“We Don't Stay Where We Feel Weak”: Experiences of Men Discontinuing Mental Health Services in Türkiye

ABSTRACT

Men continue to underutilize and disengage from mental health services, highlighting the need to understand this pattern. This study explored Turkish men's experiences of discontinuing mental health treatment using a descriptive qualitative design. In‐depth interviews were conducted with 13 men who had ended therapy. Thematic analysis revealed three themes: the process of initiating treatment, experiences in the treatment process, and reasons for discontinuing treatment. Findings showed that hegemonic masculinity shaped men's engagement with care, as masculine norms often conflicted with recognizing mental illness, seeking help, and engaging in emotional disclosure during treatment. Even when symptoms were acknowledged, doubts about treatment effectiveness, cost, stigma, difficulty accepting mental illness, fear of failure, and concerns about being negatively evaluated by clinicians contributed to disengagement. The study calls for gender‐sensitive, accessible services, clinician training in relational and cultural responsiveness, and structured approaches that align with men's values and support sustained engagement.

1. Introduction

The experience of mental health problems differs between genders (Christiansen et al. 2022; Otten et al. 2021). Certain mental health issues, such as completed suicide (Demir et al. 2018; Karbeyaz et al. 2013) and alcohol and substance abuse (World Health Organization 2025; Demiralay et al. 2021), are more prevalent in men than in women. Although global suicide rates have been trending downward since 1990 (Davis‐Weaver et al. 2025) and suicide attempts are more prevalent among women (Davis‐Weaver et al. 2025; Richardson et al. 2023; Bommersbach et al. 2022; Choo et al. 2019), men account for the vast majority of completed suicides; of the 759,028 suicide deaths reported worldwide, 523,883 were among men (12.6 per 100,000, compared to 5.4 per 100,000 among women) (Ilic and Ilic 2022).

Although mental health issues such as suicide and alcohol and substance abuse are more prevalent among men, rates of seeking mental health services are significantly lower among men (Kwon et al. 2023; Morgan et al. 2022; Seidler et al. 2020a; Pattyn et al. 2015; Yousaf et al. 2015; Smith et al. 2013). In a study examining the help‐seeking behaviors of 778 male participants who reported experiencing mental illness (Seidler et al. 2020a), 65% of men reported wanting treatment, while 35% did not. Believing that many people feel sad and depressed, not knowing what to look for in a psychotherapist, and feeling the need to solve one's own problems may be among the factors that prevent help‐seeking behavior for mental health problems. The study also reported that, compared to men who sought help for mental health problems, men who did not seek help were significantly more likely to be unsure whether psychotherapy (counseling) really worked or was effective, to not tell their counselors when they felt depressed or down, and to prefer to solve their own problems. In addition, the literature cites personal difficulties, cultural and environmental influences, self‐medication with alcohol, traditional ideals of masculinity (Lynch et al. 2018), reluctance to express health‐related feelings/concerns, shame, anxiety, fear, and inadequate communication with health professionals (Yousaf et al. 2015) as factors that prevent men from seeking help.

In addition to rates of seeking mental health services, rates of continuing to use mental health services are also lower among men (Schneeberger et al. 2024). A study examining gender differences in treatment retention among individuals participating in inpatient treatment for concurrent substance use and mental health disorders (Choi et al. 2015) found that women with concurrent disorders were more likely to remain in treatment longer than men. A study investigating the reasons Australian men leave mental health services (Seidler et al. 2021) also reported that the rate of men leaving therapy was 44.8% (n = 855). Of these, 26.6% had attended therapy once and did not return. The study indicated that the most common reasons for discontinuing therapy were an inability to connect and a feeling that the therapy was not progressing. However, factors such as young age, unemployment, identification with traditional masculinity, and whether the therapy made participants feel alienated from their masculinity were also reported as factors predicting discontinuation of therapy.

To understand men's reluctance to continue mental health services, it is important to examine the relationship between mental health and the concept of hegemonic masculinity, which Connell (2005) describes as characterized by domination and superiority over other forms of masculinity and women—an idealized form of masculinity within a specific time and place. Courtenay (2011:145) notes that, in relation to health, men adopt various hegemonic ideals, such as “men are strong and less vulnerable than women, seeking help and caring for one's health is feminine, or men who are indifferent to their health and safety are the strongest men.” Along with social changes, the way hegemonic masculinity is represented has also changed significantly. Men underwent a socialization process in which they were expected to be strong and silent, not expressing their emotions. Indeed, men were encouraged to be stoic, prove their masculinity, and display their sexual prowess. However, these meanings have changed over time, and masculinity has begun to be defined not as being strong, stoic, silent, suppressing emotions, and displaying sexual prowess, but rather as being compassionate or expressive of emotions (Kimmel 2011). This transformation can have negative repercussions on men's mental health. Indeed, one of the fundamental problems arising from the changing concepts of masculinity and femininity in modern society is the imbalance between social expectations and individual expression. Although society increasingly accepts different forms of gender expression, the tendency to judge people according to traditional norms still persists (Negara and Khayru 2022). For example, expressing emotion is seen as a sign of weakness (Cleary 2012). This creates internal conflict and tension in individuals, giving rise to anxiety that leads to an overemphasis on masculinity (Connell 2005). This can cause individuals to feel trapped in gender roles they did not choose, negatively affecting their personal development and psychological well‐being (Negara and Khayru 2022). This transformation can negatively affect men's mental health as well as their relationship with mental health services.

This is because hegemonic masculinity (Seidler et al. 2016) and mental illness stigma (Sileo and Kershaw 2020) intertwine to limit men's help‐seeking behaviors (Chatmon 2020; Affleck et al. 2018) and access to mental health services (Clement et al. 2015). Even when men begin using mental health services, these factors prevent them from continuing treatment (Seidler et al. 2021; Springer and Bedi 2021). Being strong, self‐sufficient, and courageous in the face of difficulties is internalized by many men. This leads men to develop an ineffective response to mental health issues by resisting the use of mental health services. This is because using mental health services is perceived as a sign of weakness and can be seen as an admission of failure to behave in accordance with the norms of self‐sufficiency and strength expected of a man (Whitley 2021). This can lead men to avoid risking their identity by seeking help (Lynch et al. 2018). Men's perceived threat to their masculinity may cause them to develop externalizing symptoms consistent with masculinity (Eggenberger et al. 2021). Tarsuslu and Durat (2018) note that men use dysfunctional coping methods such as self‐harm and suicide.

Simon (2002) also emphasizes that, as a result of gender‐based emotional socialization, men may exhibit externalizing behaviors such as substance use in response to emotional problems. When men do not continue their mental health treatment, the problems they experience may be overlooked and worsen. At this point, it becomes clear that early detection of mental health issues, rapid access to professional treatment, and the continuation of treatment are critically important. While treatment continuity constitutes a multidimensional structure (Burns et al. 2009), it also contributes to higher‐quality mental health services (Choi et al. 2020), reduced medical costs (Van Der Lee et al. 2016), treatment of mental illness (Cruppe et al. 2023), improved social functioning (Storm et al. 2019), quality of life (Lim et al. 2022; Storm et al. 2019), and prevention of death (Hoertel et al. 2014). The importance of continued professional treatment in men's mental health underscores the need for more information about men's experiences of discontinuing mental health services.

1.1. Men's Mental Health in Türkiye

According to the Turkish Statistical Institute's Death and Cause of Death Statistics, 3,499 suicides in Türkiye in 2024 were committed by men and 961 by women. The reasons for suicide among men include illness, family discord, financial difficulties, business failure, emotional relationships, inability to marry the person they want, and educational failure (Turkish Statistical Institute 2025). Looking at the gender distribution of substance‐related deaths in Türkiye, 92.3% were men and 7.7% were women in 2023 (General Directorate of Security, Department of Anti‐Narcotics of the Ministry of Interior of the Republic of Türkiye 2024). According to the Türkiye Mental Health Profile‐2 Survey, when looking at the distribution of DSM‐5 diagnoses by gender in the last 12 months, the rate of all mental illnesses was 20.7% in women and 13% in men (Ministry of Health of the Republic of Türkiye, General Directorate of Health Services, Department of Research, Development and Health Technology Assessment, [MoH‐RDHTA] 2025). One of the main reasons why diagnoses are lower among men than women is men's reluctance to seek help. Indeed, the same report shows that while 91% of women in Türkiye reported needing mental health help in the last 12 months, this rate was only 9% among men (MoH‐RDHTA, 2025). These data send important signals regarding men's mental health in Türkiye and point to the need for policies and services related to men's mental health. Despite these signals and needs, there are no specific policies and practices tailored to men's mental health.

Mental health services in Türkiye are generally provided through hospitals and community‐based institutions (community mental health centers). The provision of services to a very large population and the existence of a rigid medical approach based on medication use are seen as significant problems (Mental Health Europe 2018). Although both hospital‐based and community‐based models are used in the provision of mental health services in Türkiye, these services are predominantly delivered through the hospital‐based model (Songur et al. 2017). In Türkiye, mental health services such as psychotherapy and counseling, which are not covered by psychiatric medication, are mostly provided by private institutions (RUSİHAK 2008). This makes it difficult for men who experience economic problems, such as unemployment and poverty, and who are oppressed by the traditional male role of providing for the family to access these services. Stigma concerns and fears of losing power are also among the important dynamics that make it difficult for men to access mental health services. Negative attitudes toward mental illness in society and the association of seeking professional help with weakness make it difficult for men to seek professional help (Akçay 2016). In their study examining the experiences of social workers in Türkiye in providing mental health services to men, Akçay and Akar (2025) reveal that masculinity norms not only create a source of stress and a barrier to seeking help, but also create a disadvantageous cycle that makes it difficult to focus on treatment due to societal expectations that continue even after diagnosis. Consequently, in Türkiye—where traditional masculinity ideology persists (Sakallı and Türkoğlu 2019) and masculinity norms remain a significant source of stress (Kendir‐Gök and Asmaoğlu 2025; Türkoğlu 2024)—there is a critical need to explore men's experiences of discontinuing mental health services in light of concerning indicators regarding men's mental health. This study aims to examine in depth the experiences of discontinuing mental health services among men who had previously initiated psychiatric treatment or psychotherapy by contacting an institution or specialist providing mental health services, but discontinued the process.

2. Method

In this study, a descriptive qualitative design was utilized to provide direct descriptions of men's experiences of discontinuing mental health services (Sandelowski 2000) and to obtain information from those who directly experienced these phenomena (Bradshaw et al. 2017). The Consolidated Criteria for Reporting Qualitative Research (COREQ) (Tong et al. 2007) was used at every stage of the research, from its design to its reporting.

2.1. Participants

Purposive and snowball sampling were used to recruit research participants, and specific criteria were established for participation. Participants in the study were defined as male volunteers aged 21–65 who had not received a diagnosis of schizophrenia or any other psychotic disorder but had previously sought mental health services and started treatment or therapy, which they had discontinued. The reason for not including psychotic disorders in the study was that individuals with a diagnosis of a psychotic disorder may have impaired reality testing, distorted perceptions, thoughts, feelings, behaviors, attention, and questioning regarding their environment, time, and self (Ozturk and Ulusahin 2014). This situation may also limit their ability to express their experiences of discontinuing treatment. The age range of 21–65 was selected for the study as it represents adulthood.

After establishing these inclusion and exclusion criteria, the research team reached out to potential participants through key informants. To reach participants, an announcement text was first prepared and shared via the professional accounts of the medical family therapist on the research team on Twitter, Facebook, LinkedIn, and Instagram. Mental health professionals were then asked to share this announcement within their own professional networks. The announcement was then shared in WhatsApp groups where mental health professionals were present, and these professionals also reposted it on their own social media accounts. Through this process, potential participants who met the study's inclusion criteria were identified and encouraged to contact the research team directly. Potential participants were also reached through referrals from participants who had already joined the study. Between August 5, 2023, and August 29, 2024, 30 potential participants were contacted; 17 initially agreed to participate but could not be reached afterward. In this context, 13 of the 30 potential participants agreed to participate in the research. All 13 participants who were contacted and interviewed in depth became participants in the study. The characteristics of male participants who had experience of discontinuing mental health services are shown in Table 1. The men in the study ranged in age from 29 to 51. The average age of the men was 35.84. Regarding educational background, 10 participants were university graduates, and 3 were high school graduates. The number of outpatient treatment visits for the research subjects ranged from 1 to 4.

Table 1.

Participant demographic information.

Participant	Age	Education level	Marital status	Reasons for seeking treatment	Number of outpatient visits
P1	47	University	Single	− Couples therapy − Feeling lonely − Problems with partner	3
P2	37	University	Married	− Depression − Health concerns − Work focus trouble – Heavy responsibilities	2
P3	51	University	Single	− Couples therapy − Vaginismus − Post‐divorce adjustment − Anger management problems	2
P4	40	University	Single	− Heavy responsibilities	4
P5	35	University	Single	− Heavy responsibilities	3
P6	29	High school	Single	− Loss − Adjustment problems − Separation − Tendencies toward violence	3
P7	31	High school	Single	− Separation − Cope better with the situation − Attachment problems − Improve relationship quality	4
P8	30	High school	Single	− Panic attacks − Anxiety − Heavy responsibilities	1
P9	29	University	Single	− Concentration problems − Separation − Heavy responsibilities	1
P10	35	University	Single	− Impulsive decisions − Tendencies toward violence − Heavy responsibilities − Emotional withdrawal	1
P11	35	University	Married	− Anger management problems	2
P12	33	University	Single	− Loss − Procrastinating life − Separation − Struggles during military service − Heavy responsibilities − Emotional withdrawal	1
P13	34	University	Single	− Couples therapy − Anger management problems	3

2.2. Data Collection

The research team consists of three researchers (two females and one male): two academics in the field of social work and one clinician researcher specializing in medical family therapy. The researchers have experience in mental health, gender, and masculinity research, as well as in qualitative research methods. A semi‐structured interview form was developed based on a literature review related to the research topic. In the process of developing the interview questions, studies conducted in the relevant field (Akçay and Akar 2025; Schneeberger et al. 2024; Kwon et al. 2023; Morgan et al. 2022; Seidler et al. 2021; Seidler et al. 2020a, 2020b) were examined to gain an understanding of the relevant literature, and the semi‐structured interview form was created by the researchers in a manner appropriate to the objectives of the study. The semi‐structured interview form included questions that allowed men who discontinued mental health services to share their experiences and thoughts (Table 2).

Table 2.

Semi‐structured interview guide.

1	Could you tell me about yourself? (Age, education level, occupation, marital status, reason for seeking mental health services, number of outpatient visits)
2	How did you decide to seek professional help?
3	Can you describe the process from the start of your treatment until you discontinued it?
4	How do you evaluate the service you received?
5	Can you talk about how the treatment process has affected your life?
6	Can you describe your process of ending or being unable to continue treatment?
7	What factors do you think influenced your decision to end or not continue treatment?
8	How did this interview make you feel?
9	Is there anything else you would like to add?

Following the development of the semi‐structured in‐depth interview form, a pilot interview was conducted on August 5, 2023. The participant was a male recruited via social media who fulfilled all inclusion criteria. After the interview, it was determined that the questions were clear and understandable, and appropriate for the research purpose and participant group. Therefore, no additional pilot interviews were required.

The length of the data collection process was due to difficulties in reaching participants. Given the focus of the study on mental health, it is thought that men may have been reluctant to share their experiences on this topic. This raises the possibility that men may be reluctant not only to use mental health services but also to participate in mental health research due to gender norms. Despite all the challenges of the process, the researchers continued the in‐depth interviews until sufficient saturation was achieved. This saturation was achieved in the 10th interview. Three more interviews were conducted to ensure data saturation. Since coding was conducted concurrently with data collection, thematic saturation was achieved when no new codes or themes emerged. At the same time, data saturation was also achieved through observations that new data repeated what was expressed in previous data (Akçay and Koca 2024; Saunders et al. 2018). Therefore, this study achieved both thematic and data saturation. Since 12 participants were in different cities and one in a different country, in‐depth interviews were conducted via online platforms such as Teams and Google Meet. One participant was a Turkish citizen who was temporarily based overseas for work and education at the time of the study. To ensure confidentiality during the interview process, each participant was given a personal link, and the interviews were conducted only between the researcher and the participant. The interview recordings are securely stored in an encrypted file on the researchers' personal computers. Participants' identity information was not recorded at any stage, and the data were used solely for research purposes.

The duration of the in‐depth interviews ranged from 30 to 159 min. After each interview, the interview process was evaluated together with the other researchers. Throughout the data collection process, researchers held regular meetings to clearly articulate their assumptions, feelings, and potential biases, and to recognize and avoid them. This allowed the data collection process to be managed by all three researchers and minimized potential negative outcomes.

2.3. Ethical Considerations

Ethical approval for the study was obtained from the Selçuk University Faculty of Health Sciences Institutional Review Board for Non‐Interventional Clinical Research (Date: March 29, 2023; Decision No: 2023/356). An informed consent form was prepared prior to the interviews, read to the participants, and their informed consent was obtained. Participants were informed prior to the interviews that the findings obtained within the scope of the research would be used solely for scientific research purposes and that the interviews would be recorded using audio recording devices. To ensure the anonymity of the men included in the research during reporting, their names were coded as P1, P2, … P13.

2.4. Trustworthiness

To enhance trustworthiness in the research, the criteria of credibility, confirmability, dependability, and transferability outlined by Lincoln and Guba (1986) were considered. The methods described by Bradshaw et al. (2017) were used to apply these criteria in descriptive qualitative research. Within the scope of these methods, participants who were willing to participate in the data collection process and share their experiences were included in order to ensure credibility. The researchers demonstrated empathy during the interviews to establish a relationship built on trust. To ensure confirmability, the researchers took reflective notes on the interview process and maintained constant communication, sharing their observations and experiences with each other. The research report includes participants' demographic information, and participant quotes were used to present the findings. To ensure dependability, the procedures and processes of the study were reported in detail. To ensure transferability, a purposive sample was used and rich descriptions were included.

2.5. Data Analysis

The audio recordings of the in‐depth interviews were transcribed and analyzed using the six‐stage thematic analysis method proposed by Braun and Clarke (2006) in MAXQDA 2024. These stages include familiarizing with the dataset, coding the data, identifying initial themes, reviewing these themes, defining and naming the themes, and finally writing the report. An example of how the analysis process was carried out is provided in Table 3. Data analysis and data creation proceeded simultaneously. All three researchers met regularly and carried out each stage of the analysis together. Thus, the researchers reached a consensus on the analysis.

Table 3.

Analysis process.

Meaning Units	Codes	Category	Theme
“This was the first time I'd ever been through major depression. Your mind messes with you, making you think things like, ‘What's the point? Nothing's going to help anyway.’” (P2)	The belief that treatment will not be effective	Reasons for putting off	The process of initiating treatment
“There is also, of course, the financial side of continuing therapy. When I looked at the pros and cons, honestly, the therapy costs were high.” (P6)	Inability to afford treatment
“My upbringing had an impact; when I was little, I wasn't allowed to cry, so I would cry when no one was around. High expectations such as, ‘You're a man—you have to be strong, earn money, and be a role model,’ make it difficult to experience emotions. I see this in myself as well.” (P7)	Adherence to hegemonic masculine ideals
“Why don't men seek psychological support? Image is very important. So, whether you get better or not, having sought support is like an indelible stain on your reputation.” (P4)	Stigmatization

3. Results

In this study, we aim to explore in depth the experiences of men who have discontinued mental health services. Our primary research question is: What are the experiences of men who discontinue the use of mental health services? The experiences of men were grouped into three themes: the process of initiating treatment, experiences in the treatment process, and reasons for discontinuing treatment (Figure 1).

Figure 1.

Themes and categories of research. [Color figure can be viewed at wileyonlinelibrary.com]

3.1. Theme 1: The Process of Initiating Treatment

This theme encompasses men's experiences when contacting mental health services and is organized into three categories, as described below.

3.1.1. Reasons for Putting Off

This category examines four primary codes for treatment delay: (1) belief that treatment will not be effective, (2) inability to afford treatment, (3) adherence to hegemonic masculine ideals, and (4) stigmatization. In this analysis, “codes” refer to specific reasons identified from participants' experiences, while “categories” group these reasons under broader thematic areas.

Seeking mental health treatment is essential for maintaining the well‐being of men with mental health issues and the broader systems with which they interact, as well as for preventing the escalation of mental health problems over time. However, participants' accounts indicate that men often delayed seeking treatment due to a belief that it would not be effective:

This was the first time I'd ever been through major depression. Your mind messes with you, making you think things like, “What's the point? Nothing's going to help anyway.”

(P2)

I wondered how a psychologist could actually help me. I had so many problems, I just thought, ‘What could a psychologist do?” It felt like my situation was way bigger than anything therapy could fix.

(P4)

Accessibility of mental health services is crucial for men with mental health issues to benefit from them. Financial barriers, such as the inability to afford treatment, significantly reduce access to these services:

I couldn't afford therapy. Honestly, sessions with a specialist just cost too much. It was hard on my budget.

(P13)

Prevailing social expectations require men to deny weakness or vulnerability, maintain emotional and physical control, appear strong and resilient, reject help, display aggressive behavior, and assert physical dominance (Courtenay 2000). Experiencing mental health issues conflicts with these ideals, leading some men to delay treatment by refusing to acknowledge their mental health challenges:

You're a man—that's how I was raised. I'd ask myself, “What kind of man are you? Why are you talking about this to other people?” I felt like I shouldn't tell anyone. I should figure it out myself—I'm a grown man. Back then, I just couldn't accept needing help. Why? Aren't you a man? Can't you handle it yourself?

(P10)

Mental illness is frequently stigmatized in society. Analysis of participants' experiences indicates that stigma contributes to men's reluctance to seek timely treatment:

Because there's so much stigma around it, I'd never tried to do anything about it before.

(P13)

3.1.2. First Contact With Mental Health Services

This category examines men's initial engagement with mental health services, identified through three key codes: (1) prolonged delay in seeking treatment, (2) turning to treatment after hitting rock bottom, and (3) seeking services due to pressure from the social environment.

Participants frequently denied their need for treatment and postponed engaging with mental health services for extended periods:

It's not so simple. For years, there was pressure “Go do it, have you gone?” Maybe a year passed, maybe four. In my last year of high school, people would say, “You're not doing well, you should get help.” And I'd just say, “What do I need help with? If you've got a problem, just give it to me, I'll solve it.”

(P10)

Delays in initiating treatment can extend the recovery process, exacerbate symptoms, and negatively affect quality of life. Many participants reported seeking mental health services only after hitting rock bottom:

I realized I'd hit rock bottom. I looked at myself and thought, “I can't handle this by myself. I need help.” I had nowhere to turn—my family couldn't help and society didn't care—so I decided to get professional help. That's how I started.”

(P7)

When I was depressed, I'd go through times where I barely ate or drank, or I just didn't eat well. I picked up bad habits—smoking more, drinking more. When I started to see what that was doing to me physically, I knew I needed to do something. I realized I was losing my will to live, and that's when I thought, “I need professional help.”

(P1)

The social environment also influences men's engagement with mental health services. As symptoms intensify and become more apparent, external pressure from family or peers may prompt men to seek treatment despite initial reluctance:

My friend told my family, “This isn't good—he's struggling. The next thing we know, he could be gone.” That's when my family started pressuring me. My parents kept saying, “Go, son, go…” Eventually, I just gave in and said, ‘Fine, I'll go, whatever you want.’ At that point, I only went to please them, not because I wanted to.

(P10)

3.2. Theme 2: Experiences in the Treatment Process

This theme addresses men's experiences during treatment and is divided into two categories, as detailed below.

3.2.1. Reflections on Receiving Mental Health Services

This category explores men's perspectives on receiving mental health services, highlighting positive effects such as (1) improved functionality, (2) enhanced communication, (3) increased coping abilities, (4) greater self‐awareness, (5) strengthened self‐relationship, and (6) maintenance of the status quo, as well as negative perceptions, including (7) the belief that mental health services are not beneficial.

Mental health services can enhance well‐being, functioning, and quality of life, enabling individuals to achieve greater balance and productivity. Participants’ accounts indicate that such services contributed to improved functioning:

The results, at least with my trauma, were really satisfying. I got back into life—started working again, writing newspaper articles, even working on a book. I really felt like I'd come back to life.

(P1)

An important outcome of mental health services is improved communication. Participants reported developing healthier and more effective interpersonal communication skills as a result of receiving mental health support:

Couples therapy really helped us. Normally, we avoid talking about things that turn into fights—“I did this, you did that, you said this, it shouldn't be like that.” But with a neutral third person in the room, it was easier to talk. Even if it didn't fix everything, just having that third person there was great.

(P3)

Participants indicated that mental health services enhanced their ability to cope with challenges and facilitated problem‐solving:

My therapist told me, “No one dies from panic attacks.” That made a real difference. Before, I'd think, “If this lasts much longer, am I going to have a heart attack and die?” That just made it worse. But after he said that, it got easier to handle. (P8)

Prevailing masculine norms may hinder men's recognition and acceptance of their emotions, weaknesses, and vulnerabilities. Mental health services, however, promote self‐awareness and facilitate personal understanding. Participants emphasized that these services played a significant role in fostering self‐awareness:

We'd been talking about my anger for a long time. One time, I visited my parents, and all these childhood memories came back, and I realized that's where my anger came from. That awareness made me feel free, like I'd broken out of chains. It was a great experience—getting to know myself better really helped.

(P11)

In addition to promoting self‐awareness, mental health services assist men in strengthening their relationship with themselves:

It really helped me rebuild myself. It helped me come to terms with who I am, think more deeply, and start to change. When those sessions ended, it wasn't just “That's it, goodbye.” That's when you start working on yourself. Can you really do that? Yes, you can.

(P9)

Some participants reported that, despite receiving mental health services, their situation remained unchanged, resulting in maintenance of the status quo. This stability can help preserve existing relationships and positively influence interpersonal interactions:

Did we fix our problems? No. But through therapy, we learned to live with them. The same issues were still there, but we argued less. In a way, getting used to things as they were made us less unhappy—we felt a bit better, and to outsiders, our relationship looked fine. So, we just kept going for another ten years, and even had a daughter during that time.

(P3)

Participants' experiences demonstrate that mental health services can yield numerous positive outcomes. However, the extent of benefit is shaped by dynamics such as the quality of the therapeutic relationship and belief in the potential for change. These findings underscore the individualized nature of the client‐professional relationship and its impact on treatment outcomes. While some participants did not perceive benefits from mental health services, others reported significant personal and professional improvements. This contrast highlights the need for nuanced interpretation and cautions against overgeneralization, as individual experiences and perceptions in mental health treatment can vary considerably.

Honestly, I didn't get anything out of it. I kept going, hoping something would change—some progress, a different approach. But nothing ever changed.

(P5)

3.2.2. Dynamics Related to the Therapist's Gender

The therapist's gender is one of the dynamics that affect the relationship between the therapist and the client. Participants considered therapist gender important for ease of communication, with some men expressing greater comfort with male therapists and others preferring female therapists:

Some things are just considered shameful in our society because of how we're raised. For example, a man might feel uncomfortable talking about sexual problems with a female therapist.

(P13)

I can't really open up to a male psychologist, but with a woman, I can talk much more freely. Women don't know the world of men, so I feel less judged. With a male therapist, I worry he'll judge me or be prejudiced because he's a man.

(P1)

Some participants reported perceiving distinct power dynamics in therapy sessions with female therapists:

Female therapists felt more intimidating. As men, we're supposed to be strong, but in therapy, there's a real power dynamic. The therapist sits in their chair, and it feels like they're in charge—like they're the boss in that room. You're expected to be strong, but here you are opening up to a woman, showing emotions you're not supposed to show. That's not what men are taught to do.

(P3)

Hierarchical power dynamics in therapy were noted not only between female therapists and male clients but also between male therapists and male clients. Participants described challenges in working with male therapists due to perceived power hierarchies:

I think most men would rather talk to a woman than to another man. It just feels easier. Deep down, guys don't share their struggles or feelings of weakness with other men. I find it hard to talk to some men about certain things—I feel like we judge each other or look at each other weirdly.

(P12)

Conversely, some participants reported feeling more comfortable with male therapists, describing the interaction as more natural within the therapy setting:

It's easier to avoid emotions with a male therapist. The power difference doesn't feel as strong. You can just talk about soccer or whatever. Going to a male therapist felt more like hanging out with a friend, so it was easier emotionally.

(P3)

Participants' experiences reveal diverse perspectives regarding therapist gender in mental health services. However, therapist gender was not always a decisive factor; several participants emphasized the importance of professional competence when selecting a mental health provider:

I checked out psychologists and psychiatrists online, and I picked someone with experience who seemed like a good fit. I didn't care if they were male or female—experience was what mattered to me.

(P2)

3.3. Theme 3: Reasons for Discontinuing Treatment

Men discontinue mental health treatment for a variety of reasons. This theme is divided into four categories, each addressing specific factors contributing to treatment discontinuation.

3.3.1. Economic Reasons

This category addresses economic factors, including financial insufficiency and the perception that professional support is financially unnecessary. Economic constraints play a critical role in both access to and continuation of mental health treatment. Limited financial resources can restrict access and hinder treatment sustainability for men:

Back then, I was a PhD student living on a really low stipend. I couldn't afford much for therapy. I stopped going when they raised the session fee.

(P2)

In addition to financial limitations, some participants discontinued treatment due to the belief that professional support was not a necessary financial investment:

I enjoyed the sessions, but honestly, I've got friends I can talk to for free. I didn't see the point in spending so much money.

(P5)

3.3.2. Reasons Related to the Structural Aspects of Therapy

This category examines structural dynamics contributing to treatment termination, specifically (1) the duration of therapy and (2) the appropriateness of the therapy method.

Structured therapy involves planning with specific goals and intervention methods tailored to individual needs. The duration of therapy is a key component; adequate length enhances quality and supports continuation. Conversely, therapy perceived as too brief may prompt discontinuation:

A 1‐h session every 2 weeks just isn't enough. You go in with some anxiety, and you leave feeling down. You think about it for a couple of days, or you just try to forget about it. You talk, and then it's over. An hour just isn't long enough, if you ask me.

(P3)

The suitability of the therapy method to individual needs is another critical component. Participants reported discontinuing treatment when the chosen method did not align with their preferences or needs:

Schema therapy was tough for me. I didn't really connect much with the therapist, and it was all so deep—always trying to link everything to something else. It wore me out. I didn't get much out of it. Maybe it just wasn't the right method for me.

(P6)

3.3.3. Therapeutic Relationship

This category explores dynamics within the therapeutic relationship that contribute to treatment termination, including (1) therapist competence, (2) the need to feel understood, (3) trust in the therapist, and (4) superficial communication.

Multiple aspects of the therapeutic relationship, such as therapist competence, influence men's motivation to continue treatment. Some participants discontinued therapy due to perceived incompetence of their therapists:

He would just ramble and overshare personal stuff—things a therapist shouldn't do. He acted weird, and I thought, “Why should I keep coming?” If I thought he knew what he was doing, I wouldn't have quit.”

(K5)

The need to feel understood is another crucial element of the therapeutic relationship. When participants felt misunderstood by their therapists, they reported difficulty continuing treatment:

It would be better if the therapist had been through this themselves. You talk, but something's missing. I want to feel seen—I want to know they really understand me, that they get what I'm going through. I want to see myself reflected in their eyes, in their reaction. Do they really see me?

(P7)

Trust in the therapist significantly affects men's engagement in treatment. Distrust can limit openness and participation, ultimately leading to treatment discontinuation:

How was I supposed to know if she was a cop or not—an informant or something? It took me a month to convince myself she wasn't a cop. I was just suspicious of everyone back then. At first, I even looked into her background.

(P10)

Superficial communication with the therapist can hinder treatment continuation by weakening the therapeutic bond. This may result in feelings of mistrust, indifference, or not being understood, reducing engagement and leading to treatment abandonment:

I felt like nothing happened—it was just like a regular meeting. Like an hour‐long work meeting. It didn't really make any difference in my life.

(P11)

3.3.4. Masculinity Norms as Barriers to Treatment Continuity

This category examines barriers rooted in masculinity norms that impede treatment continuation, including (1) refusal to accept weakness, (2) fear of losing autonomy, (3) career concerns, (4) fear of failure, (5) avoidance of self‐confrontation, (6) difficulty expressing oneself, (7) belief in treatment ineffectiveness, and (8) concerns about sexual dysfunction.

Adherence to masculinity norms can hinder men's ability to continue mental health treatment. Participants reported discontinuing treatment due to difficulty accepting feelings of powerlessness:

Society tells us to always act strong—we don't stay where we feel weak. If we feel even a little weak in a social situation, we just leave. If we don't get something, we walk away. It's all about ego and looking strong.

(P3)

Men seeking help for mental health issues can bring up the idea of dependence on others, which can threaten their autonomy. This can cause men to drop out of treatment because of their “fear of losing autonomy”:

The way my counselor worked felt like pressure. I couldn't handle it—I felt like they were trying to control me, so I quit. They'd ask things like, ‘How many drinks did you have this week?’ Even that felt like too much pressure. No one needs to tell me how much I drink. I can handle that myself—I don't have to answer to anyone.

(P1)

A career serves as a significant status symbol for men. Prolonged treatment or hospitalization can jeopardize job security and the ability to fulfill provider roles. Consequently, career concerns may reduce motivation to continue treatment and negatively affect its sustainability:

I never actually said I was quitting—I just sort of disappeared. I was busy working on my thesis and couldn't attend the sessions. Since I was working, therapy was only during office hours, and I just couldn't make it work logistically.

(P5)

In societies with traditional gender roles, men are expected to succeed. Fear of failure can negatively impact treatment engagement, as men may interpret setbacks during treatment as personal failures, leading to discontinuation:

I was trying to deal with my addiction, but I kept refusing treatment—so I wasn't actually getting help. And each time, I felt like I was failing. That fear of failure just hung over me. I guess I thought, at least this way I wouldn't have to feel like a failure all the time.

(P1)

Engagement with mental health services encourages self‐reflection. However, confronting personal feelings and behaviors may prompt defensive attitudes, which can undermine commitment to treatment. Participants reported discontinuing therapy to avoid self‐confrontation:

Constantly analyzing myself made me uncomfortable. It was like I was always looking for my own flaws. My dad wasn't calm, and while I was trying not to be like him, I realized I was repeating the same patterns. Everything I did to avoid becoming him actually brought me closer to it—it felt like a vicious cycle I couldn't escape. I never expected that. I started to feel like there was no support for me.

(P6)

Social expectations discouraging men from expressing feelings, weakness, or vulnerability can hinder communication during treatment. Difficulty expressing oneself in therapy was cited as a barrier to treatment continuation:

It's not easy to talk in therapy, at least from my side. The first week or two, I barely talked—I just stared at the therapist. I'd give short, simple answers to her questions, just wanting to get it over with and leave. But at the same time, I was paying for it and spending my time. It was a real struggle—therapy was tough.

(P3)

Mental health treatment effects typically manifest gradually. However, some men desire rapid results, and slow progress can lead to dissatisfaction and the perception that treatment is ineffective, resulting in premature termination:

Something needed to change, but the process just kept dragging on. Maybe I was impatient—I had assignments, and I needed to prove I could handle my daily life. I was using so much energy, physically and emotionally, just to keep up. Thinking about everything, I couldn't focus. That's why I got impatient to finish.

(P9)

Some participants reported concerns about sexual side effects from prescribed medication. For example:

The therapist put me on Prozac at a pretty high dose. The first day, I had problems with erections. It scared me, so I went back and asked what was going on. He said it was a side effect and switched me to something else right away. I kept going, but I was still worried it might happen again.

(P2)

Although sexual functioning was a significant concern, the data did not indicate that these side effects directly led to discontinuation of treatment. Instead, participants described ongoing worries even after medication adjustments.

4. Discussion

This study explored men's experiences with discontinuing mental health services. Three key themes emerged: the process of initiating treatment, experiences in the treatment process, and reasons for discontinuing treatment. Similar to findings in Western cultural contexts, men in our study delayed treatment due to perceived ineffectiveness, financial constraints, difficulty accepting mental illness, and stigma‐related concerns (McKenzie et al. 2022; Seidler et al. 2020a; Staiger et al. 2020; Slaunwhite 2015). Despite exhibiting symptoms that were observable to others and consistent with masculine norms, they often denied the need for professional help. This reluctance is consistent with research by Sileo and Kershaw (2020), which found that adherence to traditional masculinity ideologies—such as anti‐femininity and an emphasis on emotional toughness—was associated with reduced engagement in mental health services. In our study, while participants did not explicitly reference “anti‐femininity,” many described discomfort with emotional vulnerability, reluctance to seek help, and a need to appear strong—experiences that align with these broader masculinity constructs. This finding parallels the conclusions of O'brien et al. (2005), whose qualitative research demonstrated that men frequently postpone help‐seeking until their distress becomes unmanageable, underscoring the pervasive role of masculine norms in shaping health behaviors. A study examining the reasons why participants aged 21–55 chose to participate in psychotherapy found that when participants perceived medication as becoming insufficient, combined with a sense of crisis or hitting rock bottom, they realized that medication was only a partial solution. and that they realized they could no longer cope with their problems on their own and wanted to seek professional help to talk about their issues (Wells et al. 2020). Bryant‐Bedell and Waite (2010) found that after hitting rock bottom, participants never wanted to return to that point, avoided experiencing such pain again, and continued seeking counseling or tried medication, or both. Similarly, Camorongan (2007) reported that Filipino Americans sought mental health services when their usual coping resources were exhausted—that is, when problems worsened, functioning declined, they felt a loss of control, or “hit rock bottom,” recognizing they could not cope without professional help.

While most participants reported positive effects from mental health services, some male participants perceived no benefit. Based on our data, this finding can be explained by men's perceptions of therapy as unhelpful being tied to shortcomings in the therapeutic relationship, feeling insufficiently understood by clinicians, unmet expectations about the therapy process, and gendered and cultural expectations rooted in masculinity norms that emphasize self‐reliance and solving problems independently. Aligning with Vidourek et al. (2014), who found that women report greater therapeutic gains—such as improved mental health, reduced stress, and enhanced problem‐solving—highlighting gendered differences in treatment experiences. Prior research by Malec (2020) suggests that some men feel more comfortable with male therapists, while others prefer female therapists, indicating that therapist gender can influence engagement. Similarly, Akçay and Akar (2025) found that men with mental illness more easily express themselves to male social workers but often struggle to communicate with female providers. However, in our study, some participants emphasized that therapist gender was less important than therapist competence. This suggests that clinicians' competence and training may be more critical to effectively engaging men in therapy than the clinician's gender alone.

The final theme identified in the in‐depth interviews pertained to factors contributing to treatment discontinuation. Consistent with River's (2018) assertion that neglecting gender dynamics in mental health services results in approaches conflicting with dominant masculinity norms, our findings suggest that many men perceive therapy methods as incongruent with their needs, which hinders their engagement and continuation in treatment. Additionally, the quality of the therapeutic relationship emerged as a significant factor influencing men's decisions to continue or discontinue care. Negative behaviors by mental health professionals—such as making sarcastic remarks, failing to consult patients, demonstrating indifference, ignoring patients' concerns, neglecting discharge planning, and exhibiting hostility toward men with personality or substance use disorders and suicidal tendencies—may lead to adverse experiences for men. Such experiences can result in avoidance of mental health services and reluctance to return to these environments (Strike et al. 2006).

Moreover, adherence to traditional masculinity norms significantly contributes to treatment discontinuation. Men are socialized to be physically and emotionally controlled, deny vulnerability, appear strong and resilient, exhibit aggression, refuse help, and maintain physical dominance (Courtenay 2000). These norms conflict with the open expression of emotions necessary for psychotherapy (Lynch et al. 2018). Internalizing ideals of self‐sufficiency, strength, and courage often leads men to adopt a dysfunctional silence in response to mental health challenges. Consequently, reluctance to seek or continue mental health services reflects a perceived threat to masculinity, as help‐seeking is viewed as weakness and a failure to conform to norms of independence and strength (Whitley 2021). Men may feel compelled to “remain silent and be brave in the face of difficulties, as ideal men should,” rather than sharing their struggles with family, friends, or professionals (Whitley 2021, p. 129). This internalization not only reinforces avoidance of psychotherapy (Eggenberger et al. 2021) but also fosters the belief that professionals will not understand their experiences (Milner et al. 2019). A study examining men's reasons for discontinuing mental health services (Seidler et al. 2021) found that participants' reasons for discontinuing services included inability to connect with the therapist, feeling that therapy was not progressing, identification with traditional masculinity, and whether therapy made participants feel alienated from their masculinity.

Stigma surrounding mental health further exacerbates men's discontinuation of treatment. Mental health stigma negatively impacts help‐seeking, treatment initiation, and retention (Chatmon 2020; Gaebel et al. 2017). Workplace stigma is particularly salient for men, who often feel pressure to fulfill norms of competence and success tied to income generation (Williams 2003). The use of mental health services can jeopardize men's employment prospects, job security, promotion opportunities, and career advancement, leading to fears of negative professional consequences. Such “career concerns” act as significant barriers to accessing and continuing mental health treatment (Whitley 2021). The results suggest that men also do not continue treatment because they “avoid confronting themselves” and due to the “difficulty of expressing themselves.” This finding is supported by Seidler et al. (2021), in which 39 therapists reported that men experience a lack of emotional expression (e.g., some men may have limited emotional literacy, which can make therapy difficult…) and a lack of insight into their problems (e.g., I see that men have more difficulty understanding and expressing their emotions…). Furthermore, therapists attributed this situation to restrictive male socialization processes that limit opportunities for open and honest emotional communication. Therefore, it was stated that men lack the necessary vocabulary to effectively participate in the emotional interactions required for therapy to bring about change. Addis (2011) conceptualizes this pattern as a “cycle of silence” operating at three interrelated levels: personal (difficulty recognizing emotional pain), private (withholding known emotions from others), and public (social and institutional contexts that discourage men's vulnerability). Together, these levels form a self‐perpetuating cycle that undermines treatment adherence by limiting both emotional awareness and disclosure.

Being “emotionless” enough to be ready to have sex with any woman is also a requirement of masculinity. From this perspective, sexuality is also an important creator of hierarchies among men, formed through a process of boasting and exhibitionism shaped by sexual performance power (Sancar 2013). This situation can pose a problem for men when sexual dysfunction is involved. Indeed, the sexual side effects of medications used in mental health treatment—such as erectile dysfunction, low libido, and orgasm disorders—can prevent men from adhering to treatment (Rabinowitz et al. 2024).

Men in our study also discontinued treatment due to their “fear of failure.” Men stated that they feared failure because they felt their behaviors would be negatively evaluated by therapists while receiving mental health services, and therefore, avoided this fear by discontinuing treatment. The professional support process is one that requires regular effort. However, difficulties experienced during the process can be internalized by men as “failure.” When the professional support process is interpreted as “personal failure” due to traditional masculinity norms, men may code this situation as inadequacy and show a tendency to abandon treatment rather than continue it. Thus, discontinuing treatment can be interpreted as a result of cultural pressures produced by traditional masculinity norms rather than an individual choice. This pressure to succeed that is placed on men makes the emotional flexibility inherent in therapy feel threatening.

One of the most striking findings in this study is that the vast majority of participants discontinued the process despite finding the professional support they received helpful. Participants mentioned economic factors, the structural characteristics of therapy, the therapeutic relationship, and dynamics related to masculinity norms as reasons for discontinuing mental health services. In addition to these reasons, the possibility arises that the majority of men in the study terminated the process because they found the support helpful, leading to a reduction in symptoms and the belief that they no longer needed professional support. This situation may be related to traditional notions of masculinity that emphasize self‐reliance, autonomy, and emotional control. Men may have preferred to be in a position to decide the course of the professional support process in a manner consistent with traditional masculinity norms and to terminate the need for support—which is inconsistent with masculinity norms—as soon as their symptoms subsided.

4.1. Implications for Practice and Research

These findings point to the importance of developing intervention approaches that attend to the systemic dynamics shaping the clinician–male client relationship, consider how gender and hegemonic masculinity norms operate through both self‐ and social stigma in help‐seeking, and place men's unique needs for remaining engaged in therapy and benefiting from it at the center of clinical work. Given men's tendency to terminate the professional support process once symptoms subside, clinicians must create awareness at the beginning of treatment that symptom reduction does not signify the conclusion of the process. Clinicians should reframe the uninterrupted continuation of the support process as an empowerment journey that bolsters autonomy and personal performance in alignment with masculinity norms. Adopting such an approach, which remains congruent with these norms, may facilitate men's adherence to the professional support process. Clinicians should adopt flexible, action‐oriented approaches that validate men's experiences and reduce barriers to emotional disclosure. For example, adapting interventions to be more structured, goal‐focused, and practical can leverage masculine values such as autonomy and competence as therapeutic strengths (Lok and Law 2025; Seidler et al. 2018). Reframing ongoing support as a journey of empowerment, rather than simply symptom reduction, may further encourage sustained engagement (Englar‐Carlson and Kiselica 2013).

At the same time, systemic and service‐level changes are needed to address barriers such as cost, accessibility, and stigma. Service‐level frameworks like the 5 C model (Co‐production, Cost, Context, Content, and Communication) may help address both individual and systemic obstacles to care (Galdas et al. 2023). Future research should develop and test effective, affordable strategies that expand access for men, as well as culturally and contextually sensitive interventions to address workplace stigma and masculinity norms and their effects on family dynamics. Longitudinal and dyadic research, including the perspectives of family members and therapists, will further illuminate how gender dynamics, relational engagement, and perceptions of effectiveness shape men's help‐seeking, retention, and outcomes in both individual and couples therapy.

4.2. Limitations

This study contributes important insights into the multiple dimensions of men's experiences of discontinuing mental health services. However, several limitations should be noted. The qualitative design emphasizes depth and context but limits the extent to which the findings can be applied. Our use of snowball sampling may have reduced participant diversity, as referrals often led to individuals with similar backgrounds. Finally, conducting interviews online may limit opportunities to gather observational data.

Funding

The authors received no specific funding for this work.