The Silent Struggle: A Scoping Review of Men's Mental Health and Help-Seeking Barriers in Urban Pakistan
https://doi.org/10.5281/zenodo.17929849
Abstract
Mental health in low and middle-income countries is a severe public health problem wherein men reveal severe unmet need and a significant treatment gap. This scoping review is a systematized review and synthesis of a bedrock of literature on what stops adult men in urban Pakistan (a population facing the interplay of strict masculine ideals and urban-stressful environments) to seek mental health. As part of the Joanna Briggs Institute (JBI) approach, a search of key academic databases, grey literature was conducted. Twenty-one researches were included and subjected to critical review. The results indicate a multi-layered ecosystem of barriers, which is synthesized into five overarching themes, including: (1) the hegemony of cultural masculinity ideals (ghairat, stoicism) that view help-seeking as sign of weak character; (2) overwhelming stigma and shame that endangers familial honour (izzat); (3) severe systemic and structural inadequacies in the mental healthcare infrastructure; (4) a critical lack of mental health literacy leading to somatic presentation and spiritual explanations of distress; and (5) economic precourty that der These obstacles are not discrete but are held together in the finest details which constitutes a perfect storm to normalize silent suffering. It is the conclusion of the review that the low help-seeking behavior is the rational reaction to the socio-cultural and economical environments that formally disables and discourages it. A multi-sectoral policy response with a sense of urgency is needed to take these barriers down, such as the integration of mental health into primary care and destigmatization campaigns, as well as economic incentives to be created to receive care. The review is a starting point evidence that researchers, clinicians and policymakers can use in developing culturally competent approaches to deal with this silent crisis.
Keywords: Men's Mental Health, Help-Seeking Barriers, Urban Pakistan, Masculinity, Stigma, Mental Health Services, Scoping Review.
