Man Therapy™: Outreach and Impact on Men’s Mental Health Program 18 Months After Launch

A White Paper by: Sally Spencer-Thomas, Psy.D. CEO & Co-Founder, Carson J Spencer Foundation www.WorkingMinds.org www.CarsonJSpencer.org Jarrod Hindman, MS Director, Office of Suicide Prevention Colorado Department of Public Health and Environment www.coosp.org Joe Conrad CEO & Founder Cactus Marketing and Communications www.SharpIdeas.com www.ManTherapy.org February 25, 2014

Innovation in Men’s Mental Health: Man Therapy

Difficult problems require bold solutions. This stance is the guiding philosophy of the Man Therapy program. The project is the result of a unique public/private/nonprofit partnership established in 2007 between Cactus, a Denver-based advertising agency, the Office of Suicide Prevention at the Colorado Department of Public Health and Environment and the Carson J Spencer Foundation, a Colorado-based suicide prevention nonprofit organization. Since its launch with an article in the New York Times on July 9th, 2012, the project has drawn national attention and international awards for its creative use of media in health literacy. Now 18 months later, the program continues grow and receive feedback about its effectiveness and provocative approach. This paper will review achievements and outcomes to date and outline a plan for future directions.

From the outset, the co-founders of the campaign made an intentional decision to unapologetically find a way to reach “double jeopardy” men – those most at risk for suicide and least likely to seek care on their own. Previous mental health campaigns targeting men have often been ineffective with this subpopulation of men, so an audacious new approach was needed. Thus, Dr. Rich Mahogany was born. Dr. Mahogany (a “fake therapist”) is the focal point of Man Therapy. He strategically uses maladaptive ideas of masculinity to bridge to new ideas that help men reshape the conversation of mental health, often using dark humor to cut through stigma and tackle issues like depression, divorce and suicidal thoughts head on. The creators’ decision on this approach was steadfast, despite some initial pushback from some in the mental health community who were concerned we were making light of a serious topic or those supporting the men’s movement who were discouraged that we chose to bring stereotypes of masculinity into the project. As you will see from the results outlined below, our target demographic told us that using humor and “manspeak” resonated with them and helped them think about their mental health in a different way.

History and Strategic Plan

The first five years of the project (2007-Spring 2011) were dedicated to research and development through multiple focus groups and in-depth interviews (read first White Paper Man Therapy™: An Innovative Approach to Suicide Prevention for Working Aged Men, July 17^th, 2012 for the results). In June of 2011, the Anschutz Foundation funded the initiative to develop and implement the concepts developed during the research and development phase.  Over the next year (June 2011-June 2012), the creative team created and tested campaign assets. On July 9^th, 2012, Man Therapy rolled out its initial version of the campaign with an article in the New York Times. 18 months later, the program continues to evolve and provide an even broader scope of resources for men’s mental health.

The purpose of Man Therapy is to provide men, and their loved ones, a place to learn more about men’s mental health, to examine their own wellness and to consider a wide array of actions designed to put them on the path to treatment and recovery. The message is that all men should be aware of their mental health, treat it like they would a broken leg, and strive to get better. Because of this “upstream” approach to suicide prevention, the program was quickly rebranded from a suicide prevention initiative to a broader and more robust men’s mental health campaign.

Overarching goals for Man Therapy include:

1. To improve social norms around mental health among men and the general population.
2. To increase help-seeking behavior among men for a variety of health and mental health issues, leading to an increase in men seeking available resources (including those provided on the site).
3. Long-term: to reduce rates of suicidal ideation and deaths among men. 

Within each of these overarching goals, the Man Therapy program works to change the following attitudes and behaviors.

Attitudes

1. Men’s attitudes toward mental health conditions like depression, anxiety/stress, substance abuse, anger and suicidal thoughts will become less stigmatized (e.g., they will endorse fewer myths).
2. Men will express a greater willingness to try self-help tools.
3. Men will express a greater willingness to seek professional help when needed.

Behaviors

1. Increased numbers of men will self-screen for mental health conditions.
2. Increased numbers of men will use on-line self-help tools.
3. Increased numbers of men will interact with peer, professional and crisis resources.
4. Increased numbers of men and women will reach out to distressed men in their lives, expressing concern and support.

Continuum of suicide prevention[SS1] 

Since the initial launch, several changes were made to expand the scope of the program:

1. A mobile version of the website makes it accessible on many more devices and improved downloading challenges facing users with limited bandwidth.
2. A suicide prevention therapist finder now helps men find qualified care locally.
3. Rich’s List compiles vetted mental health and other support resources for men.
4. The Mind Master offers men time-limited, skills mastery programs to help relieve stress and conquer many other behavioral and health challenges.
5. Support Group Central provides on-line support groups for men.
6. Man Therapy eCards (a partnership with the National Suicide Prevention Lifeline) offer words of compassion in the tone of Dr. Rich Mahogany (e.g., “everyone needs a pork shoulder to cry on.”) and are sent to men who are having a hard time from someone who is worried about them.

Knowing that we are reaching men (and the people who are “worried about a man in their life”) at various points on the continuum from prevention to intervention to crisis response, the project team is very intentional of developing strategies to address needs across the continuum. For example, on the “upstream” end of the continuum Man Therapy enhances connectedness by giving participants opportunities to send caring eCards to others who are struggling. In addition, Man Therapy augments intervention by linking results from the 18-point head inspection to qualified referral resources. Finally, Man Therapy assists with crisis response by connecting those in need to the National Suicide Prevention Lifeline.

When a man engages with Man Therapy, the intent is that the program first changes his attitude toward mental health concerns and suicidal behavior and then his behavior changes in ways that decrease these problems. While “raising awareness” is an important goal, it is a necessary but not sufficient condition for preventing suicide and promoting mental health. We must also see behavioral changes. Thus, as the program evolved over the 18 months, additional mental health tools were added to the website including a suicide prevention therapist finder and access to an online support group.

Outcomes

The Man Therapy program is evaluated by three different strategies: 1) Website analytics (where do users go, how long do they stay, how many return), 2) Pop-up survey questions (when users complete a significant experience on the website, a pop-up question asks them about their opinion about it), and 3) In-Depth survey (a longer survey asks participants demographic data and more questions about their experiences)

Website Analytics as of January 10, 2014

• Visits: 356,090 (95,807 are mobile)
• Unique Visits: 285,960
• Return Visits: 20%
• Average Time on Site: 6 minutes
• 18-point head inspection completions: 59,894
• Number of people who accessed crisis information: 19,586
• Number of people who accessed “Worried About Someone” link: 19,747

Pop-up Survey Questions (n=7,933)

A four key junctures of the website experience, pop-up questions are presented to participants to get their initial impression of the Man Therapy program. Participant satisfaction ratings for these experiences are high:

• 83% would recommend to a friend in need
• 51% agreed or strongly agreed they were more likely to seek help after visiting the site
• 73% said the 18-pt Head Inspection helped direct them to the appropriate resources on the web
• 78% satisfied or very satisfied with the quality of the Man Therapies
• 67% were satisfied or very satisfied with the quality of Tales of Triumph

In-Depth Survey (n=508)

In addition to the pop-up questions mentioned above a more in-depth survey asks participants demographic information and allows for qualitative responses (e.g., “What was one thing you liked?” “What didn’t you like?” Here are some results from this survey:

Who is coming to the site?

• 79% male
• 79% between the ages of 25-64
• 10% are Military (1% Active Duty, 9% Veterans)
• 39% there “because of me”; 8% “for a friend or family member”; 49% “just curious”

Voices of Support and Concern

The qualitative responses were analyzed for patterns and then the frequency of the major themes was tallied.

Most frequent responses to the question “What is one thing that you liked about the website?”

• 43% Humor (light-hearted, fun, hilarious)
• 37%: Quality of Website and its features (fresh, creative, accessible, helpful, honest, trustworthy, testimonials, interactive, branding, design, authentic, engaging, illuminating)
• 17%: Manly (not too touchy feeling, blunt, not feel like a wus)
• 10% Identification with Character
• 2% Reassuring/relieving During Experience

Most frequent responses to the question “Was there anything you didn't like about the website?”

• 22%: No (“nope” “nada” “absolutely not!”)
• 21%: Technology problems (bandwidth buffering, navigation, inability to print handouts, captioning needed, typos). Many of these problems were fixed over the 18-month period.
• 9%: More material needed (“Women Therapy”, more resources than Colorado, more topics covered: PTSD, spousal abuse, sexuality, prescription drug abuse, grief, chronic illness)
• 7%: Offensive, Too many stereotypes, Not funny
• 1%: Lack of Diversity
• 1% Too spiritual

Through the online survey and emails we have received, we have captured some of the qualitative experiences users are having with Man Therapy.

What did you like about the website?

Humor

At first I thought the site was nothing more than a joke due to the light and humorous nature. I was almost expecting it to be an Old Spice ad. However I am glad I decided to look around anyway, since the information inside is relevant, useful, and put forth in a way that is comfortable to read and easy to understand. I think it may have been that very feeling of humor and lightness which relaxed me and made me more open to the information.

The use of humor with this topic is incredibly important. The last place that a person struggling wants to go to is a 'sterile' site that sucks out that last bit of dignity.

Accessible and Engaging

Many men suffer from attention deficits which can create the need for the visual stimulation provided by the video on the homepage. This really helps to get the message across without requiring someone who may not have the patience to read, the opportunity to learn.

The relaxed, non-confrontational nature of the site, like a friend saying hey, c'mon over, we'll shoot some pool and chill out, the sense of acceptance and camaraderie

Related to Character of Dr. Rich Mahogany

The gentleman talking me through the site was a very welcoming addition. After the survey, his calm yet concerned voice was very reassuring, even if it was a prerecorded speech. In a sense, it helped me calm down long enough to think straight.

The only thing greater than Dr. Rich Mahogany's dry wit and wonderful sense of humor was his response to my Head Inspection results. I received a pretty awful 'score,' and the warm, comforting, and concerned response I got was perfect.

Weirdly, I feel as though the "virtual" counselor actually cares about me and that makes me much more comfortable addressing my mental health issues.

The way it is like sitting with a person in a real room. It's not like a list of rows and columns. Very nicely done!

Reassuring/Relieving

You took the guilt away from asking for help.

Your site is the first one I've found that helped with the loneliness of depression. Sure, the jokes were a cheesy and the stereotypes abundant, but tonight, I needed to talk to someone more than anything. Dr. Mahogany helped in that regard, even if I was already too educated for my own good going into it. It made me feel better seeing an empathetic face, even if it was pre-generated.

Manly.  Was upset about recent stressful problems, got a laugh out of this and helped gain perspective.

What didn’t you like?

Reinforcing Stereotypes

There's a lot of reinforcing stereotypes in the tips and the verbal segments, and I think we're sidestepping some important problems by not acknowledging that a man can be French, or like spandex and still be a man with problems... But I DO understand why these stereotypes are drawn up. It's a quick way to let men know that this kinda stuff is socially acceptable, and does NOT conflict with being a man.

At first I thought the use of stereotypes may be harmful, but that it is meant to be ironic and to appeal to the men who are most likely to avoid treatment. Keep up the good work!

Conclusion and Next Steps

Eighteen months after the launch of the Man Therapy program, Dr. Rich Mahogany has reached people all over the world, has made many laugh and has made mental health accessible for many men. Many of the technological issues have been fixed and the feedback received gives the developers plenty of room to grow. Immediate next steps include efforts to expand program outcome evaluation, to further expand the on-line mental health tools (e.g., on-line cognitive behavioral therapy) and to enhance our reach by licensing the campaign to organizations, counties, states and countries. With additional funding, the Man Therapy program hopes to continue to improve the website, testimonial library and media assets and exposure.

About the Man Therapy Partners

CactusCactus is a full-service brand communications agency providing business solutions for companies and causes through brand strategy, advertising, design, interactive and media services. Cactus has been nationally recognized for its breakthrough creative executions by The One Show, Communication Arts, The Webby Awards, South by Southwest, Favourite Website Awards, Advertising Age, Creativity and Print’s Regional Design Annual. To learn more about Cactus, visit cactusdenver.com.

Carson J Spencer Foundation - Sustaining a Passion for Living

The Carson J Spencer Foundation (www.CarsonJSpencer.org) is a Colorado nonprofit, established in 2005.  We envision a world where leaders and communities are committed to sustaining a passion for living. We sustain a passion for living by:

• Delivering innovative and effective suicide prevention programs for working-aged people
•  Coaching young leaders to develop social enterprises for mental health promotion and suicide prevention
• Supporting people bereaved by suicide

Colorado’s Office of Suicide Prevention –– Colorado Department of Public Health and Environment

The Office of Suicide Prevention, a legislatively mandated entity of the Colorado Department of Public Health and Environment, serves as the lead entity for statewide suicide prevention and intervention efforts, collaborating with Colorado communities to reduce the number of suicide deaths and attempts in the state. To learn more about the Office, visit www.coosp.org.

APPENDIX A:

Man Therapy Components, Outcomes and Accomplishments July 2012-January 2013

Man Therapy Components Established

• Website
• Interactive website gives users:
• Information about substance abuse, depression, anxiety and anger
• An 18-point head inspection (self-screening tool)
• A blueprint for how to “fix” the problems
• Guidelines on how to help someone they are worried about
• Access to crisis services
• Access to the Suicide Prevention Therapist Finder
• Access to online support groups for men
• Rich’s List of mental health and support resources
• Mobile Version allows website to be used on mobile devices and in areas that have low bandwidth
• Out of Home Campaign
• During August and September 2012, billboards and bus shelters displayed Man Therapy promotions
• Posters/Coasters/Business Cards/T-shirts – this collateral material was distributed to bars and restaurants that men tend to frequent
• 7 different posters
• 3 coaster versions
• 1 business card version
• 3 t-shirt designs
• Videos – housed on website and on YouTube
• 9 testimonial videos depicting diverse stories of men who had struggled with a suicide crisis and were not thriving
• Three “viral” videos (content is mostly compelling and less educational with the goal to drive people to the website)
• 30 second PSA
• Case study videos
• Social Media (Twitter/Facebook/YouTube)
• Twitter Followers - 286
• Facebook Likes – 868 “Likes” for Man Therapy page
• YouTube Views – 28 videos with a total of 52,410 views
• eCards – in partnership with the National Suicide Prevention Lifeline these eCards allow people to send supportive messages to men they are worried about

·      Town Hall Meetings – Twelve Man Therapy town hall meetings were held throughout Colorado between July 2012 and June 2013 attended by approximately 300 local elected officials, business leaders, community members and media.

·      Conference Presentations -- The Man Therapy partners presented on the program at over a dozen Colorado, national and international conferences on behavioral health, public health and suicide prevention, including several keynote addresses impacting over 2,000 people.

APPENDIX B:  Media, Awards and Expansion Earned

 Major Media

New York Times - Launch (print and online)

National Council for Behavioral Health (magazine)

9News Interview (TV and online)

Colorado Public Radio Interview (radio)

American Public Health Association

Psychology Today (blog)

Huffington Post (Online / Email)

Globe and Mail (Canada print and online)

Partial List of Awards Won

          Colorado Healthcare Communicators Gold Leaf Award

• Grand Gold Leaf Award 
• Gold within Advertising for Multimedia campaign 

Suicide Prevention Coalition of Colorado Media Award

Safe States Alliance Innovative Initiative of the Year Award

Expansion Achieved: Australia and Wisconsin

• On June 5^th, 2013, the Australian mental health organization beyondblue launched their own version of Man Therapy with a new character called Dr. Brian Ironwood. www.ManTherapy.org.au
• Wisconsin became the first state to license Man Therapy and launched the program roll out in the Fall of 2013.

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 [SS1]When formatting this for the final publication, would the geniuses at Cactus please make this continuum graphic more attractive?