How communications can help increase the number of men who have therapy in the UK
About the author
Martin Flegg Chart.PR FCIPR is a PR professional specialising in internal communication. He is also a guest tutor and assessor for PR Academy on CIPR qualification courses.
This case study is based on a CIPR Professional PR Diploma assignment by Alison Martin, edited by Martin Flegg.
The British Association for Counselling and Psychotherapy (BACP) is the largest membership organisation for counsellors and psychotherapists. One of its roles is to promote therapy and the expertise of its members to the public.
The BACP’s annual survey of the public’s perception of counselling and psychotherapy revealed that fewer men than women access therapy to support their mental health and wellbeing.
Men’s mental health is of increasing concern due to rising male suicide rates, and there are a range of factors which act as barriers to men attending therapy.
Men may be left struggling with mental health problems that impact on their lives, even though seeing a therapist could help them.
This case study examines how BACP could use communications to raise awareness of the benefits of therapy for men and change opinions and behaviour, so more men seek therapy if they’re struggling with their mental health.
In this case study ‘therapy’ is used as an umbrella term to refer to both counselling and psychotherapy.
Research and key findings
To understand the role strategic communications could play in increasing the number of men seeking therapy, BACP needed to have greater insight into the problem.
The research included:
- A review of the BACP annual public perception survey and other quantitative data.
- A review of relevant interviews, journal articles, podcasts, case studies and other qualitative sources.
- Stakeholder mapping using Mitchell’s Theory of Stakeholder Identification and Salience.
- An analysis of BACP’s existing external communications channels and approaches.
- SWOT and PEST analyses.
- An analysis of other relevant PR campaigns.
Men and therapy
Far fewer men than women access therapy.
In March 2020, the BACP public perception survey found that 28% of men said they had received therapy, compared to 40% of women [i], and this was the same as in the previous year’s survey.
The BACP survey has a robust sample size of 5,000 participants, but it is a public poll and not data showing numbers of referrals or visits to therapists. NHS England’s Improving Access to Psychological Therapies (IAPT) programme provides an insight into referral rates, showing that in 2019/20 nearly twice as many women than men accessed therapy (65% women, 35% men). [ii]
Men and the wider mental health context
An NHS Adult Psychiatric Morbidity Survey revealed that women are more likely to report mental health issues, with one in five women reporting symptoms of common mental disorders, compared to one in eight men.[iii] Data from 2020, including from a Covid-19 Social Study [iv]and Office for National Statistics[v] , also found mental health issues were higher for women.
Are these results found because men are less likely to struggle with their mental health?
Quantitative data, explored in the situational analysis, seemed to support that. However, other key points added further insight. The first is that men made up three quarters of suicide deaths registered in England and Wales in 2019 – a gender split that has remained constant over the past few years of the ONS’s figures[vi]. Comments from experts in qualitative sources[vii] revealed men are also less likely to self-report mental health issues or even understand they have a problem. This may be the reason why men are underrepresented when it comes to mental health data, but account for more suicides.
Whatever the reasons, higher suicide rates emphasise that men’s mental health is cause for concern.
Why men do and don’t access therapy
Secondary research helped build a picture of why men don’t seek therapy. Personal accounts and expert commentary from the BACP website, journal articles and podcasts gave a broader insight into this and added to the statistical data.
The BACP survey revealed two of the main reasons men saw a therapist. Either a GP referred them or a friend or relative suggested it[viii]. This was an important finding when considering the influence of specific stakeholders on men.
The main reasons men chose not to have therapy after considering it were: cost (29%), they didn’t know how to find a therapist (26%), they spoke to someone else (24%), or social stigma (12%)[ix].
Examining a dozen case studies from clients and journal articles provided more nuanced insight. These revealed that men find it difficult to ask for support[x], they don’t often recognise their symptoms, understand what’s wrong with them, or vocalise how they’re feeling. [xi]
Stigma is also a factor. Men face societal expectations and don’t feel comfortable talking about their mental health[xii].
There is also a perception that therapy is not for men. Author Andy Salkeld describes how he didn’t think a therapist would understand him. “They’re nothing like me.” he said.[xiii] Stuart, in a case study, said: “I’m a working-class man and I never thought of counselling [xiv].”
These were the barriers that would need to be addressed by communications to change men’s attitudes and behaviours regarding accessing therapy.
Mitchell’s Theory of Stakeholder Identification and Salience was used to examine how stakeholders with power, urgency and legitimacy have high salience and influence in encouraging men to seek help with their mental health. The theory highlights that a potential relationship can be as relevant as an actual one, which was highly relevant to the context of the research [xv].
The stakeholder mapping exposed the definitive groups to communicate and engage with to achieve BACP’s objectives. These included, men considering counselling, men searching for mental health information online, GPs, and family and friends of men struggling with their mental health.
There were also other identified groups who could help deliver and amplify messages, and the analysis also highlighted that some BACP stakeholders had no existing relationship with the organisation and communications and engagement would therefore be needed to build those relationships.
These are the key groups. GPs and family and friends can all influence men to attend therapy.
- men considering therapy
- men searching for information online as they’re struggling with their mental health
- friends and family of men struggling with their mental health who are looking to support them
- social media micro-influencers
- journalists writing about mental health, especially those at national media.
Some of these groups – such as BACP members – could be broken down further.
- men who are struggling with their mental health, but don’t realise therapy can help
- men who are struggling with their mental health, but don’t realise it
- mental health charities
- BACP chair, chief executive, trustees
- organisational partners
- BACP members
Staff could become advocates and could move to the expectant category.
- BACP senior management team
- BACP staff
These include people who don’t need therapy and don’t know anyone who needs therapy.
Analysis of existing communication channels and approaches
Analysis of BACP communications channels exposed a need to extend reach beyond the usual membership audience to communicate with the identified priority stakeholder groups.
In 2020 media coverage of BACP reached 114 million people including 9,077 reports across 719 media sources[xvi]. However, this basic data did not reveal the nature of the coverage and this would need to be monitored in the future to understand if it was good quality coverage.
OfCom’s Media Nations Report 2020 found men are most likely to use the BBC, Google, Sky News, and the Guardian websites to access news, while women are most likely to use the BBC, Google, the Daily Mail and the Guardian[xvii]. BACP data showed the organisation being regularly mentioned in the Daily Mail and the Guardian, but rarely on the BBC or Sky News [xviii]. Publications which featured BACP most often included Stylist, Refinery29 and Grazia – which all target women.
The media and journalists are important because of their role in agenda-setting and framing public opinion[xix]. However, academic research shows media coverage relating to mental illness focuses on violence and crime and can lead to stigma and negative perceptions. Carmichael’s study found mainstream media coverage of mental illness was more likely to have a negative tone, whereas citizen journalists’ reports were more positive[xx].
It was concluded that media relations would be an important tool for BACP to both increase the breadth of stakeholder reach and drive media coverage of more positive mental health stories.
BACP social reach is large across Facebook, Twitter and LinkedIn in 2020 with 4.8 million users and these channels are largely followed by its own members. Content is four times more likely to be shared by members than the public. The BACP audience on Facebook was 86% female and 14% male, while on Twitter it was 66% female and 34% male.[xxi].
This analysis revealed that BACP could not rely on these channels to reach its definitive stakeholders to raise awareness of the benefits of therapy for men without taking additional action, such as advertising or using influencers.
A study by Appel found that micro-influencers with smaller followings are more trustworthy, authentic and expert, than higher profile social media influencers [xxii]. This was valuable information for BACP’s communications planning, but there would need to be more research into how different demographics of consumer view these influencers in the context of men’s mental health.
Reviews of existing BACP Google AdWords and SEO projects revealed increases in views of public focussed pages in the previous six months. Continuing these projects would be of increased importance in enabling BACP to reach its definitive stakeholders who may be searching for information about therapy and mental health online.
SWOT and PEST analyses
The SWOT analysis demonstrated that BACP had a powerful foundation on which to build future communications, with good recognition in the mental health industry and the expertise of its 53,000 members to draw on.
There were also clear opportunities because of the increased conversation about, and media interest in, mental health. However, BACP communications channels were identified as being very member-focussed. To exploit this opportunity BACP would need extend its reach beyond its own membership audience to the wider public if it was to reach the identified definitive stakeholder groups to build trust and change their perceptions and behaviours.
The PEST analysis emphasised the need to take into account the impact of Covid-19 on therapy. There were also economic considerations such as increased unemployment and the affordability of private therapy. All of this would mean that adjustments would need to be made to future BACP communications planning.
Lessons from other PR campaigns
Campaigns such as Take a Minute [xxiii], Heads Up[xxiv], and Have Your Mate’s Back[xxv], used football to get attention. They reached audiences at places they regularly frequent – such as football stadiums.
The Samaritans’ Real People, Real Stories [xxvi] campaign focused on sharing men’s personal experiences of reaching out for mental health support.
ITV2 and NHS Blood and Transplant’s Blood Squad project[xxvii] was a successful behaviour change campaign targeting young men to encourage them to donate blood. It showed real people giving blood easily without any worries.
The latter two campaigns highlighted how people are more likely to be prompted to behaviour change if they see people like them doing it first. This was a clear opportunity for BACP to use real life case studies of male clients who had benefited from therapy which could help combat the perception that therapy is not for men.
The research concluded that recommendations could be made to address the development of a more detailed BACP communications strategy to raise awareness of the benefits of therapy for men and change opinions and behaviour, including:
- Undertaking more detailed research about men’s attitudes towards therapy and what prevents them seeking help, with data broken down further to identify specific groups of men.
- An exploration of how BACP’s individual and organisational members could contribute to research that provides a greater understanding into why men access therapy.
- The use of social listening and media analytics to understand more about how therapy is mentioned more broadly in the media on social media and how this involves men’s mental health.
- Developing a strategy and tactical plan to define future BACP communications activity – including key messages that help to inform men of the benefits of therapy and combat some of the barriers preventing them accessing therapy.
Objectives for future strategic BACP PR and communications activity over a subsequent 12-month period following the research were broken down into outputs, outtakes and outcomes. Breaking them down in this way would enable specific evaluation of the impact of the communications on raising awareness and changing opinions and behaviour regarding men’s mental health.
- The inclusion of BACP key messages (relating to men’s mental health) in 60% of media coverage.
- Increase BACP coverage within a list of key national media outlets by 20%.
- Share 12 male client case studies through national media outlets.
- Develop a network of 50 social media micro influencers, who share content featuring BACP key messages.
- Increase visits to the BACP ‘about therapy’ pages of the website by 50%.
- Increase visits to the BACP website through a unique tracking link used in all proactive communications activity by 80%.
- Reduce the number of men who say that they’ve not had therapy due to stigma from 12% to 10%, to be measured by the BACP public perception survey.
- Increase the number of men who say they’ve had therapy from 28% to 30%, to be measured by the BACP public perception survey.
Alison Martin – What I learnt from completing my assignment
“Many of the things I learnt whilst completing my assignment are very transferable, and were not just applicable to my assignment. I’m definitely thinking differently now about how I plan other PR projects and activities.
Some of my assignment objectives were about media coverage, and I’ve been taking them forward by looking more closely at what we are getting media coverage for and what we want to get it for.
So, I’m working on getting our key messages into more of our media coverage and it’s something I’m really keen to show that I can do using what I’ve learnt from the course. I had an issue recently where I had to provide a report on some media activity to our Board of Trustees. It was great to be able to say that the coverage we had was really high-quality that ticked all our boxes. This means so much more than just being able to share the usual stats about media coverage and reach.
Another important thing which came out of doing my assignment research was that I realised we didn’t have that much data from our members to inform our public relations activity. It made me think about where I could get that data from?
We have one existing membership survey which we do every year, which I referenced in my assignment, and this gives us lots of data from our members about what services and professional development they need from us. This data helps many of my colleagues in BACP support them, but we felt that we needed to gather even more information from our members. So, we’ve recently done some more research with them, using a new membership survey, to ask what impacts they have been experiencing because of the pandemic.
This new membership survey has increased our understanding as an organisation about what is happening, and what our members are experiencing, and will inform our future PR and communications planning. In the past, getting the right information to plan good PR has been a struggle in the context of communicating with, and engaging the public more broadly with counselling. Now I think I’ve got that information, which is really useful.
Before I did this course, I’d come across some of the PR concepts we covered but had never followed them up with any study or reading. It’s been really interesting doing that and understanding how to make that jump from theory to practice, especially on the evaluation side of things as this was not one of my strong points previously.
Undertaking my diploma has also coincided with getting a promotion, and I am now a communications manager. I’ve always been very content and tactics focused in my previous roles. In my new role, I knew that I had to think differently about things, but I didn’t necessarily know how to do that. Doing the course has enabled me to embed more strategic thinking in my work, including looking at the bigger picture. I’m now thinking much more about why are we doing something, what we will achieve by doing it, and how will we know that we’ve achieved it using my evaluation skills.”
[i] BACP / YouGov Public Perception survey 2020
[ii] NHS England, Improving Access to Psychological Therapies programme annual report 2020 https://digital.nhs.uk/data-and-information/publications/statistical/psychological-therapies-annual-reports-on-the-use-of-iapt-services/annual-report-2019-20 Accessed 1/12/20
[iii] NHS, Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England, 2014 https://webarchive.nationalarchives.gov.uk/20180328140249/http://digital.nhs.uk/catalogue/PUB21748 Accessed 18/12/20
[iv] Public Health England: research and analysis https://www.gov.uk/government/publications/covid-19-mental-health-and-wellbeing-surveillance-spotlights/gender-covid-19-mental-health-and-wellbeing-surveillance-report accessed 28/12/20
[v] Office for National Statistics, Coronavirus and Anxiety, Great Britain, 3 April 2020 to 10 May 2020 https://www.ons.gov.uk/peoplepopulationandcommunity/wellbeing/articles/coronavirusandanxietygreatbritain/3april2020to10may2020 Accessed 18/12/2020
[vi] ONS, Suicides in England and Wales: 2019 registrations https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/datasets/suicidesintheunitedkingdomreferencetables Accessed 18/12/20
[vii] Penning C, Why Men Don’t Talk, BACP Therapy Today, March 2013
[viii] BACP / YouGov Public Perception survey 2020
[ix] BACP / YouGov Public Perception survey 2020
[x] Banning N, Focus on … Men at Work, BACP Workplace, January 2019.
[xi] Banning N, Focus on … Men at Work, BACP Workplace, January 2019.
[xii] BACP, Therapy Today Podcast: It Changed My Life, October 2020
[xiii] Salkeld, A, It changed My Life, BACP Therapy Today, April 2020, Volume 31, Issue 3. https://www.bacp.co.uk/bacp-journals/therapy-today/2020/april-2020/it-changed-my-life/ Accessed 28/12/2020
[xiv] BACP, ‘I felt myself bit by bit starting to cope’ (2019) https://www.bacp.co.uk/news/news-from-bacp/2019/13-june-i-felt-myself-bit-by-bit-starting-to-cope/ Accessed 5/12/2020
[xv] Mitchell R,Agle, B and Wood, D (1997), Toward a Theory of Stakeholder Identification and Salience: Defining the Principle of Who and What Really Counts, The Academy of Management Review, Vol. 22, No. 4
[xvi] Kantar analytics of BACP media coverage, 2020 Accessed 2/1/2021
[xvii] Ofcom media nations 2020 UK report https://www.ofcom.org.uk/__data/assets/pdf_file/0010/200503/media-nations-2020-uk-report.pdf Accessed 5/12/20
[xviii] Kantar analytics of BACP media coverage, 2020 Accessed 2/1/2021
[xix] Sheufele D and Tewkesbury D (2007) Framing, agenda setting and priming: The evolution of three media effects models, Journal of communication, 5 (1)
[xx] Carmichael V, Adamson G, Sitter K & Whitley R (2019) Media coverage of mental illness: a comparison of citizen journalist vs professional journalism portrayals, Journal of Mental Health, https://www.tandfonline.com/doi/full/10.1080/09638237.2019.1608934
[xxi] Orlo analysis of BACP social media, 2020 Accessed 18/12/2020
[xxii] Appel G, Grewal L, Hadi R and Stephen A, (2020) The future of social media in marketing, Journal of the Academy of Marketing Science, volume 48, https://link.springer.com/article/10.1007/s11747-019-00695-1
[xxv] EFL, Mind launch Have Your Mate’s Back campaign, 2019, https://www.efl.com/news/2019/december/mind-launch-have-your-mates-back-campaign/ Accessed 18/12/2020
[xxvi] Samaritans, Real People Real Stories, 2020, https://www.samaritans.org/support-us/campaign/real-people-real-stories/ Accessed 18/12/2020
[xxvii] ITV Media, ITV2 and NHS Blood and Transport relaunch the Blood Squad , 2020, https://www.itvmedia.co.uk/making-an-impact/itv2-and-nhs-blood-and-transplant-re-launch-the-blood-squad Accessed 18/12/2020