Counselling with

Men in Mind:
Understanding and
Responding to Men’s
Distress and Suicidality

Dr. Zac Seidler

Director Mental Health Training, Movember
Research Fellow, Orygen

@zacseidler
A moment for those we have lost.

A moment for those who live on.

“Women seek help

Men die.”

Angst & Ernst, 1990

“Women seek help

Men die.”

Angst & Ernst, 1990

AUSTRALIAN 2018
Male Suicide

76%
Missing the mark

VIDEO TEMPLATE
What’s going on?
Over 60% of men who suicided sought help in the year prior
(Schaffer et al., 2016)
Cleary, 2016
12%
52 young men all COMPLETED SUICIDE
referred for
psychological 48%
treatment post
suicide attempt were ATTEMPTED SUICIDE AGAIN
followed up…
53%
ATTENDED TREATMENT FOR
<1 MONTH OR NEVER
 Men are talking,

Seidler, 2020 with their feet…

43%
DROPPED OUT OF
TREATMENT PREMATURELY
WITHOUT INFORMING THEIR CLINICIAN

We surveyed 2000
Aussie men who had
been in counselling.
The Research
We have gone to where men are to ask about their experiences
(Seidler et al., 2017):

• “I was a willing but passive participant in the experience…

It felt like reporting to a school teacher once a week.”
(Participant 1)”

• “Ask me what I’ve already done – don’t go over the same shit, meet me
where I’m at.”
(Participant 20)”

• “Well, if it’s helping me to get to where I’d like to be, I’ll keep going.”
(Participant 9)

• I gave them every tool, yet they were still unable to offer me a problem-
solving solution to it…it felt dehumanising in a way .
(Participant 16)
“Men seek help

Men die.”
What are we
missing?
What are we
missing
looking for?
The
question of
What are we looking for vs what do we find?

diagnosis
Men are often more likely
to experience their
distress as externalising
symptoms vs internalising
(Rice et al., 2018)
The What are we looking for vs what do we find?

question of
diagnosis
Men are often more likely
to experience their
distress as externalising
symptoms vs internalising
(Rice et al., 2018)
The role of
masculinity
1. Lethality and impulsivity theory
• Men are more likely to choose a more lethal
method of suicide than women.

in suicide “I taught my son how to tie a rope. The same knot that
eventually killed him.”

2.
The way men are brought
up impacts their response
to suicidality
(Seidler et al., 2017)
3.
Socialisation theory
• Men may view suicide as a courageous act to regain
control and independence or to fight feelings of
weakness from their depression.
“The thought of suicide helped me both conceal and
seemingly solve my problems.”
Interpersonal theory
• Being a “burden” is common for all people feeling
suicidal but add the combined pressure of needing
to be a provider, self-reliant and powerful, and
suddenly masculinity is hindering for men rather
than helpful.
“Nobody needed me. I was weak and useless.”
The role of
masculinity
4. Situational stressors theory
• It’s not all about “what are you feeling?” In men,
drug use, relationship breakdown, financial insecurity

in suicide & unemployment/job loss are among the greatest

risk factors for suicidal behaviour vs distress in
women.

Situational stressors
are key
"Additionally, some
reported that adherence to
masculine norms meant
that sometimes, the
feelings associated with
being vulnerable were
more anxiety-provoking
than the thought of being
dead." - Player et al., (2015)
 Masculinity
comes in all
shapes and sizes
 Men across
Older men

the lifespan
“Loss” of masculinity (sexuality/independence)
Physical health concerns
Social disconnection from mates
Highest suicide rate

Middle-age men/Fathers
It’s not just the mid-life crisis…
Environmental role stressors = fatherhood; breadwinner
Masculine identity rigidity
Post-partum depression
21st century increasing & conflicting expectations

Young men
Hormonal changes
Masculine identity formation
Social conformity = ⬆️ risk taking
Least likely to engage with mental health care
Men in Rural men

minorities • Particularly stigmatized attitudes linked with poor MH literacy

• Severe lack of MH services
• Masculine norms like stoicism and strength more pronounced with culture of
“toughing it out.”

Sexual minority men Ethnic minority men Unemployed men

• Concealment of identity can lead to
⬆️ distress, with high rates of
suicide.
• MH treatment is ”Eurocentric”
• Work is often self-identity, esteem and worth.
• System struggles to understand
• MH problems and suicidality are highest
culture/experience
amongst homeless men.
• Vulnerability is even harder when
disempowered
It’s not all bad news –
Reshaping & reframing masculinity
It’s not all bad news –
Reshaping & reframing masculinity
“It was like, how do I get out of this pit to being my
strong self again? It’s about rebuilding strength
rather than dealing with weakness.”
What to look out
for and how to
intervene
What
suicide
•Agitation and anger
•Lack of problem-solving capacity
STAGE 1
might look
like in men • Increased risk taking and carelessness
• Social withdrawal
STAGE • Talk of death and dying
(Player et al., 2015)
2
• Tying up loose ends
• Out of character connection with friends/family
• Quick shift to positive mood or periods of extreme calm
STAGE 3 • Increased self-destructive behaviour (e.g. compulsive work)
What
underpins
Each unit increase in
conformity to violence was

male
associated with 23%
higher odds of reporting

suicidality suicidal ideation

(King et al., 2020)

Each unit increase in self-

reliance is associated with
40% increased odds of
reporting suicidal ideation
How to •Normalise the experience of suicidal thoughts

intervene
•Validate the role of situational stressors in how he is feeling.
•Enact shared control and decision making over safety planning
STAGE 1 •Match his language

In his own words:

“I don’t need to feel like all these foreign

concepts are washing over me… just talk
to me like a human being. Like if she’d
said ‘Before we begin, I can’t read your
fuckin’ mind, I’m not here to judge you, I
hope this is a safe area, if you think I’m
talking bullshit, call it!’ I’d dig that.”
How to •Normalise the experience of suicidal thoughts
•Validate the role of situational stressors in how he is feeling.

intervene STAGE •Enact shared control and decision making over safety planning
•Match his language
1
• Discuss ideation and planning in detail.
• Make sure he knows exactly what an attempt will mean.
• Prompt him to vocalise what he is thinking about doing and why.
STAGE 2 • Be aware of the likelihood of his risky behaviour change

“I know you’re a risk taker, you’re

impulsive, and you’re always going to do
what you want. I wonder if an ultimate
risk you can take is by working with me to
fight this. Take a risk on life. You’re heroic
for being here - fight this. It’s a risk but I
know you can do it."
How to •
•
Discuss ideation and planning in detail.
Make sure he knows exactly what an attempt will mean.

intervene STAGE
2
•
•
Prompt him to vocalise what he is thinking about doing and why.
Be aware of the likelihood of his risky behaviour change

• Build out his list of strategies to use when particularly distressed

• Leverage masculinity - emphasise his role as a protector, provider
or father to help reiterate the practical need for him to be alive
STAGE 3 • Restrict access to lethal means due to impulsivity in male suicide.

"You feel that you are better off dead, but

let’s make a list of all the things that you
do for your daughter, and for your wife. If
you were gone, who would do this? You
can see the practical need for you to be
here."
How to •Normalise the experience of suicidal thoughts

intervene
•Validate the role of situational stressors in how he is feeling.
STAGE 1 •Enact shared control and decision making over safety planning
•Match his language

• Discuss ideation and planning in detail.

STAGE •
•
Make sure he knows exactly what an attempt will mean.
Prompt him to vocalise what he is thinking about doing and why.
2 • Be aware of the likelihood of his risky behaviour change

• Build out his list of strategies to use when particularly distressed

• Leverage masculinity - emphasise his role as a protector, provider
STAGE 3 or father to help reiterate the practical need for him to be alive
• Restrict access to lethal means due to impulsivity in male suicide.
 Keeping
men in mind
What needs to change
From workplace and parenting programs to the mental health practitioners
who treat men, when it comes to addressing men’s mental health…

it’s not necessarily just a case of MORE services, programs, practitioners

its often just a question of WHAT.

What are we offering?

What do men actually want and need (preferences)?
What are men’s strengths and how can they be included?
What are best times and places to implement programs?
What do clinicians think they know about working with men?
The case of a self-fulfilling prophecy

We need to empower men for change.

Show them what they are capable of.
Leverage their natural inclination for self-betterment.
NOT play into age old, destructive stereotypes.
 An example–
headsupguys.org
Our clinical solution
The onus should no longer be on ‘men to change’ to fit therapy.
It’s about time our mental health system adapts to fit men’s needs.

New approaches need to be designed and disseminated to UPSKILL

clinicians to better align with the preferences and strengths of men.
Gender competence training
Gender Do you seek to understand the depth of your clients’
Competence masculinities?

Do you believe masculinity can help them?

Do you ever judge their behaviour as weak internally?

What are your own stereotypical beliefs about men and

masculinity? Where do these come from?

Have you ever considered the impact of your gender

(beyond sexuality) on treatment engagement/outcome?
Delivering unique value
Target
Programs population

Traditional
model
Traditional mental health program models directly address the
needs of a large target population by providing them with a
standard approach. This puts the onus on men to change.

Programs Clinicians Target population

Men in Mind
model

The Men in Mind program model will address the mental health needs
of men, by providing clinicians with the knowledge and skills to create
personalised treatment plans, through the lens of masculinity.
Training Modules
Our Men in Mind training modules will focus on:

1. Masculinity: what is it and why should I care?

2. Your gender, your practice.

3. Engagement & motivation: cracking tough nuts

4. Male depression: assessment & formulation

5. Suicide in men: how to intervene

 Research to come 2020-2022
THE SEAS
AHEAD STAGE 3 – 2021-22
TRIAL PROGRAM
STAGE 2 – 2020-21 200+ clinicians. Test
efficacy and follow-up
retention in knowledge,
PILOT PROGRAM attitudes and practices.
30-50 clinicians. Test

STAGE 1 - 2020 feasibility/usability of

program.

CLINICIAN SURVEY
200-500 clinicians
working with men. Assess
baseline confidence and
competence.
World first survey:
Clinicians working with
boys & men

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www.programs.movember.com/counselling
OUR VISION

“Men seek help

Men thrive.”
THANK YOU
Dr. Zac Seidler
EMAIL: zac.seidler@movember.com
TWITTER: @zacseidler
QUESTIONS?