Men's mental health shame
Healthcare Counselling and Psychotherapy Journal, July 2020

Poor mental health can have a big impact on the workplace. Workers who are mentally distressed are more likely to perform badly, take time off sick and leave the job. Poor mental health not only takes a psychological but also a financial toll. A 2017 UK Government report¹ estimated the cost of poor workplace mental health to be about £9 billion, highlighting the importance of good mental health at work.

Construction is one of the largest industries in the country. It employs 2.7 million people (8% of the national workforce) and generates £150 billion annually (6% of the economy). But construction workers, a male-dominant workforce, are known to have serious mental health issues: 42% of construction workers suffer from a mental health problem (such as depression, anxiety and stress), which is more than twice the national average (17%).² Male construction workers are also four times more likely to die by suicide than the national average.³ The number of suicides due to mental health problems is 280 a year.⁴ In contrast, the number of deaths as a result of an accident at work has reduced from 200 to 40 in the past 60 years.

Evidence suggests that construction workers find it difficult to talk about their mental health. Construction News, an industry publication, recently reported that 30% of construction workers had taken time off because of mental health problems. But most (60%) did not tell their boss the reason for their absence.

Construction News also reported that a quarter of construction workers have considered suicide, but have told nobody.² A recent study identified the mental health shame of the construction industry.⁵ It found that construction workers are reluctant to reveal their emotional difficulties, which perhaps explains their reluctance to seek help. Mental health shame has been linked with mental health problems in many different populations: university students in healthcare subjects^6,7 (including psychotherapy)⁸ and business studies,⁹ UK hospitality workers¹⁰ and Japanese workers.¹¹ An individual who is ashamed of having a mental health problem therefore tends to be mentally distressed, or vice versa.

The relationship between mental health shame and mental health problems has not previously been explored in UK construction workers. But in 2018, researchers from the University of Derby (Dr Pauline Green, Professor David Sheffield and myself) carried out a research project, which was supported by a major highway construction company in the UK and included contribution and feedback from major highway clients and their wider supply chain. We agreed to explore self-compassion (being kind and understanding towards oneself in tough times), work motivation (why workers engage with work activities) and masculinity (characterised by restrictive emotionality, inhibited affection, success dedication, and exaggerated self-reliance), in addition to mental health shame and mental health problems.

Self-compassion has been linked to good mental health in many different populations. Readers of this journal will no doubt be aware from their practice and experience that people who are kind to themselves tend to have a high level of mental wellbeing.

Self-determination theory posits two types of motivation: intrinsic and extrinsic.¹² Intrinsic motivation is about inherent pleasure and satisfaction gained from a work activity. People who are passionate about and love their job engage with work because the work itself is rewarding. Extrinsic motivation is all about external rewards such as money, fame and recognition. People who work because they want to be paid are driven by extrinsic motivation. Unsurprisingly, we found that extrinsic motivation is related to poor mental health, higher shame, and unethical judgment, while intrinsic motivation is related to good mental health, lower shame, and ethical judgment.¹³

Lastly, we wanted to examine the relationship between masculinity and mental health. In many cultures, masculinity emphasises toughness, stoicism, acquisitiveness and self-reliance. Masculinity can prevent male workers from asking for help with their mental health issues, as implied by the common phrase: ‘Boys don’t cry’. But delayed treatment or no treatment can lead to poor clinical outcomes.

We put together a survey, which comprised self-report measures for mental health shame, mental health problems, self-compassion, work motivation, and masculinity. The survey was sent by managers to their teams, and we received responses from 155 workers – 138 males and 17 females. The average age of respondents was 40. Data were analysed through correlation and path analyses.

Our correlation analysis identified that:

• construction workers’ mental health shame was positively and strongly related to their mental health problems
• self-compassion was negatively related to both mental health shame and problems
• masculinity was positively related to extrinsic motivation.

The research findings suggest that:

• construction workers who feel ashamed to have a mental health problem tend to be mentally distressed
• workers who are kind to themselves tend to have less shame and fewer mental health problems
• workers who behave and think in a masculine manner tend to be driven by external rewards, rather than internal satisfaction, such as passion or curiosity.

In order to analyse how mental health shame was related to mental health problems, we performed path analysis, using self-compassion as a mediator. The results showed not only that mental health shame had a direct impact on mental health problems, but also that self-compassion mediated these two variables.

The findings of these two analyses indicated that mental health shame was strongly related to mental health problems, and that self-compassion was strongly related to both mental health shame and problems. The company that supported the research has organised mental health training across different levels of management, and for its workforce. However, the training does not, as yet, seem to have resulted in any identified or measured improvement in the mental health of its workforce.

The research suggests that workers are perhaps too ashamed to engage with mental health training. Imagine if you were invited to an event that aroused feelings of shame. Would you attend? Cultivating self-compassion might therefore be an alternative approach to boost mental wellbeing, bypassing mental health shame.

Surprisingly, masculinity was related only to extrinsic motivation, not to mental health shame, mental health problems or self-compassion. But it’s worth bearing in mind the possibility of response biases. Masculine personalities are related to repressive coping (denying negative emotions in order to preserve a good social image). In the predominantly masculine construction industry, workers might have displayed some bias when responding to self-report measures that explore emotions.

We visited the construction company, clients and wider supply chain to report our findings. The managers all showed an interest in our presentation – nodding and taking notes – until we came to the conclusion, when we recommended enhancing workers’ self-compassion. Typical comments were: ‘We don’t do self-compassion’ and ‘We don’t do self-pity’. It was agreed that many of the construction workers in the organisation would also associate self-compassion with something weak, fluffy, touchy-feely.

When we explained self-compassion, highlighting the difference between self-compassion and self-pity, the response was more positive. But a workshop on self-compassion was unlikely to attract many participants, so we decided to call it self-awareness or self-care, to minimise feelings of shame. 

Following this study, we also explored the relationships between mental health problems, mental health shame and work-life balance. We found that a good work-life balance was related to lower mental health problems and shame.¹⁴

A few months later, we were invited to an away-day with the company, where we provided self-care training. We introduced a couple of useful self-care exercises that staff could practise at work. For example, there was a workshop on self-care breathing. We put our hands on our stomach and felt it inflate as we breathed in, and deflate as we breathed out. Recent studies¹⁵ recommend that the exhale is twice as long as the inhale, in order to activate the parasympathetic system, which is related to comfort, soothing and compassion. In Japanese, breath is written as 息 (iki) consisting of self (自) and mind (心), suggesting that breathing is one way to engage with the mind. By paying attention to our breathing, we can be present, instead of feeling anxious or depressed. We practised self-care breathing individually; we also breathed together in the room. Participants reported feeling relaxed and safe, which is an important workplace psychological construct.

We also introduced reframing, which was noted as one of the most useful psychological skills in the workplace by Japanese managers.¹⁶ Reframing is about turning a negative into a positive. Rudolph the red-nosed reindeer is a great example. Rudolph was ashamed of his red, shiny nose. But Santa reframed the negative into a positive, by telling the reindeer that his nose would help him to see in the dark. Rudolph felt much better and happily delivered presents with Santa. As a manager, Santa increased Rudolph’s work engagement and motivation significantly in just a few seconds.

In the reframing exercise, we got into small groups of four or five people. First, everyone wrote down apparently ‘negative’ aspects of themselves. The other members of the group then reframed the negative into a positive. The construction workers enjoyed the exercise and left the workshop feeling much better about themselves. They were able to see their qualities from different perspectives, helping them to practise self-care.

We are currently evaluating the effects of these exercises and examining the changes in mental health and relevant factors. It is my greatest hope that our research will help not only workers in the construction industry, but also counsellors and other healthcare practitioners who work with men in all industries, supporting their self-compassion and self-care.

See Construction industry suffers silent mental health crisis in News update