An interview with Nathan Shearman

An interview with Nathan Sheaman, a qualified psychotherapist and counsellor at Red Umbrella, on what can be done to help improve the mental well-being of men in the workplace. Red Umbrella work in partnership with large employers to deliver bespoke mental health training and support solutions.

Interviewer (Nicola): Today I'm going to be talking to Nathan Sherman about men's mental health issues and what can be done to help support men at work. Nathan is a qualified psychotherapist and counsellor with a background in private practice and 10 years plus experience in the field. He's also the director of therapy and training at Red Umbrella, an organisation that's improving the mental wellbeing of the UK workforce by working in partnership with large organisations to deliver bespoke mental health training and support solutions. Nathan, welcome.

Nathan: Thank you very much, Nicola. Thank you for having me on your show.

Nicola: Can we start by discussing what stigmas exist for men when it comes to mental health issues at work?

Nathan: It's a great question. It's a great starting point because I think we have done an awful lot in the last five or six years or so to try and reduce stigmas around mental health, particularly in the workplace. But I think there's still a long way to go.

And actually, when we think about the kind of stigmas for men in the workplace, they're not too dissimilar from the ones that exist outside of the workplace. Really it kind of comes down to one thing, and that is don't be seen as weak. And I think that is the stigma that drives a lot of behaviours when it comes to men's mental health. I think it's still seen as a weakness for men. I don't think we've been able to move as far away from that thought process as much as we would have liked to do over the last few years.

I think men have grown up around messages that certain negative emotions, so things like sadness and worry, are seen as unmanly or unacceptable. Those kinds of messages that boys get raised with around "boys don't cry" and "man up" and those kind of messages. I think that leads to men hiding some of those emotions and seeing them as being branded as weak. So I think that is one of the biggest stigmas that still exists when it comes to men's mental health � it's seen as a weakness.

I always think it kind of comes down to what I always describe as the two most dangerous words in the English language, which are "should" and "shouldn't". The idea that I should be able to cope. I shouldn't be struggling so much. Everyone else around me seems to be coping, so I should too. That kind of comparison to our colleagues around us. So I think that also plays into the stigma as well. And it all kind of leads to the same conclusion, which is men don't feel as comfortable to talk about their mental health as really we would like them to be able to.

Nicola: And what types of workplace behaviours might typically raise concerns that someone has got a mental health issue?

Nathan: I always think when we think about the different ways that mental health affects us, it kind of comes down to three key ways. It's how we think, how we feel and how we behave. The thing is, we're likely to see the behaviour first. You don't always notice what someone... you don't really know what someone's thinking or feeling a lot of the time unless they're telling you. But we can see behaviours. So behaviour is the thing we tend to notice first.

I think the challenging thing we have with that is behaviour tends to be the last thing to present itself. So someone could have been having very negative or challenging thoughts and feelings for some time before the behaviours start to kick in. So by the time we notice them, they might have been struggling for some time.

And what you're really looking for is something that's out of character for that person. A colleague who is normally very chatty but is suddenly being quite quiet and withdrawn, or the person who's normally on time for every shift and all of a sudden they start coming in late, they start taking time off, or that person who's normally very positive and upbeat is starting to use negative or pessimistic language. I always think it comes down to what is out of character for that person.

Because if we were to look at, for example, a sign that someone was struggling might be that they are being very negative and irritable a lot of the time. But I think many of us have worked with someone that you could kind of... I always describe them as Grumpy Bob. It's usually Grumpy Bob who works in accounts. He's a very negative person, has a very negative worldview, likes to complain about things. In fact, he's never really happy unless he's complaining about something. But that doesn't necessarily mean that that person is struggling with their mental health. That's just who they are. That's their personality.

And so it might be that actually a sign that Grumpy Bob's not okay is when he stops complaining about things because that's out of character for him. Maybe he's no longer got the energy or motivation to complain about things. So you're really looking to understand what is someone's normal for them and when are they starting to show signs that actually we're seeing behaviours that aren't really who they would normally be.

Nicola: Where are problems likely to originate?

Nathan: I think it's a mixture, really. Mental health struggles are rarely about one thing, although it can be. I think bereavement's a good example, or trauma's a good example of one thing that can cause poor mental health. But more often than not, it's a combination of the wrong things happening at just the wrong time. And often that will be a mixture of issues at work, but also maybe at home as well.

It might be something that started at home, but because I've got issues going on in maybe a relationship and it's causing me stress and anxiety, it might mean that I'm finding it harder to concentrate and focus at work. So then my work starts to fall behind and then that's starting to cause me stress as well. Or maybe I'm so stressed at work about something that I'm taking that home and that's starting to affect my relationship with my family.

I think it's one of those things where if I've got stresses at home, but work is good, I've got good colleagues around me and a good support network, that can often help me to keep my head above water. Or if I've got things at work that are stressing me, but I've got good friends and family at home, that can help me to keep afloat. I think it tends to be when we've got struggles in both areas, where I've got issues going on at home and then I'm carrying that into work and then I've got issues at work that are contributing to this.

It can sometimes be what seems like the smallest things on paper. But they're happening over a period of time and it's this cumulative effect. So it's rarely one thing. It's normally a mixture of things happening around us at the same time.

Nicola: So you're saying that there's a direct correlation between workplace stress and mental health issues?

Nathan: Absolutely, yes. I think stress is present in all mental health conditions. It can be the cause of poor mental health. So we'll often see that stress can be a cause of things like anxiety and depression, but it can certainly make the symptoms much worse. So even if it isn't the original cause of the mental health issue, it's certainly going to make it worse.

And it isn't just a correlation between things like stress and conditions like anxiety and depression that we're quite familiar with. There was a study done last year, I believe it was, on acute psychotic disorder that showed that 82% of people that experienced the first episode of psychosis had experienced a stressful life event in the month leading up to it. So we see a direct correlation between things like stress and psychosis and schizophrenia. Or we can also see a correlation between stress and eating disorders as well. So it's not just the common mental health issues that stress correlates with, it's across the whole spectrum.

And there was a recent study that actually showed 51% of people who felt stressed reported feeling signs and symptoms of depression. And 61% of people reporting stress also said they had symptoms and signs of anxiety. So the correlation there is incredibly strong.

Nicola: That makes sense. Do men in management or leadership roles in particular worry that a mental health issue might impact their career prospects?

Nathan: I think it's something that invariably does have an impact. And it's something we see time and again with the companies that we work with. I think, again, it's that stigma of being seen as weak. I think that only really becomes more of a concern the higher up an organisation you go. I think once you're responsible for leading other people, there's an additional pressure there that you have to be seen to be the strong and stable one.

And I think that's a perception men feel they have to live up to anyway in their day-to-day life of being seen as the strong one, the stable one. I think it sort of plays into those old-fashioned stereotypical roles that men were expected to play. But when it comes about management and leadership... I think we see that much more often, that pressure of, well, now I'm responsible for a team of people. I have to be seen as being strong and stable. People are looking up to me. They're expecting things of me. And that being seen to be able to handle pressure feels really key to our careers and our career progression. I want people to see that I'm capable and competent and that I can handle whatever's thrown at me.

And I think that's a really interesting one because the experience of having mental health struggles and overcoming them, I don't think that's valued as much as we should value it. That actually, if you have never experienced a mental health struggle in your life, how do you know how you're going to react when it happens? But if you've had experience of it and you've come through the other side, I think that's an incredible strength because you now know what works for you and what doesn't and what makes things worse and what makes things better. And if you've come through the other side, you've developed a sense of resiliency around it. It doesn't mean that you will never experience mental health struggles again, but you're probably better equipped to deal with them now than somebody who's never had any experience of that. But I don't think we value the fact that we've learned from that experience as much as we value learning from other experiences.

And I do think there's a knock-on effect for that as well. Men in leadership positions who worry that a mental health issue is going to impact on their career and so put on this mask that "I'm okay, I'm fine, nothing bothers me and I can cope". What we're doing actually is we're teaching other men that firstly, it's not okay to talk about mental health. And what it also does is it makes us less approachable. We're much more likely to go and talk to someone about our own struggles if we know that they've had an experience themselves. We're more likely to think that they are going to be compassionate and empathic and understanding around it. So what we're doing actually by masking and hiding those things is we're teaching men that actually this isn't okay to talk about and we're not as approachable.

And I think it's a really interesting thing when we think about men in leadership roles compared to women in leadership roles. You'll sometimes hear women described as the mother hen role, where they're approachable and people will go to them with their problems and they're really good at supporting and encouraging them. We never describe male leaders as mother hens or father hens, I guess it would be. We don't have the same kind of language around that. There's not the same expectation. Men are just seen as being able to deal with issues, deal with stresses and just get on with things. But I think actually in hiding that, I don't think actually we're doing ourselves a favour here.

Nicola: More generally, are there other related issues that men might be concerned about when it comes to mental health at work?

Nathan: I think there's a couple of big ones. Confidentiality is a huge one. It's if I tell you about my struggles, where does that go? Does that just stay with you? Is that something that's going to be passed on to someone else? Is everyone going to find out that I'm struggling? So I think that fear around confidentiality and who is going to know plays a big role in whether or not I feel comfortable to come and talk to you about it.

But I think the other impact is the fear of the unknown. How are you going to react when I tell you? How are you going to treat me? I think there's sometimes a worry and a fear that I'm going to be treated differently. I'm going to be treated like I'm broken or fragile and you're going to be walking on eggshells around me. Or people are just going to ignore me because they don't know what to say.

If you compare it to physical health, for example, if you'd broken an arm, you would think nothing of going to a work colleague and talking about it. In fact, if I walked into a workplace with my arm in a cast, almost everyone in that workplace is going to ask me what happened. No one's going to feel embarrassed to ask the question or to talk about it or to ask how I'm doing. But if I walked into that workplace and I told people I'm really struggling with my depression right now, they might not know how to respond to that. They might think, well, I don't want to say the wrong thing, so I'm probably best just not saying anything at all. Or do I go to that person and tell them I've got this problem at work? And do I ask for their help? Am I putting too much on them?

People start to treat you differently, or at least we worry that people are going to treat us differently. And actually, mental health issues are an illness, just in the same way that you would get a physical illness. It doesn't change who I am. I'm still the same me. I'm just experiencing an illness and I need help and support to overcome that. But when it comes to mental health, we don't always treat it as an illness. We sometimes treat it as it's a change in that person's personality and who they are. And so we might treat them slightly differently as a result of that. And I think the fear around that of what is the reaction going to be, that might stop people from reaching out and talking about it as well.

Nicola: Hmm, it's complicated. If a manager is concerned that something isn't right with one of their own team members, what's the ideal next step in terms of broaching this in a safe way?

Nathan: That's a great question. And I think it's a question a lot of managers struggle with. They know that something's not right. They've spotted that maybe they've got a member of their team who's been a bit quiet recently or just looks really sad and down, isn't their usual self. You kind of know something's not right and you want to talk about it. But how do I start that conversation?

Again, we're so used to talking about physical health that we think nothing of going up to a colleague who seems to be physically unwell and asking them how they are. But we're not as used to having that conversation around mental health. And for a manager, a lot of the time the fear is, what if I say the wrong thing?

What I would say to that is, it kind of comes down to intent more than execution. That fear of what if I say the wrong thing? Well, if your intention is actually I'm worried about this person and I want to help, well, it doesn't really matter about the combination of words you use. Your intent is going to come through. The intent that actually you want to help them is what is going to shine through.

So a couple of tips I would give is find a safe and confidential time to broach the subject. I always say to managers, if you're doing a team meeting, don't hold someone back at the end of that meeting. Because the moment you say to someone, "do you mind just sticking around at the end of the call?" Everyone else is now wondering, wonder what that's about. And they're going to ask them, well, why were you held back? And that might be something they don't feel comfortable to discuss. So find a safe way of doing it. Find a time when actually you can approach that person one-on-one and just say, can we have a chat?

And I think the big thing is to say what you've noticed. I think we can be tempted to go in there and say, well, how are you? And when someone asks you how you are, how do you normally respond to that? It's normally some variation of, I'm fine, I'm okay. I think it's something that's very peculiar about British culture. I think it does exist in other cultures, but in British culture, it's something we've all learned that "how are you" is a greeting rather than a question. It's a way of saying hello. And we've all learned the correct answer is, "I'm fine, thank you, how are you?"

But I think when you say what you've noticed, you can really cut through that automatic response of, "I'm fine". Because it's really hard to say you're fine when someone's highlighted something that shows that actually you're not. So find a safe time to have that conversation with them one on one somewhere private. Say what you've noticed. "You know, I've noticed you don't seem your usual self just lately. I've noticed you seem really quiet. You know, I've noticed actually your workload isn't at its usual standard. Like normally things are really, really good. And I've noticed there's been a bit of a drop off lately. Is everything okay? Is there anything that you want to talk about? You're not in trouble, but I'm actually really worried about you and I want to help."

And I think saying what you've noticed is a really good way of starting that conversation. I think the additional tip I'd give you around that is avoid asking the "why" question. Because I think sometimes when we say why something, it can come across a little bit judgemental. We don't intend it to, but it can sometimes come across that way. So if we say to someone, "You know, why have you been coming into work late recently?" It feels like you've got to justify it. You've got to explain yourself. You've got to give a really good reason as to why you've been coming in late. But if someone said instead, "you know, I've noticed you've been coming into work a little bit late and that's really unlike you. Is everything okay? Is there anything you want to talk about?" It's a much gentler way of starting that conversation.

I think the thing we also have to bear in mind is that they might not be ready to talk straight away. I think sometimes when you call them in and say, "I've noticed you don't seem your usual self. Is everything okay?" You get met with a response of, "no, I'm fine. Everything's okay." And there's almost a little bit of a panic look to them because they realise that somebody's noticed. And they might've thought actually they were doing a really good job of masking it and hiding it. So all these thoughts rush through their brain of, "okay, you've noticed. What have you noticed? Has everyone else noticed? Does everyone else think I'm not okay? What can I say here? What could I say something? Should I tell you? What do I say? How do I even explain it to someone?" And sometimes it feels like it's just easy to go, "no, I'm fine", even though it's quite apparent that they're not.

And I think, be patient with that. Saying to someone, "look, do you want to just take a few minutes and just have a think about it? Or do you want me to check in with you a little bit later?" And if they're not ready to talk straight away, that's okay. A lot of the time, actually, what you find is when you say to them, "look, if you're not okay, just come and talk to me. I'm always here for you. Just want you to know that you can always come and talk to me if you've got anything going on." Sometimes just doing that, what you find is they might go away and then come back to you a little bit later when they've had a bit of time to think about what they want to say and how they want to say it. So be patient with them.

And if you still get a feeling the next day or the day after that something's not okay, don't be afraid to check in with them again. So I think asking the question, saying what you've noticed, and asking if there's anything they want to talk about and being really patient is the key tips I would give you around that.

Nicola: That's such good advice. So clearly the language you use is important, how you say what you say, and also having patience. That individual may not be ready and need some more time. Moving on, if a team member is concerned that one of their colleagues is regularly accessing pornography at work, is this considered a mental health issue?

Nathan: I think it's considered more of a behaviour, but that doesn't mean it's not linked to their mental health. It could be considered an addiction, depending on how often the behaviour is engaged with or how they're engaging with it. But often what we find is it can be a coping strategy for something else.

I think as human beings, we tend to find ways of avoiding things that feel uncomfortable. And if we're struggling with our mental health, a lot of the time we just don't want to feel that. So we want to avoid feeling that. And that's where things like pornography, but also excessive alcohol use, drugs, even things like social media scrolling or risk-taking, particularly in men, is quite a common one. They're things that we do as a distraction technique rather than deal with or focus on the things that we're actually feeling.

So whilst I would say it isn't necessarily a mental health issue, it could be a form of addiction. It is classified as a form of an addiction in certain cases. But it could also just be that sign that they're trying to avoid something. There's something there that's not okay. And this is a distraction technique. It's an avoidance technique. So it's something to be mindful of. Something, again, to have a conversation with your colleague about if you have concerns about it.

Nicola: How would one go about a conversation on a topic like this?

Nathan: I think, again, it comes down to saying what you've noticed. And so any behaviour that's done to excess can be harmful for us. I always think, you know, exercising is a good example for that. We're all told and we all know that exercising is really good for us and healthy for us. But if you're over exercising and you're causing harm to your body, well, actually, that's not very helpful anymore. So anything done to excess can be harmful.

So if you were to notice this behaviour and it's happening excessively, just saying, "you know, I've noticed this is something you've been doing a lot recently. And actually, this is just what I've noticed. I don't know what you're doing in your own time. Do you want to talk about that? Is there something going on there that you want to discuss?"

And again, just be mindful that there could be some embarrassment or shame around those kinds of behaviours. I think there's a lot of shame around any kind of addiction. But particularly when it's things like pornography that isn't discussed as openly in public, I think there's more shame that can be attached to that.

And I think, again, it's just coming across as I'm not judging you for this. I'm not criticising you. I'm actually just worried that there might be something else going on and this is just a sign or symptom of this. So I just wanted to ask how things are going in your life. Is there anything going on that you're worried about or stressed about? And just asking it, again, it comes back down to intent. If the intent is I just want to make sure you're okay and I just want to support you if you're not. Don't worry too much about the language that you use because the intent is what shines through.

Nicola: So is it similar with alcoholism that you've got this part behaviour, part mental and, of course, varying degrees? Or how does an employer go about dealing with reported alcohol abuse?

Nathan: Alcohol's a really difficult one for employers to manage because a lot of the time that behaviour is happening outside of the workplace, but it is having a big impact in the workplace. Alcohol essentially is a depressant. It makes us feel good in the short term, it helps to lift our mood, but actually in the long run it is suppressing our central nervous system. It's making it much harder for us to regulate our moods, so it acts as a depressant.

The difficult thing is the good phase where it feels good for us, that's happening at home. The bad phase is what's happening at work. So we start to see things like the low mood, the difficulty concentrating, increased anxiety and irritability, the lack of interest or motivation. So as an employer, that's really tricky because you're seeing the negative effects in the workplace, but the behaviour is happening at home.

And I think it's about education and helping employers and employees to understand that actually the impact alcohol has is significant. And it isn't just something that you do in your home time that you use to help manage how you're feeling, but actually it's not helping in the long run. It's actually acting as a depressant.

I think there's also the presenteeism effect of being hung over, that you're just not your usual self. If anyone's ever experienced a really severe hangover, you just know physically you don't feel good. You feel a bit more irritable, but physically you can just feel unwell. And that link between physical health and mental health is huge as well. Anything that affects our physical health also has a knock-on effect on mental health and vice versa.

So I think as employers, education is a really key part of that. It's having those open conversations as well. That is often a coping strategy. It's probably the most common coping strategy for people who are struggling with stress. So actually having that conversation and saying, "well, okay, is this a way of you coping with something? And what is it that you're trying to cope with? Is there anything happening in the workplace that's contributing to your stress that is creating this need to have a coping strategy?" So having those open and frank conversations whilst they might feel uncomfortable. Again, we're not there to judge the person. We just want to understand them and we just want to be able to offer them support and offer them signposting to the right kinds of support as well.

Nicola: Earlier, you mentioned stigmas. You also mentioned shame. In the context of this, what things can employers do to make it as easy as possible for men to access the support if they need it?

Nathan: I think the simplest thing I can give you for that is to talk about it. As a company, be open to talking about men's health. And I always say to people, talk about it until it becomes normal. Talk about it until it becomes boring. Because by doing that, it just becomes a very normal thing. So talk about it in team meetings, have internal memos, signpost to supports that you've got available and keep talking about it.

I think a lot of organisations are very good at having things like employee assistance programmes in place and they might even have mental health first aiders. And generally speaking, when somebody new comes into the company, they're told all of this in their induction. But they're also told a million other things that they've got to remember and they kind of just forget about an employee assistance program or what mental health support the company has in place. Keep reminding people so that they know it's there to access, but make it part of team meetings.

I always think the simplest thing that you can do is have it as part of annual appraisals. There's lots of companies that we speak to and we say, "well, do you do annual appraisals with your staff?" And they go, "yeah, of course we do." "It's okay. Do you have a question in there that asks them how their work affects their mental wellbeing?" "And now we don't." It's a very simple question to add in. And it means if nothing else, at least once a year is part of that formal process. You are having that conversation. "Is there any support you might need with your mental wellbeing to cope with your workload?" You could just add a couple of very simple questions in and it becomes part of the culture of that workplace.

And that's what we really need it to be. We need it to be part of the culture. And I think a lot of the onus for that comes on senior leadership. Culture's formed from the top down. So we need our senior leaders on board with this. We need them talking openly about mental health. Ideally, we need them talking and sharing their own experiences. And I know that's sometimes a difficult thing to do because it can require us to overcome that stigma that it's seen as a weakness to talk about our own experiences. But when I go in and talk with companies about mental health, I'm very open about sharing my experience, my experience as a therapist, but also my own personal experience with mental health and my struggles, because I think that normalises the conversation.

Another thing I always say to team leaders is make it part of your team meetings, whether you're doing that on a weekly basis, fortnightly, monthly, whenever it is, ask the question. "Is there anything going on at the moment that's affecting people's wellbeing or affecting your mental health?" And what I would say to you is, if it's the first time you're asking that question and you're not used to talking about mental health as a team, the moment you ask that question, all of a sudden the floor becomes the most interesting thing in the room. Everyone's looking at the floor. Nobody wants to make eye contact and nobody wants to say anything because nobody wants to be the first one to say something. But if you keep asking that question, don't be put off by it. Don't be put off if it doesn't seem like anyone wants to engage with it. Just keep asking it. Because eventually someone's going to go, "well, you know what? We keep getting asked this question. So it's just something that we do now. I'm going to take a chance to answer it." And the moment that somebody answers that question, there'll be someone else will go, "I felt like that too. I've really struggled with this recently." And all of a sudden it just becomes a normal thing to talk about. But to get to that point, we have to be persistent. We have to be willing to talk about it.

Because once we get to that point where the culture is open around mental health, where we can have open discussions around it, all of a sudden accessing support is easy because this is just something that is there to help us if we need it. And I always think of things like counselling and therapy as tools, that they're tools to help you do your job better. They're not something that we should stigmatise or we should be afraid of. They are just there to help us when we're struggling. But we only get to that point by being willing to talk openly about it.

And I think if you've got mental health first aiders within your organisation, they're an incredible resource to use as well. Have them going out and having drop-in sessions where people just come along and have a conversation with them or get them to talk openly about what it is that they do and how they can support people. And if you haven't got mental health first aiders, consider training some up because they can be an incredibly valuable resource to have within your organisation.

Nicola: Open discussions and normalising the issue. Including it in the annual appraisals all makes a lot of sense when it comes to, as you highlight, bit by bit, helping to shift the culture of an organisation. And this must, of course, come from the top. Are there certain groups that can be reluctant to reach out for help? And if so, can anything be done to encourage them?

Nathan: I think there are definitely certain demographics that we need to be mindful of. I mean men are a good example � men are much less likely to come forward and say that they're struggling. But we also know that culture plays a big role in that. So that's family history, certain cultures... certain cultures within the world are more stigmatised around mental health. So in some cultures, mental health struggles are seen as not just a shame on that person, but a shame on the whole family. So it isn't discussed openly. Some conditions like suicidal thoughts, suicidal ideation, suicide itself has been considered a mortal sin within the Catholic Church for so long that those kinds of cultures exist. So I think it's important that we acknowledge that some people will find this harder because of their experience, because of their upbringing.

I think age plays a role in that as well. If I think of my generation and generations before me, mental health wasn't understood. It certainly wasn't something that was discussed because we didn't really understand it. I think younger generations are much better now at being raised around the language around mental health and the understanding. But someone from an older generation... well, we haven't been raised with it. We don't have the language for this. And that means that we're less likely to talk about it because it's hard to talk about something you don't have a language for.

I think there's a couple of ways we can address the imbalance around that. And I think it kind of ties into being more proactive. It's understanding that we might need to ask the question a little bit more. So that might go with male employees that actually we need to be proactively asking, "how are you? How are you finding things? Is there anything that you want to talk about?" Because they're less likely to come and talk to us.

I think if you've got people who have come from other cultures where mental health might be more of a challenge to talk about... We know, for example, Black leaders find it really hard to talk about their mental health. Same with Asian communities as well. So understanding that that's maybe an additional challenge for them and proactively asking the question, "do you have any struggles? Is it hard for you to talk about mental health? Is there anything that as your employer that I can do to help you with that?" And again, being patient, they might not have any answers there and then for you, but they might go away and think about it. And they might come back and go, "actually, you know, if you did this, that would be really helpful."

So I think we have to proactively be asking. And I think we have to give them opportunities to open up. We can't just rely on them coming to us. So that's why, again, I think if you've got mental health first aiders having drop-in sessions where someone could just come along and just have a chat with them, you're giving them those opportunities. You're asking it as part of an annual appraisal. By giving those opportunities, you're more likely to get someone come forward, particularly if it becomes part of the normal culture again.

Nicola: Is it easier for women to seek help than men if they have an issue at work?

Nathan: I would say from experience and from the people that we speak to and the people we work with, I think there are concerns there still. I think that's particularly true when it's female business leaders, people in leadership positions, certainly senior leadership.

Where again, I think there's a - especially if it's an environment where it's been very traditionally male-dominated - there's sometimes that feeling that they have to demonstrate that they are as tough and capable at doing the job as the men. And I think that can lean into that sort of "I'm fine, I'm okay" attitude. That idea that's, again, seen as a weakness. I think that can sometimes be a barrier that women face.

But I do think women have grown up with different messages to men. That doesn't necessarily mean it's been easier. But I think women have been allowed to showcase a greater range of emotions. So boys growing up are told, "Boys don't cry." So you're not allowed to get upset. You're not allowed to be scared as a boy because that's not very manly. Sometimes it's even seen as "that's a girly thing" if you're scared - which, whatever "girly thing" means.

So men are taught that certain emotions, certain negative emotions are not okay. I think for women growing up, there's been a bit more acceptance of women getting upset, women being scared, which means that they're able to express those emotions. So as they grow up, they're much more comfortable, I think, a lot of the time to express those emotions.

I think there is still that worry and that stigma there of: how is it going to be perceived? Is it confidential? Who's going to find out? And are you going to treat me differently? But I think that women are more likely to talk about it because they're used to talking about it as well. They're more likely to talk about it in their friendship groups, in their families, and that be seen as okay.

I think those stigmas that men have been raised with stop them talking even amongst their male friends a lot of the time. So I think there are still challenges there, but I think it's slightly different. And maybe it's slightly easier for women to talk about certain emotions than it is for men.

Nicola: This reoccurring theme of stigma and shame - am I right in thinking that there's a connection there with a lack of confidence in an individual?

Nathan: Absolutely. And I think stigma and shame in particular - shame is a very toxic emotion and not always a very helpful one. I always say guilt is a very helpful emotion to feel. If we've done something wrong and we feel guilty about it, it's not a nice feeling to have. And what that prompts us to do is go, "You know what, I don't want to do that behaviour again. I don't want to feel this emotion again. So I'm going to avoid the behaviour that caused it." That can be really healthy and really helpful.

Shame is actually less helpful because it's not a sense of "I did something wrong." It's a sense of "I am someone wrong. There is something fundamentally wrong with me." And that is particularly corrosive when it comes to self-confidence. That when you start struggling with your mental health and if you get into that shame spiral of "I should be able to cope with this, I shouldn't be feeling this way, there's something wrong with me because I do," that can really start to erode that self-confidence quite quickly.

And self-confidence is in itself a massive protective factor against poor mental health in the first place. The more self-confident we are, the more capable we feel of being able to meet a challenge or deal with a challenge. Even if I'm struggling, if I've got a good sense of confidence in myself, I might believe, "Well, I can find a way through this. I can come through the other end of it." If you feel secure in who you are and you're confident in yourself, you're less worried about how other people are going to perceive you as well.

So I think shame definitely has a corrosive effect on self-confidence, but when we start to struggle with our self-confidence we can also then experience more shame as a result of that. And so it becomes a little bit of a cycle that, if we're not careful, becomes a spiral pretty quickly. And I think that's where reaching out to other people and talking about mental health is so important.

Because we might think that there's something wrong with me because I feel this way and because I'm reacting like this. And then you go and talk to someone and you realise that actually this is quite a normal way to react. The amount of times I've sat with a client in a therapy room as their therapist and they've told me their story and they've had these struggles at work and they've got a family member who's really ill and their relationship with their partner's falling apart and they've got money worries and they've got all these different things, and then they go, "I don't know why I feel this way though. I mean, there's nothing really that bad."

And then when you sort of read back to them, "Well, you said you've got this and you've got this and you've got this." And then all of a sudden they realise, "Gosh, that is a lot, isn't it?" And you go, "It's no wonder actually with all those things going on that you feel the way that you do."

And the moment you take that shame off the table, you can start to see that recovery happening. There's that sense of self-confidence returning of, "Okay, this isn't something that's wrong with me. This is an illness I'm experiencing. It's caused by circumstances that are pretty much out of my control in most instances. But there is something I can do about it to help my recovery." And by taking those steps, even if they only seem like small steps at first, I'm building momentum. I'm building that sense of, "I can do this."

So self-confidence and shame and stigma are very closely tied in. And if we're not careful, can become quite a toxic spiral quite quickly.

Nicola: Yes, and no doubt it must be such a relief for people who are in a bad space once they do open up and take that no doubt courageous first step - that there are actually a lot of things that can be done and support on offer that they may not have imagined would be available.

Nathan: Absolutely. And it is always that first step that always feels the most daunting, particularly if this is the first time you've ever really struggled with your mental health because you've got no experience to fall back on.

I was going to think about sort of my experience. I've lived with anxiety since I was a very young child and had periods of depression throughout my life. And every so often now I still get a moment where I slip into a depressive episode. But I've been through it so many times now that I kind of sort of meet it with like a weary resignation of like, "Oh, we're doing this again, are we?" Because I kind of know the things that I need to do that will reliably pull me out of it. And because I've got that experience to fall back on, it doesn't hit me quite as hard. I just, I know what I need to do.

But if it's the first time, all of a sudden it's terrifying. It can be really scary. And "well, I don't know, am I ever going to recover from this? It's just going to be who I am now." And talking about it feels really daunting because I don't know how people are going to react.

Almost always what you find is when you do reach out and you talk to someone, particularly if that person is understanding, non-judgmental and empathetic, what you're met with is, "Gosh, that was really helpful. Getting that off my chest felt really good. You know, actually, that gives me the confidence to maybe go and talk to someone else."

So if I talk to my line manager and I get a really positive response, I'm more likely to go and talk to my doctor about it. I'm more likely to talk to my family about it. Maybe I'll talk to a counsellor or therapist about it. That positive experience - and I think, if you are a line manager, that's so important to hold onto - that if you just give someone a positive experience of listening to them without judgement and showing a genuine concern for their well-being, even if you can't fix what's going on for them, just that positive experience might be enough for them to take the next step and to get the right kind of support that's going to help them through this.

So it is a daunting first step. But every time I speak to someone who's taken that first step, they're glad that they did because it's led them back onto that road to recovery.

Nicola: Nathan, thank you. I really appreciate your time here today on this important issue.