Dennis J. Barbour
Friday’s tragedy in Connecticut was wrenching. Once again an apparently troubled young man devastated a community. Once again our nation searches its soul, asks how it could happen, and asks how we can prevent such a nightmare from happening again. Who among us can forget the moment we first saw the images of those children who died so violently? Like the images of those who perished on 9/11, they are now indelible.
There are so many reasons why such horrible events keep occurring, and why so many of them are at the hands of young white men. The issue is very complex. Yet, the fact remains that while many of our young men are troubled, a larger issue is that our nation’s young men as a whole are in trouble.
Very serious trouble. Even the stable young men in our country are not keeping up with rapid changes within our society, and they are beginning to fall between the cracks.
Both the data and personal anecdotes of parents tell the story. Boys are not doing well in school. Their rates of disengagement, maladaptive behavior and suicide are alarming. If they enroll in college they acquire only 40% of bachelors and advanced degrees. That percentage has been dropping steadily and shows no signs of abating. Once graduated, young men may be unable to find employment, so they return home to at least have a roof over their head. Middle class manufacturing jobs once the mainstay of male employment and identity are vanishing more quickly than men are able to adapt to it. There are reasons to celebrate the many young men who innovate, adapt and flourish in our rapidly changing and challenging environment. But there are also reasons to be concerned about those larger numbers of young men who are confused by rapid changes in the definition of their role as males and are deeply depressed about their futures.
The failure of young men to thrive has been attributed to numerous factors – family breakdown, pop culture, video games and the culture of violence, drugs and the prevalence of guns, to name just a few. Another important factor, mentioned in the wake of Newtown, is mental health services. Or, for male adolescents, it should be characterized as the lack thereof, especially within the context of overall health services for young males. The fact is, unlike many adolescent and young adult females, adolescent and young adult males do not typically interact with the health care system.
Health care for young males is largely passive and does not focus on screening and prevention, except in the most superficial ways. High school and college males largely show up for health care only after they’ve had an acute injury, like a concussion. Once treated they usually don’t interact with the healthcare system until another crisis develops. Even if a health care professional perchance is confronted with evidence of a medical condition in a clinic visit, underlying mental health issues can be overlooked, left untreated, or cleverly hidden by a troubled patent, with devastating and irreversible consequences like last week’s event. In short, our healthcare systems for adolescent males handle all of their needs poorly. Given that, even if we were to invest in funding for mental health services for adolescent males, the current system could not absorb it in a productive way.
This can change, and it must change. We can start by calling on the health and medical communities to join together in an examination of how we can construct a more coherent and comprehensive system of healthcare for young males. Adolescent and young adult males should be provided a range of health care services, from reproductive health to substance abuse. Mental health is certainly one of the most important, but it cannot be adequately identified and treated in isolation – to be effective it must be part of a larger range of services that most accurately reflect the multi-dimensional aspect of all health care. Beyond that challenge, not only do we not have adequate systems in place to provide these services, but we’ve not developed the strategies for engaging young males in their health care. Further, medical professionals have not yet developed the medical guidelines that can assure the best care. With that said, medical providers and researchers have spent years exploring these issues and proposing solutions to many of these challenges, albeit often in isolation. In short, to address the mental health issues of young males most effectively we must address them within a constellation of health services. As complicated as that may sound, we know what we can do in this regard, and we know what we must learn to make it possible.
The problem so hideously exposed in Newtown is complex. But we cannot allow the perfect to be the enemy of the good. We have no choice but to make a start somewhere. Better and more coherent healthcare for adolescent and young adult males is one place to start. The pieces to make that happen do exist. We just need to bring them together.