Where Are All the Men? A Model for Explaining the Barriers to Men’s Access to Professional Mental Health Support

Introduction

The study of men and masculinity has gained momentum in recent years, with a growing recognition of the need to develop knowledge about men’s psychology and effective intervention tools to help them in times of distress. However, it is evident that the field of mental health treatment has largely neglected this area. Professionals are not adequately trained to provide gender-sensitive responses for men—responses that take into account the psychological, social, and cultural components shaping their gender identity and influencing their treatment (Baum, 2006; Furman, 2010; Winnett, Furman & Enterline, 2012).

This article aims to promote, through a theoretical model, a deeper understanding among professionals of one of the most concerning phenomena in men’s mental health treatment—compared to women, men tend to avoid seeking professional mental health assistance or accessing services designed to support individuals in distress, even when they are in need.

Based on previous research and knowledge from the field, the model explains the three main barriers preventing men from seeking professional mental health help. The first explanation addresses men’s negative attitudes toward mental health assistance. The second focuses on the lack of specialized services tailored to men. The final explanation highlights the fact that even when services are available, many suffer from gender blindness. Additionally, I will discuss ways to enhance men’s motivation to seek professional mental health support.

Men and Seeking Professional Mental Health Assistance

When examining the issue of seeking professional mental health assistance, it becomes clear that despite the availability of services and interventions aimed at alleviating suffering and promoting well-being, the decision to seek help is not an easy one (Vogel, Wade & Hackler, 2007). In fact, only one-third of individuals who need mental health support actually turn to professionals or mental health services (Andrews, Hall, Teesson & Henderson, 1999).

From a gender perspective, research findings show that men are less likely than women to seek professional mental health support and are more inclined to hold negative attitudes toward doing so (Addis & Mahalik, 2003).

In Israel, literature on gender-sensitive therapy for men and men’s psychology remains scarce (Baum, 2006), including data on the prevalence of men who voluntarily seek mental health support across different settings. However, a comprehensive study conducted across five countries examining the prevalence of mental health treatment among individuals with mental disorders found that young men with lower levels of education receive the least mental health support compared to other population groups (Bijl et al, 2003). There is broad consensus that men seek mental health assistance significantly less frequently than women when experiencing psychological distress (Ang, 2004; Arnocky, 2014; Addis & Mahalik, 2003; Husaini, Moore & Cain, 1994; Nam, 2010; Rickwood & Braithwaite, 1994; Oliver et al, 2005; Robertson & Fitzgerald, 1992; Kovess-Masfety et al, 2014).

Moreover, men are less likely to seek professional mental health assistance than women even when experiencing the same level of distress (Kessler, Brown & Bromen, 1981) and when suffering from depression, addiction issues, or stressful life events (Mansfield, Addis & Mahalik, 2003). This is further supported by a report from the World Health Organization (WHO) on suicide, which identifies men’s reluctance to seek mental health assistance as one of the contributing factors to their higher suicide rates compared to women (WHO, 2014).

Men who do seek mental health support often do so due to external motivation. A study examining personal motivation versus external encouragement for seeking mental health services among men found that 96% of the men surveyed sought help due to encouragement or involvement from an external source (Cusack, Deane, Wilson & Ciarrochi, 2004). According to this study, the primary sources of encouragement were close family members or general practitioners. Similarly, in the field of social welfare, many men seek professional assistance due to external motivations—mainly fear of the personal and legal consequences they may face (Addis & Mahalik, 2003). This fear often stems from the involvement of law enforcement agencies and their recommendations for men to seek mental health support, as well as the awareness that they are under the scrutiny of these systems.

Although data is limited, social workers in the field of correctional services (offenders) generally agree that men are more likely to accept mental health support from these services, even if they do not personally believe they have a problem or need professional help. This is reflected in data from a report by Israel’s Ministry of Welfare and Social Services (Social Services Review 2013), which shows that in the field of correctional social work, men make up 90% of clients in the adult probation service, 80% of clients in the juvenile probation service, 62% of youth in residential care facilities, and 81–84% of those receiving treatment for addiction within the Ministry’s frameworks.

Despite the concerning findings regarding men’s reluctance to seek professional mental health assistance, it is only in recent years that there has been widespread recognition that this tendency constitutes a significant issue affecting men’s physical and mental health, as well as their overall quality of life (Good et al, 1996; Courtenay, 2000). In discussing this issue, Rochlen states:

“Men’s attitudes toward seeking mental health support, their willingness to seek help, and their actual help-seeking behavior remain among the most concerning issues in men’s health. The low rate of men’s engagement with psychological services is one of the most stable findings in research related to help-seeking behavior in mental health” (Rochlen, 2014, p. 3).

The Barrier of Attitudes Toward Seeking Mental Health Support

A variety of factors influence the decision to seek mental health support. These include demographic variables such as ethnic background (Chang & Chang, 2004; Soheilian & Inman, 2009) and age (Berger et al., 2005; Nam, 2013), as well as personal factors like awareness of the problem (Mansfield, Addis, & Courtenay, 2005), attachment style (Shaffer, Vogel & Wei, 2006), expectations regarding the benefits of therapy (Vogel, Wester, Wei & Boysen, 2005), fear of psychological treatment (Kushner & Sher, 1989), tendency toward depression (Carlton & Deane, 2000), psychological distress (Deane & Todd, 1996), alexithymia (Berger et al., 2005), willingness for self-disclosure (Pederson & Vogel, 2007), fear of stigma (Soheilian & Inman, 2009), stigma associated with seeking mental health support (Vogel & Wade, 2009), level of social support (Vogel & Wei, 2005), masculinity ideals and gender role conflict (Addis & Mahalik, 2003; Good, Dell & Mintz, 1989), prior experience with psychological treatment (Deane & Todd, 1996), sexual orientation (Sánchez, Bocklandt & Vilain, 2013), treatment accessibility, cost, and more.

However, there is broad consensus that men’s reluctance to seek professional mental health support is primarily linked to their negative attitudes toward seeking help and mental health services. These attitudes are considered the most common explanation for this phenomenon (Addis & Mahalik, 2003; Fischer & Turner, 1970; Komiya, Good & Sherrod, 2000). Such attitudes manifest in men’s tendency to ignore physical or psychological pain and avoid seeking help from doctors and mental health professionals (Mahalik & Addis, 2003). Moreover, they can strongly predict whether men will seek treatment or avoid it altogether (Rosenzweig, 2007; Cramer, 1999; Lane & Addis, 2005).

Denial of Vulnerability

The process of socialization into gender roles and the reinforcement of an ideology rooted in traditional masculinity help explain men’s negative attitudes toward seeking professional mental health assistance (Addis & Mahalik, 2003; Fischer & Turner, 1970; Komiya et al., 2000; Leong & Zachar, 1999; Mackenzie, Gekoski, & Knox, 2006). The concept of “traditional masculinity ideology” was first introduced by Brannon (1976), referring to a specific societal perception of masculinity—a set of beliefs and expectations about what a man should or should not do. This perspective is based on the social constructionist theory of gender and the theoretical framework of “gender role strain” (Pleck, 1995), which views masculinity as a social construct rather than a psychological or biological trait. Therefore, masculine ideology should not be considered a personality dimension but rather a set of attitudes that an individual holds regarding masculinity in general and ideal masculinity in particular (Pleck et al., 1995).

The internalization of traditional masculinity ideology, which according to Brannon (1985) includes anti-femininity (“No sissy”), being a respected provider (“Big wheel”), emotional toughness (“Sturdy Oak”), and risk-taking (“Give ’em Hell”), is fundamentally at odds with seeking mental health assistance as a response to distress among men (Baum, 2006; Addis & Mahalik, 2003; Good & Wood, 1995; Robertson & Fitzgerald, 1992). For a man to seek professional help, he must acknowledge his need, admit his vulnerability to another person, and place trust in others. Seeking mental health support is linked to recognizing emotional problems, exposing them to someone else, and admitting the need for help—all of which contradict societal messages about masculinity (Mahalik, Good & Englar-Carlson, 2003). Furthermore, men who internalize these ideals learn to value independence, deny vulnerability, and perceive men who seek mental health support as “weak” (Davies et al., 2000).

Levant (2006), drawing on gender role theory, formulated five key social beliefs about masculinity that have been internalized by men and contribute to their reluctance to seek professional mental health assistance:

1. Seeking help is a sign of weakness – This belief makes it difficult for men to acknowledge the existence of a problem and increases their need to deny it.

2. Dependence on others and forming attachments are unmanly behaviors – Men are expected to “succeed on their own.”

3. Men should suppress their emotions – This belief leads to a lack of emotional vocabulary among men, making it difficult for them to articulate their issues.

4. Men should adopt a stoic stance regarding their emotions – This reinforces their fear of being in an intimate space, which may be experienced during therapy.

5. Beliefs about male sexuality – Men may struggle to separate emotional intimacy from sexual desire, leading to anxiety about potential sexual tension with a female therapist or homophobic fears when seeing a male therapist.

Differences in Attitudes Toward Seeking Professional Help

As mentioned, the internalization of social perceptions of masculinity indeed influences men’s attitudes and motivation to seek psychological assistance. However, men are not a homogeneous group, and there are differences both between male communities and within them regarding attitudes toward seeking professional mental health support. Connell (1995) criticizes the attempt to present a single model of masculinity, arguing instead for the existence of multiple masculinities, which manifest across different communities and among men within those communities. Indeed, studies have found variations in men’s attitudes toward seeking mental health assistance based on ethnic background (Lane & Addis, 2005; Vogel et al., 2011), socio-economic status (Bijl et al., 2003), and sexual orientation (Cochran, Sullivan & Mays, 2003; Vogel et al., 2011).

While Levant (2006) suggests examining the influence of idealized masculinity on men’s decisions to seek psychological help, O’Neil’s (1981) Gender Role Conflict Theory provides a theoretical and empirical framework for understanding the variation among men. It is one of the most widely used empirical foundations for explaining this issue. This theory is based on the premise that the socialization of masculine roles in Western society and men’s identification with them have negative cognitive, emotional, and behavioral consequences (O’Neil et al., 1986). The theory emerged from Pleck’s (1981, 1995) Gender Role Strain paradigm, which describes the tension men experience due to the “discrepancy between the self and the ideal self as defined by cultural gender expectations” (Pleck, 1981, p. 278).

Building on the Gender Role Conflict paradigm, O’Neil formulated six dimensions of the “ideal self” as perceived in Western culture among men: power, success, competitiveness, suppression of emotional expression, avoidance of affection between men, and conflict between work and family. Due to the pressure placed on men to conform to this “ideal self,” which represents culturally valued masculinity, men experience an internal conflict between their authentic selves and the idealized masculine self they have internalized (O’Neil, Good, & Holmes, 1995; O’Neil, 2015).

Since gender roles as defined in modern culture are rigid and their consequences involve restrictions, diminished self-esteem, and harm to oneself or others, men experiencing high levels of gender role conflict may fear acting contrary to societal expectations of masculinity. This fear stems from anxiety over any perceived femininity in their self-identity and the potential social sanctions associated with it (O’Neil et al., 1986; O’Neil, 1990). The higher the intensity of this conflict, the more men tend to conform to social and cultural expectations of masculinity rather than acting according to their authentic needs and desires.

Following the development of Gender Role Conflict Theory, numerous empirical studies have been conducted across different populations. These studies have consistently demonstrated a strong correlation between adherence to traditional masculinity ideology, gender role conflict, and psychological distress (O’Neil, 2015, p. 24). The findings suggest that men who strongly uphold traditional masculinity and experience high levels of gender role conflict are more likely to hold negative attitudes toward seeking mental health support, even when they need it (Blazina & Watkins, 1996; Fischer & Turner, 1970; Good, Dell & Mintz, 1989; Good & Wood, 1995; Komiya, Good, & Sherrod, 2000; Mahalik, Good & Englar-Carlson, 2003; McCusker & Galupo, 2011; O’Neil, 2015; Robertson & Fitzgerald, 1992).

Addis and Mahalik (2003), drawing on Gender Role Conflict Theory, propose that men’s decisions to seek psychological help are influenced by the degree to which they perceive help-seeking as a threat to their masculinity. They developed a model for analyzing differences among men in this context, suggesting that men base their decisions on five cognitive and emotional variables:

1. The extent to which they perceive their psychological distress as normative – whether they believe many people experience similar issues.

2. The extent to which the problem is perceived as non-central to their ego – whether they see the issue as not fundamentally defining their identity.

3. The extent to which they believe they can reciprocate the help received – whether they feel they can give back in some way to the helper.

4. The extent to which they expect support from other men in their social network – whether they believe their peers will encourage and validate their decision to seek help.

5. The extent to which seeking help is not perceived as a loss of control – whether they feel that getting help will not compromise their sense of autonomy.

Given this, it can be assumed that the gender roles defined in a given society and internalized by men within that community may create an internal conflict between their desire to conform to masculine norms and their need to seek professional help in times of distress. The intensity of this conflict significantly explains the variation in men’s attitudes toward mental health help-seeking. These attitudes, in turn, have a direct impact on men’s engagement with mental health services designed to address their psychological needs. However, the issue is more complex, and these attitudes alone do not constitute the only barrier preventing men from seeking help.

Limited Social Services for Men and Lack of Accessibility

The homepage of the Israeli Ministry of Welfare and Social Services website provides extensive information about the various services it offers, including details categorized by target populations. Under the “Target Audiences” section, women receive significant attention. A deeper look at this page reveals a range of specialized services tailored to different groups of women, such as adolescent girls and young women, women struggling with addiction, women involved in prostitution, victims of domestic violence, and unmarried pregnant women (molsa.gov.il). However, men are not recognized as a distinct group, and no dedicated services for them exist.

A review of the book Social Work in Israel, edited by Hovav, Leventhal, and Katan (2012), which aims to compile and cover the various aspects of social work in Israel, reveals a full chapter dedicated to feminist social work (Peled & Krumer-Nevo, 2012). This chapter focuses entirely on gender-sensitive interventions for women, yet does not address men as a target population. Compared to women, professional literature in the field of social work rarely considers men as a group with unique needs (Baum, 2006), despite the fact that Israel’s welfare and social service system also provides psychosocial assistance to men.

This phenomenon is not unique to Israel. Farrell (1998), a key advocate for discussions on masculinity, men, and social services in the United States, highlights in his article “Do We Care More About Saving Whales Than Saving Males” the dire state of social services for men and the lack of visibility of men’s struggles among mental health and welfare professionals in the U.S.

Unique Characteristics of Men’s Distress

The disregard for men’s distress and the lack of psychological services tailored for them is not coincidental. A review of research on men’s psychology reveals that early psychological studies primarily used men as the reference point for analyzing other social groups, without critically examining masculinity, men, and their unique psychological needs. Masculinity was considered normative, adaptive, and associated with healthy functioning, whereas deviations from this normative and idealized masculinity were seen as problematic (Wester & Vogel, 2012). Furthermore, hegemonic masculinity was perceived as a natural, inherent state rather than one influenced by familial, social, and cultural contexts (Hare-Mustin & Marecek, 1990).

Men are still viewed as the dominant gender, and this perception is reinforced by the ongoing reality of social gender inequality that continues to disadvantage women. At the same time, when men experience distress, they often struggle to articulate their need for help, and some may even channel their distress into aggressive behavior. Consequently, discussions about men’s struggles seem foreign to the existing social discourse. This is reflected in the terminology used for social services for at-risk youth in Israel, which has only recently been updated. While services for girls were previously called “Services for Girls in Distress,” the equivalent services for boys were referred to as “Youth at Risk Services.”

Despite the difficulty in recognizing men as a group experiencing psychological distress, the data presents a different picture. Men do experience distress, and some of their struggles are unique to them. Partial data indicates that 31–47% of men will develop substance dependency issues at some point in their lives (Cochran, 2005). Additionally, according to the 2015 report from the Israeli Prison Service, 98.6% of criminal offenders incarcerated in Israel are men (ips.gov.il). It is reasonable to assume that many of these men adopted criminal behaviors—sometimes from a young age—due to the distress they experienced. Moreover, incarceration itself generates significant psychological distress among men.

Additionally, recent data from the United Nations’ global suicide report covering 172 countries reveals that men commit suicide at a rate 3.5 times higher than women (WHO, 2014).

Thus, just as children and women are vulnerable to specific risk factors and some of their struggles have distinct characteristics, men should also be recognized as a group with unique challenges requiring gender-sensitive solutions.

An Invisible Population

A review of the Israeli Ministry of Welfare website and a general internet search indicate that Israel lacks dedicated services for men in various areas specific to their needs. These include non-custodial fathers, single fathers, fathers transitioning into parenthood, male victims of violence, abused men in domestic violence situations, unemployed men, men experiencing loneliness due to communication disorders, estranged fathers, and widowed elderly men. Even if such services do exist, they are not easily accessible to the general public, and there is a significant lack of available information to help these populations cope with their distress.

When men are addressed as a distinct group and encouraged to seek help, it is usually in the context of their potential for violence. For example, the only public outreach campaign in Israel in recent years (2011) that specifically targeted men as a gender group focused on domestic violence, urging men to seek professional help for their abusive behavior toward their partners. The official explanation on the website of WIZO’s “Step Out of the Shadow” campaign, which led to the establishment of a hotline for men involved in domestic violence (a service still active today), states:

“This is an unprecedented appeal from a women’s organization to violent men, who have previously only appeared in such campaigns as a faceless, threatening shadow. For the first time, this campaign attempts to describe the feelings and factors that drive men to act violently toward their families and demands that they take responsibility for their actions and ‘step out of the shadow’—seek treatment and stop harming their loved ones. WIZO believes that addressing only the women affected by domestic violence, as has been done for many years, will not lead to true and complete change. Only by raising awareness among men and recruiting them to deal with their violent tendencies can we significantly reduce the phenomenon of domestic violence.”

(http://www.wizo.org.il/page_32874)

While the fight against domestic violence and the need to help men manage their distress in non-harmful ways is crucial, this campaign raises an important question: Who is the actual client of this service? (Raz, 2014). Did the creators of this hotline intend it to be a service for men in distress, or was it primarily designed as an additional service for women and children suffering from male-perpetrated violence?

Moreover, many of the social services available to men are stigmatizing, which discourages them from seeking assistance even when they need it. A prime example of this is the domestic violence prevention centers operated by local municipalities in Israel, which men perceive as facilities primarily focused on preventing male violence against women. This labeling reinforces the broader social stigma associated with seeking welfare and mental health services, which often portrays those who seek help as weak, unstable, or have lost control over their lives (Corrigan, 2004).

It turns out that logistical factors, such as waiting times, availability of services, and privacy concerns, also affect men’s willingness to seek mental health support. Tudiver and Talbot (1999) found that long waiting times in reception areas, limited office hours, and the need to disclose the reason for their visit in a public waiting room all serve as barriers preventing men from seeking mental health assistance. Additionally, given the work-family conflict experienced by many men, they are less likely to attend services that are only available during morning hours.

Furman (2010) notes that when it comes to developing social work programs for the most impoverished and vulnerable populations, men are the most invisible group. There is indeed a pressing need to design and develop welfare and psychological services for men within a multicultural framework (Levant, 1990). According to Vlassoff and Garcia Moreno (2002), incorporating gender considerations into the planning of health services can improve service delivery for all genders in several ways. These include better identification and treatment of issues affecting previously overlooked groups, a more accurate understanding of the epidemiological aspects of psychological distress in a gendered context, improved recognition of unique factors influencing how different genders perceive and address problems, increased relevance of treatment services for target populations, and greater outreach to potential clients who could benefit from existing services. This approach challenges the traditional notion that a single, uniform service is effective for everyone. A clear example of this approach in action is the development of specialized welfare services for girls and women in Israel (Peled & Krumer-Nevo, 2012).

Given the above, there is a critical need to develop gender-sensitive services for boys, young men, and adult men that address the unique characteristics of their distress throughout the life cycle (Levant, 1990, 2006). Gender-sensitive services for men must be both attuned to them and responsive to them. These services should be aware of the psychological and social processes influencing men’s thinking, emotions, and behaviors. Furthermore, they should acknowledge men’s concerns about seeking help and provide therapeutic tools and communication methods that accommodate these apprehensions.

The Barrier of Gender Blindness

Beyond negative attitudes toward seeking professional mental health assistance and the lack of gender-sensitive services for men, gender blindness in the diagnostic and intervention processes is another major barrier preventing men from receiving appropriate treatment when experiencing psychological distress.

Only recently has awareness been growing regarding more effective diagnostic and therapeutic tools for the psychological treatment of men. This is reflected in the expanding body of professional literature on interventions and psychotherapy tailored for men. Despite these developments—including the establishment of Division 51 of the American Psychological Association (Society for the Psychological Study of Men and Masculinity – Division 51)—many mental health professionals remain unaware of the importance of integrating gender-sensitive approaches when working with boys, adolescents, and men.

Depression in Men and Gender Bias in Diagnosis

Depression in men is one of the most extensively researched topics highlighting gender bias in mental health diagnosis (Glazerman, 2014; Laufer & Berman, 2014; Addis, 2008; Cochran & Robinowitz, 2000; Pollack, 1998). Professional literature often states that depression rates in women are twice as high as in men. However, growing skepticism among researchers questions this statistic, as it is now understood that many cases of male depression go undiagnosed. This is due to the unique ways men express pain, helplessness, and grief—manifestations that differ from the symptoms outlined in commonly used diagnostic tools, such as the PHQ-9 depression screening questionnaire.

Among men, symptoms of depression do not necessarily align with conventional indicators such as low energy, sadness, social withdrawal, and decreased self-esteem. Instead, depressive symptoms in men tend to be more covert and less outwardly expressed (Glazerman, 2014). Cultural expectations for men to suppress sadness and avoid crying contribute to difficulties in diagnosing depression in male patients. Pollack (2005) describes the “mask of masculinity” as a frequent defense mechanism that shields men from openly expressing pain and grief. This often manifests in substance abuse, workaholism, hypersexual behavior, and even violent tendencies. These factors may contribute to the apparent lower depression rates in men compared to women and the concerning data on male substance abuse and suicide rates.

Postpartum depression is another area where men are significantly underdiagnosed due to societal focus on motherhood. The transition to fatherhood is often studied primarily from the perspective of women, while men, who are less likely to disclose their emotions when in distress, are frequently overlooked (Komiya, Good & Sherrod, 2000). Research has shown that the emotional changes men experience during the transition to fatherhood can lead to stress and psychological distress, manifesting as chronic fatigue, anxiety, and depression (Condon, Boyce & Corkindale, 2004; Giallo et al., 2012, 2013; Seymour et al., 2014). Additionally, studies indicate that 15% of new fathers have partners experiencing postpartum depression, placing them at 2.5 times greater risk of developing depressive symptoms themselves. Empirical research suggests that 5–10% of men experience postpartum depression within their first year of fatherhood (Berger, 2010; Condon, Boyce & Corkindale, 2004).

Clash of Perceptions

Another issue frequently criticized regarding gender bias in diagnosis and treatment is the neglect of male victims of domestic violence. Accumulating research (Fiebert, 2012) indicates that domestic violence services primarily focus on violence against women while overlooking substantial evidence—both from research (Straus, 2010, 2012) and clinical cases—demonstrating the prevalence of reciprocal violence in relationships, as well as female-perpetrated violence against male partners (Williams et al., 2008).

Ben-David (2014), in her article “Male Victims in the Family – Does Such a Phenomenon Exist?”, reviewed extensive research and concluded:

“Given the evidence presented, one must ask why research on violence in heterosexual relationships and family settings continues to focus exclusively on violence against women, while other victims—children, men, and the elderly—receive far less attention. Furthermore, why is there such a strong emphasis on men as perpetrators, with little discussion on female-perpetrated violence? Three main perspectives can be considered: social perceptions, the feminization of domestic violence discourse, and the influence of feminist advocacy on shaping public policy.” (p. 24).

Barriers to Therapeutic Interventions

Gender insensitivity among mental health professionals and services further discourages men from seeking psychological support. Most academic training programs for social work and psychology in Israel do not include education on male psychology or gender-sensitive therapy for men. Consequently, social workers often struggle to recognize the connection between men’s internalized masculine ideals and their ambivalence toward seeking mental health treatment (Engler-Carlson, 2006). Many professionals also fail to acknowledge the impact of gender role conflict on male distress, which includes factors such as competitiveness, ineffective anger expression, intimacy and sexual issues, work-family conflict, parenting challenges, and the psychological toll of patriarchal expectations.

Additionally, many therapists do not fully grasp the complexity of men’s emotional worlds, where alexithymia (Levant, 1998) and the mask of masculinity (Pollack, 2005) are not indicators of emotional incapacity but rather learned coping mechanisms for processing emotions.

This issue is further complicated by the multicultural nature of Israel’s welfare system (Rabin, 1999). Many communities that interact with welfare services in Israel adhere to traditional gender norms. Brooks (1998) argues that there is a cultural clash between men who adhere to traditional masculinity and therapy services that promote new models of masculinity. This conflict arises for several reasons:

1. Rejection of psychotherapy – Traditional men often reject therapy because they perceive it as feminized, believing that mental health services view male clients as weak, needy, and powerless.

2. Mismatch in expectations – Traditional men have different expectations of therapy and therapists compared to the prevailing attitudes in social service professions.

3. Perceived bias against men – Some men believe that mental health professionals, particularly women in these roles, are biased against men and favor women.

4. Lack of representation – Many traditional men feel that therapeutic communities fail to recognize their unique needs and challenges.

This negative perception is reinforced by the fact that most mental health professionals are women who often support liberal and gender-equality values. Traditional men may view these values as conflicting with their worldview, further discouraging them from seeking help. For men with strong traditional masculine ideologies, the association of therapy with liberal values may create an additional barrier, pushing them even further away from seeking support.

The Role of Therapists’ Gender in Male Engagement with Therapy

The fact that most mental health professionals are women raises the question of whether this discourages men from seeking professional psychological support. Few studies have examined the impact of therapist gender on treatment outcomes for men, and existing research does not provide clear conclusions regarding its influence (Owen, Wong, & Rodolfa, 2009). However, research suggests that male clients prefer therapists who exhibit stereotypically feminine qualities, regardless of the therapist’s biological sex (DeGeorge et al., 2013). Johnson (2005) found that men often prefer female therapists, citing reasons such as feeling more comfortable expressing pain to women, perceiving women as more empathetic, and having negative past experiences with male professionals. Mazur (1989) also found that men are more likely to disclose emotions to female therapists than to male therapists.

Despite these encouraging findings regarding male clients’ attitudes toward female therapists, the feminization of the mental health profession has several implications. First, social work as a profession tends to focus more on women’s issues, primarily serving female clients and employing a female-centric therapeutic approach (Kosberg, 2002; Baum, 2006). Additionally, gender stereotypes internalized by female professionals influence their interventions with male clients (Cree, 2001).

Johnson (2005) argues that female therapists must be aware of their perceptions of men and masculinity, just as they are conscious of their biases regarding women and femininity. She suggests that working with male clients and engaging in supervision groups with male therapists can increase awareness of gender biases. Given that social work heavily involves family and parenting issues, professionals’ attitudes toward fatherhood, child-rearing, relationships, custody disputes, and power dynamics in the family can significantly impact men’s willingness to seek help in these areas.

Finally, the therapeutic language itself, often centered on emotional expression, can deter men from seeking psychological support. Men in distress tend to value problem-solving approaches over emotional disclosure, leading many to view traditional therapy models as alienating (Kilmartin, 2010). Rochlen (2014) describes this as a “cultural crisis” between masculinity and psychotherapy, emphasizing the need for therapeutic approaches that align with how men naturally form connections and open up.

Implications and Recommendations

To encourage men to seek professional mental health assistance, the first challenge in social work is to avoid blaming men for their reluctance to seek help. Understanding their difficulty in seeking assistance within its cultural and social context will enable social workers to approach male clients with greater empathy and sensitivity (Johnson, 2005). Many men who encounter welfare services already feel judged—by their partners, families, and the legal system—due to their struggles in fulfilling their roles as partners, fathers, and responsible individuals. These men need support systems that understand them and show compassion toward their challenges.

Moreover, seeking professional mental health assistance is not a given. Due to the prevailing perception of social work and psychology, turning to these services is often seen as an admission of weakness, a sign of being unable to solve one’s problems independently. This negative stigma conflicts with the idealized image of masculinity as defined by society. The societal stigma surrounding mental health assistance, internalized by many men as self-stigma, prevents them from seeking professional help even when experiencing severe distress (Gur Apter, 2018). Research has shown that men are more likely than women to internalize the stigma associated with mental health services (Vogel, Wade & Hackler, 2007), leading them to avoid seeking help altogether.

To address this issue, efforts must be made to break the stigma surrounding mental health struggles and to increase men’s awareness of the benefits of seeking help. The more men perceive seeking mental health assistance as a normative behavior, the more likely they will support and engage in it when needed (Addis & Mahalik, 2003; Rochlen & Hoyer, 2005). Public campaigns encouraging men to seek mental health support through media outlets can help normalize reaching out for assistance with issues such as depression, trauma, addiction, grief, and loss. Such campaigns have proven effective in combating stigma in other countries. For example, public testimonies from well-known figures—including actors, politicians, and athletes—who have faced psychological struggles and sought professional help have been shown to raise awareness and promote help-seeking behavior among men (Addis & Mahalik, 2003; Kosberg & Sun, 2010).

In Israel, no nationwide campaigns have been launched to encourage men to seek help for issues unrelated to domestic violence. The only cases where such issues have been publicly discussed were through news articles and television reports. Examples include articles such as “The Silence of Boys Who Were Sexually Abused” (Ynet, 05.03.07) and “Combat Trauma Victims: We Are Not Treated Properly” (NRG, 12.11.2010). These reports represent some of the few attempts in Israel to normalize mental health struggles among men and to combat societal stigma surrounding male psychological distress.

Another method to reach male clients is by distributing informational brochures on mental health issues in key locations such as clinics, hospitals, and workplaces. A study examining the impact of informational pamphlets on career counseling for men found that brochures increased men’s appreciation for counseling services and reduced associated stigma (Rochlen, Blazina & Raghunathan, 2002).

Finally, to advance gender-sensitive approaches in mental health services, it is crucial to integrate gender-sensitive therapy for men into the training of social workers and mental health professionals (Baum, 2006; Kilmartin, 2010).

Conclusion

Social workers in Israel are now more prepared than ever to address multicultural perspectives and to critically examine the unique challenges faced by male clients. Social workers are increasingly exposed to multicultural approaches, making them more aware of cultural and social influences on men’s identities. Additionally, there is growing recognition that gender is a “silent and invisible” component that shapes the lives and experiences of both male and female clients. In recent years, the guiding principle in culturally sensitive mental health care has emphasized the need for gender-sensitive approaches for both men and women (Rabin, 1999; Englar-Carlson, 2006).

This article has sought to confront one of the most concerning issues in gender-sensitive therapy for men: their reluctance to seek professional mental health assistance when needed. There is a growing understanding of how social constructions of masculinity shape men’s attitudes and contribute to what is referred to as the “double risk” for men in distress—not only does the internalization of ideal masculinity contribute to psychological suffering, but it also discourages men from seeking professional help (Good & Wood, 1995).

This article presented a theoretical model based on the accumulated knowledge in the field of The New Psychology of Men to explain three primary barriers preventing men from seeking professional mental health assistance. While most research focuses on how societal perceptions of gender roles influence men’s attitudes toward mental health services, this article introduced two additional explanations: the service barrier and the diagnostic and treatment barrier. However, this article does not attempt to determine causal relationships between these factors. Further empirical research is needed to examine the theoretical model presented, including the relationships between these factors, the strength of their impact, and how they interact.

From an applied perspective, gender-sensitive practice in men’s mental health in Israel is still in its early stages—both in terms of professional training, the integration of gender awareness into existing services, and the development of unique intervention models tailored to men in a multicultural context. Promoting changes in men’s attitudes toward seeking professional help, developing specialized services for men, and increasing awareness among mental health professionals regarding the unique diagnostic and treatment needs of men—all of these efforts can improve access to mental health services for men. Furthermore, these changes will contribute to a more tailored, sensitive, and accessible mental health care system for men in need.

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