Talking with Men about Mental Health with Dr. Simon Rice

Dan welcomes back Dr. Simon Rice, Clinical Psychologist and Principal Research Fellow based at Orygen, Centre for Youth Mental Health at The University of Melbourne, Australia.

Dan and Dr. Rice continue diving into the complexities of men's mental health, particularly focusing on suicide risks and the societal norms surrounding masculinity that often prevent men from seeking help. They highlight the importance of effective communication strategies for supporting men in distress, the role of "Movember" in advancing men's health initiatives, and the challenges faced in advocating for men's health in a contested space while emphasizing that improving men's health ultimately benefits everyone in their lives.

Special Guest: Dr. Simon Rice

Movember

Movember Men's Health Institute

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Chapters

• 0:00 Introduction
• 0:35 Men's Mental Health Challenges
• 3:45 Barriers to Help-Seeking
• 5:00 Approaching Ment who may be Struggling
• 8:30 Introducing Men in Mind Training Program
• 10:00 Overview of Movember Institute of Men's Health
• 16:00 Pushback in the Field of Men's Mental Health
• 18:00 Broader Benefits of Investing in Men's Health

Transcript

0:00

[Music] Broadcasting from the most beautiful city in the world, I'm your host, Dr. Dan Cox, a professor of counseling psychology at the University of British Columbia. Welcome to episode number 48 of Psychotherapy and Applied Psychology, where we dive deep with the world's leading applied psychology researchers to uncover practical insights, pull back the curtain, and hopefully have some fun along the way. If you find the show useful, it'd be much appreciated if you shared it with someone else who might enjoy it too. Today, I can be more excited to welcome back one of the world's authorities on men's mental health. My guest is a clinical psychologist, professor at the University of Melbourne, a global director of the November Men's Health Institute. He also won several prestigious awards, including the Australian Psychological Society's Early Career Researcher Award, and the Australian and New Zealand Mental Health Award for Innovation. In this part of our conversation, we discuss several aspects of men's mental health, including challenges young men face and building relationships, approaching conversations with men in distress, a training initiative for clinicians, the November Men's Health Institute, and much more. This episode starts with my guest talking about his research on men and suicide, and they're finding that men often do not disclose their psychological pain until they hit a breaking point. So without further ado, it is by pleasure to welcome back my very special guest, Dr Simon Brace. Well, I think again, this comes back to our social norms around expectations that men have around masculinity, manhood, a challenge with being vulnerable. And I think, you know, there are assumptions that we sometimes make that, okay, well, we need more men's therapists or we need more men primary care physicians, general practitioners who are better attuned to the needs of men. And there's a couple of things to consider there that, you know, we did some some foundational work some time ago, asking men, you know, what are your thoughts on the gender of a therapist that you were going to see? Does it matter? And by and large, most men didn't really care. Some had a preference to say a male therapist, some had a preference to say a female therapist, but for the most part, they just wanted someone good and competent who was going to be able to be useful to them and support them. And I think sometimes by extension, we can make assumptions that, you know, in the medical sphere that male practitioners are sometimes going to be more attuned to the needs of men. I don't know whether that's necessarily accurate because expectations around masculinity and norms can play out in their own way when there's a health care encounter between, you know, a medical practitioner who's male and a patient who's seeking support for something. And there can be not saying this is necessarily always the case, but but challenges around, you know, a way of relating in a caring capacity that can both be received by the patient, but also expressed by the physician without falling into, you know, norms of provado or just being humorous or things like that. So I think, you know, coming back to this point around men's suicide risk, it too often we're saying that men will reach out for help at that point of crisis. And obviously in any health condition, that makes things more difficult in terms of the range of options that are available in that moment. And so you're, you know, you're providing support in terms of acute intervention, which we know is and can be highly effective, but will be much better if we could get men to be able to identify earlier in the piece to put them on a different trajectory to start with. And then for too many men, you know, the support networks, their health networks don't even have a good sense of challenges they're experiencing with their mental health. And sometimes at the horrible instance of a suicide attempt, many will say, I had no idea. And, you know, again, I think we've got a real challenge with our culture that men feel like they're not able to reach out and for help prior to those really challenging moments. So it feels like much of our expectations around men who are in twined with some of these, these kind of factors. So one thing I was thinking as I was reading in preparation for this is that, so you give the example of where just people in their social network have no idea. And there's also folks who they feel like maybe there's something going on with a man in their life, but the traditional masculine sort of it does, it's very effective in terms of pushing people away. Right? That if I'm stoic, if I'm, you know, hey, what's going on? Nothing? You okay? Yeah, I'm fine. Right? Like that, that is a very, yeah, it's very common. So I was curious to your thoughts, because I think that this is something even for mental health, you're sort of trained practitioners, but also for, I guess I was thinking like trained practitioners, but in their personal lives, but or just the regular person in their personal life, there's a guy in their life who they feel like, you know, it seems like they're struggling a little bit with something their affect has changed a little bit. They're, you know, they're not responding as much as they used to, but every time I sort of, you know, tiptoe up to inquire about it, I get pushed back in one of those ways. What, what suggestions do you have for those folks out there in terms of how they could approach someone a man in their life who they maybe feel like is struggling, but it doesn't seem to be budging in terms of being willing to talk to them or anybody else? Yeah, that's a great point, Dan. And it can definitely be really challenging at times, there's no doubt about that. You know, we talk about men communicating shoulder to shoulder, I think it's a bit of a trope, but I think that can sometimes create a greater sense of openness around conversation, going for a walk, going for a drive, doing an activity, and then having a conversation whilst engaging in their activity can sometimes be a little less threatening. I think for many young men and men it takes quite a while to warm up, that there can be a bit of a testing of the waters of, you know, saying something that's, you know, a tiny bit vulnerable testing how that's received, because, you know, we live in a culture where there are elements of, you know, vulnerability expressed can be taken advantage of. And if a young man or a man has a poor experience of communicating something really difficult, challenging, where they've felt particularly vulnerable, and that hasn't been managed in a supportive, sensitive, thoughtful way, the likelihood of them sticking their neck out again is very, very low. And so those can become profound learning instances, and, you know, young men and men can be really swayed by those. And I think, you know, trying to think, well, what, where is the point of leverage here in trying to generate some change? What might this young man, man, be particularly interested and motivated to be better at, to be more competent in, and maybe that could be your point of conversation, rather than pitching it as therapy, it's coaching, rather than managing symptoms, it's around supporting peak performance. So some small tweaks like that can sometimes be useful. And I want to, I think that that's great. And what you said to start sort of shoulder to shoulder, I think that's a really, I hadn't thought about sort of how you articulate it, which is extremely practical, which is, again, please correct me, but it's rather than, you know, hey, you know, trying to get them to disclose what's going on and that being your primary mission in sort of way of your entry point instead, hey, what can he and I do together? Right, let's just go do a thing, right? And that would be something he would enjoy and I would enjoy and maybe something we've done before, whatever it is. And then that is, yeah, that as a point of entry instead of question and disclosure as a point of entry, it seems like a very practical way of going about it. That can be useful, you know, building the connection, strengthening and deepening the connection, reducing resistance, working on the points of motivation, you know, you can think about motivational interviewing as a useful tool in the tool belt as well. So, you know, we're, push where it moves, where can some small changes and gains potentially be made or there might be a little bit more flexibility around, you know, a particular way of working or a domain and then building off from there. So, can you tell us a little bit about men in mind? So, men in mind is a great initiative that is being championed by the November Institute of Men's Health. Men in mind is a training program for mental health clinicians to be better engaging men in therapy, primarily for mood disorder, but really it's relevant much more broadly than just mood disorder. It's a great modularised program where MoVemba has invested a lot in the production quality, evidence-based supported by a randomized controlled trial. It's basically published in American psychologist and it's a really useful way of upskilling our workforce, regardless of their own gender, in some of the challenges that men experience, some of the presentations that can unfold during the therapeutic encounter, and things to be really mindful of when working with men over the longer term. So, it's a self-paced program, self-paced and it's, as I said, really supported by a lot of evidence and we're looking forward to make it widely available in the near future. There are parts of the world who can access many of mine now, but not all parts at this point in time. Got it? Okay. Okay. So, that sort of leads right into MoVemba. Could you tell us a little bit about MoVemba, your role in it, all that stuff? MoVemba is the world's leading charity in supporting men's health. We've had a strong focus traditionally in the areas of prostate and testicular cancer and we've been able to raise a lot of money and then really change the game in terms of health outcomes with prostate and testicular cancer through new tests and treatments. That work continues and we're also now pushing into new areas around better understanding the interaction between what it means to be a man and health, both physical and mental health, and better understanding men's relationships and their emotions and how those emotions and relationships can impact men's health and young men's health throughout their life course. Recently, the MoVemba Institute of Men's Health was founded that launched in November 2023. It's my dream job to be able to lead the institute and through the work of the institute, we are focusing on kind of four key levers to driving impact around increasing awareness of mental health and improving mental outcomes. So, our first part of that work is through advocacy and supporting our work in making sure that we have mental health strategies and policies developed in countries and markets across the world. We only have a small number of countries that actually have a mental policy or strategy at the moment. We'll be having a strong focus on convening the sector and bringing the mental sector together because we need that as a sector to be much stronger to be able to better advocate for improved mental health. We will be doing a lot of work, continuing our kind of strong basis in real-world program delivery. So, that's things that are happening outside of research trials. Either we're delivering, so through the MoVemba Institute of Men's Health. So, that's things like men in mind or our middle health skills and literacy program ahead of the game where we're using sport as a vehicle to engage young men in particular. And so then our fourth element is our research and real-world evidence where we will have an in-house research team supporting the next generation of evidence and also working with key partners through universities and external institutes to build the next generation of research leaders in the field of mental health. So, is the MoVemba Institute of Mental Health is that like a part of the larger MoVemba umbrella? It is part of MoVemba and we basically have developed the Institute to supercharge our impact work and really have a greater focus on effective implementation. We know from implementation science research that, you know, the famous quoted statistic of 17 years between the discovery through to actually seeing it rolled out in practice. In men's health, it may well be longer than that because we don't have a super strong field and a cohesive bunch of people who are working on things together and really strong networks. So, what we're trying to do is bring the field together, develop a field, develop the next generation of leaders and really push our impact in our program and our work with governments and our advocacy work into a new sphere. MoVemba still absolutely exists and the Institute is an addition to that to bring our impact work to life more strongly. And is that something that like you and your colleagues were sort of working over time to put together and then to justify the November and then that sort of has become actualised in the last few years? It was an initiative that grew within MoVemba and then my role as Global Director of the Institute was put to market. Now, I'm very grateful for being the successful person, appointed to that role and then over the last 12-ish months it's been the process of developing up the plans and then getting support from their board to bring those plans to life. Okay, yeah, I was online. I was trying to figure out all the different parts and what your role was and all that and I was just like, I was trying to figure it all out. This is helpful. And we will be doing a lot of work into the near future on refreshing at digital presence. The Institute comes to life so it will become easier for people to find us and recognise what we're doing. Yeah, updating websites and the lake is a never-ending task. It is, that's wrong. So the last couple of things, so one, I always like to ask folks if they've experienced any pushback for their work? Look, I think coming back to the idea of men's depression, it's definitely a contested space and from talking to prominent psychiatrists who have run major research trials in psychotherapy and need a present use in the past, they're not necessarily on board with the idea that depression may look different in men and that we might need some tweaking to the diagnostic criteria because I think in their mind, you know, when they see young men or men coming into their research trials, like they meet the criteria for MDD. Why do we need to think about changing the thresholds or the criteria? My point is that we, yeah, you see that cohort because they have been through the various filters, making their way into a psychiatry research trial, so they would have been a whole bunch of assessments and, you know, you've kind of, we know the population down and we've never said that the diagnostic criteria for depression is not useful or that that it's not useful for a cohort of men. What we are suggesting is for practitioners to be mindful of screening, using a screening tool, so it could be the PHQ9, widely used screening tool for depression, in a junk, in adjunct to a male depression screening tool. So one of the ones that I've developed is a male depression risk scale, well, well supported with psychometric data and there's a brief version of that tool out now and so that you can use those together to see, well, a young man or a man might not be quite rating on the PHQ9, but they might be rating on the load of depression risk scale, which would potentially indicate there might be something going on, you might want to ask a few more questions, potentially do a suicide risk screener or understand what else is going on in their life. Have there been much, have you gotten much pushback just in general for focusing on men sort of focusing that's that one shouldn't be? Look, I think people have a range of opinions on where we should be focusing. My interest is on understanding men's experience and better supporting men, which we see as a powerful vehicle to a healthier world, healthier men equals a healthier world. We recently released a report where we talked about and we had statistics to bear this out, the profound ripple effect of men's poor health on other people, and usually that is women and adolescent girls providing the caring role for men who are not doing well. So by providing men with better physical and mental health, we're actually improving opportunities for women and girls because we also heard in that report that many women and girls have had to especially women throughout the latter course of their life have had to reduce their hours at work, have had to experience challenges with their own social relationships because they've been in the caring role. And they do that with all the care and love in the world, but I'm sure they would prefer if they could have things different that they would be able to continue to work for a few more years in a full-time capacity or engaging in closer social connections with their own their own peer groups. So what we do see is that an investment in men's health can be good for all. Yeah, and I think that's the thing that is so important for folks to understand. I think most people get it intuitively, but that this the idea is that if men are doing better than everybody in their lives are doing better, right? That if you don't have, if your brother or your dad, your son is higher functioning, then it's just a better world for everybody around them. That this very much is not a zero sum if we're doing research and studying how to help men, that that doesn't mean that these things aren't also helping women. That's right. And we need to advocate for improved services for women and all gender groups. November has never been about advocating to take resources away. We've been about adding resources because the the health economic social, relational, psychological benefits are quite profound. Ladies and gentlemen, Dr. Simon Race. That's a wrap on our conversation about men's mental health. As I noted at the top of the show, it'd be much appreciated if you spread the word to anyone else who you think might enjoy it. Until next time.