I want to begin with a statistic that I find genuinely disturbing: suicide is the leading cause of death for men aged 20–49 in England and Wales. Black men are underrepresented in mental health service use but overrepresented in crisis presentations — which means they reach services only when things have become very serious.
The cultural narrative in many African communities around men and mental health is not benign. Men are expected to be strong. Providing for the family is proof of mental toughness. Emotional vulnerability is weakness. Depression is laziness. Seeking therapy is for people who cannot handle their problems.
I say plainly: this narrative is killing people.
What depression actually looks like in men
Depression in men often does not look like what people expect. The stereotype is someone who cannot get out of bed, crying constantly. That happens. But male depression frequently presents differently:
Irritability and anger rather than sadness. Many depressed men present as short-tempered, snapping at family, angry at small things. This is depression — not a personality problem.
Withdrawal. Stopping hobbies, avoiding friends, becoming quieter. Not dramatic — just gradually less present.
Physical complaints. Back pain, headaches, fatigue, digestive problems with no clear physical cause. The body expresses what the mind cannot say.
Increased alcohol or substance use. Self-medication. A glass of whisky becomes a bottle. Cannabis use escalates.
Reckless behaviour. Driving too fast, working excessive hours, taking financial risks. Numbness-seeking.
Difficulty at work. Concentration problems, mistakes, underperformance — often the first place depression shows up.
The classic sadness and tearfulness can be present — but in men, it is frequently masked by these other presentations.
Why African and Black men underuse mental health services
The barriers are real and documented:
Cultural stigma. In many African cultures, mental illness is associated with spiritual failure or family shame. Seeking help risks being seen as weak or mad.
Religious frameworks. Faith is a genuine source of strength and resilience. But when religious communities frame mental illness as a lack of faith, or when prayer is offered as the only intervention, it can prevent people from seeking medical help. Both can coexist.
Mistrust of healthcare. Black patients have legitimate reasons to be cautious about healthcare systems that have historically failed them. This is real. But it should not prevent accessing help.
Practical barriers. GP appointments, therapy waiting lists, cost (for private therapy), time off work.
The provider gap. There are very few Black male therapists. Some Black men find it easier to open up to a therapist who shares their cultural background — and that representation gap is real and needs addressing.
Case study: Tendai's story
Tendai, 41, a logistics manager from Zimbabwe based in Leicester, came to see me not for depression but for insomnia and back pain. He had been having trouble sleeping for 8 months. His back had been investigated — X-rays and MRI were normal.
I asked him how he was doing generally. He said fine. I asked more specifically: was he enjoying things he used to enjoy? He paused. "Not really." Was he feeling hopeless about the future? Another pause. "Sometimes."
I administered the PHQ-9. He scored 16 — moderate-severe depression.
He had been depressed for at least 8 months. He had not mentioned it because he did not recognise it as depression — he thought he was just stressed. And because, as he told me later, "Men in my family don't talk about that sort of thing."
He started sertraline and was referred for CBT. Eight months later he told me: "I feel like myself again. I didn't realise how far I had drifted."
What actually helps
Talk therapy (CBT, counselling): Highly effective. Can be accessed through NHS Talking Therapies (self-referral at talkingtherapies.nhs.uk) without a GP referral.
Medication (SSRIs): Effective for moderate-severe depression. Takes 4–6 weeks to work. Not addictive. Commonly used SSRIs: sertraline, fluoxetine, citalopram.
Exercise: Strong evidence for mild-moderate depression. 150 minutes of moderate aerobic exercise per week has a measurable antidepressant effect.
Social connection: Isolation maintains depression. Deliberate reconnection — even when it feels effortful — helps.
Addressing underlying stressors: Financial stress, relationship problems, work pressure all maintain depression. Practical support alongside therapy is often needed.
If you are worried about someone
Men are less likely to ask for help directly. If you are worried about someone:
- Ask directly — "Are you okay?" followed by "No, really, how are you doing?"
- Listen without trying to fix
- Do not tell them to man up or pray more
- Help them find information or a GP appointment
- Stay in contact — isolation is dangerous
If someone expresses thoughts of suicide, take it seriously. Stay with them if possible. Contact the Samaritans (116 123) or take them to A&E.
Sources: Office for National Statistics — Suicides in England and Wales 2022; NHS Race and Health Observatory — Black, Asian and Minority Ethnic Groups' Mental Health 2020; NICE NG222 — Depression in Adults (2022); Mind — Men and Mental Health 2023.