The social stigma surrounding mental health can complicate treatment and negatively impact outcomes — particularly when it comes to men. What can social workers do to overcome this hurdle?

Mental health isn’t often thought of as a “men’s health” issue in particular, although it probably should be. The stigma surrounding mental health is particularly strong for men, and as a result, they are more likely than women to go undiagnosed or untreated for mood disorders such as depression and anxiety.

John Hoyos, a California-based nurse practitioner who specializes in treating mental health conditions in young men, is deeply familiar with the challenges posed by this stigma. We spoke with Hoyos about his career, the mental health issues men most often face, and his advice for nursing and social work graduates interested in pursuing careers in this growing and increasingly urgent field.

USC Suzanne Dworak-Peck School of Social Work: Could you walk me through how you became a nurse practitioner?

John Hoyos: I started my career as an emergency medical technician many years ago, so I’ve been drawn to health care for a really long time. I find it very rewarding to be able to help people when they need it most and to have the education, skills and specialized training to do it effectively.

Over the course of my career, I discovered that mental health was the area that most interested me. It’s very stimulating — intellectually speaking — because in a way, people are like puzzles, and being able to work through and find solutions to their problems is both fascinating and rewarding. That’s what drives me.

Some of my training over the years has been with MSW graduates from the USC Suzanne Dworak-Peck School of Social Work, and my experiences with them have given me a deeper understanding of the psychosocial factors that affect my patients. Early in my career, I was able to gain experience in counseling and therapy, as well as manage patients’ medication and biological needs. I saw just how incredibly useful it was to take a holistic approach that allowed us to offer sophisticated solutions to complex problems. So for that reason, I enrolled in a nursing training program, and then later completed a doctoral degree at the University of San Diego in 2016.

USC: What are some of the most prevalent mental health issues you see among the men you treat?

JH: Depression is one. Mood-related problems are underdiagnosed in men. Part of the problem is that the word “depression” seems to suggest low mood or tearfulness. But oftentimes depression doesn’t present itself that way in men. Instead, it presents as anger and aggression.

Sometimes, it’s accompanied by an increase in alcohol consumption to help correct for the mood problems, but of course, we know that alcohol is not an effective antidepressant—it actually tends to make things worse. For young men, in particular, alcohol consumption has been normalized, and it ends up yielding second-order effects like difficulty with sleep, mood swings, and social or work-related dysfunction.

I deal with a lot of mood disorders and anxiety issues, which can often co-occur. Long-term anxiety can aggravate, exacerbate or even precipitate mood problems. I also see the effects of trauma in my practice with young men, some of whom have experienced abuse as children, been involved in combat, survived motor vehicle accidents or dealt with sexual assault (which is drastically underreported in men).

USC: How has the societal perception of mental health, and men’s health, affected the work that you do? Has there been any progress in destigmatizing these issues?

JH: That’s a complex question that ultimately lives in the culture. I think we have a long history as Americans of taking a rugged, individualistic approach to things. Young men, in particular, tend to pride themselves on being able to take care of themselves without asking for help. That’s part of what aggravates the problem of young men not seeking the help they need when they need it.

In this field, we’re continuously warring against the public perception that mental health problems are somehow fundamentally different from other health problems. What we’re trying to do is convince people that in the most important sense, mental health problems are not unlike other health problems. They are treatable. Mental health problems, heart problems, skin problems—they all fall under the same umbrella of “health problems,” and there are treatment options for each and every one of them. Having a mental health problem does not reflect badly on you as a person or as a man, and it’s ok to get help.

In fact, it’s a sign of strength for men to get help when they need it because it allows them to be of more use to the people that matter to them. It’s not uncommon for me to see young men in my practice who are responsible for their family, or for a team at work, and they’ve gotten to the point where they recognize that unless they get help, they won’t be able to effectively shoulder those responsibilities. Sometimes, that’s part of how we get around the stigma—we get people to remember that in order to take care of others, they first need to take care of themselves.

USC: Do you have any advice for graduates who might be considering going into a career in mental health or men’s health?

JH: Developing a good understanding of yourself is one of the most important things you can do as an aspiring health worker. To that end, I always encourage personal therapy. A lot of graduate programs will mandate this; psychology programs and social work programs usually do. Being in therapy, first off, helps you understand what exactly therapists do; but it can also help you see biases or blind spots that you might be bringing with you into your patient care.

Additionally, a social worker preparing for therapy training should have very strong people skills, a background in being an active listener, and the ability to bring a fresh perspective to people and their problems without judgment. Social workers need to be able to accept people as they are, and work with a variety of people from different backgrounds. They should be able to recognize a patient’s autonomy and personal agency, while also helping them to get better. We don’t force people to get better—we give them the resources and guidance to help themselves.