True Grit: Lessons From the Frontlines of Mental Health and Suicide Prevention

Co-authored by Nathaan Demers, Psy.D. and Trip Starkey

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People holding sparklers spelling the word Grit

Using humor to address mental health might come across, to some, as being in poor taste. Given the acute nature of suicidal ideation, it might sound misguided to say that a suicide prevention campaign should have some levity, with an emphasis on entertainment and engagement. And taking an irreverent, no-B.S., no-holds-barred approach to addressing rising suicide rates in working-age men would certainly strike some as completely absurd. 

Enter Dr. Rich Mahogany’s Virtual Office on ManTherapy.org – an entirely new approach to men’s mental health that was created to directly tackle the issue of suicide and suicidal ideation among working-aged men. By using this unique and unconventional approach, leveraging humor to break the stigma around mental health and connect men with life-saving resources, Man Therapy is able to go upstream and bridge the gap for at-risk men before they find themselves in a crisis. 

In 2013, the creation of Man Therapy – a joint effort between Cactus and the Colorado Department of Public Health & Environment – came in response to a desperate need to change the conversation on how society, specifically men, addressed mental health crises. In the near decade since Man Therapy’s launch, this straight-forward, upstream approach to mental health has led to a refined strategy around developing whole person well-being. In fact, the campaign’s success in supporting mental health led to the creation of an entirely new company – Grit Digital Health – with a single mission: harness design, innovation, and technology to drive behavior change. 

Here are some lessons we’ve learned about how to impact mental health and well-being:

  • 1. Prevention does not mean playing catch-up.

It goes without saying that the aim of prevention lies upstream of a crisis. In the same way that the medical community realized treating high cholesterol was more effective than treating heart attacks, our work at Grit Digital Health is taking a similar upstream approach to treating mental health by treating stress, mild anxiety and depression, and substance use disorders rather than waiting for an acute crises. The stats around suicide remain alarming:

  • Working-aged men (25-54 years old) account for the largest number of suicide deaths in the United States, and men are 4x more likely to die by suicide than women.
  • Suicide remains the second-leading cause of death among college populations.
  • EMS workers report suicidal thoughts at a rate 10x higher than the national average.
  • Veterans reflect a 52.3% higher suicide rate than non-Veterans.

For a solution to be effective in addressing suicide and suicidal ideation, it should not only educate people about warning signs, it must also engage them in a meaningful way (whether through humor, timely content, or relevant resources), while encouraging help-seeking behavior prior to the point of crisis. Take, for example, Man Therapy’s 20 Point Head Inspection, which offers men an interactive way to engage with themselves. The Head Inspection intentionally quizzes men on a range of topics related to everything from their social lives, to sleep habits, to what angers them, and whether or not they have thoughts of suicide. All of this is supplemented with crass interjections from Dr. Rich in an effort to engage men in a way they understand and help normalize mental health conversations. Ultimately, men are sharing the website due to its humorous, engaging tone, which offers the added benefit of spreading awareness about mental health. The results from this approach prove the effectiveness of our method, with more than 1.5 million users, over 420,000 completed head inspections, and more than 38,000 clicks on the crisis line. What we’ve proven is that prevention efforts do not (and should not) be boring – rather they must be engaging to garner interest prior to the point of crises when these areas of need might not be top of mind. 

  • 2. Effective Well-Being is Comprehensive Well-Being.

In 2015, the notoriety and success of Man Therapy resulted in administrators from Colorado State University reaching out to Joe Conrad, CEO of Grit Digital Health, after 17 students tragically died by suicide in the prior two academic years. Through partnership with Colorado State, Grit set out to tackle suicide prevention in higher education, which ultimately led to the creation of YOU at College through a co-design process with CSU students. During these co-design sessions, we discovered that effective well-being solutions ultimately must take a 360º view of a student’s experience and tailor well-being tools specifically for them. In reality, most students come to a point of crisis not as a result of previous behavioral health diagnoses, but through life events such as a failed test, a difficult break-up, or worrying about finances or scholarships while in school. We know an individual’s mental health is impacted by a variety of stressors that compound and shift over time, resulting in a wide array of needs, all of which weigh on their well-being success. It became clear that, for a tool to be effective, students needed to be able to connect with content relevant to those unique experiences in a timely manner. We realized that maybe a student didn’t need to schedule that counseling appointment, rather they might be better served by connecting with their career center or joining a club on campus. Nowadays, you can’t access anything like a playlist or newsfeed without it being completely curated to your unique tastes and interests. At Grit, we realized that, when it comes to mental health and well-being tools, we had to take a similar approach to personalization that helps people access the right door at the right time – after all, we all have unique life experiences that contribute both positively and negatively to our mental health and well-being. 

  • 3. Mental Health Work Is Gritty.

In her book, Grit: The Power of Passion and Perseverance, Angela Duckworth states: 

“…there are no shortcuts to excellence. Developing real expertise, figuring out really hard problems, it all takes time … And here’s the really important thing. Grit is about working on something you care about so much that you’re willing to stay loyal to it…”

During the six years since Grit’s inception, we have witnessed, and participated in, the evolving conversation around mental health while remaining on the forefront of developing tools to meet these ever-changing needs. In working to expand our suite of behavioral solutions to higher education, employers, emergency responders, and veterans, we have learned that it takes a lot of hard work and innovation to develop successful interventions that address the complexities within mental health. Complex human challenges are not solved overnight. In understanding that grit is a certain kind of resolve to not give up in the pursuit of something, we believe that as needs around mental health change, it remains imperative that we continue developing innovative and unique solutions that can meet those needs. The mindset and attitude that led to the creation of tools like Man Therapy, YOU at College, ResponderStrong, and Operation Veteran Strong is one of action and resilience, which leverages design and technology innovation to educate and address warning signs prior to the point of crisis.

What we’ve learned is that suicide prevention and mental health demands more strategic partnerships to help develop tools that empower individuals to take control of their well-being. Through proactive technology developed by multidisciplinary teams (i.e. psychologists working alongside designers, marketers, and technologies), we can develop tools that encourage individuals to engage with their well-being on their own terms. As we move forward with a more defined picture of how to best leverage technology to confront suicidal ideation, the answer to creating and sustaining truly powerful mental health resources comes by way of grittiness in facing these issues head-on, taking science-backed and evidence-based approaches, and using design and innovation to create tools that are functional and impactful in driving behavior change.

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