Gender Perspectives in Help-Seeking Among Canadian Youth Accessing an Integrated Youth Services Centre: "Most Guys Will Wait until It's Too Late"

Introduction: Gender differences in mental health perspectives and willingness to access services have been found during adolescence. Children internalize gender-based norms regarding emotional expression, with girls socialized to be more emotionally expressive than boys. North American norms of masculinity require boys to be emotionally stoic and self-reliant which can act as a barrier to help-seeking. The purpose of this study was to understand whether there are gender differences in accessing mental health services at an integrated youth services center called Foundry. Foundry offers services to support mental health, sexual wellness, life skills, other content suggested by youth, as well as virtual services and peer support.

Methods: Forty-one youth recruited from one centre using purposeful sampling participated in an hour-long open-ended interview conducted by social work graduate students between the years 2018-2020. This study is part of larger grounded theory study looking at perspectives of mental health service use among youth accessing services at one Foundry centre. An iterative approach between data collection and analysis was taken, and a question about gender differences was added to the interview guide, as this emerged as a salient theme early on. Interviewers asked the question, “Do you think there are gender differences in the way that a young person seeks out mental health services? Theoretical sampling was conducted to recruit youth across the gender spectrum. Two analysts conducted open and focused coding using the software NVivo, with a third analyst participating during consensus building meetings. Constant comparison was conducted that led to the development of a codebook.

Results: Participants mean age was 20 (2.6), gender characteristics included 46% Female, 32% Male, 12% Transgender, 5% non-binary, and 2% two-spirit, and race was categorized by 83% White, 7% Bi-racial, 10% percent including Latin American, Filipino, and South Asian. Several themes emerged highlighting perceptions of masculinity. Fifty-six percent of participants endorsed cultural rules of masculinity. Subthemes included the beliefs that cisgender men don’t show vulnerability, weakness, emotions, and don’t ask for help. One participant said, “Guys are expected to toughen up and they’re not expected to have the visible symptoms of anxiety.” Other themes that emerged included cisgender men experiencing mental health and service use stigma, as well as having a harder time expressing emotions and seeking help compared to cisgender women. Two transgender youth discussed previously experienced gender-based stigma when accessing services, but grew from those experiences and were thus more open to seek help than cisgender males, while two other youth spoke about how society makes it more difficult for youth who do not fit into the arbitrary gender binary to access mental health services.

Conclusions and implications: The results from this study suggest the importance of organizations such as Foundry continuing to work closely with young people to ensure diverse gender perspectives are incorporated into all aspects of care planning and service delivery. Integrated youth services have an important role to play in discussing gender identity, gender health goals, and provide gender-affirming care that increases support and engagement for youth across the gender spectrum.