We feature highlights from the Intimate Partner Abuse of Men Workshop held on Wednesday 16 June 2010 in Perth, Western Australia. The workshop was aimed at service providers plus anyone who works with victims and perpetrators of family and domestic violence, and considered the implications for service providers of the Edith Cowan University (ECU) Intimate Partner Abuse of Men research.

In this, the fifth part of the workshop, Professor Rob Donovan talks about men’s help-seeking behaviour.

Rob Donovan: Well, I think the real expert on engaging with men is the talk after mine, but I have been involved over the years on research with men’s help-seeking behaviour. And so I’m gonna provide a broader brush, if you like, because the sort of work I do generally goes into public education and overall communication strategies. But some of the group research and the qualitative research we’ve done gives us some insights.

I think we self-destruct. One of the common themes that comes out when you talk to men about their health - they do have an awareness that they smoke too much, they drink too much, they take too many risks, they don’t watch their diet, and all other sorts of occupational things. There’s that realisation there that yes, the reason that the statistics are different for morbidity and mortality for men and women is that men are more wilful at engaging in unhealthy behaviours and pastimes.

Men tend to soldier on and be the hero. Yes, we sort of feel that we’re in charge, or we’re believed to be, or hoped to be in charge, and that when things go wrong and we’re feeling a bit off and that, nevertheless the expectation from society out there, and even from within our families, is that we’ll be stoic. We’ll keep going, and we will solve the problem for everybody. And so we tend to soldier on regardless of how we feel ourselves, because we want to be the hero... and besides – we’re in the dark a lot. We tend not to know where services are, how to access them, what the real facts about health, what are the causes and risks and so on for different diseases? And that’s, of course, why we rely on women to a large extent, if there are women in your life.

So what’s the overall problem as I see it? Well, it’s basically “men don’t seek help.” They don’t seek help for relationship problems, either with their partner or with their kids, for family relationships in general, for mental health issues, and of course the big one there is suicide stats - and over 80 percent of people who take their own lives are men – and for physical health issues, as well. And they don’t seek help either ever - it just gets all too much, and away they go - or they don’t seek it soon enough, and they don’t seek it often enough.

So they go to GP’s less often, and when they do go to a GP they’re less likely to talk about other problems other than the immediate one. And they tend to find GP’s not particularly easy to talk to, either.

Just a little anecdote there... a few years ago I was talking - working, rather - on a ‘time to treat’ program for the National Heart Foundation. They wanted to increase awareness that if you have chest pains that persist over 20 minutes, you should call an ambulance and get to hospital. If you get to hospital within a particular certain time, and you get a drug, then that can arrest the heart attack, if that’s what you’re having, and can lessen the likelihood of permanent damage to the heart. So the key thing is call an ambulance and get there within 20 minutes.

So I wrote three ads for this campaign, which we went out and tested. They were based on research we’d done with people who had had a heart attack. And then, one night, I was lying in bed, and around half-past-two I started to experience some chest discomfort. By about 3:00 it was getting severe, and but I kept thinking, “well, I’ve got a busy morning, tomorrow morning we’re launching a ‘young people are smoking’ program, and I’m pretty busy, and I don’t really want this to be what it might be.” And so I thought if I could just go to sleep, it’ll go away. But of course it didn’t, and it intensified.

By 4:00, I was in quite extreme pain, and I thought, “I have to make a decision here.” And what spurred me actually was I thought, “they’ll be hanging around at the wake, and they’ll be saying, ‘Funny, you know. He was working on a time to treat program at the time.’” So I thought after an hour and a half of dilly dallying, I thought “I’ve gotta make a decision.” The decision was I woke my wife, and I told her so that she could make the decision to get down to the hospital.

So off we went. So even if you have all the knowledge under the sun, and you have all of these other sorts of bits of information and that, there are some of these factors that we’ve been talking about - in Greg and Emily’s research and other people’s research – that are real anchors. But what I have learned in the research was that if you tell somebody else, you absolve yourself of that responsibility for the decision because one of the big fears is when you get there, and they say, “You haven’t got a heart attack. You’ve got indigestion.” And then you’re gonna feel silly and embarrassed and so on, and particularly if you’re a male.

As it turned out, after three hours in the hospital the doctor came in, and he said, “Look, I’ve got patients over here with real heart attacks, so I’ve got to get over there and look after them.” And of course I realised from the research then why a lot of people don’t go because they anticipate that sort of reaction from the doctor. So all I do is hope and pray now that I never have chest pains severe enough that I’ve got to make that decision again.

So I think the overall goal that we’ve got with this problem is to encourage help-seeking behaviours in general. Now many men are aware of this problem. When you do actually talk to them, they know that they have this reluctance to open up, and they do have a desire to talk. In many of the group discussions we’ve done, you have to drag men in there, but after about an hour-and-a-quarter you’ve got to beat them with a stick to get them out of there because they’ve found that actually opening up and talking to other men about some of those issues is really good. And then they want to stay there and just keep talking and generating it.

We found with weight-loss programs and the gut-buster programs, once the men have met to talk about losing weight. Then they actually say at the end of that, “Well, can we continue on about other things?… about health issues, or other issues in general in our lives.” So once they get in there and overcome their reluctance, they do want to talk about it.

And there are a lot of responses out there now in response to the awareness that men do want to do these things, provided it’s accessible easily, and it’s non-threatening, and it offers them a real solution to some of those things. So Foundation 49 deals with men’s health issues across a broad variety of areas. Dads in Distress and the Tom Net is a seniors’ one for older men’s social activities, professional development activities, development activities and so on.

So there’s a lot of it out there, and even the Prostate Cancer Foundation which seems to pop up everywhere now... and Movember and - they certainly raise some money. And Mike Brady – some of you may know of – who wrote “Up There Cazaly” - if you’re a football fan, which I’m not particularly, but apparently he wrote that. He now has a song out called “Talk About It,” which you can get by a $10 donation to the Prostrate Cancer Foundation. So there’s sort of things happening out there and a few well-noted people in depression have started to life the veil on those things.

So, why this reluctance on men’s part? And one of the slides that Greg and Emily put up was on the gender issues, and what do these sorts of things mean? Well, I guess when we talk about this we always put it in contrast to women. Well, women go to GP’s quite regularly. They open up, they talk about it, but men, particularly, don’t go, and they don’t talk about it. So, what’s the reason for this reluctance?

I mean I used to notice it even in - when I was a commercial market researcher – with focus groups with men, were always much harder than with women. You could get a group of women in, and just say, “Okay, tell me about how you do the washing or the laundry and softness and all this sort of thing...” or about any other sorts of issues, and women would chat and be quite open. Men would come in and sit there like this... all guarded, all defensive until you had worked out your strategies to get them to relax, to make it non-threatening, and to open up a little bit. Men were always more interested in, “What do you really want to know?” When, you know,  what you want to know is Why did you choose a Holden instead of a Commodore or a Falcon? or something like that. But there was always this guarded, you know... What are you really about? Whereas women were more likely to accept the surface thing and go on and chat about it.

So what’s the reason for some of this reluctance? Well, some people say that we really are different, and John Gray, he says, in fact the pre-runner to this is... he has made a career out of talking about differences in communication between men and women – I would say he’s also made a small fortune about it. But he also says “I don’t think we become different over time, but rather we start out that way”, which means that it’s possibly in our genes. “I have a hammer, I can put things together, I can knock things apart, I can alter my environment at will and make an incredible din all the while. Oh, it’s great to be male.”

So in other words, there is a certain... there is a difference between men and women that sort of goes a little deeper than some sort of sexual apparatus and so on. But are men and women really different, and how different are we? So these are some of the things you see around – that’s man, you may have seen some of these before – that’s “boom”. The men usually laugh at these. Mission: go to the GAP, buy a pair of pants. The female is the red line, time: three hours, 26 minutes, cost: $876. Male: 6 minutes, cost: $33.

There’s actually some English psychologists who have said that this is actually based on the prehistoric hunting and gathering differences. So men would go out, and the sole object of the exercise was to get some sort of creature, get is as quickly as you can, kill it with a minimum of risk, and then get back, and get it cooking or whatever else. Whereas women were more the gatherers, and so they took time, and they explored, and they looked at this and all that because you didn’t want to take home something that was poisonous or non-nutritious. 

So seriously, these are genetic differences... Of course, the comedy doesn’t go all one way, of course. This is the annual meeting of single, good-looking, straight, emotionally stable, financially secure, intelligent men looking for a long term commitment.

So, do the differences... well the reason for looking at them of course is do the differences explain the differences in help-seeking behaviours, and then how we deal with those? Does it matter, anyway? But in another sense, why don’t we just investigate the barriers and develop strategies and interventions to remove or minimise these? So that is the pragmatic view, and it’s a pragmatic view in a lot of psychological therapies as well. It doesn’t matter how you got here: what really matters is where you want to go next, and how we’re gonna get there. But for some people it is important to have an understanding of what might be the factors that lead to this because sometimes that provides additional insights into how you might go on to the next stage.

But I’ve got a little comment there... do we need more studies like this? Evolutionary sexual selection theory predicts that males will behave in more risky ways than females. So they explored in humans two everyday situations: catching a bus and crossing a busy road. So sure enough, single men left the time span much finer than did women, so that they would arrive just as the bus arrived or just a few seconds before. And also crossing the road to get to the bus stop... men would take far more chances as they dashed and danced between the cars than did women.

The interesting one for them, and I guess for all of us, is that males were more likely to cross in high-risk conditions when females were watching, whereas women did not. But what they seriously suggest of risk-taking is showing off as mate advertisement. In this sense maybe aggressive or assertive behaviour, which does tie in with some other stuff. And you may have seen in yesterday’s paper it was, it said “men are not shallow, it’s in the genes.” Men only take a fraction of a second to determine whether or not a woman is attractive to them, whereas women tend to take a little longer in determining whether a man might be attractive to them. And they base that back to... Well, men equated initially, attractiveness with fertility, and so if you wanted to, in your survival, keep the family going, then you chose the most attractive female because she was the most fertile.

Women’s survival, though, depends on whether a man is going to be committed, and that takes a little longer to figure out when you’re looking at somebody as to whether you might be attractive to them. So there probably are some real differences down the line that relate to psycho-biological things, and of course the current socialising.

So what are some of the differences that exist out there that have been found? Well, men are more assertive – that pops up frequently on most personality tests. Women are more agreeable. Men are more aggressive, particularly to strangers. Warmth - women are warmer, more tender-minded. Men are less empathic, less emotionally expressive – except anger. They’re far more likely to express anger but not other sorts of emotions. Higher anxiety amongst women, but greater trust. Socially and intimacy are different, and I’ll deal with that in a moment. And things like openness to ideas amongst men versus openness to feelings amongst women.

Now these are generalisations. When you actually look at the data, there’s far more differences between or amongst men and amongst women than there are between them in the sense, but the overall population differences are there, but what they do then is perpetrate social norms on these differences. So whether the differences are real or not – men and women start to believe that they’re different, and then they start to act in those differences.

If we look at sociality and intimacy and differences in belonging, and Baumeister has talked a lot about this: belonging as the basic fundamental need. And it goes right back to the tribal aspects and so on – belonging to a group ensured you survived. Being separate from the group lowered your chance of survival pretty markedly, and also standing out in a group often lowered your chances of survival.

So when we look in here, there’s a common belief out there that women seek interdependence whereas men seek independence, so we hear a lot about, well men all want to be autonomous, independent, have a separate sense of self; whereas women are more interdependent, gregarious, gathering round, and seeking this sort of self that’s associated with others. But Baumeister and so on argue, well that’s actually all wrong. Both seek connections; we all have a sense of needing to belong, a sense of identity, of who we are, where we come from.

But how women meet the need to belong is through fewer and more intimate relationships, whereas men seek it through broader and less intimate relationships. And he takes that back, too, about how men originally had the power in the tribal areas of villages and so on... so men rose to power and status through their deeds. Women rose to power and status through marrying or coupling with the men who had the power and status. But nevertheless, it’s sort of different strategies are coming through, then, but for men status and power now becomes more important, and it’s a way of achieving belonging by standing out in your group, by being respected, by people wanting to come around and follow you; whereas women it’s still more via empathy and then positive emotional expression.

So it sums up as female sociality then tends to be more dyadic between intimacy and between lesser numbers of people, whereas most male sociality is tribal. And we see a lot of that even in the gangs that exist. There’s not many women’s gangs around, but there’ s plenty of men’s gangs around, and although sports like football are becoming more popular with women, they still don’t seem to have this sort of thing about the - like the soccer followers in Europe, and so on, and even some of our followers.

So this thing about being more aggressive – well, that’s quite true, but in a wider society the more aggressive you are, the more status and power you have, and therefore the more connections. So for men there’s a desire then to hide these signs of weakness, to hide signs of vulnerability, because that sends the wrong message out there in terms of autonomy and an image of being strong and dominant. And of course, the catch is, though, that men still do desire intimacy in some of them, but more in their partner relationships. And there’s quite a bit of evidence that men experience more distress in break-ups than do women, and more women currently initiate the break-up than do men. And there may be a lot of reasons for that... possibly women are a little more courageous and want to talk about these things and do something about it.

But the aspect of being tribal – these broader social networks and how men connect on a large number of levels – suggests that social norms campaigns could be more effective for men than for women. And I think Gary sent round an email that... after the publicity about this research, the Salvation Army had referred on three men who’d been victims of violence, in a matter of a few days, whereas they normally refer on one a year. And the Relationships Australia article that came out that expressed a different view here and there, but what was included in there was that 7,000 men attended counselling. So information like that resonates with men who still are thinking about what I should or shouldn’t do. So that sort of thing suggests a social norms approach could be a good way at getting men to engage.

And appeals to strength and power could be effective for men provided they’re credible. That’s a campaign that’s going on in Hull in England at the moment. Some people think it should be spelled ‘Hell,’ but the statistics there are quite horrifying for various socioeconomic and economic indicators. But that’s “Find the strength to stop domestic violence”. It was built very much actually on the “Freedom from Fear” campaign, and other campaigns you see around, “My strength is not for hurting. So when I wasn’t sure how she felt I asked.” So those are the sorts of themes that might come from looking at some of those things which give us some insights.

I’ll now talk about just a a few of the barriers that we’ve found, and these are some of the studies that I’ve had more or less a little bit of involvement in, or in some cases no involvement in, but I’ve got some data from them, over the years. And the interesting thing from when we first started with some of this in the mid and early 90’s up to 2006-2007 – the same sorts of themes just keep on emerging, so there’s a universality and a generality in there. So some of these... some of the barriers to men attending relationship counselling that came out of the work mainly done by Mark Francis, Rodney Blaze and Rhonda Sapelli from my old company, Donovan Research. And you’ve seen some of these themes come up in the research already. Self-reliance, a belief that the problem should be sorted out within a relationship where you don’t have to go outside. This ego deflation - is what the researches called it then - you’re admitting failure, you’re adding weakness, you’re admitting that you can’t solve this problem when society and all other expectations are that you should.

That fear of what might happen in the counselling session, of what I might divulge, that fear of breaking down, of getting all of this stuff out, I don’t know how I’m gonna hold myself together so I don’t wanna go into that. The embarrassment associated with admitting that you’re having relationship counselling to other people. Beliefs that counselling doesn’t work or that counsellors take sides. And that’s a particular theme that comes out in the ECU research, in this particular case, of men thinking that most of these services are actually going to be a little bit disbelieving because it doesn’t really work that way. And then there’s just the lack of knowledge.

This is a study by Sven Silburn and Kate Miller on distressed and previously suicidal men’s reasons for not seeking help, and you can look at the same sorts of things are coming through there. “I thought I could sort it out myself. I didn’t want to be a burden. I didn’t know where to go. I don’t want to talk to my mates about that - it’s too personal. Men don’t seek help; it’s just not done. I didn’t know what was wrong at the time...” The denial of things that come out or not recognising them as being what they are. And stigma comes through again, no faith in the services, and financial reasons, and previous negative experiences. The thing about a lot of men is what they do come up with, barriers is that, Well, I do have to work. I’ve got shift work; I can’t take off time. Those waiting times are too long and various other things. And they were the things that came up that Greg showed, in this particular study... denial, fear of not being believed, shame, lack of services, bias, and so on.

So essentially, they’re the sort of barriers – and then there are the list of facilitators we’ve mentioned that need to be taken into account when developing services and engaging men in them. So, one of the things that came through as a motivator, and it came through in this research, and in our research with men who are violent, is the impact on children of what they’re doing. So this is a campaign from overseas, “What does your child feel - scared, confused, etc?” And you may remember that the Hull ad also used the impact on the child. The “Freedom from Fear” campaign here was based on that very essence. I can’t play you the ad because it won’t play on this machine, but I’m sure some of you remember it. But it was all about that the impact on children, and there were themes like the children are not watching a horror movie – they’re living one. This child is not having a nightmare – they’re actually living one inside.

And there was a very powerful motivator...

Audience member: It was all “women are the victims”: there was no men at all in that campaign except as perpetrators.

Rob Donovan: There were no... that was a campaign targeting men.

Audience member:  On the sexist assumption that only they are the perpetrators and all women are victims.

Rob Donovan: Ah, no, that wasn’t an assumption. It was simply a campaign that targeted men. What you’re saying is that there should and could be campaigns targeting women.

Audience member: I’m saying it should be gender-neutral.

Rob Donovan: Well, that’s another way to do it. Our research would suggest that if you want something to really reach men, you let men know that it is for men, and that would be far more effective than a generic one. Interestingly, and we’ve got some of the original helpline counsellors here, one of the first people to ring the men’s domestic violence help line as a result of this campaign was a female perpetrator. So, should there be a campaign separately? Well, maybe. But that campaign certainly attracted, engaged men, it got them on the line. And I notice some of the research coming out in here is if the men start to get concerned about the impact of the violence on their children.

So what our research suggests for engaging men... fairly commonsensical stuff. But really important that you’ve got to gain trust and confidence before they walk in and disclose, whereas women already come in if you like far more trusting and seeking help.

You’ve got to show empathy, similarity, non-judgmental, show an understanding of where they’re coming from. Don’t over-claim, but you must emphasise that the help will be formal and effective. The research that went into the “Freedom from Fear” campaign, what the men kept saying was that We don’t want wishy washy help. We’re just not gonna go walk down and see a local minister or something like that. We want help that’s gonna be formal, professional, and effective.

Be concrete... I had one man who... doctor told him, “You’ve gotta drop your cholesterol, you’ve gotta eat less saturated fats,” and so on. He came back three months later, and the doctor said, “Your cholesterol level is the same. Have you changed your diet?” “No, I haven’t.” And he said, “Well, what have you had for breakfast?” And he said, “Well, bacon and eggs, and toast and butter and that.” And he said, “Well, have four Weet Bix and forget that.” Then the guy said to me, he says, “There it was. I suddenly knew what to do. Four Weet Bix instead of bacon and eggs.” So you can’t always assume that men know what to do. You sometimes have to spell it out.

Other work, quote scientific data, avoid abstract concepts. I would use scientists rather than male celebrities – unless the celebrity has the problem that you’re talking about and they’re going to talk about how they solved it. Make it easy, make it discreet. Country towns are sort of a little notorious for that. You need to be able to park around the back or come in through another door and do things.

And work site stuff – always more acceptable than out in the community. And talking to Centacare yesterday about suicide prevention, and it just came up in the conversations there that the work site programs are a far easier way to get men to engage in some help-seeking behaviour than in the general community.

Use male testimony, especially similar background. Get the group to make a decision, particularly on the work site, again. Men can make a decision whether to have a health check in there, get these mobile vans or whatever they are. Publicising, taking action, which I said, act local, culturally appropriate. Some of these are pretty straight-forward.

Intrusive media. Men are not actively seeking out information about health unless they’re really, really crook, or something’s triggered that. So you need intrusive media. Television reaches them, but radio leads to discussion, and there’s a lot of men out there that listen to radio at work. Posters are good up around a wall at work.

If you’re gonna have community talks, the topics have got to be very specific. Putting up something about parenting is not going to work. Putting up something about drug abuse amongst teenagers – or preferably spell out the drug - ice use among teenagers or something - far more likely to get men in.

And make it clear as I said before that the service has got to look as though it’s for men. This is what Donovan Research a couple of years ago came up as a counselling positioning for men dealing with those essences of control, so the message was “this is a sort of a therapy or counselling where you do it. You actually work it. You solve the problem, but the counsellor helps you.” It was goal-directed, like the solution-specific or solution-focused approaches which are working quite well with perpetrator programs now. We’re gonna solve some specific problems, not other ones.

And again, that sign of strength, not failure. The car service analogy, you’ll see that all around the... overseas and here. This is a campaign for healthy blokes, which distilled into “is your body due for a checkup and service?” So you had a nutrition questionnaire, a physical activity questionnaire, and a basic overall checkup, because what men like is a little score. If they’re above that score, then they’ve got to go and do something. If they’re below their score... much easier because it’s concrete rather than saying, “Well, how do you feel? You’ve got some of these symptoms, some of that, something else...” No. “Give me a score, Doc! If I’m below it, I’m okay” - or above it, or whatever it might be.

So, men do delay help-seeking until often it’s a crisis point. They realise this, they want to change. Our task is to identify the incentives, remove the barriers, whether they’re real or imagined. They must feel that the quest for assistance will be accepted as genuine and treated sympathetically and professionally.

So given limited funds, the best strategy might be a generic help-seeking campaign targeting men that de-stigmatises men talking about their physical, mental and emotional problems. So it’s all about help-seeking – not about help-seeking for this that - that can be built into some of the detail. But I think what we need, like Mike Brady’s song “Let’s talk about it”, and so on... is let’s start to open up. And not necessarily, but this is a campaign that is operating in New South Wales – it’s only a day or a week or so, at the moment – but it’s based on reaching out to men... getting them to ask the men around them, “are you okay?” if something doesn’t look right.

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