to face during the national lockdowns so they have faced that fear and increased anxiety of travelling to work and worrying whether they will get ill because of COVID and passing it to other members of their families or their environment once they were leaving work. So for many people that experienced mental health difficulties before the pandemic, going through the COVID-19 pandemic it may have also exacerbated some of these difficulties. Also, from my observations working in a service during the pandemic I noticed how many male colleagues were more reluctant to request flexible working or leave when they needed and my hypothesis was that this may be linked to societies expectations of men during that period to be strong to be not vulnerable and to provide for the family during those difficult times. Titian: I mean that is all really important and I guess from my background as well it is worth mentioning the bits about, some of the thoughts about someone from a black, Asian, minority group background. Particularly on the stand that the term BAME covers a wide range of people with very diverse needs so we are not trying to bring in a term that is one size fits all kind of the thing. The things that I’m talking here I can only represent myself and I am coming much from my own experience but I guess it’s worth thinking why it is particularly difficult for male colleagues and it is worth holding in mind that some individuals experience may be even more difficult than ours. Perception, prejudice and judgement from colleagues or even service users may be at a different level. Particularly as well when we are talking about men, it is worth thinking that some of our colleagues may be identified as part of the LGBTQ+ community and we are aware there are existing discriminations against people’s gender identity, particularly where people are working in healthcare professions so it might have a profoundly negative impact on them as well. I guess we might not have too much to contribute to it but it’s worth holding it in mind. I guess my background, talking about different cultures and why it might have an impact on us. I’d say different cultures and gender have very different interpretations about mental health and thinking about what we have experienced. Men often find it quite difficult to express their feelings and difficulties. This may partly due to the gender role because we always have to, in a way, “pull our socks up” and go. And let’s be honest, when was the last time for the 3 of us talked about our own feelings and difficulties right, rather than sit down with a pint of beer and get on with life? It’s quite difficult. We’re not blaming men for not having that language to talk about it, it’s just sometimes it’s quite difficult. Panos: We’re not used to it. Titian: We’re not used to it, definitely. I guess speaking from my own culture, as an individual from an Asian country, my culture always taught me to just ‘shut up and go’ and to follow what the community think or what our mothers think so it was difficult to include our own thinking or our own feelings in conversation. One of the examples I’ll give is that during the pandemic, when the first Covid cases started, I didn’t know what to do or who to speak to and the last thing I wanted to do is tell my family that I’d been exposed to situations like that because I didn’t want them to worry. So, it has a profound impact on me as someone who came to the UK and tried to start a career here and one of the things I really don’t want to do is worry my loved ones. So yeah, it is quite difficult. Alex: And going back to the fact that male professionals are under-represented in the care professions, I always think how I have in the past been expected to be the male voice on a lot of issues that have come up in the workplace in relation to men’s wellbeing. I remember often being asked in work settings my opinion and expertise on certain issues that some male clients may have experienced which I guess was quite helpful for some people but at the same time it’s quite unfortunate because I have my own perspective based on my own background and my own experiences which may not always be representative of everyone’s experience. So, for example, my perspective into the experience of someone working within the NHS during the pandemic was influenced by the fact I was born and raised in a European country and I’m white and that may mean my experience is different from other people who come from a completely different background. Titian: And I guess it’s super stressful to work in a healthcare profession let alone the chaos of the last two years and a lot of the time, there is a priority on the outcome on the services we’re providing. So, a lot of the time we don’t get to stop and talk about how we’re feeling with the people that we trust. Panos: That’s a very good point. Working in a system where there is a lot of pressure can be quite challenging. It can contribute to feelings of despair or anxiety for all the reasons you’ve just mentioned. So, moving on to our next point of conversation and having thought about what you’ve just said, talking about stigma and shame, for example. What would you say to those male colleagues who might not speak up about their mental health because they’re afraid or ashamed to do so? Alex: I think stigma is quite a powerful force and men in particular experience the pressure to keep quiet about their mental health and to show no vulnerability. The cultural pressure is huge for many men; where the community stigmatises them for talking about their mental health or seeking professional support. Men are often taught from an early age not to cry, to hide their emotions and to be strong otherwise they may be perceived as weak. Many have built their identities on being solid and steady providers for their families, being a ‘rock’ and a protector for their children, their wives and their loved ones and often strength is associated with masculinity. The stronger or tougher they appear, the more masculine they are perceived to be by society or the community. Titian: Sometimes I’d be in fear of being judged by people. I’d want to put on a face in front of people and say ‘I am strong’. Alex: Also, opening up about mental health or showing signs of vulnerability or weakness may trigger a fear of losing that strength and for many people it may be a risk for their masculinity. Then, there is the professional pressure. While many workplaces have made significant progress to support mental health care the recent years, historically opening up about depression or anxiety in the workplace could cost people their jobs. There have been many stereotypes and assumptions that people experiencing mental health difficulties are not productive enough or they are unable to cope with their duties or they are not resilient enough. A lot of these beliefs have been internalised, which makes it difficult for men, in particular, to admit that they are struggling in the fear of losing their jobs and their networks. Titian: I guess for men, working in healthcare professions, they also often feel they have a responsibility to take care of the people in their families or outside of work which is an additional level of pressure. I feel like I have to be strong, like I have to provide. Alex: Yes exactly. I think that’s reflected in the data we have from the NHS which shows us that women are more likely to seek help for mental or physical health problems. Whereas for men, their engagement with services is more sporadic and less frequent than women. As Panos said earlier, the numbers of male suicide are much higher. For the NHS workforce and frontline staff, they face increasing risk in regard to their mental health which accounted for over ¼ of staff sickness absences. We know that over the past few years, male frontline workers often didn’t seek help and they were disproportionately affected by those problems. Titian: Thinking about my own experience, I found it difficult to seek help because firstly, I wasn’t entirely sure where the resources are and also I worried about the consequences of seeking help. Panos: Yes, the worry about how men will be seen when they talk about their vulnerability? Titian: Yes. I guess for me as well, coming from an entirely different cultural background. When I tried to talk about my struggles, I had a certain level of fear that people wouldn’t be able to understand it but if you think about it, it’s more my own worry than the person in front of me not being to understand what I’m going through. Sometimes for me, it’s about taking that first step and talking about what I’m feeling or thinking in order to open up to the conversation about what might be helpful for me. Alex: And I guess those worries may be linked to the stereotypes that we know about the history of male evolution, where men were portrayed as hunters or fighters. However, we live in a modern world and things have significantly changed. So, I think one of the important steps is deconstructing these ideas of masculinity and power and support seeking. For example, men can be given the message that they are taking control by seeking help rather than losing control by doing that. Panos: And this is what we’re trying to say in this podcast, that men need to reach out and seek support when they feel they need it. Alex: Yes, focusing on the idea of emotions and how expressing emotions Is not a bad thing but think about how emotions are a core sign of human existence and survival. By paying attention to our own emotions, it is more likely we will be able to manage. So, opening up and being reflective about our emotions can be scary but it’s one of the first steps we can do to deal with distress. Titian: Yeah and I guess thinking about that, being able to recognise how difficult the situation is, is often a great start. Instead of thinking of it as a way of showing our vulnerability, it’s actually showing how courageous you are being able to accept people’s assistance, support, and all kinds of resources that can help you to move forward. Because when you are going on a lifelong journey of supporting other people’s mental health, or even other people’s health, you have to take care of yourself as well. Along the journey, it is important for us to also have that level of compassion towards our self- being able to open up, being able to recognise it…okay, this is really difficult now. What can I do- shall I speak to somebody? Should I open up to somebody- at least to get some support from there. Just so we are well-rested and recuperated so that we can move on to the next step in our career, in our life- whatever that may be. Panos: Yeah, agreed. And thinking about now the last part of our conversation – what has helped during these difficult last two years, two plus years we have all been through. What has helped you keep going through the pandemic, and now as you learn to live with Covid, any advice or tips you would like to share with our male colleagues that, of course, would be applicable to both male and female colleagues? Titian: Well I mean for me it’s definitely having a good structure for the day. It could be structuring your work day or structuring your weekends as well. Having a good routine of meeting our basic needs … I would 100% make sure that I eat properly, keeping my body healthy. I know a lot of people would struggle with their sleep as well. There are plenty of resources, plenty of ways that you can help with your sleep. It might be something to do with your sleep hygiene, how you can keep well with the way you build a wind-down routine before you go to bed as well. And I guess it’s also important to have regular breaks and finish work on time. I know this is something quite difficult within the NHS, but if it’s some kind of boundaries that we need to try and enforce, anything to keep our self well in that sense. And you know, thinking about workspace as well. It was really helpful for me to connect with other colleagues and actually talk about how bad it might be at work, and how terrible it might be at a certain time of the day, and it’s always good for me to talk to people around me. So my friends, my family, my colleagues…sometimes it’s good to connect with my culture as well. For someone it might be their faith. I always have a really nice meal for my birthdays whenever I feel sad, just to give me that level of satisfaction and connection, and maybe a little bit of nostalgia in there, but it’s also really very important for me to be connected with my roots, knowing that I am not alone. Alex: Of course. And also within the workplace, it can be quite helpful to make use of all the NHS resources on wellbeing that are available. Make sure that we do use all of team opportunities within the teams we are working, and make sure we are using the reflective spaces that are available within teams. Also, using line management supervision can be help us to talk about some of these issues, and problem-solve some of the challenges we may face- so supervision, and line management supervision can really help at times. And of course, joining networks and unions can really help us connect with other people and also, to make some significant kind of systemic change if there’s any need. Panos: Of course, and we have a role as well at the Keeping Well NCL Hub in supporting people who might need to have some kind of signposting opportunities for some psychological therapy or if a line manager is wanting some kind of reflective intervention, reflective space for their team to process difficult things. This is something we can offer and people can get in touch with us, have a look on our website. You mentioned sleep hygiene- mindfulness as well. We have lots of resources that people can use to help themselves, but also to reach out for professional support if needed. Titian: Definitely. Panos: So I want to thank you both for this discussion, I think it’s been very very interesting and helpful. Titian: It’s my pleasure to be here. Alex: Thank you. Panos: Thank you both Titian: Thank you. Panos: Bye.

Panos Vythoulkas, clinical psychologist and KeepingWell NCL Hub Senior Practitioner, talks in-depth with first-year trainee clinical psychologists Alex Tsefos and Titian Tam about how it feels to be a man working in caring professions. They discuss the impact on male healthcare workers’ emotional wellbeing, gendered stereotypes around mental health, and the importance of seeking help when you need it.

Drawing on their first-year placement in a London Home Treatment Team, Titian and Alex also share with Panos some of their personal and professional experiences of working in a caring profession, and some self-care tips.

This podcast runs for 28 minutes. Take a moment for yourself by finding a quiet place to sit and listen, and think about how your feelings and experiences relate to their discussion.

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