John* is in his 40s. He's extremely successful and runs his own business, borne from decades of experience in his field. That business provides for his family.
John has a beautiful wife, four beautiful children, a beautiful home.
John also has depression.
The last six years, he says, contained some of the blackest days of his life. John kept quiet. This was a conscious decision. A business decision. "Nothing scares clients or investors quicker than the smell of desperation," he says. "Saying anything about mental health is dangerous."
Then there's Alex.* He's in his 30s.
When Alex was younger, he was sexually abused. Abuse he never reported, "for stigma reasons." As a result, Alex suffers from depression and has for years. His wife knows about the abuse. She has no idea about his depression.
Alex was comfortable talking about the abuse. He wasn't comfortable talking about its effects.
"I am the rock," he says. "I am the stable one. Weakness is bad. Men are strong."
Today, October 10, is World Mental Health Day, and regardless of age, race, gender or occupation, we're all susceptible. Some groups are statistically at greater risk of depression and suicide. People in the LGBTQ+ community, particularly young trans people, as well as members of the military and veterans, experience higher rates of depression and suicide compared with the general population.
Men, despite the advantages and privilege they tend to have, are statistically more likely to attempt suicide. In Australia, 75 percent of suicide attempts involve men. In the US that number is 78 percent.
Men are terrified of talking about their mental health, and it's literally killing them.
Certain subsets are at an even higher risk: working-class men, men approaching middle age, men in rural areas. All are more likely to feel isolated, to believe that discussing mental health is a sign of weakness and statistically more likely to self-medicate with alcohol or other drugs.
"The number of men who die from suicide is three times the number who die in car accidents," says Dr. Grant Blashki.
Blashki is a clinical adviser for Beyond Blue, an Australian nonprofit working to help those suffering from depression and anxiety. He believes gender roles make it extremely difficult for men to acknowledge mental health issues. A broader cultural shift is required.
Perhaps cutting-edge technology has a part to play. There are apps for everything.
Apps that let you do regular psychological check-ins. Apps that provide daily mindfulness techniques. Apps that connect directly to smartwatches and use biometrics to diagnose potential mental health issues before you even recognize them in yourself.
All are designed to circumvent the stigma men feel when discussing issues of mental health.
"In many ways it's easier to be open on a screen," Blashki says, "than with someone looking you in the eye."
Headgear is one of those apps.
Built in partnership with Beyond Blue, with funds from men's health charity the Movember Foundation, Headgear has a simple aim: Help men manage their mental health with proven therapies like mindfulness, a technique that involves bringing attention to the present moment. A technique proven to reduce rumination and worry.
Headgear is free to download for iOS and Android and open for anyone to use, and the team is running a study with over 3,000 employees in male-dominated work industries. Firefighters, paramedics and truck drivers are using the app regularly and reporting back on its effects.
Men in these industries are often at increased risk when it comes to mental health.
"There tends to be a lot of shift work in male-dominated industries, which can be disruptive to sleep," explains Mark Deady, one of the psychologists behind Headgear. "There are long hours at play. If you're in, say, the mining industry, there's also a lot of fly in and fly out work, which is disruptive to social and family connections.
"These are all indicators when we're looking at mental health."
Researchers have long been interested in using mobile phones or online services to help combat men's mental health issues. Many suspect app-based treatments could be a promising way to deliver information and cost-effective treatment, particularly for men, who've been resistant to seeking help in more traditional, face-to-face situations.
The Headgear app features a 30-day challenge, with daily "bite-sized" tasks designed to improve what Headgear calls "mental fitness." These videos, quizzes and mental challenges are designed to build coping mechanisms that help long after users have deleted the app.
The Headgear team is in the process of writing up the results of its initial study, but according to Deady, early signs are positive. Anecdotally, male users have seen a reduction in depressive symptoms.
"In terms of the different tools and techniques, participants have learned from using the app, many have been really happy and grateful for it," he says.
The old brain box
Anyone can use Headgear, but the app is clearly aimed at men.
"Toughen your nut" is the tagline. The dashboard logo is a speedometer. The app has a section called "Toolbox" accompanied by an image of an actual toolbox. In short: Headgear is an app designed to appeal to hypermasculine ideals. That could potentially reinforce stereotypes that make it difficult for men to come forward to begin with.
This concerns Brett Scholz, a research fellow at the Australian National University. He's worked on a number of awareness campaigns focused on men's mental health and believes tools like Headgear are a positive step forward. But there's a risk, he believes, of appealing to a specific type of masculinity, to the potential exclusion of those who identify differently.
"These apps are saving lives," he says, "but at its root there needs to be a way to change how we think about masculinity and mental health."
Scholz references a 2013 campaign by Beyond Blue called "Man Therapy," a campaign fronted by the fictional Dr. Ironwood, a brawny, mustache-wearing character described as a "straight-talking man's man."
"One of the manliest things a man can do," he says, in an early promotional video, "is talk about what's going on up there, in the old brain box."
Man Therapy was a well-meaning campaign, designed to raise awareness about mental health issues, but Scholz says it played to male stereotypes that were potentially harmful.
"It reinforced the idea that there is this 'ideal man'," he says.
"A lot of the men I spoke to in my research said it made them feel less likely to seek help."
In 2011, Scholz worked on "Soften The Fuck Up" (STFU), an online awareness campaign in Australia. STFU was designed to tear at the root of damaging, toxic masculinity -- the kind that categorizes men as weak for seeking help. "We don't need to redefine masculinity," said the tagline, "we need to undefine it."
In hindsight, Scholz is also critical of his own STFU campaign, for many of the same reasons he was critical of Dr. Ironwood and Man Therapy -- STFU appealed exclusively to men willing to subvert traditional concepts of masculinity. STFU and Dr. Ironwood sat at opposing end of the same spectrum. Both communicated to one type of man while potentially alienating others.
"There needs to be a diversity of services," Scholz says, "because there's a diversity of men."
"Some guys want physical health services, some want to go to meditation classes, some want to talk remotely. The more diverse services we can offer the more we can help.
"We need to break down the stigma, and I still don't think we've got it quite right."
'Frogs in boiling water'
Peta Slocombe has been practicing psychology for the last 25 years. When it comes to mental health, she believes technology is being underused.
Slocombe is senior vice president at Medibio, a company that uses biometrics to diagnose, monitor and manage mental health issues.
It should be stated from the outset: Medibio isn't a nonprofit like Beyond Blue, or a charity like the Movember Foundation. Medibio is a mental health technology company that provides "corporate health solutions" to companies that suffer financially when employees struggle with mental health issues.
Medibio is a company with a product to sell. And in the growth market of corporate health, where sick days cost billions of dollars, it's a potentially lucrative one.
Medibio's solution is Inform, a mobile phone app that combines traditional psychological evaluations with biometrics taken from smartwatches. Medibio believes Inform can help empower people who don't even know they have mental health issues.
This problem is especially prevalent in men. According to Medibio's own research, 73 percent of men living with a mental health disorder are completely unaware they have a problem.
"They're like frogs in boiling water," says Slocombe.
Inform begins with an in-depth psychometric test, the kind you might take with any mental health evaluation. It asks users about their mood and the success of their coping mechanisms, as well as personality tendencies. It provides a set of scores like any psychological test.
Then it asks if you have a smartwatch.
Inform syncs directly to Fitbit or Garmin smartwatches, and uploads your sleep patterns, heart rate and arousal levels to Medibio's database.
"From there," says Slocombe, "we can start to look at some incredibly useful trends and patterns."
Medibio compares user's biometrics with 23 years' worth of data from patients with a variety of mental health disorders. From there Medibio can go deeper, providing users with a more definitive view of their mental health and recommendations based on that interpretation.
'I want to know'
But what about the data Medibio collects?
The Inform app requires biometric data, which is potentially problematic, especially when you consider that Inform's tech is currently available only through an employer (a consumer version is in the works). Do you really want your boss to have access to your biometrics?
But Slocombe says data is deidentified, meaning employers will never get access to individual biometric data. She says Inform is compliant with both the US Health Insurance Portability and Accountability Act (which protects how health information can be used and disclosed) and the UK's new General Data Protection Regulation. She says privacy is central to the Medibio's business model.
"If Inform gave data directly to employers, I'd be able to count our users on one hand," says Slocombe.
So what data does the employer get?
Essentially, employers get topline data -- they know how many employees are taking part and receive reports based on collective scores, not individual scores. The idea, says Medibio, is for companies to identify broader, systemic issues and respond to them.
Corporations have spent decades trying to solve the mental health problem, but the research consensus is most employee assistance programs have little to no impact. Slocombe says Inform is essentially a more cost-effective replacement, or supplement, to the traditional employee assistance program.
"Organizations already spend a massive amount on mental health, but they're spending it on yoga mats and fruit baskets," she explains.
Data, believes Slocombe, inspires real-world action, particularly with men.
"If you have a chat with a psychologist like me and I say you have depression, it's easy to say, 'no, I'm good, it's just a tough break.'
"People are more likely to approach data objectively."
Inform isn't tailored specifically for men, but it has been successful with men. Women are 63 percent more likely than men to seek out help for mental health issues, but Slocombe says Inform has an even male/female split when it comes to engagement on the app.
"Men are effectively saying 'I want to know'."
Not fast enough
John, the businessman, isn't sure an app could've helped him. When things were really bad, he explains, he wouldn't have used anything.
"Measuring your stress levels doesn't help pay the rent," he says.
Alex, the abuse survivor, has a different view. He didn't even know apps like Headgear existed. He'd be cynical about sharing his biometrics, he says, but an app could have potentially helped him.
When it comes to men and mental health, many experts agree we're heading in the right direction. Both hope that technology can be part of that broader change.
"We've seen a huge shift," says Beyond Blue's Dr. Blashki.
In his own practice, says Blashki, older patients will arrive, claim they're "here for a checkup," but eventually open up about their mental health.
Younger men, he says, are far more relaxed. "Overall, it's far more common for me to hear men talking about mental health."
Scholz agrees. He's spent most of his academic career talking to men about their mental health. "It has slowly -- very slowly -- been changing."
Older men, says Scholz, still struggle with the stigma of discussing mental health, but younger men, particularly men in their 20s, are far more willing to openly discuss issues they're facing.
Our society, Scholz believes, is finally becoming more accepting of mental health issues.
"Things are changing," he says. "But they're not changing fast enough."
* Some of the names in this story have been changed to protect privacy.
If you're struggling with negative thoughts or suicidal feelings you can call these numbers:
US: The National Suicide Prevention Lifeline can be reached at 1-800-273-8255.
UK: The Samaritans can be reached at 116 123.
AU: Lifeline can be reached at 13 11 14.
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