Supporting men who experience intimate partner abuse and violence

Intimate partner abuse and violence (IPAV) is described as a major social and health problem,¹ which encompasses physical, psychological, sexual and financial abuse² characterised by a pattern of fear and control.³ Refer to previous chapters for an introduction to IPAV, details on identification and initial response, safety and risk assessment, and ongoing support and management for women who experience IPAV. While both men and women may use IPAV, men use violence more frequently and severely so that females are more likely to fear for their lives, be injured or killed (50 women die due to IPAV per year in Australia).¹

To date, the primary focus when it comes to IPAV identification and response has been on the safety of women and children.⁴ Men who experience IPAV from women partners have not been researched as comprehensively as women who experience IPAV from male partners.^5,6 It is becoming increasingly acknowledged that men’s experiences of IPAV remains an important issue of concern for health professionals, including GPs.⁵ While men’s experience of IPAV is an under-researched topic,⁷ health practitioners, including GPs and practice nurses, need to ensure they acknowledge and are aware that men also experience IPAV and how they might present to general practice.

Figure 6.1. Prevalence of lifetime intimate partner abuse⁸

Source: Australian Institute of Health and Welfare.

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Men’s experience of IPAV by women is a relatively controversial issue. This controversy is due in part to conventional theories that conceptualise IPAV to be the result of patriarchal norms,⁹ and the use of IPAV to maintain men’s dominance over women within intimate relationships.¹⁰ There have been conflicting findings of IPAV prevalence by women against men, raising questions about the methodologies employed, sampling methods and instruments used to obtain data.¹¹

Nevertheless, an Australian-based qualitative study indicated that men reported experience of a range of physical, sexual, verbal, coercive-controlling and manipulative behaviours by their female partners.⁶ Some men have reported that they did not retaliate due to fear of being arrested, fear of seeking help, fear of losing custody of their children or because of moral objections to using physical force against women.¹² In terms of the impact of men’s experience of IPAV, research¹³ has found a negative impact on physical and mental health, development of future relationships, and relationships with their children.

A 2019 systematic review of 12 qualitative studies explored help-seeking experiences and interactions with support services of men who experience IPAV.⁵ This review highlighted that ‘barriers to help-seeking are complex, but fear of disclosure is central, overlapping with the challenge to both men’s personal sense of and societal interpretations of masculinity and the importance of the relationship with the abuser’.⁵

Men were less likely to seek help due to commitment to intimate relationships and keeping the family intact.¹² Furthermore, societal attitudes and perceptions of men as abusers were among barriers to help-seeking or leaving the abusive relationship.¹³ While some men who disclosed abuse received support from family and friends, other men reported secondary abusive experiences, with police and other support services responding with ridicule, doubt, indifference and victim/survivor arrest.⁶

The following barriers to help-seeking were identified:^5,14

• social (traditional gender roles and norms, challenge to masculinity),
• personal (shame, identity impacts) and commitment to relationship
• practical (cost, fit) barriers to support service access
• further victimisation from services
• fear of disclosure and seeking help
• having nowhere to go (lack of services).

While most research studies about male help-seeking behaviour for IPAV have only used qualitative methodologies with a relatively small sample sizes, there are various resources available for men. For example, the Domestic Violence Resource Centre Victoria provides information about services that may help men who experience IPAV.

Health professionals working with men who experience IPAV

There are recommendations¹⁵ for the need for health practitioners working with men who experience IPAV to recognise the significance of resistance to men’s help-seeking. Some of the key barriers to help-seeking or leaving the abusive relationship include inappropriate service responses, further victimisation from services, and inappropriate responses from friends and family members.¹³ A 2020 Australian study indicated that following disclosure, men who experience IPAV reported secondary abusive experiences, with police and other support services responding with ridicule, doubt, indifference and victim/survivor arrest.⁶ Another issue that arises with men who experience IPAV is the fact that many health practitioners are not trained to accept a referral with this gender of ‘victim/survivor’ due to lack of skill set or knowledge.¹⁶

The first step in dealing with this issue is to acknowledge that IPAV can happen to men and that they (as victim/ survivor) need to be asked, believed, validated, and their safety and that of their children explored.

Some men who use violence (perpetrators) will sometimes present themselves as ‘victims’. This is a strategy that may take time to sort through.

There is a need for more training in managing men who experience IPAV who present to primary health, and more research exploring how the health system can respond in a believing, supportive and healing manner.

Peter, age 35 years, had been married 10 years to Susan. They had two children aged 8 and 4. The relationship had not been good for some time, with Peter doing much of the cooking and housework. Susan was often verbally abusive. Susan was starting to drink more and one evening she hit out at Peter and he put up his arm to defend himself. Susan hit his arm and fell, hurting her arm. She rang the police and went to the hospital and was found to have a fractured wrist. He was accused by the police of being the perpetrator. He went before a magistrate, who listened to his story. The magistrate referred him for an assessment. The assessor saw him and informed the magistrate that in his opinion Peter was not a perpetrator. This was very helpful and supportive to Peter.

By then the relationship had broken down completely and Peter had left the house. The arrangement was that the children would be with Susan during the week and with Peter at the weekend.

The children were neglected and not being cared for or fed. The school reported the children to the children’s protection services, but nothing really changed until Susan was caught driving under the influence of alcohol by the police with the children in the car. She was admitted to detox and the children went to live permanently with Peter, to the relief of the extended family.

The children were traumatised and very angry with their mother. They are gradually healing and their schoolwork is improving. They are refusing to go to her house or drive anywhere with her in the car. They are seeing her once a week for one to two hours. They too have been believed, validated and provided with a safe place.

If this family was presenting to the GP, then there would be an opportunity to inquire about the family circumstances and to hear Peter’s story and to believe him, validate him, and check on his and the children’s safety.

Some family violence services will be willing to see men who are victims/survivors – refer to resources.