HeadsUpGuys

Men’s depression and suicide, once referred to as a “silent crisis,” is starting to receive attention; but how clinicians should respond to this crisis has been largely unanswered.^1,2 Men tend to have poorer mental health knowledge and perceive higher mental health stigma than women do, are less likely to engage services, and sometimes lack the knowledge needed to make informed choices.³ Research also suggests that many men find it challenging to seek help as a result of culturally dominant masculine ideals and norms that emphasize and amplify men’s need to be independent, to suppress emotion, and to minimize disclosures about their vulnerabilities.⁴ For example, to be seen to endure pain and to deny—or at least be strong and resilient about—emotional injuries has been identified as a key practice of masculinity.⁵ Yet, while these constructions of masculinity remain relevant, and are a backdrop for men’s health practices and illness experiences, it should not mean that we adopt a view that positions men as victims of their own actions or inactions. Rather than blaming and therefore attempting to redress or “reorient” men, it is now being argued that greater focus should be placed on providing information and health services that are relevant and responsive to men’s needs.⁶

The Internet has become an important tool for men seeking health information, with some reports suggesting that they are twice as likely to independently seek electronic health information as they are to consult a health care professional.^7,8 The Internet has considerable advantages as a method of interacting with men, as it can reach a wide audience, be accessed 24 hours a day at little or no cost to the user, be updated frequently, provide interactive content, and link to other relevant resources. Furthermore, the Internet might address some men’s strong desire for independence and autonomy, and provide a nonconfrontational medium through which to seek help.

Given the increases in uptake of electronic health resources and Canadians’ high Internet use, there is strong potential to enhance men’s mental health knowledge and care, and promote effective men’s depression management and suicide prevention strategies through “virtual” means.^9–11 Yet, until recently, there has been no Canadian-based online resource focused on depression management and suicide prevention strategies specifically for men.

Men-friendly channel for information

Building on the promise of using the Internet to provide men access to information about depression, a team of clinicians, researchers, and mental health advocates created the HeadsUpGuys website (headsupguys.org). This is a free online resource that offers men information, practical tips, and guidance for managing and recovering from depression. The resource provides a men-friendly medium through which to start the help-seeking process. It is designed to capitalize on men’s desire for independence, autonomy, and preference for self-sufficiency, while still building in messaging that cues men to connect with professional help. By building a laddered approach that normalizes help seeking, HeadsUpGuys bridges men’s tendency to self-manage their mental health with other formal and informal resources. The language used on the site is purposefully everyday, rather than using biomedical labels, amid a clear call to action that positions effective self-management as a manly strength and normative value.

The HeadsUpGuys website provides not only information on and contact resources for men living with depression, but also includes a self-check screening tool for depression and testimonials from men who have recovered from depression (Box 1). In fact, we have compiled what is likely the Internet’s largest repository of videos of men telling their stories of recovery and offering others helpful tips for recovery. These videos can be found on the website and on a companion HeadsUpGuys YouTube channel.¹²

Box 1. The HeadsUpGuys website.

The HeadsUpGuys website, headsupguys.org, contains the following:

• Information about men’s depression and suicide, including potential risk factors and triggers, as well as common misconceptions about depression among men (eg, depression is a sign of personal weakness)

• A self-check screening tool for depression (PHQ-9), including directives for action when the user is provided with the screening score results

• Practical tips for self-management, focusing on the topics of sleep, stress management, social life, physical activity, food, and sex and relationships

• Health and crisis lines that men can reach out to for help

• Information about professional services, including psychotherapy, medications, and inpatient services

• Guidance about what to do if a crisis (ie, heightened suicide risk) arises

• Advice on how to reach out to others, including friends, family, and health professionals

• Testimonials (stories of recovery, practical tips) and YouTube videos from men who have recovered from depression

• Guidance for supporters of men living with depression

• Links to social media outlets (Facebook, Twitter, and Instagram) to encourage user engagement

PHQ—patient health questionnaire.

Promote men’s mental health

Since launching in June 2015, HeadsUpGuys’ profile and effect has increased substantially.

• It now has about 21 000 followers on its various social media outlets (ie, Facebook, Twitter, and Instagram).

• The site has had more than 460 000 visits (about 19 000 visits per month) from people in many different countries (Canada, United States, United Kingdom, Ireland, Australia, New Zealand, Philippines, India, Pakistan).

• More than 65 000 self-check questionnaires for depression have been completed.

• HeadsUpGuys has had more than 70 media features, including in the Canadian, US, and UK editions of the Huffington Post, The Telegraph, and The Mighty.^13–17

• There are more than 60 websites linking to HeadsUpGuys as a formal resource (eg, Government of British Columbia, Bring Change to Mind, the University of British Columbia, Movember Canada, Movember United States, Anxiety and Depression Association of America, Guard Your Health, Mood Disorders Society of Canada).

While several good depression management resources currently exist, none is explicitly and exclusively focused on Canadian men. HeadsUpGuys targets men as a means of advancing the well-being of men with depression and their families, thus making the development of this online resource novel and innovative in that it talks to the problems of men’s depression and suicide, and provides resources for addressing these problems. In raising awareness of men’s depression management and suicide prevention strategies through Web applications, this online mental health resource has potential to promote men’s mental health, reduce stigma, support recovery among men living with depression, and perhaps ultimately reduce male suicide. The flow-on benefits of such gains will undoubtedly reach women, children, and other men to advance the well-being of all Canadians.