Suicide_Prevention

How One Colorado Suicide Prevention Program Got Through to Working-Class Men

They start with a joke — and keep laughing from there

Imagine you’re a suicide prevention worker and you need to reach the most at-risk demographic in your community — men between the ages of 25 and 64 with only a high school diploma. Men die by suicide at 3.5 times the rate women do, but men with only a high school diploma die by suicide at twice the rate that men with a college degree do. And in the top 10 list for suicide rates by profession, the first and second slots are construction work and installation, maintenance and repair — industries with high turnover, grueling physical labor (and resulting pain) and not much in the way of financial security.

Nor are these the kind of guys to open up emotionally and start tossing out their feelings to the nearest stranger. If anything, they’re embarrassed and ashamed to admit they’re even having them, much less that they need help with them. As such, you know that many men in your community die by suicide without ever reaching your existing services. (You also know that someone who’s at risk for suicide, on average, experiences the onset of symptoms for eight to ten years before even connecting with treatment.)

So how do you provide mental health services to someone who doesn’t want them, or who goes out of their way to avoid using them?

You could start by making jokes about their dicks — as well as reference many other manly man things. As in: “Give your mental health the same attention you give your penis.” Or: “You can’t fix your mental health with duct tape.” Or: “Therapy from the creators of pork chops and fighter jets.”

It worked for Colorado, a state that ranks in the top 10 for suicides, which is common among firearm-friendly mountain states with lower, spread-out populations. The state’s Department of Public Health partnered with a Denver design agency called Cactus and a digital mental health and wellness company called GRIT, and invented Man Therapy.

That’s Dr. Rich Mahogany in the video, a fictional therapist played who guides men through the murky waters of their feelings with two clear aspirations: 1) To ease the stigma and embarrassment of having mental health issues in the first place with humor and wit; and 2) to not lose the audience with clinical or touchy-feely mumbo jumbo.

It’s tongue-in-cheek macho meets no-bullshit likable. In the introduction, Dr. Mahogany says there won’t be any complaining, just getting off your ass to tackle feelings like anger, and so on. The campaign, which carried through as PSAs on billboards and posters above urinals, uses a similar ironic machismo to lighten the mood enough to engage with the reality. Taglines include, “As it turns out, there are worse feelings than being kicked in the giblets,” and “A mustache is no place to hide your emotions.” Similarly, the site defines anxiety as “when worry grabs you by the balls.”

Underneath the humor, however, is an interactive mental health site that walks men through depression screening tools, explanations of how feelings work and resources for getting their lives back on track. “Men aren’t reaching out for support, and this very much applies to the blue-collar, working man,” explains Nathaan Demers, a clinical psychologist and vice president and director of GRIT Digital Health who says that working-age men are considered to be at double jeopardy for suicide because they’re the most likely to die from suicide, and the least likely to reach out for support. “So much of the messaging around mental health is feminine and doesn’t resonate with that male voice. Men have a pull yourself-up-by-the-bootstraps, don’t-show-your-emotion attitude, so we developed Man Therapy and Dr. Rich Mahogany as part football coach, part drinking buddy and part therapist.”

He adds, “Working-age men also aren’t cruising the internet looking to take a depression screening test.”

Thus, even the Man Therapy 20-point head inspection, which serves the same purpose as the official PHQ-9 questionnaire given by doctors to assess depression severity, packs an irreverent punch. For example, before asking you about your sleep habits, it reads: “Did you know koalas sleep 18 hours a day? Lazy little bastards.”

While it might seem unnecessary to need to entice men in such a comical way to address their feelings, it’s important to understand that by not attending college, working-class men skipped a lot of touch points around mental health. “There’s a culture and climate on college campuses that says it’s more acceptable to reach out for support and use these services,” Demers explains. “Higher education also tends to be a pretty progressive place. It promotes introspection and looking at one’s self and personal growth. If you go right into the workforce — and my father did, as a cabinet maker — people don’t talk about feelings, and if you cry, you’re weak. That encourages people to stuff their emotions. Dying by suicide then can be less scary or intimidating than admitting vulnerabilities.”

There are particular stressors, too, that can contribute to the suicide rate for working-class men: The loss of a parent. Divorce. A bad marriage. The decline in marriage overall. And maybe most of all — job loss. “A lot of times, men identify their worth and value with their job,” Demers says. “Losing a job and not being able to provide for their family has a lot of implications with one’s self-worth and identity.” (Still, he cautions against thinking of suicide as an act that can be tracked back to a single cause. “It’s never one thing,” he stresses. “It might be the straw that broke the camel’s back, but it’s never just one reason.”)

Given the gravity of all of this, as Man Therapy progressed in development, there were some concerns about the tone coming off as mocking or too lighthearted for something so grim. But the Office of Suicide Prevention in Colorado, which is part of the state’s Department of Public Health, felt strongly that the humor was perfectly suited to the difficulty of the subject, just as jokey campaigns in the past have been used to get men to pay more attention to prostate exams and erectile dysfunction.

They were right, too. Once Man Therapy was pushed out into the world, it clicked with men fast — and spread even faster. Today, it’s helped more than 300,000 men with depression screenings, and over 30,000 men have accessed its crisis information, which in many cases, has saved lives. “One man called and broke down in tears,” Demers says. “He said, ‘Your website saved my life last night. He had a loaded gun, but he clicked on the red phone on the site [which connects users to the National Suicide Hotline], and it ended up saving his life.”