As a clinical psychologist who has treated men with a background in defence and emergency service organisations over many years, I'm all too aware of the common tendency amongst men to be stoic and self-reliant when it comes to mental health. It can often be many years after developing a concern about mental health that men find their way to treatment. And when they do present, it is often because a wife or partner has encouraged (or in some cases forced) them to do so.
Encouraging men to seek help for mental health concerns is a challenge of immense proportions, shared by health practitioners around the world. When I was approached to be part of a team at the University of Melbourne, led by Professor Jane Pirkis, working to devise a way to address this challenge I was excited to do so. When I learned that the project was funded as part of the Movember Foundation's strategic approach to tackling men's suicide and would involve a collaboration with film producers, it was even better. It was definitely time to try a new approach.
In our early meetings with the film production company, Heiress Films, there was a lot of polite acknowledgement of ideas from me and the other psychologists about how we could use the documentary to introduce men to simple cognitive behaviour therapy strategies to build resilience and enhance coping. The creative people at Heiress Films quickly convinced us that while we may have expertise in psychology, we were lacking a bit of know-how when it came to making a documentary that would engage men. So we let go of the control ropes and gave Heiress the green light to do what they do best. Man Up was the result.
Setting the scene
The documentary title, Man Up, deliberately challenges the conventional use of the phrase which is often used to encourage men and boys to 'toughen up', hide their emotions and deal with problems on their own. Man Up takes the audience on a journey to investigate how traditional norms of masculinity can contribute to men's reluctance to seek help for mental health concerns, which in turn, can lead to increased risk of suicide. The journey is led by Gus Worland, an archetypal Aussie bloke who loves his family, his mates and his beer. Gus, a Sydney radio personality, was driven to be part of the show by the unexpected and shattering suicide of a close friend, who hadn't opened up to anyone about how he was feeling, leaving Gus feeling gutted, guilty and angry in equal measure.
In the three-part documentary Gus travels Australia talking to men from all walks of life – from military veterans to schoolboys, CEOs to jackaroos, inner-city bearded metrosexuals to outback farmers. His mission? Trying to understand how traditional views of masculinity may be related to the risk of suicide. In particular, Gus explores how masculine characteristics like stoicism and self-reliance can get in the way of men seeking help in tough times. Many of the men and women that Gus meets have been touched by suicide and he comes to appreciate how widespread the impact of a single suicide can be. He also discovers the fantastic efforts underway, on the part of individuals and organisations, to reach out to men and link them to support.
Inspired by what he sees, Gus kick-starts a campaign to bring about change. He has some ideas, based on what he's heard from the men that he's met, but much like our experience with Heiress Films, Gus quickly learns that you need the help of an expert. Consumer psychologist Adam Ferrier comes up with the goods with an advertising campaign that goes viral with more than 40 million views at the end of the campaign (Turnure, 2017), and the number still growing (Lockley, King, Schlichthorst, Phelps, & Pirkis, 2018). Adam's experience on this project featured in the June 2017 edition of InPsych (Ferrier, 2017).
Can a documentary lead to change?
As scientist-practitioner psychologists, of course the key question that we want answered is, does it work? More specifically, can you change men's attitudes and intentions to seek help by viewing a documentary?
Professor Jane Pirkis led a double-blind randomised controlled trial (RCT) to test whether Man Up could increase men's intentions to seek help for personal and emotional problems. To our knowledge, the use of the RCT design to test the impact of a documentary is a world first.
Men aged 18 and over were recruited through posters, public meetings, local newspapers and word of mouth. Participants completed a baseline questionnaire that included the General Help Seeking Questionnaire, the primary outcome of interest. They were then randomly assigned (1:1) via computer randomisation to view Man Up (the intervention documentary) or Test Your Brain (the control documentary). They were sent away to watch the allocated documentary in their own time and asked to provide feedback on their immediate responses. Four weeks later, they went online and repeated the original questionnaire.
As also reported elsewhere (King, Schlichthorst, Spittal, Phelps, & Pirkis, 2017), 354 men were randomised to view Man Up or the control documentary. All of the men who watched Man Up had an immediate positive reaction to it. The vast majority enjoyed it, thought it would have a positive impact on men's health and wellbeing, and indicated that they would recommend it to their friends and family. At four weeks post-viewing, those who watched Man Up had changed significantly on the key outcome variable, indicating that they were much more likely to seek help if they needed it, and that they would encourage a friend to do the same. There was no change for those who viewed the control documentary. Qualitative analysis of free-text responses to open-ended questions showed that there were important changes in men's awareness of their own and others' emotional lives and a desire to provide support to others.
In short, the research found that Man Up was well-received and effective in changing men's attitudes and intentions to seek help if they were to experience emotional problems. This was an encouraging outcome for the RCT, but the importance of the finding is amplified by the reach of the documentary. During its initial screening on the ABC, it garnered an average viewership of 642,000 for each of its three episodes. These numbers have continued to increase because it has been re-screened twice and remains available on the ABC's catch-up service, iView. Thus, Man Up represents an effective, population-based intervention for encouraging help-seeking amongst men.
Opening up
The RCT found that men who viewed the documentary were more open to the prospect of reaching out for help for emotional issues, should they need to do so. As such, it could be a useful tool for engaging men in therapy – increasing the social acceptability of opening up about mental health concerns and acknowledging emotional vulnerability. In my practice, I've shared the documentary with men who have expressed embarrassment about coming to see me as a psychologist, partners and parents who are concerned about a loved one who is refusing to seek help, and men who are worried about a mate who has cut himself off from friends. Without exception, my clients have valued the documentary and thanked me for introducing them to it.
For those already engaged in treatment, and who may be struggling with self-esteem or distressed because they don't fit their stereotype of masculinity, the documentary and accompanying website (au.movember.com/mens-health/man-up) are a useful adjunct to therapy. As psychologists we know that the way a message is delivered – the form that it takes, and the credibility of the messenger themselves – is critical to its uptake. When our clients hear firsthand, the stories of other men from all walks of life who have grappled in one way or another with their upbringing, their identity as men, their mental health concerns, or issues with drugs and alcohol, those stories provide valuable insights and help to challenge their own negative self-evaluations, reinforcing the work done in therapy.
Working towards change
Man Up will also be of benefit to boys in their transition to adulthood. For clients who are parents of adolescent boys and for psychologists working in schools, Tom Harkin's on-screen workshop with teenage boys in particular, will be moving and instructive. By getting the boys (including Gus Worland's son Jack) to talk about themselves and their issues in a truly authentic way, Tom demonstrates how traditional masculine norms, such as strength and toughness, can sit alongside emotional vulnerability. As the boys step up to the challenge of acknowledging their own vulnerabilities, and supporting others to do the same, there's a real sense that something has shifted in the quality of their connection with each other, and in the way they view themselves. This segment could be a lifeline for a teenager who is facing a tough time in their lives, or grappling with their identity, and feeling that no one understands.
I urge all psychologists and other mental health practitioners to view the documentary themselves and, where appropriate, recommend it to their clients (both men and women). Through a snowballing effect, Man Up will reach the greatest number of people who could benefit from it. It may even save lives.
Man Up is a three-part presenter-led documentary that explores the interplay between masculinity and mental health in Australia. It was developed by Heiress Films with funding from the Movember Foundation. Man Up was broadcast by the ABC and is available on iView and Movember's website au.movember.com/mens-health/man-up
Acknowledgements
Thank you to the Movember Foundation for supporting the development and evaluation of Man Up, and to Heiress Films for producing the documentary and associated social media campaign, and the Australian Broadcasting Corporation for screening the documentary. Thank you also to The University of Melbourne team (led by Professor Jane Pirkis and including Dr Kylie King, and Dr Marisa Schlichthorst) for involving myself and others in the Advisory Group that provided guidance at various stages in the project. I would also like to acknowledge Gus Worland and everyone else who appeared in the documentary and shared their personal stories.
The author can be contacted at [email protected]