How do we get more men to try therapy when those most at risk are also most reluctant?

Mental health experts have long known that although women have nearly twice the rate of depression diagnoses, men are much more likely to die by suicide, drug overdose and alcohol related deaths – sometimes referred to as deaths of despair. Nearly 80 per cent of suicides are among men, with males older than 75 and those who work in traditionally blue-collar jobs, such as mining, construction and agriculture, having the highest rates.

Despite men’s higher risk of death related to mental illness, women are more likely to seek out help. In 2020, 15 per cent of men reported receiving either psychotropic medications or therapy in the past year compared with 26 per cent of women.

This disparity in care has left experts scrambling for ways to reach more men, particularly those most at risk and who might be reluctant to talk about their mental health. Research has found that men who exhibit traditional stereotypes of masculinity, such as stoicism and self-reliance, are even less likely to ask for help.

“We call some of them ‘double jeopardy men,’ ” said Sally Spencer-Thomas, president and co-founder of United Suicide Survivors International. “They’re men who have a number of risk factors and who are also least likely to seek help on their own.”

In response to this growing mental health crisis, the American Psychological Association released its first set of guidelines for practitioners working with men and boys in 2018.

“There is clearly growing recognition that we have to reframe mental health care and our approach to addressing the mental health needs of men,” Arthur Evans Jr, CEO of APA, wrote in an email. “Early indications are that when we do this, men are willing to engage in addressing their mental health challenges.” For instance, he said, it helps to reframe therapy as an opportunity to become strong or well, rather than a treatment for mental illness.

Some therapists and public health campaigns have adopted this approach and are using other unconventional messaging in an attempt to appeal to hard-to-reach men. This might include using humour or leaning into some masculine stereotypes. (Think: fewer feelings, more sports analogies.) Experts hope that once these men are in the door, they’ll come to see that asking for help and going to therapy is a sign of strength, not weakness.

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Over the course of two years, Spencer-Thomas conducted interviews and focus groups with men who had survived suicide attempts about what might have helped them during their time of greatest need. She quickly learned that the standard communication around mental health was a turnoff for the men she spoke to.

“One of the things they said was, ‘You know that message you mental health people like to put out there, “If you’re depressed, seek help”? That misses us on both counts,’ ” Spencer-Thomas said.

For one thing, the double jeopardy men she interviewed did not consider themselves to be mentally unwell, so language about depression or mental illness didn’t resonate. Instead, they said the source of their problems was an overwhelming world – stressful jobs, financial concerns, conflicts with their partner and worries about their kids.

The second issue was that these men had been conditioned to be the strong ones, the ones that other people lean on. So the idea of seeking help, especially for their minds, was a foreign and off-putting concept.

“I don’t want to say it’s harder for men, because everyone deals with their own struggles, but I think the stigma around it is that men don’t need to go to therapy,” said Rafael Gomez Jr, 22, who works at a software company in Los Angeles. Gomez started going to therapy after temporarily moving back home during the pandemic, something he initially hid from his parents.

Using the insights from her research, Spencer-Thomas partnered with the Colorado Department of Public Health and Environment and the branding agency Cactus in 2012 to develop a public health campaign, called Man Therapy, that they hoped would engage men who identify with more traditional concepts of masculinity.

Man Therapy, despite its name, is not intended to be a replacement for formal mental health care. It’s a website designed to educate, reduce stigma and encourage men to seek help in times of crisis. In addition to providing links to the National Suicide and Crisis Lifeline and a therapist-finder tool, the website also offers a screening questionnaire to help men evaluate their mental state and self-help tips.

These resources are fairly standard for mental health websites; it’s Man Therapy’s tone that is unique, using humour and masculine stereotypes to draw in men. Slogans splashed across the home page include “It’s okay to cry, even when it’s not about sports” and “Feelings: they’re not just for the hippies.” A mustachioed fictional therapist, Rich Mahogany, who strongly resembles the Parks and Recreation character Ron Swanson, guides users through the site.

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Many men go to therapy willingly and openly. But for those who are resistant to the idea, getting them into a professional’s office is only half the battle. Persuading them to talk can be another challenge.

John D’Agostini, 38, who runs a leadership programme for young men near Minneapolis, tried going to several counsellors throughout his 20s and early 30s, but he found the sessions very difficult. “It had nothing to do with them – it was me,” he said. “I didn’t have the skills and I didn’t have the humility.”

This type of resistance can be more common among men, said Mitch Abrams, a psychologist specialising in anger management who treats patients in New York and New Jersey. “They come in and they say, ‘I’m only here because my wife told me to.’ ”

To encourage these men to engage in the process, Abrams tries to help them see that although someone else might have initially recommended therapy, they wouldn’t be in his office if they hadn’t made the choice to be. “There are a lot of guys who know they want to be there, but they don’t feel that they’re allowed to say it because their pride is in the way,” he said.

D’Agostini finally made progress when he found a therapist he felt he could open up to. “I didn’t feel like I had to keep up appearances,” he said. “I could just really drop it and be really honest and vulnerable with another human being.”

Niall Geoghegan, a therapist based in Berkeley, California, said when he works with new male clients, he’s less likely to talk about emotions. “A lot of people bristle against that stereotypical ‘How do you feel?’ ” he said. “That’s not always helpful for many people, but it’s specifically not helpful for a lot of men.”

Instead, Geoghegan will begin by asking about their sleep, appetite and motivation, which can be indicators of depression or anxiety.

As the therapy continues, Geoghegan said the men he sees are just as willing and able to go as deep as the women. Many men might say, “I’m not in touch with my feelings,” Geoghegan said, “but after a few sessions, they’d find things just pouring out.”

Another challenge facing not only men but anyone wanting to see a therapist is finding a local practitioner who’s taking new clients. Despite being located in the San Francisco Bay Area, Geoghegan fields inquiries for teletherapy from men all over the country. He said that sometimes these men worry they’ll experience stigma if they’re seen seeking help locally, so teletherapy can be a more attractive option.


The point of initially playing into traditional ideas of masculinity is to get hard-to-reach men to start to question some of the gender norms that no longer serve them, Spencer-Thomas said.

Man Therapy’s ultimate goal, she said, is “to show these men that while those norms might work for you in some situations, they’re not working here” and then introduce a different approach.

Abrams has a similar objective. “What I try to do for men is I recalibrate their idea of what being tough is,” he said. “It’s not a sign of strength or toughness to avoid problems that are destroying your life. It’s a sign of toughness when you confront them.”

By Dana G Smith © 2022 The New York Times

This article originally appeared in The New York Times.

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