Evidence In-Sight:
Strategies and resources to engage boys and
Contents
young men in mental health
services
TOC 1 – Level 1 (see formatting palette / styles)
Date:
March 2016
Engaging boys and young men in mental health services
Request summary ................................................................................................................................................ 3
Overview of inquiry ............................................................................................................................................. 3
Summary of findings ............................................................................................................................................ 3
Findings ............................................................................................................................................................... 4
Report context ................................................................................................................................................... 10
Search tools and terms ....................................................................................................................................... 11
References......................................................................................................................................................... 12
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Engaging boys and young men in mental health services
Request summary
In this report research was conducted to address the following questions:
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How can adolescent boys and young men be recruited to participate in mental health services?
What factors (e.g. barriers, incentives, etc.) affect young men’s participation in services, especially their initial
participation in new services?
What factors, resources and tips can be used to strategically offer mental health services to male youth?
We prepared the report given the contextual information provided in our first communications (see Overview of
inquiry). We are available at any time to discuss potential next steps.
Overview of inquiry
This report was developed for a mental health agency that specializes in youth peer support and youth engagement. The
agency was interested in strategies, resources and suggestions to increase recruitment of boys ages 13 to 18 to their
mental health services. They noted that when boys are able to begin participating in the agency’s events and meetings,
their retention rate is quite high. Families and parents often want their sons to participate in events but the youth
themselves are reluctant if they are new to the agency. The agency is already offering drop-in sessions so that youth can
participate in events without a commitment. The agency also plans to host focus groups and connect with boys and
young men who are already involved in programming. In the meantime, they are interested in best practices and related
literature to assist them with this issue.
Summary of findings
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Boys and young men seek health services, including mental health services, less than girls and young women
(Smith, Braunack-Mayer & Wittert, 2006).
Boys are less knowledgable about mental health issues than girls and face higher rates of mental health stigma
than girls (Chandra & Minkovitz, 2006). Even when boys and young men are able to recognize mental health
issues and identify appropriate supports, they tend to be reluctant to receive services because they want to
appear masculine and avoid stigma (Burns et al., 2013).
Although efforts to reduce stigma are thought to be helpful, boys’ and men’s health needs could be met more
strategically by tailoring services to increase their interest and engagement (Smith et al., 2006).
Young men in particular may be more likely to participate in services that capitalize on technology and the
internet (Burns et al., 2013; Ellis et al., 2012; Smith et al., 2006).
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Engaging boys and young men in mental health services

Community awareness and community-based initiatives may also be important for spreading the message about
mental health services to boys and young men who are particularly at risk for developing mental health issues
(Burns et al., 2013).
Findings
Factors that limit young men’s access to services
When boys and young men experience a mental health issue, they often do not access services for a variety of reasons,
including a lack of mental health knowledge and to avoid stigma. American adolescent boys were found to have less
knowledge of what mental health is compared to girls and had higher levels of stigma than girls (Chandra & Minkovitz,
2006). Specifically, boys were more likely to believe that seeking mental health supports indicated a person was weird,
different or weak. They were also more likely to conflate mental illness and intellectual disabilities. Accordingly, boys
were half as likely as girls to acknowledge willingness to access mental health services (Chandra & Minkovitz, 2006).
Even when boys and young men have adequate mental health knowledge and recognize the value of mental health
services, they are reluctant to actually receive help. The masculine ideal of being an independent and invincible source
of strength prevents young men from expressing emotion or seeking support from others (Emslie, Ridge, Ziebland &
Hunt, 2006; Moller-Leimkuhler, 2002; O’Brien, Hung & Hart, 2005). In Australia, a national study found that boys and
young men ages 16-25 often only begin using services when they reach a crisis point (Burns et al., 2013). At times,
suppressing emotion and maintaining a masculine presentation may even contribute to male suicidality (Emslie et al.,
2006). Recruiting adolescent boys may be especially difficult as they transition to independence and rely less on parental
support. When parents and families no longer accompany youth to appointments and events, it can be more difficult to
establish relationships with families, which in turn can further isolate youth (Cole, Kim, Lotz & Munson, 2016).
Strategies to increase young men’s access to services
Reducing stigma
Reports on Ontario youth in grades 7 to 12 show that while both boys and girls have unmet mental health needs, boys
are especially unlikely to seek professional help (Boak, Hamilton, Adlaf, Beitchman, Wolfe & Mann, 2014). Similar gender
differences are present among Australian youth (ages 16 to 24) in that less than one in four boys and young men said
they would recommend professional forms of support to others. Researchers attributed these gender differences to
stigma (Burns et al., 2013). Efforts to meet boys’ and men’s mental health needs have developed in different directions.
Community awareness initiatives that create a common understanding and appreciation for mental health issues can
help to reduce stigma across communities which may be especially important for boys and young men (Burns et al.,
2013).
Providing peer support can also help to reduce youth’s stigma, including their self-stigma (Alvarez-Jimenez et al., 2012;
Corrigan, 2006) while simultaneously providing social and interpersonal support (Canadian Mental Health Association,
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Engaging boys and young men in mental health services
BC Division, 2007). A youth peer support model was also shown to increase client recruitment among lesbian, gay,
bisexual and transgender (LGBT) youth ages 16-20, as clients were offered incentives to recruit other youth (Mustanski
& Liu, 2012). Youth can also provide psychoeducation to families, school staff and community leaders as well as help
other youth navigate services. In addition, peer support may be useful to provide easily accessible information on how
to seek help, manage stress, and create and maintain well-being (Burns et al., 2013)1 .
Technology
Men access health services less frequently than women and many men’s health needs are simply not met (Smith et al.,
2006). While explaining the harm of stigma to boys and men is important, some researchers and clinicians believe boys’
and men’s mental health needs could be met more strategically by tailoring services for boys and men (Willder, 2012).
Specifically, mental health services could be tailored to reach and attract adolescent boys and young men by capitalizing
on technology, such as online forums, social media platforms and computer games. Young men are more likely than
young women to visit online forums, play computer games, and access videos and/or music online (Ellis, Collin,
Davenport, Hurley, Burns & Hickie, 2012). As a group, Canadians spend more time online than any other country (CIRA,
2013), with 99 percent of Canadian students in grades 4 to 11 accessing internet outside of school (Steeves, 2014).
Reports on Ontario youth show that the vast majority of youth access the internet and social media websites daily and
that boys are more likely than girls to spend time online (Boak et al., 2014), so providing mental health information and
services online may increase access and engagement for Ontario’s boys and young men.
In Ontario, only 18 percent of boys in grades 7-12 sought professional mental health care from a physician, nurse or
counsellor compared to 26 percent of girls in the same grades (Boak et al., 2014). If mental health supports were
available on technology, researchers (e.g. Burns et al., 2013; Ellis et al., 2012; Smith et al., 2006) believe it could leverage
boys’ and men’s propensity to access and receive support because information and communications technologies align
with boys’ and men’s preferences for autonomy and anonymity (Ellis et al., 2012). An Ontario review of over 100 articles
examining technology-based mental health services for children, youth and families found that many online services
were able to provide information and services in a non-intimidating, youth-friendly format. Furthermore, technologybased services were thought to reduce stigma by breaking down barriers related to geography/location, culture, time
and other factors that prevent youth and families, including boys and young men, from seeking services (Boydell et al.,
2013). This review showed that many services were as effective as in-person services, if not more effective, although
further evaluation is needed as a number of services had not been evaluated (Boydell, Hodgins, Pignatiello, Edwards,
Teshima & Willis, 2013). Some policy makers were concerned about how technology could affect therapeutic
relationships (i.e. between clinicians and clients) but in general, technology was thought to be a positive way to enhance
services (Boydell et al., 2013).
1
Please note that we did not search for peer support literature for boys or young men specifically or find gender differences in peer
support literature. Peer support mental health programs are increasingly popular and have been found to be effective in youth
(Ansell & Insley, 2013) and adult (Sunderland & Mishkin, 2013) mental health programs in general.
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Engaging boys and young men in mental health services
It is worth noting that studies suggest that youth should limit their time online, as too much screen time could
contribute to mental health difficulties, including mood fluctuations and impulsivity (Dunckley, 2014; Lin et al., 2012).
Nevertheless, many progressive, Australian youth mental health initiatives recommend using technology to reach young
men because most youth already spend much of their time online (Burns et al., 2013; Ellis et al., 2012; Smith et al.,
2006). Given the reportedly high usage of the internet and social media among Ontario youth, similar technology-based
mental health strategies may be applicable. Using technology may be especially useful in attracting, engaging and
supporting youth who may not otherwise be able or willing to access mental health services. Boys and young men who
are geographically isolated, disabled, economically disadvantaged or marginalized because of other factors may
especially benefit from online mental health information and services (Burns et al., 2013; Boydell et al., 2013).
Examples of technology-based mental health supports
Technologies such as game consoles, tablet computers, cell phones and other electronics may be valuable resources in
reaching young men. Online services could be developed to relay psychoeducational information and/or act as a mental
health support. Some child and youth mental health services have been delivered online via chat rooms, discussion
boards, social networking and interactive games, and are thought to improve existing services (Boydell et al., 2013). For
example, MoodGYM, an interactive web program designed to prevent depression (National Institute for Mental Health
Research, n.d.) provides information about depression and explains cognitive-behavioral skills that can help to treat
depression, such as cognitive restructuring and problem solving (O’Kearney et al., 2006). Social marketing and creative
communication strategies may also be helpful in recruiting young men (Smith et al., 2006).
Research on MoodGYM shows that it has beneficial effects for adolescent boys, although effects were only mild to
moderate, and were not sustained at a four-month follow-up (Calear, Christensen, Mackinnon, Griffiths & O’Kearney,
2009; O’Kearney, Gibson, Christensen & Griffiths, 2006). It is also important to note that these results compared
MoodGYM to personal development activities in school curriculum, and not to other mental health supports, as
MoodGYM was designed to prevent depression, rather than provide acute treatment. Online mental health treatment
programs may be a useful complementary resource to engage boys and young men (Calear et al., 2009).
Providing attractive technology-based services likely requires agencies and staff are as familiar and competent with
technologies as their clientele (Burns et al., 2013). Boys and young men can inform staff on technology-based services
throughout their development, including the design of services. Creative technologies that capitalize on games and
music may attract youth, especially if they are accessible from portable devices (Burns et al., 2013). While the field of
child and youth mental health is bursting with technological advances, there is a particular need for more mobile-based
technologies and further evaluation of these services (Boydell et al., 2013).
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Engaging boys and young men in mental health services
Additional considerations
The following considerations may also be helpful to increase the engagement and participation of boys and young men:
 Advertise services in community and public venues that boys and their families frequent, such as schools and
community centres (Burns et al., 2013).
 Share information on the agency’s events and meetings (including drop-ins and informal events) with other
service providers. Ensure there is enough time for clinicians and service providers to not only integrate the
information into clients’ treatment plans, but to relay that information to clients and their families.
 Partnering with other agencies and sectors may also be worthwhile. Organizations in the social services,
developmental services, health services and education sectors may be able to refer clients and help with
advertising.
 When embarking on new initiatives, such as introducing technology-based services, ensure that boys’ and young
men’s preferences help to shape the development of new services (Burns et al., 2013).
A number of additional resources may be useful to further explore how boys and young men can engage and participate
in mental health services:
Book
Title: Engaging boys in treatment: Creative approaches to the therapy process
Author: Haen, C. (2011)
Description:
This 324-page book was praised by Shahieda Jansen (2011) in the Journal of Child & Adolescent Mental Health who
suggested it would be a helpful resource to overcome gender barriers and engage boys in psychotherapeutic treatment.
Reports
Title: Motivation and engagement of boys
Description:
The Department of Education, Employment and Workplace Relations in New South Wales has online resources on
motivating and engaging boys. A report on Motivation and Engagement of Boys is geared for the education sector but it
states its principles are relevant for any learning setting which may include mental health programs (Munns et al., 2005).
The New South Wales Male Health Clearinghouse website includes more information on this report that can be accessed
free of charge (Munns et al., 2005).
Link: http://www.mengage.org.au/MENGAGE/media/MediaLibraryOne/DEEWR/motivation_engagement_boys_pdf.pdf
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Title: Game on: Exploring the impact of technologies on young men’s mental health and wellbeing
Description:
The national telephone survey of Australian youth mentioned earlier (i.e. Burns et al., 2013) was conducted by the
Young and Well Cooperative Research Centre. As the title suggests, the report primarily focuses on the role of
technology to engage boys and young men. Both the survey and report are comprehensive and while findings are
Australian, the concepts and recommendations may apply to Ontario’s youth. The report includes recommendations for
health centres, employment centres, schools and other organizations on engaging youth with creative strategies.
Link: http://www.youngandwellcrc.org.au/wp-content/uploads/2014/03/Young_and_Well_CRC_Game_On_Report.pdf
Title: Using technologies safely and effectively to promote young people’s wellbeing
Description:
This Australian report reviews online technologies that promote mental health and well-being in young people. The
report involved a meta-analysis of Australian and international literature and provides guidelines on providing
technologies to meet the mental health needs of youth and young adults.
Link: http://www.youngandwellcrc.org.au/wpcontent/uploads/2014/03/Guide_Using_Technologies_Safely_and_Effectively_Young_and_Well_CRC_Mar2013.pdf
Title: Using technology to deliver mental health services to children and youth in Ontario
Description:
This policy paper presents information on how technology can be used to improve mental health services for children
and youth in Ontario. It includes a scan of Ontario agencies that use technology in providing mental health services to
children and youth, as well as recommendations based on research findings and current practices in the field.
Link: http://www.excellenceforchildandyouth.ca/sites/default/files/policy_using_technology_0.pdf
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Webinars
Title: Practical applications of #socialmedia in health care: The good, the bad, and the ugly
Description:
An upcoming webinar on using social media in health care contexts may be informative given youth’s affinity for
technology. It will take place on April 6th, 2016 from 11:00 a.m. to 12:30 p.m. and has limited space. It is the third
webinar in a three-part series discussing how to engage different stakeholders (including professionals, clients and
families) in health care using social media platforms. Three professionals, including CHEO’s Ann Fuller (vice president,
volunteers, communications and information resources) and CHEO Research Institute’s Dr. Eric Benchimol (pediatric
gastroenterologist and assistant professor of pediatrics and epidemiology at the University of Ottawa), will discuss their
social media experiences and engagement strategies. Participants can join the April 6th webinar free of charge by
completing their registration here.
Link:
http://ken.caphc.org/xwiki/bin/view/Other/Practical+Applications+of+%23SocialMedia+in+Health+Care%3A+The+Good
%2C+The+Bad%2C+and+The+Ugly
Title: Engaging young men in mental health settings
Description:
Orygen in a youth-focused mental health organization in Australia that focuses on research, evidence-informed practices
and clinical services. This webinar presents strategies to engage young men in mental health practices (i.e. clinical
assessments and therapy) as well as socialization, diversity and risk-taking. This webinar can be accessed at any time
free of charge.
Link: https://orygen.org.au/Campus/Expert-Network/Webinars/Engaging-young-men-in-mental-health-settings
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Engaging boys and young men in mental health services
Online resources
Title: ReachOut
Description:
ReachOut is an online resource hub for mental health professionals that includes information on youth mental health
and online supports. For instance, there are breathe apps to reduce stress and apps to schedule worry time to prevent
worrying from taking over other activities. A host of other apps and resources support general well-being.
Link: http://au.professionals.reachout.com/
Next steps and Centre resources
Technology appears to be a popular, innovative mode of improving access to mental health services (Boydell et al.,
2013) and attracting adolescent boys and young men to services to better meet their mental health needs. A number of
pertinent resources are available to help agencies and service providers in this regard. Researchers have also advocated
that community awareness initiatives are important. Establishing a common understanding of mental health issues that
reduces stigma is especially important for boys and young men (Burns et al., 2013).
The Ontario Centre of Excellence for Child and Youth Mental Health has a number of resources and services available to
support agencies with implementation, evaluation, knowledge mobilization, youth engagement and family engagement.
For more information, visit:
http://www.excellenceforchildandyouth.ca/how-we-help or check out the Centre’s resource hub at
http://www.excellenceforchildandyouth.ca/resource-hub.
For general mental health information, including links to resources for families:
http://www.ementalhealth.ca
Report context
The following Evidence In-Sight report involved a non-systematic search and summary of the research and grey
literature. These findings are intended to inform the requesting organization, in a timely fashion, rather than providing
an exhaustive search or systematic review. This report reflects the literature and evidence available at the time of
writing. As new evidence emerges, knowledge on evidence-informed practices can evolve. It may be useful to reexamine and update the evidence over time and/or as new findings emerge.
Evidence In-Sight primarily presents research findings, along with consultations with experts where feasible and
constructive. Since scientific research represents only one type of evidence, we encourage you to combine these
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Engaging boys and young men in mental health services
findings with the expertise of practitioners and the experiences of children, youth and families to develop the best
evidence-informed practices for your setting.
While this report may describe best practices or models of evidence-informed programs, Evidence In-Sight does not
include direct recommendations or endorsement of a particular practice or program.
___________________________________________
We appreciate your responding to a brief satisfaction survey that the Centre will e-mail to you within two weeks. We
would also like to schedule a brief phone call to assess your satisfaction with the information provided in the report and
to discuss possible next steps. Please let us know when you would be available to schedule a 15-minute phone
conversation.
Thank you for contacting Evidence In-Sight for consultation on your question. Please do not hesitate to follow up with
the lead author or to contact us at 613-737-2297.
Search tools and terms
Search Tools: PsycInfo, PubMed, Journal of Youth and Adolescence, Medical Journal of Australia
Search Terms: boy(s), male youth, young men, recruit(ment), access, participation, barriers, engage, access, reach,
mental health, mental illness, services
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Boydell, K. M., Hodgins, M. Pignatiello, A., Edwards, H., Teshima, J., Willis, D. (2013). Using technology to deliver mental
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