Evo Terra (Host): Welcome to the Live Greater podcast series, information for a healthier you from the University of Maryland Medical System.

I'm your host, Evo Terra, and today I'm joined by Dr. Ryan Barnes, a Doctor of Nurse Practice or Nurse Practitioner at the University of Maryland, Baltimore, Washington Medical Group Primary Care at Millersville. Our topic of discussion, men's mental health. Thanks for joining me, Ryan.

Ryan Barnes, DNP, CRNP, FNP-C: Thank you for having me. It's a pleasure to be here.

Host: Let's start with this. What are the most common misconceptions that you encounter among men and their mental health issues?

Ryan Barnes, DNP, CRNP, FNP-C: I think the biggest thing I run into, especially in the primary care setting, we see a lot of different concerns that mental health challenges in men are a sign of weakness. Kind of the unmanly or goes against the uh, idea that men should be able to fix things on their own. Another common misconception I've run into is really the symptoms and how things present.

So that can really delay identifying the problem and getting help for it. So you may expect for depression, symptoms of sadness, but many men might not present like that. They may have irritability, anger, feeling flat or reduced sex drive, and a lot of risk taking behaviors that could also include misuse of alcohol or abuse of drugs.

Host: Speaking for myself, I could answer this question, but I want to ask this of you. Why do you think it is that some men are so reluctant to talk about or seek help for mental health conditions and, and also along with that, what tips would you offer to help dispel this stigma that seeking help is bad and making it easier for men to actually seek help.

Ryan Barnes, DNP, CRNP, FNP-C: Absolutely. And you nailed the nail on the head, the stigma surrounding the issue of mental healthcare and men. Societal and cultural norms of masculinity kind of go against, the grain of admitting there's a problem and seeking help. So men feel like it might not be the tough mainly or self-reliant thing to do.

Some of us grow up in backgrounds where it was discouraged to share emotions and it kind of conditions us later in life to do the same and not break that cycle. I think the best way to address this is just normalizing the conversation, teaching the younger generations and those in our own generation to have those discussions and seek help and that we can check in on one another. And, that should be seen as a sign of strength.

Host: Yeah, that, that's a good point. I know I tend to share my own struggles with mental health with others. Something that would've been anathema to me, you know, 20 years ago or so. But now, in this new world of sharing, well, why not? Let's show things are normalized. How about some common mental health conditions? What do you see most often in your male patients? And are there any hidden signs that might be overlooked?

Ryan Barnes, DNP, CRNP, FNP-C: Absolutely. So the more common things I'll see, especially in this primary care setting, depression, anxiety. A good bit of post-traumatic stress disorder, and then a fair amount of substance abuse. Again, alcohol, a lot of people will brush over that they're abusing or misusing it, to maybe cope with their mental health, but it is quite common.

And then suicidal ideations as well, of course being a major concern that we see that we really want to make sure those patients are identified and that they're getting some kind of care before they're out the door or have some, touch point where we know that we're going to be following up with them and they have something to look forward to. As far as the, other part of your question, what we talked about before, some of the symptoms can be very misleading. So really just being in touch and having those, I call them tactical pauses of how am I feeling? How am I able to get through my day? Am I dealing with additional stress?

A lot of these issues, again, can be co-occurring, so each person is very unique and, requires a different approach.

Host: So for the men out there who are watching and perhaps even the family members of those men, what signs indicate that it's time for the man to seek help, and where should they go to find it?

Ryan Barnes, DNP, CRNP, FNP-C: Absolutely. So I think, one of the big things you'll see early on before men might be able to really get a finger on the pulse of the issue is that maybe you're just struggling to get through your day. It doesn't seem as manageable. The stress might not be as manageable. You might be leaning towards things to help cope, like drugs or, alcohol or taking more risks. And you may be having thoughts of self-harm or actually have taken acts towards harming yourself. Those are all good times to recognize the issue and get some kind of care. So that's where we come in, in primary care and of course, mental health specialists as well

are available, but we'll never fault anyone, particularly men though too, the topic today, for coming in early and being proactive with their mental health. And I always have to touch on the resource I want everyone to be aware of is 988. It's the suicide and crisis line. So it may not be something that each man would need for themselves in the future, but something that they could possibly help someone else with.

Host: I know that many men are likely going to be surprised to learn about the variety of treatment options available. I know I certainly was. So, let's talk about those. What are the most common mental health treatments, that you can offer?

Ryan Barnes, DNP, CRNP, FNP-C: Absolutely. This would be a refer out situation, but for various types of psychotherapy that are incredibly helpful, my favorite being cognitive behavioral therapy, pretty common. There's a number of self-guided resources. Not everybody's ready to take that step to talk to someone. So it will kind of meet them halfway.

And there's a lot of mindfulness, meditation, psychotherapy apps available. Many of them free, as well, which is always great. And then there's a number of peer support groups. Some people are in specific situations that it's helpful to be surrounded by people that can kind of relate to what you're going through.

And lastly, medication, can offer significant symptom improvement. And I find that usually it takes a variety of approaches to address each person's unique, concerns. The best thing I can say is just reaching out and talking to somebody and we can kind of walk you through the options.

Host: Yeah, about that meditation. I, I can't tell you how thankful I am to have been taught the simple leaves on a stream, process of read. It just, it works. It, it's a mind blowing how well it works. So, fellas, listen, talk to someone. These things work. One of the challenges with mental health care is that it, look, it can be expensive, right?

And there are people who are low income, either underinsured or uninsured. And finding a mental health provider in their area, is difficult. So what resources do you have to offer? You mentioned 988 for crisis moment, but someone's seeking help. What should they do?

Ryan Barnes, DNP, CRNP, FNP-C: Absolutely. So if it's not in the office with us, in primary care, the best resource, if it's just one thing we're looking for that's going to help most people is the substance abuse and mental health services administration or SAMHSA has a treatment locator, and it has a number of resources for that are low cost or free of cost.

 And this could be for mental health concerns specifically, or substance abuse issues or a combination of both. And easy to find. It's findtreatment.gov. You can go in there and put your zip code and specific concerns filtered down, and review options that may be a good fit for you.

Host: I know that my own understanding of mental health has changed over the years, but I also know, I'm assuming that the older someone gets, the less likely they are to want to seek out some help. That may be a misconception on my part. But, you know, thinking about my father, I'd love for him to seek some help, but that's not going to happen.

So for someone who was worried about their brother, their husband, their dad, their son, or even a friend, what's the best way to start a conversation that gets them towards the idea that they might need to seek some help for their own mental health?

Ryan Barnes, DNP, CRNP, FNP-C: Oh, absolutely. And it can be a really tough conversation to have also. So I think approaching it and not trying to trick someone into getting care or help, but, letting them know that you have a concern or you're concerned about them and their wellbeing, letting them know that you care about them and that's why you are having this conversation and that laying out your concerns plainly.

 It can be uncomfortable, but just kind of addressing it heads on because it's one of those conversations, there's plenty of people that wish they had that conversation and that they had kind of a do over if things didn't go as well with someone, that they loved. And, uh, we all have that opportunity, throughout our life and it can be a really important moment too.

Let someone know you care about them, and, have that conversation and normalize mental healthcare as well.

Host: Very good idea. I, I would've loved to have had these conversations when I was younger than it is, but hey, we take it when we can. Okay. What about those of us who figured it out? We know that we need to take care of ourselves. Our mental health is as important as our physical health. What tips do you have to help us do that?

How can we nurture our mental health everyday?

Ryan Barnes, DNP, CRNP, FNP-C: What I find more and more in my practice too, is that mental and physical health are so incredibly intertwined. So I, kind of equate it to a three legged stool. And this is something I've taken from my experience in the Army National Guard as well, because this is, trained into us.

But the three legged stool approach is exercise, sleep, and diet. And so eating healthy, getting regular, adequate sleep, taking care of your body, working yourself out physically, all can make us much more resilient to stress as well. I let people know that you need to take care of your physical health as well as your mental health.

A lot of the things we'll do for one is good for the other. And then, not to be understated, the importance of a support system, and this could be friends, family, social or church groups. We see more and more the importance of that and just having some type of structure or fellowship, that we can lean on in times of mental health challenges.

Host: Yeah. I mean, for me, the hardest thing was not coming out to my wife with my issues because she was well aware of them. But coming out to my friends, right. I was, I was really worried about it. And of course I was, they were wonderful. Everybody was great, you know, totally accepting about this. So that's the good news. We need to wrap up here. Is there a key takeaway you want to leave with the audience?

Ryan Barnes, DNP, CRNP, FNP-C: I think the biggest thing would be that mental health challenges are common among men, that they're treatable. And seeking help is really a sign of strength. And also to check on your friends, check on your family. And if they need help, remember some of the resources that are available. If it's not coming to see us in a primary care office, SAMHSA has a treatment locator@findtreatment.gov and also 988 is the suicide and crisis line that you might be able to help save someone's life with that or your own.

Host: Ryan, thank you very much for this conversation. It was great.

Ryan Barnes, DNP, CRNP, FNP-C: Yeah. Thank you so much for having me.

Host: And thanks to you for listening to Live Greater a Health and Wellness podcast, brought to you by the University of Maryland Medical System. You can find more episodes just like this one at umms.org/podcast on your favorite podcast listening platform, and on our YouTube channel. And if you loved this episode, please share that love on your social media. We look forward to you joining us again.