Helping Men Live Life to the Full

Liz RaffertyWISH Programme Manager

Men and Depression

• 17 per 1000 for men 25 per 1000 for women• Studies suggest that depression in men occurs as

often as in women but men are less likely to be diagnosed with depression

• Men’s experience of depression is different to women

• Men use different coping mechanisms - 3 x more likely to be alcohol dependent and 2 x more likely to be drug dependent

• Suicide is the most common cause of death in young men under 35

Men and Help Seeking

• Reluctance by men to seek help in general whether physical or for mental health issues

• Being in “therapy” is in conflict with traditional attitudes to male role

• Men prefer less emotionally intrusive interventions

• Men in most need of psychological help are least likely to come forward

• Men respond similarly to therapy as women

Gender Sensitive Approach

• Pathways PCMHT in SW Glasgow• Short questionnaires 8 (31) practices x 100 • 71 returned• Youth Counselling Service & football complex• Nil returned• Made changes to publicity, groups available and

timings 32.1% (503) 2007 35.6% (659) 2010

Clinical Guidelines

Recommend CBT the main form of psychotherapy offered

The Cognitive Behavioural Therapy (CBT) Model

• What people believe affects what they feel

• What people believe affects what they do

• Name associated with it is Aaron Beck.

Traditional CBT Model

• Expert practitioner• Face to face• 1hr• Approximately 20 sessions• Clinic based

Access to CBT limited

• Few accredited/experts

• Waiting lists in many areas

• Scary to attend?

• Embarrassing to attend?

• Does the usual CBT model – 1:1, talking about how we feel – fit how many men want to work?

Issues about mental health and men

• Stigma – label matters• Access – location matters• Focus – practical and here and now versus

emotions/past• Choice – how you want/when you want to work • Fit with life styles e.g. work/other commitments• CBT can be delivered in different ways

Professor Chris WilliamsFive Areas Approach

Life Situation, relationship, practical resources and problems

Altered Thinking

Altered Feelings Altered Physical Symptoms

Altered Behaviour

The Five Areas Model: impact of low mood

Evidence based ways of delivering CBT

• Different sizes and shapes of CBT

• Books (big/small) – can teach CBT

• Online courses (cCBT)

• DVD (LLTTF DVD)

• With support:– One to one support (telephone or email)– Class based support

Other ways of accessing: New www.llttf.com website (free)

Total registered users 136,434 Total Hits in in Nov 10 1,776,224

Who uses the site?

OTHERVOLUNTARYPERSON

CARER/FRIENDHEALTHPRACTITIONER

SOMEONELOOKING FOR

HELP FOR SELF

1,400

1,200

1,000

800

600

400

200

0

Co

un

t

The ratio of women to men using the site is 2/1

LLTTF Demographics

5%7%

8%

9%

6%

64%

1%

SELF - EMPLOYED

FULL TIME AT HOME

RETIRED

UNEMPLOYED

STUDENT

EMPLOYED

SCHOOL

EMPLOYMENTSTATUS

Are people receiving help?

• Only 32% of the individuals were currently seeing a mental health practitioner

• 37% were taking medication for their mental health difficulties

• Two thirds of the users are not receiving any formal input from their health service

• Importantly, 24% of people who are definite cases anxiety or depression are not seeing a health care practitioner for help

Is LLTTF meeting unmet need?

CURRENTLY SEEING SOMONE FOR MENTAL HEALTH

NOYES

Co

un

t

5,000

4,000

3,000

2,000

1,000

0

Bar Chart

case of anxiety or depression

No case of anxiety or depression

Depression or anxiety case at HAD10

The LLTTF Classes – easy, accessible, effective, fun

• LLTTF – 8 sessions• 1: Why do I feel so bad?• 2: I can't be bothered doing anything• 3. Why does everything always go wrong?• 4: I'm not good enough: (low confidence)• 5: How to fix almost everything• 6: The things you do that mess you up• 7: Are you strong enough to keep your temper?• 8: 10 things you can do to help

you feel happier straight away

The WISH Programme and associated projects

• Training : 3 Health Board areasDAS: National delivery of LLTTFi

• AWARE: Northern Ireland LLTTF classes

Successfully working in partnership to build capacity in local communities

DAS supporting LLTTFi

• Commenced in November 09

• High quality cCBT site

• Open referral across Scotland

• Supported DAS support worker

• 6 sessions

• Interactive

• Activity summary of sessions

LLTTFi Session

Data

• 96 participants

• 28 (29%) Male

• 68 (71%) Female

• 40 (42%) have completed course

Outcomes

Shift in PHQ9 and GAD7 mean score for each module for those completing LLTTFi

02468

101214

1 2 3 4 5 6

Module number

Mea

n s

core

Mean PHQ9

Mean GAD7

Improvements in PHQ 9 & GAD 7

• Of those who complete all 6 modules 13 (86.7) achieved a 50% or more reduction which is widely accepted as a measure of clinical recovery

• Improvements are still evident in those who complete 1-4 modules

Completion Rates for Men

• Number of men registering for LLTTFi are no different from those taking up other services BUT:

• 65% of men complete all six modules compared to 51% of women

• 78% of men complete 3 or more modules compared to 67% of women.

Comparison of Mean PHQ 9 for Men and Women

Feedback from Men

• “The course is helping me think things through and I’m coping better. I’m better able to catch and stop negative thoughts” (Student, 22yrs)

• “The online course with the follow up phone calls is genius! It has helped me so much and helped me get back to work” (Teacher, 40yrs)

• The anxiety session was a real eye opener for me. Thanks for your support it has been a great resource. (Social Worker, 46yrs)

Aware Defeat Depression

AWARE EvaluationDr Katrina Collins

• 24 Men who have attended the LLTTF Classes

• Completed both pre and post evaluation measures

• Selected from different Health Boards across Northern Ireland

The 12-item General Health Questionnaire - GHQ-12

1. Able to concentrate2. Lost much sleep3. Playing a useful part4. Capable of making decisions5. Under stress6. Could not overcome difficulties7. Enjoy normal activities8. Can face up to problems9. Feeling unhappy and depressed10. Losing confidence11. Thinking of self as worthless12. Feeling reasonably happy

INSTRUCTIONS

We should like to know if you have any health problems and how your health is at the moment.We want to know about present and recent complaints, not those you had in the past.

GHQ scores at the beginning

GHQ scores at the end

Aware Defeat Depression

Summary of Results

• 13% in ‘Happy’ category at start compared to 74% at end

• 69.6% in ‘Depressed’ category at the start compared to 8.6% at end

• 17.4% in ‘Not Depressed’ at the start and this percentage remained at 17.4 % at end

Attendance rates

• n= 24 men

• 50% of the 24 men attended all sessions

• 29.1% attended all but one session

• 8.3% missed two sessions

• Two men dropped out of the programme at session 2

Aware Defeat Depression

Participant feedback at end of programme

Rated scores 1 (very poor) -7 (excellent)

Average was 6.4

100% would recommend the course to a friend

Understanding of stress and low mood

Your ability to understand how low mood and stress affect you– Your ability to plan activities to boost how you feel

– Your ability to respond positively to your negative thinking

– Your ability to plan ways to boost your confidence

– Your ability to overcome practical problems in your life

– Your ability to overcome unhelpful behaviours in your life that are worsening how you feel

– Your ability to overcome problems of anger and irritability in your life

– Your ability to do things that make you feel happier and healthier

• Statistically significant increase in knowledge and understanding about stress and low mood

Aware Defeat Depression

Participants Comments

• “Highly useful and good to meet others with similar problems”

• “I have an understanding of factors that lead to depression and ways to cope with it made me feel better about myself”

• “This has led to a dramatic change on my outlook in life and seeing a way forward and being positive”

• “This has given me hope and the ability to change and become more self-confident”

Additional Feedback

• What did you dislike about LLTTF?

“Stress caused by being out of my comfort zone but had to be done”

• What would you like more of?

“More on temper and anger management”

Next steps

• Considering men only classes• LLTTF online - ? Advertise for a men-only

“book club”• Advertise LLTTFi with men in mind• Partner with organisations working with

men• Go where men are. Consider other settings

e.g. prison/younger people

Any questions?

www.llttf.com