The Unique Mental Health Challenges Men Face & Suicide Prevention

Depressed man holding his head

Dr. Sally Spencer-Thomas, a clinical psychologist, inspirational speaker, podcaster, and impact entrepreneur explains the dangers of rewarding victim behaviour, the unique challenges faced by men who suddenly find themselves lost in a rapidly changing world that offers little clarity about their roles and identities, the looming threats to mental health in today’s’ very uncertain world, and warning signs of suicide and steps for prevention. 

Dr. Sally began her innovative work in suicide prevention after her brother died of suicide. Known as an innovator in social change, she has helped start multiple large-scale, gap-filling efforts in mental health, including “Construction Working Minds” and the award-winning Man Therapy campaign. She currently serves as the president of United Suicide Survivors International. Dr. Sally has a TEDx talk, gave an invited speech at the White House and was honoured with the ENR Newsmaker of the Year distinction for her efforts in construction.

YOU CAN LISTEN TO THE CONVERSATION OR YOU CAN READ THE Q&A OR Just the summary BELOW-

How dr. Sally Takes care of her mental health

Dr. Sally emphasizes the critical importance of self-care for those in the helping professions, sharing how a severe depression episode in 2012 led her to develop a robust routine to prevent burnout. She shares her self-care regimen and her preferred strategies to manage the demands of her career while maintaining her mental well-being, highlighting the necessity of self-care routines for individuals in high-stress, emotionally taxing professions.

Dr. Sally: So many of us in the helping profession, especially in mental health, see so much work that needs to be done. There are so many things that need to be changed, and we always put our well-being in the backseat until we’re completely burnt out.

So, I’ve been down that path. I don’t want to be down that path again. I went through a pretty major episode of depression in the spring of 2012. That pretty much wrecked me for a long time, so I don’t want to go back there. So, ever since then, I have been doing a number of things to prioritize my well-being. One is I have a daily ritual.

I think many, many people discovered this during COVID; I discovered it after my depression episode that starting your day with a morning ritual, that is, mind, body, and spirit, even In short form, can really do such great things to set your day up for success. I’m also a wannabe runner. I was not given any of the jock genes, so running is pretty much what I can do because you can’t really screw that up. I’m super slow, but I get the job done. So, I do some kind of running, hiking, or walking with my dog. I write gratitude journals, and I have a daily practice of writing gratitude and what to expect and what I’m looking forward to in daily affirmations.

I meditate. I go to support group most mornings. All of those things are part of the first two hours of my day. It’s not a small thing. It’s a big thing. I get up really early and just start the day that way. So those are my daily practices.

The other piece that’s really important for my self-care and soul care is what my friend Sarah Gere likes to call it. How I fuel my soul is that I travel a lot for work, but in my travel, I tag on something. I tag on time with friends, I tag on an adventure travel kind of thing, and I do things outside of work that make it meaningful or social or restful or something.

And then the third thing I say is that I prioritize sleep. So this is also very hard when you’re traveling a lot because of time zones and that kind of stuff. I don’t sleep well anyway, so I know how important sleep is to a lot of people. All things related to health and longevity.

So I have a lot of tricks, a lot of practices, a lot of rituals, including a mask. That’s actually right here. You know, a mask that plays Bluetooth into my ears. I’ve gotten all the things down because when I start to lose sleep, I start to lose my mental health. So, I really try to prioritize that to the best of my ability. There are a bunch of other things, but I think that’s probably good enough for now.

Krati: Gratitude, of course, is important. Everyone talks about gratitude. That is one of the reasons why some people think it’s been commercialised. It’s been hijacked, but there’s a reason for it: it’s awesome, and it lights you up right away.

Dr. Sally: Well, and I also learned this from one of my podcast guests that, you know, our brains are wired to solve problems. So if you give it the problem to solve of go think of something that you’re grateful for right now, and then go think of something you’re really excited that’s going to happen in the near future.

That’s what your brain thinks about first thing in the morning. You give it a task, it’s on the task. And that’s what I want my brain to be thinking about. Not like, oh my god, my to do list, or like, this thing’s not going well, or that person’s mad at me. Like, no! Like, what are we grateful for? What are we looking forward to?

And that’s what I think about first thing in the morning.

biggest threat to mental health & Solutions to consider

Dr. Sally highlights the profound uncertainty and complexity shaping our future. These evolving challenges, often overlooked in routine mental health conversations focused on traditional stressors, are crucial for framing contemporary discussions on mental well-being and preparing for the future.

Dr. Sally: I have five or six answers popping up in my head. Uncertainty and complexity, I guess, are the big terms that I’m coming up with. So, for example, big questions are lingering, especially with our young adults, about their futures. Climate change, global unrest, economic uncertainty. I have three young adult sons, and they cannot, you know, find a way to make a living that supports their living, and this is just one of several things that are really weighing on them.

AI, I think, is another one. AI is super cool right now, but we can all see that our world is going to be completely different in, like, six months or two years. We’re not even going to recognize where this has taken us. And all of our science fiction nightmares and dreams will start coming true. Will we have jobs because these things are happening, or will we be able to function with the skillset that we’ve been trained in? We don’t even know, and I think that causes a lot of uncertainty. So that’s a big one. 

The complexity and uncertainty of our futures. I think another one for the United States will continue to be our relationship with drugs and alcohol and, specifically, the opiate crisis that has not been cleared up at all.

And we now know it is seeping into, you know, just about everybody’s family in some way. So that’s a big threat. I feel like I just need to call out because addiction is often easily hideable, but it does impact a lot of families.

Krati: I ask this question simply because whenever we talk about mental health, we always go to the usual culprits. We think about the things that cause us anxiety, like being overworked and the relationships in our lives. We’re not really focused on all the things that have changed, that have shifted. I want people to consider that so that as they’re planning self-care and planning to bring up certain topics with their families, they think about these things.

Very few of us discuss how war happening between two countries that are not your own is impacting you. Rarely would we ask a parent, ‘Hey, how are you being affected by the war going on between Israel and Palestine?’ and if we do ask them, the response we’re likely to get is, ‘What, I’m not thinking about that.’ But you are. You are thinking about it because it’s so much in the air, and the stress and the worry so much in the air and, as you said, the uncertainty.

Dr. Sally: Oh yeah, I have dear friends who have polarised views on this and can’t speak to each other. I have a lot of people in my life who fear for their safety and that of their loved ones. I have, you know, people on college campuses now who are canceling graduation ceremonies. I mean, it’s a big deal. People are very heated. It’s causing a lot of unrest everywhere. 

Krati: That’s something else that we don’t consider. How are we supposed to seek out support when the people that we would go to for support may not see things the way we see them? So, tell me what solutions you would ask people to consider as they battle with these situations. 

Dr. Sally: I do like to think on this level, like systems and cultural change, kinds of approaches to wellbeing versus what medication or what therapy, which again has its role in the whole thing of things. But I think in our country, we over-emphasise the medicalised aspects of mental health, and we under-appreciate the environmental, social, structural, all of those things. So I appreciate the question. I just can’t tell you that I’ve totally thought it through. No, I have. I have. I just got to figure out how to connect the dots in my head. 

So one of the things that I think eats at our well-being, in our country especially, is divisiveness. We tend to get really polarised, and then it’s all us and them. The more we plant down on our side, the more they look evil and then everything gets interpreted through a lens of their evil. I think that’s very, very problematic for our country’s well being. As you probably know we’re, we’re dying younger and younger. A lot of our evaluations of our well being show that we are more and more stressed. We have more and more stress related illnesses. We are a really unwell country, and I feel that it has a lot to do with this divisiveness. So what I would recommend on that front is to quit it.

I don’t know if you remember that therapist show, but his answer to everything was just quit it. But really like quit it, and sit down with people that are different than you, who have different viewpoints and hold the judgment back. Understand why they are the way they are, and why they have the world views that they have and what was their life story that got them to this point.

And I promise you, if you do that with an open heart, you’re going to see a human being that looks a lot more like you than is different than you. I know for people who are entrenched in their hate and entrenched in their belief structure, that is a very big ask, but I believe that’s how we get through this and that’s going to help our own mental health and help our country’s mental health. So rather than just hunker up with the peers that see the world the way you do, which just kind of emboldens our world views, step over, be curious. How do people get there? How did they get to the place that they’re at, holding a very different view than you? It’s a challenging emotional experience, but it’s a rewarding one when you get there.

So, for example, I was born in Connecticut. I have pretty liberal views. I wouldn’t say I’m uber progressive, but I have pretty liberal views. Never saw a gun or thought about guns. It wasn’t even on my radar ever until Columbine. So that’s, you know, decades into my life when I was living in Colorado and all of a sudden we had a mass shooting pretty much in my backyard. And now today I talk about gun safety. With, with communities who are firearm owners. Okay. This girl has zero credibility. But I feel, I feel like it’s very important for me to understand their perspective on their second amendment rights and. Their history with firearms and how much it means to them and then together in a very respectful Conversation we can find a place where I can say your family’s not as safe When there’s suicide on the menu when you have a firearm in your house And they can hear that right and I can hear you’re not gonna get my damn guns out of my house like, okay I got you like fine.

And now, today, I talk about gun safety with communities who are firearm owners. Okay, this girl has zero credibility, but I feel like it’s very important for me to understand their perspective on their Second Amendment rights and their history with firearms and how much it means to them, and then together in a very respectful conversation, we can find a place where I can say your family’s not as safe when there’s suicide on the menu. When you have a firearm in your house, and they can hear that. I can understand that you’re not gonna get your guns out of your house, so let’s find a way to make your house safer for your family and for people in your house who experience suicidal thoughts. So that’s one example. And, you know, I also work in a pretty conservative industry. Most days, I work in the construction space, and they’re very conservative fiscally, in their political views, in all things, and we deeply respect each other. So I never knew that I would be accepted by any of those groups, but I think it’s really important for me to get out of my own shell of what I’ve experienced in my life and what I think is true and really try to understand things from their perspective if I’m really going to be able to be of value.

Is therapy still a good tool for mental health support? what are some good alternatives?

Dr. Sally: Therapy means a lot of different things to different people. It runs a gamut between medicalised treatment modality to somebody could say that a spiritual retreat is part of therapy, right? All kinds of other ways that people do it. So, I’m a big fan of what works for people. I’m not being flippant, but different people need different things, different people resonate with different things, and different people think different things are credible, which also impacts how effective they are.

If you think something’s full of malarkey, you’re not even going to give it a chance. And you could take a pill from a doctor who says this is going to help you, and it’s a sugar pill, but you don’t know that, but if it’s a doctor giving it to you, you’re going to have a placebo effect. It’s going to help, so it’s very interesting.

What does therapy mean, and is it going to be helpful? I’m an advocate for ‘let’s innovate’. We’ve got a lot of questions on diagnosis in this space. Our over-reliance largely, again, United States based, but our over-reliance on our insurance system, and they need the code, so they know what to bill. I get it. It’s short-handling communication, but putting people in boxes is very difficult. We are way too complex and fluid in this part of our lives, and the simplification to a diagnosis is significant. So, I would like for us to innovate more because what I see happening is that there are a few therapies that are easier to measure.

So things like cognitive behavioral kinds of things where we’re looking at behavior change or, you know, things that are a little bit more easier to measure. in the short run tend to get a lot of attention. And I was trained as a behavior therapist, so I was attracted to that too. And then you get in there there and you’re like, is that really recovery? Is that really somebody having a transformational experience or is it just the superficial behaviour because it’s easier to measure. And again, some types of behavioural therapy, some types of cognitive therapy, super helpful for people. I’m not knocking it, but it gets a lot of attention in the research because it’s easier to measure. So things like cognitive behavioural kinds of things where we’re looking at behaviour change or, you know, things that are a little bit more easier to measure, in the short run, tend to get a lot of attention. And I was trained as a behaviour therapist, so I was attracted to that too, but then you get in there, and you wonder, is that really recovery? Is that really somebody having a transformational experience, or is it just superficial behaviour? Because it’s easier to measure. Again, some types of behavioural therapy and cognitive therapy are super helpful for people. I’m not knocking it, but it gets a lot of attention in the research because it’s easier to measure. As I’ve evolved, I’ve gotten more jaded because I’ve watched our systems fail. I’ve watched our traditional therapies that have been approved work in the short run, but not the long run. I’ve watched other people have more transformational experiences that have been longer lasting through experiences with their faith and spiritual awakenings or with animal-assisted therapy, you know, which got totally knocked down by scientists for a long time.

We’ve been connected to animals our entire evolution. Why would you think that that might not be a viable form of healing for people? It’s reciprocal. I mean, anyone who has a pet can tell you their pet is a big part of their mental health. I know it’s true for me. So why would we just dismiss that? Well, it’s, you know, a threat to one’s identity when you can say a dog will do a better job than somebody I’m paying $200 an hour. Maybe it’s true on some days. I don’t know.

I’m also a big fan of 12-step types of healing for people. There’s a lot of beauty in that. Again, it’s not for everybody, but let’s put it on the buffet and make it a legitimate place that people can go. It’s universal acceptance to a group of peers who have already walked the path. There’s a stepwise progression. You can choose what you like. And it also has a spiritual component. For me, that’s a good number of good things in the salad. And it’s free, you know, and millions and millions of people around the world have been helped and are helped every day. So I would just like the mental health world to get over itself, basically, listen to what the people say is actually helping them through things. Stop focusing so much on the things that give us marginal changes. 

For this example, in my world, I focus a lot on suicide prevention. And again, the United States in particular, we are absolutely obsessed with predictive risk assessments. That’s all people talk about. That’s all the research. All people talk about is what tools you are using and how’s your risk assessment work. And I’m like, we have decades of research that show we can’t do it. We cannot predict imminent risk with our tools. We have marginal, tiny little increments of success, and I don’t think any of that is helping anybody.

Nobody is being helped by being asked a million questions in an interrogated form. As you check boxes on your checklist, it looks like nobody’s being helped by that. You’re just trying to get over your fear of somebody dying on your watch. I understand that that’s scary, but let’s really get back to the business of helping people. I’m very jaded right now with continuing to do the same things over and over again and things not changing, you know.

Krati: What you’re recommending here is that somebody having mental health issues should maintain an exploratory mindset and therapy is not necessarily for everyone, but perhaps we should try and access the more easily accessible solutions like getting a pet or spirituality, religion.

Dr. Sally: I’m gonna say both-and. I would say exploratory mindset is a good way to put it. Put a lot of things on the buffet. Give them a taste. See if it works for you. Also, there are a lot of really great therapists out there. I don’t want to knock therapy off the table completely. There’s also a lot that are burnt out. So shop a lot of people, a lot of everyday consumers of therapy don’t recognise that they are the consumers of this service and they get to say, this isn’t working for me. I need to try something else. And after, you know, one or two sessions, if it’s not working, you can walk away and it’s okay. In fact, any therapist worth their salt should be preempting that by saying, let’s see if this feels like a good fit. And if it’s not, no harm, no foul, we’ll find you somebody else. They should be saying that but a lot of people feel like they’re locked in. They have a couple of, you know, therapy sessions and they are like, this is for the birds. And then they never go back rather than thinking of it as a mismatch in a relationship. They think the whole thing is not going to be any good. So to really empower people to think, you know, you’re the one driving the bus here. If it doesn’t work for you, let’s keep searching. So searching within different forms of modalities of treatment, different types of providers, different ways of getting therapy, whether it’s Telehealth or whatever like you get to explore that.

The other thing I’ll acknowledge is that that’s hard to do when you’re feeling depleted and lost and overwhelmed and have no idea how to navigate any of this. So my other recommendation here would be to find a peer. A peer who’s just a little bit above you or a little beyond you in their journey. They’ve gone through some trials and tribulations. They have ideas of where you can look and they will help advocate for you because it is daunting to try to figure out what the right things are to feel better.

power of storytelling (& rewarding victim behaviour)

Dr. Sally: Storytelling is one of the most powerful tools that we have as human beings. Again, in our evolution, we were telling stories way before we were doing pretty much anything else. It’s so core to how we connect with one another and how we make sense of our own experiences. And when it comes to mental health, it works when it’s done a certain way. 

It’s organizing chaos that’s in our being, especially around trauma, owning the parts of our narrative that are true for us. And then reflecting on our experiences. I like to say from the framework of a hero’s journey. So I went through this horrible thing, but I’m not begging for sympathy. What I am doing is reflecting on the strength that it took to get through that. The lessons that I learned along the way, the trials and tribulations, what I have today that I would have never had had I not been tested in this way, my views on myself, my views on humanity, my views on the world are enriched. I would not want to wish this harm that I went through on anybody else, but because I went through it, I now understand, and I have meaning in a different way than I had before. That’s how we coach our storytellers to think about telling their story to themselves and to the world. You know, a lot of narrative psychology is the same thing: putting the cohesiveness of a story structure on the chaos of our lives is healing.

Thinking about it through the lens of how I have grown through this helps us to have a redemptive flavor to our narrative rather than a victim flavor. And the other thing that we do is we don’t encourage our storytellers to think it through before they share their story.

Are you ready? Do you have support in place? Do you have enough perspective from the thing that you went through that you can actually reflect on what happened to you rather than live in it in the moment? I think some of those things get people tripped up when telling it before they’re ready, and then their emotions are so raw. That people cannot help but respond. Sometimes, it’s probably intentional that they want that kind of reaction, and sometimes, they’re just not ready. And then people want to take care of them. So I always say if you’re working on your own story in your own head and or with your therapist, you are where you’re at. Just continue. But if you’re sharing your story publicly, think it through. What is your why? What is your end game? And if your end game is to get a gazillion likes on your Instagram reel, why? Like, what are you actually trying to do? Because, yes, a powerful, emotion-filled story like that will probably get you a gazillion likes on your Instagram reel. What does that do for you? What does that do for the world? What are you trying to do differently in the world? 

So how do we get ourselves out of our own kind of victim mentality when maybe we are seeking this type of support? I guess we just need to check in with ourselves. Like again, that same kind of question. What is my why here? What am I trying to do? Because if I’m telling the story so that I get people to say, Oh my gosh, I’m so…. That’s an overwhelming sense of sympathy, not compassion. What is that doing for the world? What is that doing for me? Is it empowering me in some way? And if I consistently do that and then I never change my behavior, how perhaps maybe that’s keeping me trapped? How is that reward of getting this huge influx of attention for my pain maybe keeping me stuck where I am versus helping me transform out of it?

Krati: I feel like a lot of people don’t know that they’re doing it, necessarily. They’re not trying to reel people in and, they’re not playing a game. They’re just not realizing yet how easy it can become to constantly lean on someone, lean on validation, and then unconsciously seek out experiences that continue that pattern.

Dr. Sally: I do have a few people like this in my life. I also just want to speak to the fact that they say out loud often what a lot of other people think but don’t have the courage to say out loud. So there are some good things that they’re doing in terms of making some of these conversations more permissible.

But I worry sometimes that, because of all the attention they get back, they have a hard time evolving out of that. They get reinforcement for describing in a very intimate way their vulnerabilities and they may not see a pathway out of that where they’re getting the same level of attention for healing.

Traditional norms of masculinity and the modern man

Dr. Sally: Oh, so many double binds for men! They’re endless, you know; we still expect them to be strong, whether we say it out loud or not. We expect them to solve problems. We expect them to lead. We do. But then, if they do, then we demonize them for taking control and being aggressive and like total, total double bind.

I have three young adult sons, and I’m proud of them. They’re navigating it to the best of their ability, but I also worry. I worry because life is easier to navigate when your role is clear. It just is. I know who I am. I know what is expected of me now, 20 years from now. I know where I’m going.

It’s clear. When our roles and expectations are not clear, we falter because we are anxious. Am I going to fail? I don’t even know what I’m supposed to be doing here. Constant anxiety about who I am in the world and what I’m supposed to be striving for. 

I work a lot with men who hold traditional norms of masculinity. I started my career off in law enforcement, working with law enforcement, first responders, and firefighters. I spent a good chunk of my career on college campuses, which was also great from this perspective of empowering young people to find who they were in the world. It was awesome. Today, I spend a lot of my time working in construction, transportation, and, you know, male-dominated industries. So this has actually been a big theme, and I like where I’m seeing some of the thought leadership go today. 

I really recoiled when I heard all of the language of toxic masculinity being thrown at people, not even bantered, literally thrown at groups of people. Because I know when people are feeling the finger being shook at them, they don’t behave well. And even if they’re trying, they tend to want to hide. Nobody likes to be shamed, attacked, labeled. Nobody likes that. And so what I saw starting to happen is that a lot of men just ducked under the table. They just hid. A few ventured out and tried to navigate it, but then they felt like they were walking on eggshells the whole time. But a lot of men went and hid because they said, I don’t have any clue what I’m supposed to do here. And especially if they were in roles, vocationally, where they had to be aggressive, decision-making, problem-solving, in charge kind of people, which, by the way, you want. You want your firefighters to put their emotions aside and go in and do what needs to be done to save lives. You don’t want them feeling all the feelings in that moment, waffling with their certainty. Same with our surgeons, like all of these people.

The roles that people play where they need those more traditional norms of masculinity types of qualities. So, especially when the men were priding themselves in their ability to do that, and then the rest of the world is telling them they’re toxic, it’s a confusing space. So what I’m seeing now that I really love is how do we flip the script?

How do we embrace those traditional norms of masculinity? And say these traditional norms of masculinity also define a good percentage or some percentage of the modern man. These are not throwback values from centuries ago. The modern man who has a deep sense of honor for himself, his family, his community, the modern man who, you know, wants to have courage in all kinds of spaces, including around his mental health, you know, just taking these traditional norms of masculinity and applying it to the modern man so they don’t feel like they’re completely alienated. To all the things that they feel are true for them. I like how that conversation is going. 

I just did an exercise two days ago with a room full of sheet metal union workers. I mean, these guys are super tough. My construction dudes are super tough, big, burly dudes who work with their bodies every day. And by the way, where would our world be without them? People who are willing to stand up 800 feet in the air on scaffolding that builds the buildings that we live and work in. People who are out there toiling in really hot weather to put down the pavement and the bridges so we can do the things that we love to do. We would be absolutely nowhere without our construction infrastructure. And yet those are the kind of guys that get really labeled with toxic masculinity all the time, and they want nothing to do with that conversation. They will just, you know, push the whole thing aside, and yet, they’re also the ones dying by suicide, dying of overdose, and the consequences of addiction at higher rates than any other vocation. They need to be able to address this in a way that makes sense to them. 

Addressing loneliness and identity in men

In many men, anger is actually depression. That when we have changes in anger where people are flying off the handle with small stressors and small conflicts they are really suffering and that's just how it's coming out.

Krati: What can men do if they’re feeling lonely and isolated? There is a shift in the gender roles as well. Some of it is, I think, great, and some of it is hard to understand, especially for men because their roles are being questioned and they don’t quite know where do they belong now in this entire conversation and what areas they get to own completely, if any.

Dr. Sally:  This has played out in my own life. It’s been a very interesting journey. So, earlier in my marriage, my husband was the breadwinner. He had a degree in geophysics. He was working in oil and gas. I was working part-time raising the kids, nonprofit, you know, I was contributing financially, but I definitely wasn’t paying the bills.

And then, mid-marriage, my husband not only lost his job but pretty much lost his career in the field mostly because he just couldn’t do it anymore. It was too soul-sucking. And that led into, you know, a big depression for him and all kinds of challenges. And then my nonprofit collapsed and we were destitute, like that all happened. But then my career took off financially and in all the ways. So I could support the family, but the demands of my career meant that my husband needed to take care of the kids and the home. And that took a couple of years of adjustment. But now we’re all settled in, and the kids are grown. So now he just takes care of me, which is lovely. Absolutely lovely, and it works for us because, again, the roles are clear. I know what I’m doing. He knows what he’s doing. We respect each other’s space. When it wasn’t clear, there was a lot of resentment, just a ton of resentment back and forth. Like, why aren’t you doing that? What’d you spend that money on? Like, ugh, you know, constantly. But now, we got our lanes, and it’s clear again. So, it kind of flip-flopped the entire dynamic in my own relationship. 

Now, how do they fight the loneliness? Well, you find peers. I mean, that’s really it. Whether it’s other couples or other men or whatever, that have gone through similar things, and you know, with today’s ease of finding like-minded communities, you can find that if you look for it. You can find other like-minded people. Women tend to be much better at doing that. We see value in it and are more proactive in making sure that our social networks are up to date, intact, we’re connecting, making an effort, we’re intentional of, you know, meeting up for coffee, calling people, whatever while a lot of men have been conditioned to be that lone wolf. And if you can’t figure it out on your own, by yourself, then you have failed. It’s really that big of a deal, which is absolutely ridiculous. Again, we are social creatures from the entire evolution of our being. We are meant to be together, but men often are told to do it on their own. So, self-reliance as a value is the strongest traditional norm of masculinity that is connected to suicide, and yet it’s so much inherent with so many men who just pride themselves on white-knuckling it. I did this all by myself. Look at me. And it really sets men up for honestly a life of misery because I don’t care how successful you are if the only thing that gives you a sense of self-worth in your life is how much you’ve achieved or how much money you’ve made. You feel empty. Those goalposts always move. You never get there. There’s always someone richer and more successful than you. And the more you strive, and the harder you work, the more you lose everything else. You lose your health, you lose your relationship, you lose your sense of meaning because you’re just chasing stuff. It doesn’t have meaning for you anymore. And it leaves men in a huge sense of loneliness and despair, you know? So we got to, again, flip the narrative on what it means to be a man, not to take it away, but to reframe it. Those same core values in a way that’s life-enhancing for men, not depleting.

What do men really need & the success of Man Therapy

Dr. Sally: You know what I’ve found, though? You give them the little, the littlest sense of permission or empowerment, and it just puts a little bit of psychological safety around the situation. They are so hungry for it. Again, even my toughest of the tough, they are so hungry for it, and I’ll give you one example.

So, I’ve done this a million times and again, I have zero credibility, I am a girly girl, a girly progressive girl. I have zero creds, but I have watched it happen so many times. I say, ‘I know that all of you have pain because you’re human. We all have pain. You don’t know that about each other, and

we’re going to keep the stories here.’ I put them in small groups, and boom. There it is, like five seconds later. We’ve got people who may not be talking about their deepest, darkest. I don’t want them to but saying oh my gosh, yes, when my wife left me, I couldn’t sleep for three months or whatever it is. So, about a year ago, I had a very big keynote and I was speaking to probably 1,500 construction workers, 97 percent men in the middle years, traditional norms of masculinity, super tough.

And I shared, you know, stuff about mental health and suicide prevention as I’ve witnessed, not lived through, witnessed in, in their community. You know, and I got off the stage. I took, you know, I’m just like, I just got to get off the stage. I go to get my computer and pick up my things, and I walk off the stage, and all of a sudden, I hear this voice.

I’m just trying to get out of the way for the next thing that’s happening, and I walked to the back of the auditorium, and all of a sudden, all the people in the room, mostly men, stood up and there’s a man at the microphone, and he’s crying because he had just lost a coworker, a beloved friend to suicide. He’s crying at the mic in the back of the room. They passed the mic back to him. Everybody stands up. They all link arms, 1500 of the toughest of the tough linking arms and together they started chanting. I have your back. I have your back. You are not alone. I have your back over and over and over again.

It was so completely moving, you know. So, they do have absolutely the capacity to do this. They just need to know it’s okay and that other men are feeling the same way. And then boom, it’s there. The peer support. Pieces of this are so healing when people know there’s others very similar to them who have already walked the path and they’re they’re not alone.

Something else that I’ve seen work its magic is humour, especially in places where it feels daunting or taboo, or we’re not sure like, eh, I just want to sit on the sidelines like resistance to stepping in the arenas as Brene Brown says, you know, a little bit of humor goes a long way. Now, it has to be the right kind of humor. Obviously, it’s not humor that pokes fun at, but humor that gets you to self-reflect on your own stuff. So Man Therapy, mantherapy.org, is what emerged out of us asking a lot of men in surveys and interviews and in focus groups, especially men who had survived suicide attempts or near misses. When we asked them, I said, what did you need? What would have prevented that moment or, better yet, upstream from that? What would have prevented the despair that led you to that moment? They told us a whole bunch of stuff. You know, they said, ‘It’s your strong mental health language. We don’t resonate with it.’ They said, ‘We don’t believe those experts really understand our experience. We’d listen to a peer before people with a whole bunch of letters after their name. We want to understand how our physical symptoms like sleep, pain, and low energy are connected to this. And we’ll just go to our primary doctor, and they just give us pills, and we think that that’s being resolved, you know, rather than understanding what the root causes are.’ You know, they said a whole bunch of stuff. Oh, another big one was, can you give us a chance to check in with ourselves first before you send us away? There was this idea that you’re going to send us away to something that feels really scary or stupid and definitely is not going to work. Before you send us away to that thing, can we just have an opportunity to check in with ourselves and maybe try to fix ourselves? Like, give us some tools, give us some self-help things that might actually do the trick so we don’t have to go to this scary other place.

And then we said, ‘Okay, great. All of this stuff is super. How do we actually, like, cut through the clutter and get into your mind or into your ears or into your consciousness?’ And they said, ‘You make it funny.’ And we’re like, ‘Excuse me, what? We can’t make this stuff funny. Mental health and suicide and addiction, that’s not funny stuff.’ They’re like, ‘Yeah, but you make it funny. We’ll pay attention. You make it funny. We’re actually going to be curious about what the heck this is. And we might even pass it along to other dudes. So make it funny.’ So luckily, we worked with the right messaging group, advertisers actually, that understand how to cut through people’s clutter of their information, get their attention, and get them to engage, and it’s hilarious. I mean, everywhere I show it, men are rolling with laughter, and what the laughter does is it just gets people to exhale and feel that okay, all right, we’re going to be okay. And literally on the hormonal level, our bodies get flooded with things that help us relax. So, we bond over humor. The humor is just secret sauce stuff here. But again, it does have to be the right kind of humour because you can really go off the rails if it’s the wrong kind of humour, it can be very divisive. So, you got to have the right, the right art of the humour. And that’s another trick that I learned again: a woman who has no credibility and no lived experience, I threw a couple of things in of humour, and all of a sudden, we’re buddies now.

Well, and that also ties together all the dots of what I’m trying to advocate for. Listen to the people with the lived experience. They will tell you – how you get my attention, what I need, what I think is valuable and meet them where they are. Because if it was up to the mental health professionals, who, by the way, completely rejected Man Therapy when it first came out. They thought it’s superficial. This is making fun of something that’s not funny. I’m like, you know what? If you all had figured it out, we wouldn’t be having this conversation. You got as far as you could go, and there’s this huge group of men that are completely falling through the cracks because what you’re doing is not resonating with them. Maybe we can listen to them and innovate. Not try to do the same thing over and over again with just more effort, but actually do something different. And now, you know, 10-11 years later, we have a randomized control trial. That was huge. That shows, yeah, it works. It tracks the men that are hard to reach. They spend a lot of time exploring the resources. They are more likely to seek help. I mean, it works. So, yay for innovation.

Krati: Anything else you want to say about Man Therapy’s success?

Dr. Sally: Yeah, it’s been a very fun road. I got to do an official shout-out to Cactus, who created all the creatives behind it. And honestly, the Colorado Public Health Department made it legitimate. So, from the beginning, public health and the government had to make sure that it was legitimate, or they would get egg on their face. They would get completely laughed out of the whole thing, and because of those two powerhouse mechanisms, creativity and legitimacy came together. We have partnered for a decade. Now we have something that is reaching people, and also the entrepreneurship piece of it; we have scaled to almost all of the states at this point to the country of Australia. It’s great, and again, small treatment-oriented mental health thinking is not going to get us there. We need to partner. We need to partner with other types of ways that people influence. Reach in new ways and move hearts and minds. So,

I’m all about the collaborative aspect of that project as well.

Krati: I recently had a firefighter reach out to me after reading an article I wrote for Mind Body Green. He shared a personal dilemma: despite his traditional “manly man” image and similarly masculine friends who might ridicule him, he wants his partner to lead and make decisions, especially in social settings. He’s torn between conforming to peer expectations and embracing his true preferences in his relationship. Faced with this conflict, I advised him to choose whatever feels right for him at the moment, acknowledging that it’s okay to make a different choice in the future. This situation made me reflect on the pressures of societal expectations and personal identity. What advice would you give to someone in his position?

Dr. Sally: Be who you are and surround yourself with people who make you feel good. If you’re not who you are because you’re afraid of getting laughed at, that’s the wrong road. You need to be who you are and surround yourself with people who love you for who you are. So, I would say minimize your contact with these toxic peers. You can still do your job really well without that and be who you are in your relationship. If that is feeling good to you and that feels good in your relationship, in the end, guess who wins? And not that it’s a win-lose thing, but if you’re happy in your relationship, you’re going to be a more satisfied person, you know, it’s just, that’s how, you know, it’s just how it is.

And so find out, find out because I’m certain you’re not the only firefighter who is trying to figure out gender roles in their relationship and also what it means in the vocation. Like I’m sure you’re not the only one; a lot of emerging, especially the emerging firefighters, are all figuring that out right now. You’re not the only one. So, find them, find the other ones who are also like, ah, how do we do that? And then hang out with them cause at least they’re in the struggle with you. Walk away from the bullshit; walk away because that will speak loud. You know, and I would just also say come out proud. I mean, if you’re solid enough in your relationship, just come out proud. They’re going to be jealous, honestly, that you have a solid relationship because, you know, the domineering type of relationship doesn’t last long.

Warning signs and risk factors of suicide

Dr. Sally: Oh, the warning signs and risk factors is just a conversation that I get fatigued of having because while there are definite signs, and I will speak to them, but so often, the people most at risk of dying by suicide are very good at masking and they are very lethal on the first attempt and they have good reasons for not disclosing. So, and that’s again, not everybody, but you know, mostly the men in the middle years who take their lives. It’s one attempt, and it’s fatal, and everybody’s shocked. So, really, my answer is to talk about it. Open up the conversation. Don’t wait for the big red flag because the big red flag might not come.

If you know, even some life experiences that they’re going through that would make anybody highly distressed. Circle the wagons. The number one is any kind of disruption in the primary relationship, divorce, separation, or domestic violence. You might not know about domestic violence, but you probably know about separation, and certainly, you know about divorce. Circle the wagons because that is an upending transition for just about everybody, even when it goes well. And that’s an example. Job transition is another one. You know, when you are being let go from a job, for men who identify strongly as a provider, that’s a big deal. Circle the wagons. 

Substance use, right? Because it’s reinforced in peer culture as a way of coping. Again, I’m talking largely about the culture of the United States. It varies a lot in different parts of the world. But when we did our interviews with the guys who were at risk for suicide, they’re like, yeah, cause we totally reinforced that behavior. When we are struggling, you know, we encourage our male friends to go gambling, sexual exploitation, drinking, and drug use. That’s what we do. Like when we’re having fun, and then it gets us in all kinds of trouble, and then we’re wondering why our life sucks. You know, I’m like, well, stop doing that. And maybe that would be better. But yeah, increases in substance use, withdrawal for sure, when people are not engaging in the things that used to bring them joy, socially or athletically, or in their faith community or whatever. It’s because it takes energy to engage. It takes energy to be positive and be with people. It takes energy to do stuff when you’re not feeling well, but you don’t have that energy, and what your brain tells you is, you know, stay put, hunker down, hide. So, I think any of those changes are the big ones.

The other one I would like to highlight for men is anger. So, a lot of research shows that in many men, anger is actually depression. When we have changes in anger where people are flying off the handle with small stressors and small conflicts, they are really suffering, and that’s just how it’s coming out. And what does anger get men? Anger gets men; I don’t want to be anywhere near you; you’re now in trouble at work, in the relationship, if they push it too far, now they’re in trouble with the law. Anger gets men more problems, but it is kind of this instinctual response when they’re experiencing things like depression in particular.

It does not get them empathy and compassion, does not get them people leaning in to have open and honest conversations about what’s happening, but we can, we can. So that’s my other thing. For example, when you start to see changes in anger, lean in before it becomes more catastrophic. Because, you know, the famous saying, hurt people, hurt people. It’s true. Those are some of the things I would look for. Changes in anger, changes in substance use, and then life circumstances that often lead to despair, distress, things like changes in job, changes in relationship. Now, as people get closer to thinking about suicide, there’s a big chunk of the group that will have suicide kind of on the menu, but it’s way back here. It’s kind of lingering, it’s fleeting, and then all of a sudden, a major thing happens, and it’s very impulsive. So that’s tricky because the surge in suicide intensity goes from zero to 100 very quickly. And if they have access to lethal means, sometimes that’s a fatal outcome. Very hard to get in the way of that last little bit. So we’ve got to do stuff more upstream to prevent that one. Other people plan it, and they plan it, and they think through it, and they tie up their affairs, and they do all these things to make it go the way that they envisioned it. Often, in that process, because it’s not such a surge, they will give it away. It’s just subtle because that kind of thinking and planning is a very big secret that is too big to keep. So often, they give it away, but they give it away indirectly. They give it away with vague statements, you know; one group calls it invitations. They’re actually inviting people to have a conversation with them about this. It’s just that nobody knows what they’re listening to. They just know it seems weird. So vague statements about worthlessness or invisibility or failure or whatever, but it just, it’s not a direct statement of, ‘I’m going to kill myself.’ It’s just indirect, like, why does this matter? That kind of statement. They feel like they’re shouting on top of the world. It’s too subtle for the everyday person who’s just going to talk themselves out of it to pick up. And the more people don’t pick it up, the more they feel ignored. So again, that’s something to lead into. If the hairs on the back of your neck are going up because it seems like a weird thing to say, ask them, what did you mean by that when you said that? Because usually, they got a big answer behind it. They’re just looking for the right person to talk to about it. So those indirect kinds of statements. That seems odd and speaks to someone who is not doing well. Practicing the event is also an indicator. So, sometimes, people do research on their phones or computers. Sometimes, they’re going to hotspot places, certain bridges, or other things, and they’re going there too often. It doesn’t make sense. They’re changing their behavior around firearms or whatever, like all of those kinds of things. They’re working up, as Thomas Dreidel says, the capability; they’re working up the courage, they’re testing things on, they’re fantasizing, they’re envisioning.

All of that is, you know, taking steps towards it, but along that whole journey, we also have ambivalence. So, half of the brain, half of the soul, whatever you want to call it, does not want to die. They want to stay. And so there’s this epic battle that starts to happen, and half the being wants to escape or find relief from their pain, and half the being wants to figure it out and stay, and so they fight inside. And when the epic battle is coming to a head where it’s getting really intense, one of the other telltale signs is agitation. The fight or flight response gets fully engaged because the soul knows it could possibly die, except the saber-toothed tiger, in this sense, is the person, right? So the fight or flight is going up and up and up because, Oh my God, we’re going to die. But Oh my God, you’re the one; you’re going to do it, you know? So agitation, I always say, is our friend because the body gives us away. We can say things out of our mouths all the time that are not reflective of our reality, but we have a hard time controlling this beast. It gives us away. So we blush, you know, or whatever. Like we can’t control blushing. We can’t control our blood pressure surges. So if the verbal and the nonverbal do not seem the same, you just reflect that back. You say, I know you’re telling me you’re fine, but here you can’t keep your eye gaze with me.

Your foot’s going a million miles an hour under the table, and you’ve gotten up to pace four times here. Or here’s another one: sleep. Agitation, and we’ve all had bad nights where we toss and turn and toss and turn and toss and turn because we have something on our minds. When it comes to suicide intensity, many people just stop sleeping for days as they’re working their way up to the act.

And again, that’s the ambivalence, fighting it out all through the night. So, ask them about sleep because we don’t tend to feel ashamed talking about not sleeping. It’s a good window into, you know what, sometimes people don’t sleep well when they’re having a tough time. Are you having a tough time?

You know, and then into deeper conversations about suicidal thoughts. So those are just some things to look for. But I would also just say, ask. Ask again, create psychological safety, and make it a trusting relationship. Like working hard to earn the trust where you’re going to get an honest answer, but then just ask, even if you think you might be wrong, which is the fear.

Like, what if I’m wrong? What’s the worst-case scenario that happens when you’re wrong? Maybe there’s a moment of embarrassment. I don’t know. Maybe they are offended. That’s a possibility. Like people play at all of these tremendously horrible scenarios like what if that actually drives them to suicide? It won’t. If you come at it with compassion and gentleness and I care about you, you don’t seem like yourself, and I miss you. It’s not going to put an idea in someone’s head. People feel seen, heard, and known, and it opens the door to rich conversation and companionship.

But people, if they’re offended, you just say, I see my questions upset you. Tell me what that’s about because it’s not about you. It’s about them, and they’re afraid. They’re afraid of your judgment, your rejection, that you’re going to take control away, like all kinds of fears. So just stay the course, be curious, and reflect back what you see.

Helping someone contemplating suicide

Dr. Sally: I think anyone can do this work, even strangers. Anyone can lean in and do this work, and sometimes having a more inner circle person complicates the situation because they want to protect that other person. Sometimes, it is the second ring of acquaintances, coworkers, neighbors, and so on that can actually move the needle a little bit farther because they just have a little bit more of an objective relationship.

Again, this played out in my life. I had a loved one who was entrenched in an addiction. Someone very close to me who hid it really well, and it was a second rear-ring person who stepped in and said, ‘Yeah, let’s go. We’re going to go get help. We’re going to go now.’ In a way that I could never have done because it was hidden from me.

So yes, I think anybody can do this work. You know, Kevin Heinz, one of the most famous stories of a suicide attempt survivor, survived a jump off the Golden Gate Bridge. You know, he talks about how he walked over the bridge with the question, which is if anybody sees how upset I am, he’s crying, he’s very visibly upset. If anybody looks up at me and asks me, are you okay? Then I won’t jump. But if nobody notices that I am standing here, crying, then obviously, I don’t matter, and then, of course, somebody interacted with him, and they didn’t ask him, and he jumped. But that’s what I mean. That’s why it’s important.

I was sitting next to someone on an airplane one day, and she was crying. Like, how could I not say, ‘I noticed you’re crying. I’m here if you want to talk about it.’ Total strangers, but we can do that, even with people we don’t know or acquaintances.

Resources recommended by Dr. Sally

  1. Man Therapy: This is a men’s mental health campaign that uses humor to help men open up about their mental health challenges. The website is designed to help men figure out if they are okay, should be concerned about themselves, and guide them to helpful resources.

  2. Construction Working Minds: This is a construction-specific mental health platform, available in nine languages. It focuses on suicide prevention and mental health resources tailored for the construction industry.

  3. Workplace Suicide Prevention: This site hosts the national strategy for workplace suicide prevention. Organizations can take a pledge to make suicide prevention a health and safety priority and access practices that can be implemented.

  4. HOPE Certification: This certification program helps organizations implement comprehensive strategies for suicide prevention and is part of the Workplace Suicide Prevention site.

    • No direct link provided in the script.
  5. United Suicide Survivors International: This organization is focused on turning personal pain from suicide into purposeful change, involving survivors in advocacy and change-making.

    • Website not specified in the script.
  6. Dr. Sally Spencer-Thomas’s Personal Website: Provides more information about her initiatives, projects, and ways to contact or follow her work.

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Hi! I'm Krati Mehra

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I know what it’s like to fall apart and gradually put your pieces back together to build something better than what you had before and I share all my lessons in this space hoping that you will share my learnings without the struggle.

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