It's the first and most common question we ask in polite, friendly small talk between colleagues and acquaintances: how are you?
The reality is, the most common sing-song response – fine thanks and you? – given by many men to this innocent enough question is often a lie. And a dangerous one at that.
RU OK? Really...
Better and more constructive conversations around mental wellbeing are a focus of this week's Men's Health Week thanks to a confronting new statistic released last year by Australia's Biggest Mental Health Check In: 73 per cent of men who qualify as having a mental health disorder are actually unaware they have one (for women, the statistic 58 per cent), including severe depression, anxiety and stress.
The study, conducted by Medibio, took 18 months and was the result of a survey of 7500 people across 40 different organisations committed to providing better mental health check-ins for their staff. Participants included PWC, Rio Tinto, and the AFL.
The finding shocked Peta Slocombe, an accredited psychologist who led the analysis of the Medibio study: "It really did surprise me" she says. "We knew some men could be compared to the frog in boiling water metaphor – a gradual creep, then they're too far gone to get out. But this is the new normal now. Perfectionism and self criticism are largely to blame. I expected men to be in mildish ranges [of mental health disorders] but a lot of men were in severe ranges."
When no means yes.
Are you ok? - a question Australians are encouraged to ask each other regularly by organisations such as RUOK? Day - at least provides an invitation for a welcome dialogue if the answer is anything but yes.
But some men may say yes when they really mean no.
"People often don't know if they are ok, and men aren't so great at looking out for the signs that they're not," says Slocombe.
"Social withdrawal has the closest correlation with depression. Other signs include sleep disturbance - either insomnia, or crashing out at 6pm and waking in the early hours. Both indicate you're over-processing."
"Then there's a lack of joy - no highs or lows, a bit grey in the middle."
Physical signs don't trump emotional
Men often wait until the signs become physical before they present to a GP.
"Men don't go to the doctors for low moods. They go for headaches, weight loss and fatigue," explains Slocombe.
Clinical psychologist Lillian Nejaf, PhD, says "The signs of mental illness in men can be quite obvious once you know what to look for; the problem is these signs are often not attributed to depression or other mental health problems."
The signs, she says, fall into three categories: physical,behavioral and emotional: "Physical signs include: fatigue, lethargy, pain, insomnia, anxiety-related symptoms like rapid heart rate, tightness in chest."
"Behavioural signs include: excessive or chronic substance use, difficulties at work, low motivation, conflict in relationships, lower libido, and social isolation."
"Emotional signs are more likely to be irritability and anger rather than sadness" Nejaf says.
"I started travelling south instead of north"
Stuart Taylor recognised the signs of a downward spiral early on. As CEO of Springfox, founded as the Resilience Institute Australia, he knows what these look like: overload > disengagement > withdrawal > anxiety > depression.
In 2002, Taylor was diagnosed with terminal brain cancer and given 2.5 years to live. Although he has since defied doctors' predictions, he recalls a dark time.
"I remember staring at my computer in my corporate job after my operation and thinking: what the hell am I doing here? A big part of it was a loss of spiritual purpose. It was almost impossible to focus. My conversations with myself were about worry and pessimism rather than a pathway forwards.
"Those early downward spiral stages are relatively easy areas to bring forward practices that stop the descent south and start heading north. For the first time in my life, I bedded down a meditation practice. Getting out of bed at a consistent time to run made a huge difference."
A technological solution
If men are reluctant to have these conversations with their GPs, one solution is less intimidating: tech.
A new app, called Medibio Inform, gives men the chance to do a twelve minute check-in. It asks questions about how they're feeling and tracks their biometrics through 50 markers such as heart rate, posture and sleep patterns.
"For men, quantifying these things and tracking them can be more useful than just answering 'how are you feeling today?'" Peta Slocombe says. Men can also provide an email address of a mate to look out for them and track their results.
The consequences of not doing regular mental health check ups, as we would with melanoma, are now notorious.
"Suicide is still one of the leading causes of death amongst men" says Slocombe.
"To use the Australian vernacular, we need to make it in your face. Mental health issues are entirely foreseeable. The fact we're not checking for it until relationships end or people aren't functioning is just ridiculous."
Men's Mental Health Week runs from 11-17 June.
Support is available, for those who may be distressed, by phoning Lifeline 13 11 14; beyondblue 1300 224 636; Kids Helpline 1800 551 800; Mensline 1300 789 978.