Social Work Practice with Men at Risk?
Rich Furman, MSW, PhD
Director and Associate Professor
University of Washington, Tacoma
Abstract: The purpose of this article is not to assert that men are at more risk than women, but to call attention to the notion that many men are indeed at risk, and that the profession of social work may not be sufficiently attending to the men who are at risk of various biopsychosocial maladies
Key words: Men, Practice with Men, Masculinities
Social Work Practice with Men at Risk?
Social work practice with men at risk? A curious title of an article, given that men, as a segment of the population, have more power, money, and social status than women. Yet, in spite of their power and privilege, many men are at risk. Men, at the hands of other men, are more likely to be the victims of violence (Clatterbaugh, 1990), and have lower life expectancies (Center for Disease Control, 2004) than women. Poor older men, returning male veterans, homeless men, and men from various diverse communities face challenges of access that are associated with social isolation, discrimination and significant risk.
The purpose of this article is not to assert that men are at more risk than women, but to call attention to the notion that many men are indeed at risk, and that the profession of social work may not be sufficiently attending to the men who are at risk of various biopsychosocial maladies such as schizophrenia, depression and anxiety, to mention only a few. In this brief article, we will explore the ethical and practical reasons why the profession should devote more attention to the needs of men. We shall highlight the major categories of risk, the current scope of practice with men at risk, and implications for the profession. Our overall aim is to draw attention to the need for the profession to develop culturally responsive practices based upon an understanding of men and masculinities.
The Need to Practice for Men at Risk
The profession of social work has a long and storied history of creating and providing services to meet the needs of diverse communities (Weaver, 1999). Culturally sensitive or competent practices have been developed to make social work practice congruent with important cultural variables and historical and social contextual factors in order to provide relevant services to women, Latinos, African Americans, Asian Americans and other groups. Yet, few social work scholars have explored the notion of a culturally competent practice for men (Furman, 2010; Kosberg, 2002). There are several key reasons for this. First, it has been widely assumed that theories of development and change have largely been developed for practice with middle class white men. However, these theories may merely “split the difference;”they are equally deficient in exploring the needs of women as they are with explanations of masculinity and male identity development (Bannon & Correia, 2006). In other words, while clearly more research has been conducted on men and on the male body, this research has largely ignored gender specific aspects of masculinities and how gender is implicated in this research. Second, the help seeking and receiving behaviors of men and women differ greatly (Addis & Mahalik, 2003). When understanding the meaning and nature of seeking help, it is normal and natural to contextualize this understanding within the context of how each of us feel and behave. Since the vast majority of practicing social workers are women, it would be useful for them to learn what it means to receive help through the eyes of men. For instance, according to the hegemonic masculine ideal, or the dominate form of masculinity to which men are acculturate to strive to achieve (Connell & Messerchmidt, 2005); receiving help is viewed as a sign of weakness. Male social workers have an intuitive understanding of this cultural norm that women may struggle to connect with on a personal level. Third, what works with women in the helping relationship may not work with men. Men tend to be instrumental or behavior in their approach change, and downplay the role of emotions in the change process (Furman, 2010). Social workers who focus extensively on affect and emotions, especially in the early phases of treatment, may perceive men who refuse to talk about their feeling and want to “do something” as being resistant, when in fact they are behaving according to traditional masculine roles. To ask them to do otherwise, without help and training, may feel unnatural. Four, a number of scholars and practitioners, particularly in the world of international development and non-governmental organizations, contend that human service professionals must attend to the needs of men if they seek to help women (Bannon & Correia, 2006). By not viewing the needs of poor, oppressed and at risk men, those professionals that do not work with the whole family, including men, run the risk of engaging in interventions that do not change the whole system, thereby minimizing the potential for lasting and meaningful change. The goal of gender equity is best served by including men as allies and partners in the process. Lastly, many men indeed are vulnerable, hurting, suffering and at risk. Ethically, social work is called upon to provide services to society’s vulnerable citizens, many of whom are men. If social workers are to continue to work with men, as we always have, we are ethically charged to practice effectively and from a culturally competent perspective. From an ethics of care approach, which sees society as an interdependent network, the wellbeing of one person risk jeopardizes our work with other populations. In other words, since men clearly have relationships with members of their community, they affect the wellbeing of others; by not attending to the needs of men at risk, we not only fail to serve this population, but we also miss the opportunity to further support the populations that we do, in fact, serve. Furthermore, if men represent nearly 50% of the US population, failure to provide adequate and appropriate services to men at risk would appear to be a significant failure on the part of social workers.
Who are Men at Risk
Again, the purpose of this article is not to argue that men are at more risk than women, but to explore how many men are indeed at risk. As a population, given our historical legacy of patriarchy and sexism, many of our social institutions remain deeply biased against women. Women continue to make less money than men (DeNevas-Walt, 2005), are blocked from many social roles (Andersen, 2007), and are disproportionately the victims of severe domestic violence. Ending violence against women must remain an important focus of our profession.
Still, many men are at risk and are in pain. It is beyond the scope of a brief article such as this to explore all the areas in which men have risk, yet a few include: substance abusing men; men in prison, men in war and veterans; unemployed men; poor men; men from historically oppressed communities, gay, bisexual and transgendered men who are the recipients of reactive violence and discrimination; and men who are undertrained and unprepared for the social upheavals of the 21st century. The current economic crisis and greatly depends on the wellbeing of others (Tong, 1998); thus, neglecting the needs of men at the wars in Iraq and Afghanistan place two groups of men at special risk, unemployed men as well as military personnel and veterans.
Statistics show that men have been disproportionally impacted by the economic downturn. Since the beginning of the recession, over 800, 000 men have become unemployed, and have accounted for 78% of the job loss (Wall, 2009). While the national incidence of unemployment hovers at a near fifty-year high of 10%, for some segments of men, the statistics are far grimmer; nearly 16% of African American men are currently unemployed. For men, prolonged unemployment has extremely serious mental and physical health impacts. Masculine scripts and traditional means of forming identity have largely hinged on the importance of work and the ability to be a provider. Large segments of unemployed men are finding prolonged unemployment deleterious to their mental and physical health. Without as many ways of defining themselves positively outside of the economic sphere, many men are experiencing a sense of worthlessness that places them at risk of substance abuse and other dangerous behaviors (Meltzer at al, 2009).
The wars in Iraq and Afghanistan have had profound effects on American service personnel, the majority of whom are men. All wars have risk factors that are similar and unique at the same time. Longitudinal studies have shown that all wars predispose men to mental health and health problems (National Center for Posttraumatic Stress Disorder, 2006). Several factors associated with the current wars exacerbate soldiers' risk factors. First, many soldiers are deployed multiple times, often over the course of several years. These multiple and elongated deployments have been shown to increase various types of mental health disorders, including depression and PTSD (Foa, Keane, & Friedman, 2000; King et al, 1999), and places veterans at greater risk of suicide. Additionally, the nature of fighting a war against guerrilla insurgents is far different from what we know as conventional warfare. The hypervigilance associated with this mode of combat greatly increases stress reactions, including PTSD. Further, this particular type of combat places men at greater risk of serious health concerns, such as Traumatic Brain Injuries (TBIs).
The Scope of Practice
with Men at Risk
Programs that do not take into account the specific needs of men as a cultural group and the insights from gender and masculinities studies will likely not be as effective as programs that take into account the nature and needs of men. Likewise, gender-neutral services attempting to meet the needs of both men and women may not fully meet the needs of either. In this sense, using gender as a lens and variable to guide practice, is perhaps as important a consideration as is ethnicity or race. As we have explored above, the problems that men face are varied and diverse. However, the number and types of programs that integrate key concepts from gender studies, or in this case from masculinity studies, as variables in designing services are fairly limited. The majority of programs designed for men fall within the domain of several areas: violence prevention and amelioration; fathering; and sexual health. Innovative programs within each of these areas have helped those whom they serve immeasurably and must be continued. This is particularly true of violence prevention and treatment programs, as the violence of men against women remains one of the most significant social problems that we face. Yet, the paucity of programs specifically designed for men in other areas is lamentable.
It is my hope that social workers will begin to more fully explore the implications of key gender studies concepts and theories and their utility for practice with men and woman alike (Furman, 2010). In terms of providing services to men, too few social workers are educated to understand the implications for gender and masculinities on the provision of micro, mezzo, and macro social work. To help men become more fully involved in prevention, treatment, and social change programs, social workers must begin to understand the nuances of how diverse groups of men view the process of change, the helping relationship, and other key factors that lead to treatment success. It is time that social workers more fully and deeply apply and integrate insights from culturally competent practices to their work with men, and men at risk in particular.
Addis, M.F. and Mahalik, J.R. (2003). Men, masculinity, and the contexts of help
seeking. American Psychologist. 58 (1), 5-14.
Andersen, M. L. (2007). (ed.). Race, class & gender. Belmont, CA:
Bannon, I. & Correia, M. C. (Eds.). (2006).The other half of gender. Washington, DC:
The World Bank.
Chatterbaugh, K. C. (1990). Contemporary perspectives on masculinity: Men,
women, and politics in modern society. Boulder, CO: Westview Press.
Connell, R. W., & Messerschmidt, J. W. (2005). Hegemonic masculinity: Rethinking the
concept. Gender & Society, 19(6), 829-859.
DeNavas-Walt, Carmen, Bernadette D. Proctor, and Cheryl Hill Lee (2005). U.S. Census
Bureau, Current Population Reports, P60-229, Income, Poverty, and Health Insurance
Coverage in the United States: 2004, U.S. Government Printing Office, Washington,
DC. Available online at http://www.census.gov/prod/2005pubs/p60-229.pdf
Foa, E. B., Keane, T. M., & Friedman, M. J. (Eds.). (2000). Effective treatments for
PTSD: Practice guidelines from the International Society for Traumatic Stress Studies.
New York: Guilford Press.
Furman, R. (2010). Social work practice with men at risk. New York: Columbia
James, E. (2002). Race, emotions and socialization. Race, Gender & Class. 9(4), October
King, D. W., King, L. A., Foy, D. W., Keane, T. M., & Fairbank, J. A. (1999).
Posttraumatic stress disorder in a national sample of female and male Vietnam
veterans: Risk factors, War-zone stressors, and resiliency-recovery variables. Journal
of Abnormal Psychology, 108(1). 164-170.
Kosberg, J.I. (2002) Heterosexual males: a group forgotten by the profession of social
work. Journal of Sociology and Social Welfare. 26, (3), 51-70.
Meltzer, H., Bebbington, P., Brugha, T., Jenkins, R., McManus, S., & Stansfeld, S.
(2009). Job insecurity, socio-economic circumstances and depression. Psychological
Medicine, 11(1), 1-7.
National Center for Posttraumatic Stress Disorder (2006). War-zone related stress
reactions: What families need to know. United States Department of Veterans Affairs.
Retrieved from the World Wide Web on March 25, 2007.
Tong, R. (1998) The Ethics of Care: A feminist virtue ethics of care for healthcare
practitioners. Journal of Medicine and Philosophy, 23 (2), 131-152.
Wall, H. J. (2009). The “Man-Cession of 2008-2009: its big, but it’s not great. The
Regional Economist, October. Retrieved from the world wide web on February 23,
Weaver, H. N. (1999). Indigenous people and the social work profession: Defining
culturally competent services. Social Work, 44(3), 217-225.