Providing the right support and care for male victims of domestic abuse

In the 14 years since the author first published an article on domestic violence against men (Barber, 2008), there have been changes in the definitions and meaning of domestic abuse and violence, as well as in the experiences of those affected, and in the availability of support and resources. The changes mean that the issue is now also considered from the perspective of male victims, with greater awareness and understanding of men's experiences (Varney, 2016; Safe Lives, 2019; Respect, 2019).

This article seeks to update, discuss and explore the issues related to male victims and survivors of domestic abuse in the context of the earlier work (Barber, 2008).

What is domestic abuse and violence?

Domestic abuse and violence can be a contentious issue, partly due to the occupation of ‘gendered spaces' of the phenomenon and related issues (Khalida et al, 2013; Chelliah, 2016). Further issues that make the subject contentious include a lack of consensus on what constitutes domestic abuse and violence, the lack of appropriate support structures for victims, and the historical stigma often associated with the experiences of those affected, which can be both common to and different for all genders (National Institute for Health and Care Excellence (NICE), 2014). Although much has been written about domestic violence and abuse, this has generally been from the standpoint of the female as the victim and survivor, with the male taken to be the perpetrator and aggressor (Women's Aid, 2022a). The scope of this article is to focus on the experience of men who are victims and survivors, rather than perpetrators.

It may be helpful to begin by exploring definitions of domestic abuse and violence. Box 1 shows the definition used by domestic and sexual abuse charity Living Without Abuse and the description used in the Domestic Abuse Act 2021, which the author deems worth citing in full.

Box 1.Definitions of domestic abuse
Behaviour of a person (‘A’) towards another person (‘B’) is ‘domestic abuse’ if:A and B are each aged 16 or over and are personally connected to each other, andThe behaviour is abusive

The first two sections of the statutory definition are self-explanatory. However, although the Act includes examples of ‘economic abuse’, it does not provide examples of ‘controlling or coercive behaviour’ and ‘psychological, emotional or other abuse’, which within the context of domestic abuse can include stalking and harassment. Therein lies a quagmire of debates, meanings and understanding, many of which may not be helpful because they amount to saying that ‘abuse is abuse’, without exploring exactly what is meant by the term. The definitions and forms that domestic abuse can take need to be made explicit and clear both within the legislation, and within any related policy and strategy documents, citing examples to prevent possible misunderstanding and unnecessary legal argument.

The Social Care Institute for Excellence (SCIE) (2020) provides a fairly comprehensive list of the forms and subforms that domestic abuse can take, but it makes no claims as to its value in preventing legal arguments over the meaning and forms of domestic abuse. The definition provided in the Act refers to the minimum age of the perpetrator and victim, which in both cases is 16 years. This does not take into account cases of domestic abuse in which a perpetrator (aggressor) is aged under 16. Although unusual, it is not unheard of for younger teenagers to physically, psychologically or emotionally abuse their parents and/or siblings (NICE, 2014). These issues need to be addressed in either guidelines to the Act or future amendments to the legislation.

Anyone can experience domestic abuse, regardless of race, ethnic or religious group, gender, sexuality, disability or lifestyle (NICE, 2014). The charity Living Without Abuse uses both ‘abuse’ and ‘violence’ in its definition, which is a frequent conflation. The two words are often used interchangeably, and are considered to have a similar, if not the same, meaning (Bradbury-Jones, 2016).

An earlier definition given by the Oxford Dictionary of Law (2018) viewed domestic abuse and violence within a physical construct and space, defining a battered spouse or cohabitant as an individual subjected to physical violence by their husband, wife or cohabitant. It did not include ‘non-physically violent’ forms of abuse and violence, such as:

• Emotional, psychological and mental abuse
• Sexual abuse, both in terms of forced sex (rape) and the denying or withholding of sex
• Financial abuse
• Verbal abuse
• Religious and spiritual abuse
• Honour-based violence
• Forced marriage
• Female genital mutilation
• Behaviour deemed as controlling in nature
• Stalking and harassment.

The above is not an exhaustive list of violent and abusive behaviours but serves as an indicator as to the forms of behaviour that can occur (SCIE, 2020). Again, some behaviours may be prevalent in relationships where the woman is the victim or survivor, and others in those where the man is the victim or survivor (Women's Aid, 2022a).

Statistics

In the earlier article, Barber (2008) suggested that it was difficult to find accurate statistics on domestic abuse in which males were the victim/survivor. Reasons for this include:

• The historical ‘gendered space’ approach taken more than a decade ago to such abuse (Khalida et al 2013; Chelliah, 2016)
• The reluctance of many men to disclose that they have been abused (Wright, 2016)
• The reluctance by many health and social care providers and the criminal justice system (police and courts) to consider that men can also be abused by partners, be they in same-sex or heterosexual relationships (Wright, 2016).

Research by Lupri (1992), cited in the earlier article (Barber, 2008), found that 17.8% of men questioned admitted to abusing their female partner, and 23.3% of women admitted to abusing their male partner. Lupri did not explore why more women had disclosed their abusive behaviour; neither did Lupri state whether the research had included disclosure statistics on same-sex relationships. There appear to be no up-to-date statistics on abuse experienced by all genders, so it is imperative to advocate that research be undertaken to estimate the percentages of men and women who abuse, including potential regional variations across the UK.

At the time of writing, the most recent full set of statistics available were for the year ending March 2020: these put the number of adults aged 16–74 years who experienced domestic abuse in the preceding year at 2.4 million, with a female to male ratio of roughly 2 to 1 (Office for National Statistics (ONS), 2020a). See Box 2 for an extended picture of the statistics for 2019–2020, which are taken from the Crime Survey for England and Wales. The latest figures for the 6 months to year ending 2022 show that little has changed, with similar numbers affected by domestic abuse compared with 2 years ago.

Box 2.Statistics on domestic abuse on violence, year ending March 2020

• An estimated 2.3 million adults aged 16–74 years experienced domestic abuse (1.6 million women and 757 000 men), a slight but non-significant decrease on the previous year
• The female-to-male ratio of adults experiencing domestic abuse was roughly 2 to 1
• Women are more likely than men to experience multiple incidents of abuse, different types of abuse (intimate partner violence, sexual assault and stalking) and, in particular, sexual violence
• Across England and Wales, the police (excluding Greater Manchester Police force) recorded 758 941 abuse-related domestic crimes, an increase of 9% on the previous year. This ongoing trend may reflect the improved recording of incidents by the police, as well as higher rates of reporting by victims
• The number of domestic abuse-related incidents and crimes reported to the police was 1.2 million. However, 529 000 cases were subsequently not recorded as a crime, with 759 000 remaining on record as crimes
• The data for the year up to March 2020 show no significant differences in the prevalence of domestic abuse for men and women aged 16–74 years compared with the year to March 2019
• The age range of individuals included in the statistics of recorded incidents of domestic abuse differ over the decades. In the first decade of the 21st century the range covered was 16–59 years, while in 2017 the range was extended upwards, and has since recorded data for those aged 16–74 years

Source: Office for National Statistics, 2020aNB The data are taken from the Crime Survey for England and Wales, year ending March 2020, the latest full survey available at the time of writing

Use of language

There is an argument that whoever controls language and how it is used controls the debate and its framing, course and outcome (Partington, 2003; Khalida et al, 2013), so careful and thoughtful use of language is crucial in the context of domestic abuse and violence. While Khalida et al (2013) focused on communication within a gender discourse, the arguments made should surely be relevant within other sociopolitical discourses, especially in the use of language with regard to disability (Medway NHS Foundation Trust, 2017) and gender identity. The way that language is used applies as much to domestic abuse and violence as to any other area of human behaviour and associated sociopolitical, economic and philosophical debates and outcomes. The word ‘victim’, for example, may not be adequate to describe the feelings and position of those who experience domestic violence and abuse, because the word can imply a passive experience of both the violence and any ‘support’ that may be offered (Women's Aid, 2022b). The label and status of ‘victim’ and ‘victimhood’ may also affect how a person is viewed and engaged with by health care, social care and law enforcement professionals, and may lead to covert discrimination – unintended or deliberate – of the person affected (Women's Aid, 2022b).

Sociopolitically, a number of concepts are used with regard to people affected by domestic violence. For example, the ‘politics of victimhood’ is used to describe individuals who engage in demanding sympathy and recognition for being victims (Taylor, 1997; Horwitz, 2018). Another concept, termed the ‘politics of disgust’, is applied to individuals and groups who purportedly ‘offend’ the morals of the majority, for example by being in a same-sex relationship. The ‘politics of disgust’ deems that the individuals should be blamed, marginalised and repressed for their ‘offending’ behaviours, and any perceived consequences (Nussbaum, 2010).

The Domestic Abuse Act 2021 uses the word ‘victim’ rather than ‘survivor’, including in its definitions of domestic abuse (see point in Box 1). However, according to Women's Aid (2022b), which term is used will depend on the context. The term ‘survivor’ is widely preferred, with many organisations working with and supporting those experiencing domestic abuse, regardless of gender, choosing to do so; in some cases the term ‘thriver’ is used instead of ‘victim’. The latter term is preferred because it emphasises an active, resourceful and creative response to the abuse, in contrast to ‘victim’, which implies a passive response.

This change in the terminology used reflects a gradual move away from viewing the person as a ‘cowering’ and passive victim to an assertive ‘survivor’, an individual who seeks to be empowered and to empower others in a similar situation (Single Parent Action Network (SPAN), 2022). Therefore, viewing the debate around ‘male victims of domestic abuse’, which was the focus of the article published in 2008 (Barber, 2008), may no longer be appropriate or accurate, or reflect current thinking in terms of language and empowerment. It is therefore surely a given that future discourse and action around men who experience domestic abuse must be couched in terms of empowerment and creative responses to abuse, rather than being submissive and passive in tone (SPAN, 2022). This will require a change in the mindset of both the men who experience domestic abuse and the professionals working with them in the care and criminal justice systems. The change in words could lead to a change in framing of not only the discourse, but also the outcomes and support offered, and expanding the discussion based on current thinking (SPAN, 2022).

As previously stated, the words ‘abuse’ and ‘violence’ are often conflated and used interchangeably (Vonder Haar Law Offices, 2020; Followill, 2022). The two terms, however, do not mean the same, nor do they represent the same set of behaviours; there may be subtle, nuanced, but important differences (Wright, 2016; Lambert, 2019). In the context of domestic abuse and violence, the word violence can suggest a physical act such as hitting, scratching, kicking or biting, with non-physical forms of behaviour implied rather than explicit. Abuse, used both as a noun and a verb, could mean either misusing something or acting in a violent manner, suggesting a wider range of behaviours, both physical and non-physical (Wright, 2016; Lambert, 2019). ‘Violence’, therefore, suggests a relatively narrow set of behaviours of a physical nature, while ‘abuse’ is a broader term used to describe both physical and non-physical behaviours.

The current change from using ‘violence’ to ‘abuse’ as a linguistic term, with the attendant shift in emphasis and implications, is reflected in the Domestic Abuse Act 2021. Although the term ‘domestic violence’ is used only a few times and the term ‘survivor’ is not cited in the Act, there are numerous references to the term ‘domestic abuse’. Thus, there is acknowledgement of the language and discourse around what constitutes domestic abuse – and also that the term ‘abuse’ describes a wider set of behaviours than ‘violence’. The term ‘gender inclusive’ is now used within the Act, with recognition that change will continue into the future. The differences in the use of words and language are acknowledged in the Act, as is the need for this to be reflected within support practices.

Throughout the article, the word ‘abuse’ will be used in preference to ‘violence’, or the term ‘abuse and violence’, unless the word ‘violence’ is appropriate or cannot be avoided.

Analysis

It is not possible to make direct comparisons between the numerical and statistical data as recorded by the ONS (2020a) and the figures cited in Barber's previous article (Barber, 2008). The age range used in statistical data has been extended by 15 years, and is now 16–74 years (see Box 2, final point). In addition, as social attitudes have changed, public and professional understanding of, and attitudes towards, those subjected to domestic abuse have also shifted, with increased awareness and understanding of the issues. However, domestic abuse continues to be considered very much a ‘female’ issue (Abrar et al, 2000; Bagshaw, 2011; Local Government Association, 2015:13; Women's Aid, 2022c), with the language and discourse around the subject seen as a feminist issue, and couched and debated accordingly (Chelliah, 2016).

The feminist standpoint is that domestic violence stems from an imbalance of power, with men holding the upper hand. However, such framing of the discourse is unhelpful for men experiencing domestic abuse, whether at the hands of female or same-sex partners. It may even be harmful because it potentially makes it harder for men to acknowledge that they are experiencing domestic abuse and more difficult for them to be taken seriously, and to seek support (Chelliah, 2016).

The statistics for each of the past two decades reveal a significant difference between the number of domestic abuse incidents reported to the police and the numbers subsequently recorded by the police as a domestic crime. The reasons are difficult to ascertain, but one possibility is that, within the framework of the law, some forms of domestic abuse are not classified as ‘criminal acts’ and are therefore not recorded (ONS, 2019). There may be a case to be made that the totality of domestic abuse, in all its forms, as well as the identities of the perpetrator and victim/survivor, should be re-defined in law and recorded as criminal acts.

The statistics show that the gendered incidence of domestic abuse has not changed over the past 14 years. The data reported both in 2008 (Barber, 2008) and 2020 (ONS, 2020a) point to a roughly 2 to 1 female to male gender split. Although most of those affected are women, men comprise a significant proportion. In the previous article, Barber (2008) suggested many reasons why domestic abuse against men may go unrecognised and why men may be reluctant to report incidents

Today, things may have changed to a certain degree, with occasional media references to male victims of domestic abuse (Christodoulou, 2011; Rees, 2019; BBC News Online, 2020; ITV News Online, 2021). Again, the previous article (Barber, 2008) highlighted a number of issues experienced by men when disclosing their abuse at the hands of their partners to health and social care professionals and the police. This included disbelief, being blamed for being abused, and even being arrested and charged. There would be merit in further research to explore the extent to which men continue to experience these issues 14 years on and why the situation has changed little: if found that the experiences persist, it would indicate that not enough has changed over the intervening years.

One form of domestic abuse most commonly experienced by men is ‘gaslighting’ (Hardy, 2021; Relate, 2021): this is a specific type of psychological and emotional abuse when a person is manipulated into doubting their memory, perceptions and judgements (Safe Lives, 2019; Relate, 2021). Research by Safe Lives (2019) found that 71% of men who had reported abuse said they had had their ‘memory questioned or told that they were imagining things they knew to be true’.

Education

These statistics make for grim reading and show that domestic abuse targeted at men is as much of a social and health problem today as it was in 2008, and it is still not being taken sufficiently seriously by health, social care and law enforcement professionals. This is not meant to be unfairly critical of health care and law enforcement professionals, but the reality is that many nurses do not feel prepared or empowered to work with domestic abuse survivors, regardless of gender (Bradbury-Jones and Broadhurst, 2015).

There is a general a lack of education and continuing professional development for health professionals on the subject of domestic abuse and related issues. There is therefore a need to ensure that appropriate gender-neutral or gender-inclusive training around domestic abuse is covered in pre-registration education and post-registration continuing professional development (NICE, 2014; Bradbury-Jones and Broadhurst, 2015). Resources such as the Royal College of Nursing's (RCN) Guidance for Nurses and Midwives to Support Those Affected by Domestic Abuse (RCN, 2020a) could be a starting point for developing an education programme.

Time

The lack of education on the subject is not the only issue – professionals are also limited in the time they have available to address any suspicions, and the availability of safe spaces within which to facilitate disclosure. Given the wide range of competing priorities health professionals have to deal with daily, the lack of time may preclude them from pursuing any suspicions they may have about a patient. Consideration of domestic abuse may, therefore, slip through the priority gaps.

Safe environment

It is important to have spaces where a patient can be assured privacy in order to engage in often highly sensitive and complex conversations, and where an assessment regarding domestic abuse can be carried out. It is also important to be able to refer a victim or survivor to a place of safety urgently following assessment. Such spaces however are often not available, and are especially lacking for men affected by domestic abuse.

Other barriers

In addition to the above, identifying an individual experiencing domestic abuse can be problematic because they may be accompanied by the perpetrator/aggressor when attending healthcare appointments. This inhibits them from disclosing that he or she is being abused. The same will apply when the nurse engages with a patient during a home visit, when the perpetrator or aggressor is likely to be present (Medway NHS Foundation Trust, 2017).

Such barriers can be compounded by the still prevalent belief, both in health care and society more widely, that women are the victims/survivors and men are the perpetrators/aggressors (Wright, 2016). The stereotype of the woman as the victim persists, perpetuating the attitude that men are not at the same risk as women, and that they should be able to defend themselves (Wright, 2016).

One of the issues touched on briefly by Barber (2008) was that of domestic abuse in same-sex relationships. There is scant research on domestic violence within same-sex relationships, and what research there is tends to focus on lesbian and female bi-relationships, and to do so from a feminist perspective (Hester and Donovan, 2009). There has been limited research undertaken on domestic abuse within LGBTQ+ communities, so individuals in an already marginalised group (eg gay, bisexual or transgender) who are subjected to domestic violence often find themselves forgotten or ignored (Merrill and Wolfe, 2000). Additionally, domestic abuse is an not an issue that is well recognised or discussed within the LGBTQ+ communities.

According to the charity End the Fear (2022), about 25% of those identifying as LGBTQ+ experience domestic abuse, which may be associated with:

• Outing or the threat of outing being used as a method of control
• The person may begin to associate the abuse with their sexual orientation and feel that, if they were not gay, bisexual or transgender, they would not be experiencing it. This can lead to internalised feelings of homo-, bi- or transphobia.

Those identifying as LGBTQ+ are part of a marginalised group, and may often be hidden and isolated. Consequently, an individual's main friendships and relationships will be with others within their community, and will often be their main source of support. The isolation is exacerbated for those living in smaller towns and rural areas, where there is no active LGBTQ+ community, making it difficult for an abused partner to seek help. This reality for LGBTQ+ individuals points to a need for in-depth research into the prevalence of domestic abuse, and the experiences of, gay, bisexual and trans men in relation to domestic abuse – and strategies for action based on the findings – to improve the situation (Safe Lives, 2021).

Another group whose experiences of domestic abuse merit further exploration are men with disabilities. Further research into their experiences is much needed, with follow-up strategies developed and put in place (Public Health England (PHE), 2015; Varney, 2016; Millar, 2018).

Support services

Lawrence (2003) suggested that the type of support resources and networks available for female victims of domestic abuse, for example safe homes and women's shelters, were not available for male victims/survivors. She also highlighted that the UK did not have an equivalent to the US Violence Against Women Act 1990. In the UK, the limited support that was available 14 years ago was mainly in the form of telephone helplines and web-based resources (Barber, 2008). This lack of accessible support for men may not have changed much since the publication of the earlier article.

Harvey et al (2014) suggested that research into, and consequent work with, those identifying as gay or bisexual is ‘few and far between’; they cited a number of works focusing on gay and bisexual men experiencing domestic abuse, but acknowledged that most research and consequent action is based around the needs of ‘straight’ women. Thorough research focusing on the specific needs of gay and bisexual men who experience domestic abuse is therefore needed.

In 2004, an LGBT charity Broken Rainbow was formed in response to the lack of services for this group to support gay, bisexual and transgender men experiencing domestic abuse at the hands of their partners. Although the organisation ceased operation in 2016, its work continues through the LGBTQ+ anti-violence charity Galop, which has a helpline for gay, bisexual and transgender men. Other organisations offering support include Mankind Initiative (https://www.mankind.org.uk) and Respect: Men's advice line (mensadviceline.org.uk). Mankind Initiative provides a counselling and listening service, as well as offering information on external support systems such as community-based outreach workers; in addition to the advice line, the latter also provides web-based support, signposting to other vital services, and offers information and support to frontline workers supporting men experiencing domestic abuse.

Domestic abuse refuges provide emergency temporary accommodation with planned programmes of therapeutic and practical support (Mankind Initiative, 2022a). The number of such services in England has decreased since 2010, albeit with small increases in 2013 and 2017 (ONS, 2020b): in 2020, there were 261 refuge services compared with 294 in 2010 (ONS, 2020b). Despite this long-term fall, the number of bed spaces in refuges in England increased for five consecutive years between 2015 and 2020, from 3578 to 3923 respectively (ONS, 2020b). However, it is not clear from the statistics whether the refuges and associated bed spaces are for all genders or specifically for women (Mankind Initiative, 2022a). Although refuges and associated support services targeted specifically at women are woefully inadequate, similar services for men are almost non-existent, with no more than a handful of male-oriented refuge services and places of safety (Mankind Initiative, 2022a). Considerable research and practical work needs to be undertaken to redress the imbalance, while acknowledging that men experiencing domestic abuse will require different support mechanisms to those provided for women.

Aspects of the nurse role

Nurses working in a variety of settings such as GP practices, community health centres, mental health teams and emergency departments are likely to encounter men, both in heterosexual or same-sex relationships, who experience domestic abuse. Domestic abuse is a significant public health issue, with the incidence of the male as victim or survivor under-reported and the issue poorly understood by health professionals (Perryman and Appleton, 2016). Health visitors have an important role to play, both in influencing policy and in practice, to address the health and social care needs of male victims and their families. For health visitors in the UK, knowledge of all aspects of domestic abuse is vital for delivering evidence-based practice (Wright, 2016; Medway NHS Foundation Trust, 2017; RCN, 2020a; 2020b).

It is important to support male victims of domestic abuse, and encourage them to report incidents and seek help, as emphasised in the previous article (Barber, 2008). The suggestions made 14 years ago with regard to the role of the nurse in supporting the men affected remain relevant (Box 3), and will repay re-reading and reflection, and appropriate follow-up action taken.

Box 3.Recommendations for nurses supporting men affected by domestic violence (Barber, 2008)

• Be aware of local support services
• Create a supportive environment in which the person can talk
• Be aware of the signs that could indicate domestic abuse
• Know what questions to ask to encourage the person to feel safe to confide in you
• Validate and support the person who reveals abuse
• Provide information about the relevant support agencies
• Maintain detailed and accurate records but do not write this information in hand-held records
• Ensure confidentiality and, if you need to share information, follow trust guidelines
• Address any health needs

First, the role of the nurse is to recognise that men can become victims or survivors of domestic abuse, and understand the impact that domestic abuse can have on men (Respect, 2019). There is a range of free-to-access online resources nurses may find useful, including materials produced by Galop, Respect: Men's advice line and the Mankind Initiative (see Box 4).

Box 4.Resources

• Crown Prosecution Service: Domestic abuse, cps.gov.uk
• Domestic Abuse Act 2021, https://www.legislation.gov.uk/ukpga/2021/17/pdfs/ukpga_20210017_en.pdf
• End the fear: Same sex domestic abuse, https://www.endthefear.co.uk/same-sex-domestic-abuse
• Home Office: Statutory definition of domestic abuse factsheet, 11 July 2022. https://tinyurl.com/ho-da-factsheet
• Kent Public Health Observatory: Domestic abuse needs assessment, https://tinyurl.com/2xr4av53
• Mankind Initiative: How we can help, mankind.org.uk
• Office for National Statistics: Domestic abuse prevalence and trends, England and Wales: year ending March 2022, https://tinyurl.com/ons-da-2022
• Respect: Men's advice line: Support for frontline workers helping male victims, https://mensadviceline.org.uk/frontline-workers

Organisations setting up/running services to support men experiencing abuse must ensure that these are in line with the legislation set out in the Domestic Abuse Act 2021. Parts 4-6 (sections 57-74) of the Act will be of relevance to those working with individuals experiencing domestic abuse. For example, the law requires each local authority area to establish a ‘domestic abuse partnership board’ (section 58): this must include at least one person who has experienced domestic abuse, at least one representative for children in abusive relationships, and one health professional. The nurse may be involved in such partnership boards.

Nurses who are aware of male victims of domestic abuse, and of the experiences and issues affecting them, should endeavour to consider the points outlined on Box 5 and incorporate them in their practice.

Box 5.What nurses can incorporate in their practice

• Where there is a suspicion that a male patient may be subject to domestic abuse, the nurse should try to elicit information by asking appropriate questions, while taking into consideration the sensitive nature of the issue
• The nurse should listen and ensure that the approach used makes the individual feel understood and validated
• Use of the Making Every Contact Count approach (Public Health England, 2020) offers opportunities for nurses to reach out to men suspected of being affected by domestic abuse
• Assessment tools for domestic abuse tend to focus on the experiences of women. Nurses should consider whether their team could develop a gender-neutral assessment tool
• Nurses should find out if there are safe spaces in their locality where men in this situation could meet and share experiences. Nurses should provide information about local groups to men they suspect may be affected. Some healthcare environments are now establishing safe spaces where men can feel safe in making the first steps to disclosing their situation
• Nurses should work with health care and other services, to ensure a multi-agency approach

Steps to supporting men

Ask the right questions

It is imperative that nurses talk to men they suspect of being subjected to domestic abuse. Given the highly sensitive nature of the issues, many may not be willing to disclose their experience for fear of being ridiculed, stigmatised or blamed (Christodoulou, 2011; Rees, 2019). It is crucial to ask the right questions at the right time, in the right way (NICE, 2021). Failure to do so means that honest answers and the right information will not be forthcoming, without which relevant interventions and strategies cannot be implemented (NICE, 2021).

Validation

It is crucial that men experiencing domestic abuse feel listened to, understood, believed and validated. When working with women this is considered to be standard practice. It is no different when working with men, who should be accorded the same dignity, respect and rights.

Encourage change

The use of existing approaches, such as Making Every Contact Count (MECC) (PHE, 2020), can be used as a vehicle to ask the right questions. Implementing national healthcare strategies such as MECC at a purely local level could involve health and social care professionals actively providing safe spaces for male (and female) survivors of domestic abuse in a range of clinical and non-clinical environments. Such safe spaces are needed to enable survivors to share their experiences in a non-judgemental way. Given that MECC is an approach to behaviour change, it is important to not send out the wrong – and potentially harmful – message that domestic abuse is a ‘lifestyle’ issue and that the survivor is to blame, ie that, were the survivor to change their behaviour, there would be less risk of domestic abuse or violence. Therefore, MECC could assist those working with survivors not so much to change their behaviours as to address collaboratively with the survivor any physical and mental health issues arising from the domestic abuse.

Non-gender-specific tool

Existing domestic abuse assessment tools may not be helpful because they tend to focus on the experiences of women at the hands of men. In their practice, nurses could consider developing an assessment tool that is gender neutral, gender inclusive or focuses specifically on the experiences and needs of male victims and survivors.

The SafeLives Dash Risk Checklist (https://safelives.org.uk/node/516) is the most commonly used domestic abuse checklist and assessment tool in the UK, with gender neutrality embedded in both the wording and best practice guidance.

Information

It is vital to provide accurate information about external third sector support services such as Respect: Men's advice line and Mankind Initiative to men who experience domestic abuse. This can be conveyed by phone, text messaging, email or via web pages, or provided via face-to-face support groups, where individuals can also be pointed to further resources and support organisations. Although the Respect: Men's advice line provides many such support services, there is a need to research and design alternative ways of disseminating accurate information in a way appropriate for men experiencing domestic abuse (Domestic Abuse Commissioner, 2021). There is also a growing body of research into many aspects of male survivors of domestic abuse (Mankind Initiative, 2022b), which includes:

• Experiences of telephone support providers for male victims of domestic violence and abuse
• Male victims of coercive control
• Gendered stereotypes and intimate violence.

Support groups

A support group established, facilitated and run by its members – with the input of health professionals being solely to organise a meeting space (be this physical or virtual) and to manage any admin – may be a useful way for men experiencing domestic abuse to meet others in the same situation. Such groups may meet at physical locations, such as a coffee shop, pub or community centre, or online, and offer safe spaces to share experiences and offer mutual support and advice (Gala, 2022).

In Bradford, the charity Men Standing Up ran such a support group until early 2020, but restrictions during the COVID-19 pandemic forced it to end face-to-face meetings and continue with telephone-based support (BBC News Online, 2020). Research is needed to establish whether men living across areas of the UK could benefit from face-to-face support groups, as well as of the nature and function of such groups, and how they could be funded in an era of tight budget constraints.

Safety

Safe spaces in all clinical environments must be established so that men do not feel threatened or afraid, and feel safe to disclose their experiences. Whether working with women or men who experience domestic abuse, this should be standard practice. Under a scheme supported by the government, pharmacies have put or are planning to put in place safe spaces for men affected by domestic abuse (Home Office, 2022; UK Says No More, 2022a). Such schemes need to be expanded to include all health and social care environments and retail spaces (Barr, 2020; UK Says No More, 2022b).

Cross-agency collaboration

It is crucial for nurses to engage in multi-agency working with other care professionals such as social workers and those working in social services, schools (when children are involved), GP practices and the police (NICE, 2014). The nurse may also be involved in providing education for these colleagues, and it will be crucial that any training promotes a gender-neutral and gender-inclusive approach, to ensure that men's experiences are not invalidated.

Refuge places

In 2011, there were almost 4000 places for women in refuges in England and Wales, but just 16 for men (Christodoulou, 2011). Although this statistic is more than 10 years old, this is unlikely to have changed. In 2020, Respect welcomed funding from the Mayor's Office for Policing and Crime in London to provide emergency accommodation for male victims of domestic abuse. The charity hoped that the service would become ‘a blueprint for other parts of the UK lacking provision of emergency accommodation for male victims’ (Respect, 2020).

There is little information about the availability of, and resourcing for, regional or local accessible refuges and ‘safe havens’ for men, so this is an issue warranting further investigation.

Disability

The needs of male victims of domestic abuse who have a disability must not be ignored or overlooked. Nurses may be involved in research and follow-up action relating to this group of patients (PHE, 2015).

Conclusion

Regardless of the intervention engaged in or offered by nurses, the suggestions made above are not intended to be exclusive. It is crucial that they are focused on the specific needs of men experiencing domestic abuse, based on an awareness gained through asking the right questions in the right way at the right time, and making the time to listen to their answers (Sheffield DACT, 2016).

Domestic abuse, whether it affects women or men, is a major health issue – and many nurses will encounter and engage with those experiencing it at the hands of their partners. To ignore the men affected would serve only to further stigmatise and isolate vulnerable individuals, and such attitudes have no place in contemporary health care.

Some specific areas require further research and follow-up action, for example ensuring that the experiences of gay, bisexual and transgender men are listened to and validated, that there is availability of safe refuges for men, and that the needs of male victims of domestic abuse with disabilities are accommodated – all areas that have been discussed in this article.

Nurses are well placed to ensure that there are safe, listening and caring environments within which men feel comfortable in disclosing that they have been, or are being, abused by their partner – and that their experience is validated. Anything less is neither appropriate nor acceptable.

Finally, if a future review of this article in another 15 years or so indicates that very little has changed in relation to attitudes towards, and support services for, male victims/survivors of domestic abuse, we as nurses should be deeply ashamed and the question that will cry out to be asked and answered will be: ‘Why are things still the same, and what can we do to change them?’

KEY POINTS

• Although much has been written about domestic abuse, this has mostly been from the standpoint of the female as the victim/survivor and the male as the perpetrator
• Out of 2.36 million people who experience domestic abuse around one third are men, or just over 1% of the UK population
• About 25% of those who identify themselves as being LGBTQ+ experience domestic abuse
• Much of the existing resources that are accessed by men revolve around telephone outreach and online information and support groups
• Key to the role of the nurse is validating men's experiences, asking the right questions and listening to the answers without judgement

CPD reflective questions

• Consider what you could do to enhance the safety of patients in your own clinical setting
• Are there particular features of your clinical setting that may contribute to your patients feeling unsafe?
• Regarding the themes covered in the article, can you identify one that you could further reflect upon and discuss with your wider team?