Notes on Men's Mental Health and Suicide Prevention: The 'Man Up' Intervention

PSY2014 Men’s Mental Health – A Multimedia Suicide Prevention Intervention

Acknowledgement

This presentation acknowledges the Traditional Custodians of the land, the Kulin Nations, paying respects to Elders past and present. It recognizes Indigenous resilience and innovation in suicide prevention, as well as the lived experience of suicide and the diverse gender identities often underrepresented or misrepresented in research and healthcare. The information discussed represents real people's lives.

Male Mental Health Statistics (2020-2021)

General Mental Disorders

Data from the National Study of Mental Health and Wellbeing (ABS, 2020-21) indicates the prevalence of any 12-month mental disorder by age and sex. While the slide displays a graph, it shows that for younger age groups (16-24 and 25-34 years), females generally experience higher rates of mental disorders. For instance, in the $16-24$ age group, approximately 40\% of females reported a 12-month mental disorder, compared to about 20\% of males. This trend shifts or narrows in older age groups.

Substance Use Disorders

Similarly, data on any 12-month substance use disorder confirms a different pattern. Males consistently show higher rates of substance use disorders across all age groups compared to females. For example, in the 16-24 age group, around 12\% of males reported a substance use disorder, whereas females were below 5\% (ABS, 2020-21).

Suicide Deaths in Australia (2021)

Suicide deaths in Australia in 2021 show a clear gender disparity. Males have significantly higher age-specific suicide rates per 100,000 population across most age groups. The highest rates for males appear in the midlife age groups, such as the 40-50 year olds, often exceeding 25 deaths per 100,000, while female rates remain considerably lower, typically below 10 per 100,000 (AIHW, 2022).

Why is Suicide Higher Among Men?

Several interconnected factors contribute to the higher rates of suicide among men:

• Acquired Capability: This refers to the idea that some men may habituate to painful experiences, reducing their fear of death and increasing their tolerance for physical pain. This, combined with increased tolerance and exposure to painful or provocative events (e.g., aggression, risk-taking), can elevate their capability for suicide.

• Stronger Intent to Die: Men often employ more lethal means in suicide attempts, indicating a higher intent to die.

• Gendered Expectations Around Suicide: Societal expectations can influence how men approach suicidal ideation, sometimes leading to more decisive and lethal actions.

• Externalising of Depression: Unlike typical presentations of depression (sadness, lethargy), men may externalize their distress through aggression, substance abuse, and risk-taking behaviors. This can alienate others, reduce help-seeking, and, paradoxically, increase their capability for suicide due to familiarity with dangerous situations or substances. Health professionals may also fail to identify depression when it manifests in these externalizing ways.

• Substance Use: High levels of substance use contribute to increased distress, impulsiveness, and disinhibition, all of which are risk factors for suicide.

• Social Connectedness: Men often experience high levels of social disconnection. While social connection is a known protective factor against suicide, emphasis on self-reliance among men can hinder the development and maintenance of strong social bonds.

• Help-Seeking: Negative attitudes towards help-seeking, often rooted in masculine norms, lead to reduced engagement with mental health services.

• Masculine Norms: This is likely an underpinning factor for many of the above points. Traditional masculine norms shape how men experience and express distress, interact with social networks, and approach professional help.

Australian Masculinity and Mental Health

Australian men are frequently socialized into traditional masculine norms emphasizing stoicism, independence, invulnerability, and the avoidance of negative emotions (Rice, Fallon, Bambling, 2011). While these traits can be advantageous in certain life situations, an inflexible adherence to them can lead to significant problems.

Conformity to some traditional masculine norms is associated with:

• Reduced and delayed help-seeking for mental health concerns (Galdas et al., 2005; Emslie et al., 2006).

• Increased incidence of suicidal thoughts, attempts, and death by suicide (Pirkis et al., 2017; Coleman et al., 2020).

• Higher rates of alcohol and substance use (Hawton, 1998).

• Overall negative mental health outcomes (Wong et al., 2017).

Suicide Prevention Framework

According to the Australian Government Department of Health and Ageing's Living is for Everyone (LIFE): A framework for prevention of suicide in Australia (2007), suicide prevention efforts can be categorized into several levels:

• Universal (whole population): Aims to address key social determinants and build resilience across the entire population. Strategies include awareness raising, restricting access to means, responsible media reporting, and promoting help-seeking.

• Selective (at-risk populations): Targets specific groups identified as being at higher risk of suicide, focusing on training, early detection, diagnosis, and treatment.

• Indicated (those with symptoms): Interventions for individuals already experiencing symptoms of mental ill-health or suicidal ideation, providing treatment, support, and aftercare.

• Postvention: Responding to and supporting those impacted and bereaved by suicide to mitigate further risk and support healing.

Gendered Approach to Suicide Prevention for Boys and Men

A gendered approach is crucial to address the context of men's suicide, encompassing:

• Awareness raising: Increasing self-awareness and awareness in others regarding mental health challenges.

• Challenging and changing social pressures: Addressing societal expectations that encourage men to be stoic and self-reliant.

• Encouraging help-seeking: Promoting and normalizing seeking professional help.

• Increasing social connection: Fostering stronger social bonds and reducing isolation among men.

• Equipping men to support each other: Providing tools and encouragement for men to support their mates' mental health.

• Training of health professionals: Ensuring health professionals can identify and respond to male-specific presentations of mental distress.

• Accessible and useful services: Developing and promoting services that are tailored and appealing to men.

The Media and Suicide

The Werther Effect

The Werther effect describes the potential for media to have a negative impact on suicide rates. Sensationalist, repetitive, or prominent media reports on suicide, especially when detailing method or location, can trigger imitative suicides. For instance, following the death of Robin Williams, there was an 11\% increase in suicides in Australia over 5 months, largely among men aged 30-64 using similar methods (Pirkis et al., 2020). Similarly, after the release of the TV series 13 Reasons Why, the overall suicide rate among 10-17 year olds in the United States increased significantly in the subsequent month (Bridge et al., 2020).

Responsible Reporting of Suicide (Mindframe Guidelines)

Mindframe guidelines provide crucial recommendations for reporting on suicide and mental ill-health. While direct evidence for positive outcomes from media reporting is limited, it is agreed that media plays a vital role in discussing the broader issue of suicide, challenging misconceptions, raising community awareness, and encouraging prevention. Helpful reporting focuses on:

• Presenting suicide as an important community concern.

• Covering suicide sensitively and accurately to reduce stigma.

• Informing the community about risk factors, warning signs, and where to get support.

• Sharing personal stories of overcoming suicidal thinking to promote hope and help-seeking.

• Framing suicide as a health and community issue.

• Showing the impact of suicide on individuals and communities.

• Providing a 'call to action' for the general community.

Problematic vs. Preferred Language:

The Papageno Effect

The Papageno effect illustrates the potential for media to have a positive impact on suicides. This occurs when media reports focus on positive examples of healing, hope, and help, demonstrating how individuals can navigate a suicidal crisis and increasing awareness of suicide prevention. Studies have shown a decrease in suicides when media coverage highlights individuals who successfully coped with suicidal crises (Niederkrotenthaler et al., 2010).

The Media as a Vehicle for Health Interventions

Media can effectively produce positive changes or prevent negative behaviors regarding various health risks (Wakefield, Loken et al., 2010). Mass media campaigns and documentary films can alter knowledge, attitudes, and behaviors (Pirkis and Francis, 2012). Positive reports of depression and anxiety in news media, for example, have been shown to increase men's help-seeking to telephone helplines (Machlin, King et al., 2014). Social media campaigns also hold significant potential for promoting health behavior change and positively influencing suicide-related behavior (Webb, Joseph et al., 2010; Luxton, June et al., 2012; Maher, Lewis et al., 2014; Robinson, Cox et al., 2016).

"Man Up": A Multimedia Suicide Prevention Intervention

Overview

"Man Up" is a multimedia suicide prevention intervention funded by the Movember Foundation. It comprised a multiplatform TV series (broadcast on ABC), a dedicated website (manup.org.au), and a social media campaign.

The Documentary

The "Man Up" documentary was a three-part presenter-led series, screened in primetime (8:30 pm) on ABC on three consecutive Tuesdays in October 2016. It attracted over 642,000 viewers per episode and remains available on Movember's website. The series featured host Gus Worland investigating why suicide is the #1 killer of Australian men under 45, exploring solutions, and creating a campaign to challenge the notion that suicide is a solution.

Digital Campaign Reach (Data as of December 12, 2016)

• Total Reach: The combined digital campaign reached an estimated 10 million people.

• Viewership: Each episode of the TV series had 642,000 viewers.

• Website: The manup.org.au website received 12,000 visitors and had 814 followers.

• Social Media: The overall digital campaign garnered 2.4 million people reached on social media. Examples from Twitter show engagement with posts challenging masculine norms and encouraging communication.

The Three-Year Research Project

A comprehensive research project evaluated the impact of "Man Up," utilizing both controlled and real-world environments:

• Controlled Environment: Concept Test & RCT: Before launch, promotional material and the website underwent concept testing. A Randomized Controlled Trial (RCT) evaluated the efficacy of the documentary in changing help-seeking behavior.

• Real World Evaluation: This included an evaluation of the website and social media campaign, with the website acting as an information hub. Website usage and social media engagement (promotion and content interaction) were monitored.

Research Findings: Impact of "Man Up"

Quantitative Measures:

• Increased Help-Seeking Intentions: Participants showed an increase in help-seeking intentions as measured by the General Help Seeking Questionnaire.

• Decreased Conformity to Masculine Norms: There was a decrease in conformity to traditional masculine norms, assessed by the Conformity to Masculine Norms Inventory.

Qualitative Measures (Open-Ended Questions):

• Awareness Change (82\% of respondents): Participants reported increased awareness of what others might be experiencing, the prevalence of male depression and suicide, the importance of talking about feelings, and the need to seek help.

• Behavior Change (38\% of respondents): Some participants reported actively trying to communicate their thoughts and emotions.

Illustrative Quotes from Participants:

• "It made me reach out to my brother who is going through a difficult relationship breakdown and make sure he knows I’m here for him."

• A noteworthy quote: "If your car was bogged you would call your mate first thing no worries, but if it’s something affecting your own mental health you won’t." This highlighted the disparity in asking for help for physical versus mental issues.

• "As a parent of three children it has taught me that communication and talking about feelings is very important."

• "I have noticed when talking to other males I now pay more attention to what they are saying it, and have asked if they are ok more often."

• One participant, despite good advice, still struggled: "Despite all the good advice and recommendations I still really struggle to seek help or talk about my mental health anywhere or with anyone. The documentary was very good at making me consider these things but currently I’m just not in a place where I feel like I could ever do them."

• Another reported deeper connections: "I have had a few much more in-depth conversations with my male friends, particularly other dads. I feel closer to these friends."

Campaign Ad Impact (Data as of December 12, 2016)

• The "Man Up" campaign ad achieved 40.1 million views.

• Growth was almost entirely organic, driven by shares from large platforms like Daily Mail UK and Lad Bible.

• Daily Mail and Lad Bible combined contributed over 617,000 shares, 433,000 reactions, and 25,000 comments.

Overall Impact

The "Man Up" intervention was found to be efficacious and effective, demonstrating significant reach and a potentially substantial impact on male mental health and suicide prevention.

Resources

• "Man Up" Trailer: iview.abc.net.au/show/man-up

• "Man Up" Full Episodes: au.movember.com/mens-health/man-up