MEN-MINDs Project: Co-producing change for better mental health for adolescent young men at the margins

The mental health and wellbeing of adolescents has been getting worse over time and the COVID-19 pandemic has also had a negative impact on young people's mental health. The mental health of adolescents has been described as being at a crisis point. While adolescent females are often perceived to be at higher rates of internalising disorders such as anxiety and depression, males are more likely to be diagnosed with behavioural disorders. These diagnosis rates reflect not only underlying mental health issues, but also other factors such as help-seeking behaviours, the availability of mental health support and how services work with young people. Young males are at greater risk of poor mental health and wellbeing outcomes in key health and wellbeing areas such as suicide and substance use. This might be because young men are less likely to seek help for emotional, psychological or other distressing problems, or it might be that the symptoms of distress in young men are different and are less recognised by young people, parents or professionals. Young men are also less likely to take part in mental health research, so it is difficult for researchers and mental health professionals to fully understand why these differences exist.

Certain groups of young men are also more likely to be excluded or discriminated against in society, such as young men who get in to conflict with the law, who identify as LGBTQ+, or who have migrated to the UK. These young men are at greater risk of poor mental health outcomes because of their life experiences, and are even less likely to have their mental health needs addressed or to participate in research. The primary aim of MEN-MINDs project is to advance adolescent mental health research by improving understanding of how we can effectively engage marginalised adolescent males in research on mental health and how services can improve support available to them.

The MEN-MINDs project aims to address this gap in knowledge over three stages of work. A Young People's Forum (YPF) will have a central role in producing the research and sharing the findings with other audiences. The YPF will consist of 9-12 adolescent males who will work with our team as co-researchers to design new ways of doing research that are more interesting, relevant, or easier for young males to take part in. We will share these research tools with other researchers so that they can also use the methods in their own research. We will then use the research tools created by our co-researchers to carry out research with 60-80 young males who are in one of the vulnerable groups we identified: in conflict with the law; LGBTQ+ (including transgender men); or migrants. This will allow us to find out how they think about their masculine identities, what mental health and wellbeing means to them and what changes to policies or services would encourage them to seek help for mental health. We will work with mental health or other support organisations to implement these changes with the aim of improving both young males' experiences of service provision and the outcomes of mental health support.

The project is innovative because it seeks to understand the impact of young people's complex identities on their mental health and help-seeking behaviours and because new methods of research will be co-produced with young people from the three groups affected. The study will fill a gap in information about adolescents' help-seeking behaviours and the methods of research they are comfortable with when discussing mental health. It will produce evidence to help other researchers and service providers to evaluate and understand masculine identities and help-seeking behaviours among three of the most marginalised groups. This will also lead to improvements in mental health research, services and policy for adolescent males.

Barriers to help-seeking disproportionately affect men (Topkaya, 2014). Marginalised young men, such as those in conflict with the law, migrants or those who identify as LGBTQ+ are more likely to have experienced adversity, to experience poor mental health and face additional barriers to accessing support. However, the barriers that young men face in accessing services also apply to participation in research and young men are underrepresented in mental health research (Ellis et al., 2014). Little is known about how marginalised adolescent males define and conceptualise wellbeing and mental health and there is also a need to understand their perspectives on their intersectional identities and experiences of stigma, inequality and the relationship with help-seeking and mental health.

The aim of MEN-MINDs therefore is to increase understanding of how masculinities are conceptualised and enacted among marginalised adolescent males aged 16-24 and the impact these masculine identities have on help-seeking, mental health and wellbeing. The research will emphasise participation and co-production, involving young people in shaping both the design and delivery of research, and providing the opportunity to co-produce knowledge and change future research, policy and practice. In order to address methodological and knowledge gaps, the project will deliver on the following key objectives:

*Advance adolescent mental health research by increasing understanding on how we can effectively engage marginalised adolescents in co-producing research on mental health;
*Co-produce new knowledge and redefine concepts relating to adolescent marginalised masculinities, help-seeking, wellbeing and mental health;
*Produce typologies of adolescent marginalised masculinities and identify key help-seeking constructs to guide the development of research measures;
*Engage with a wide range of non-academic partners to ensure that policy and practice change leads to real-world impact.