Research: Trained staff can help people overcome the barriers they face in intimate relationships
Research from the Tizard Centre at the University of Kent finds that supporting people with learning disabilities in intimate relationships can present a challenge to staff and a culture of risk-aversion can prevail. Training can help staff to engage with the dilemmas they often face. Dr Claire Bates reports
Summary
Aims:
This research review discusses some of the barriers to relationships people with learning disabilities face and how they can start to be addressed.
Methods:
11 adults with learning disabilities were interviewed to share their experiences of selecting and being in an intimate partner relationship.
Further information: http://www.emeraldinsight.com/doi/full/10.1108/TLDR-03-2016-0009
Background
Having someone to love who loves you back is highly valued. The importance of relationships is now recognised by the Care Act (2014), which identifies the development and maintenance of personal relationships as an eligible need. In 2001, Valuing People aimed for more people with learning disabilities to form intimate and sexual relationships. However, in 2009, Valuing People Now showed a lack of progress. Mencap highlighted that in 2016 little had changed as just 3% of people with learning disabilities lived with a partner.
Safeguarding processes are often accused of creating a climate of liability avoidance, with support providers being fearful of supporting relationships, particularly sexual ones, due to criticism if something ‘goes wrong’. However, people with learning disabilities are more vulnerable to abuse and support providers have a duty of care to protect. Research has shown that people with learning disabilities face restrictions, often put in place to ‘protect them’, but as a result their relationships are highly supervised. Restrictions such as not being allowed to share a bed, limited privacy and forbidding sexual relationships.
Findings
Accommodation: impact on choice and autonomy
Some people with learning disabilities explained how their living situation affected their relationship. One couple were unhappy due to the restrictions placed on them by staff and conflict with housemates, such as not being able to share a bed on weeknights or cuddle in communal areas as this upset their housemate. Staff had to balance the wishes of all members within the group home. However, some of the restrictions implied possible control by staff as opposed to support. It also appeared that some people still felt they required the staff’s permission to engage in normal adult activities such as sharing a bed. This was not an option for some as housing providers did not always provide double beds. This suggested that the person was not seen as an adult who might wish a partner to stay overnight.
Sexual relationships: capacity and consent
Not everyone needed support to initiate relationships. A woman with low support needs engaged in relationships with partners who could be considered ‘undesirable’. Staff have a duty of care to protect vulnerable adults in such relationships; however, if a person has the capacity to consent to a relationship, staff can only offer advice and support. The Mental Capacity Act (2005) states that capacity should always be assumed unless there is evidence to suggest otherwise. In an interview, one person’s responses suggested that she did not have the capacity to engage in a consensual sexual relationship at this time. What was unclear was whether the woman had received any support or education to help increase her capacity to understand a sexual relationship and consent. With this support, she may have been able to consent to this form of relationship in the future.
This example demonstrates again the balance staff need to achieve between enabling individuals to engage in relationships while still protecting them from harm, including considering their capacity to make decisions regarding sex and partner choice.
Risk avoidance
Possible indications of a culture of risk avoidance in organisations were identified such as the double use of contraception for one couple (pill and condoms), a woman with an implant who was not sexually active and another person’s insistence that she was unable to remove her clothing with her partner. The first couple could have been screened at a family planning centre to rule out any fear of STI’s. This suggests that staff may have been fearful of a pregnancy, despite all participants being adamant that they did not want children. However, not all organisations were risk averse in all areas and were, for example, actively supporting one woman to start a sexual relationship (in terms of providing emotional support and sexual health advice), despite her previous experience of sexual assault.
Conclusions
Risk aversion persists around sexual relationships. People with learning disabilities are not always treated as adults or as free as other people to make their own choices regarding their intimate relationships. People with learning disabilities need a clearer understanding of their rights to know when they are being unfairly restricted. It was clear that supporting intimate relationships was challenging for staff, and also that there was good practice. They often face difficult dilemmas, balancing providing support and protection to individuals in relationships without being overly protective. Staff training needs to be improved, which includes considering issues such as contraception, capacity regarding sex, and supporting individuals who have experienced abuse in starting new relationships.
Key messages
- People should be treated as adults in regards to relationships and their rights respected. Unnecessary restrictions should not be placed upon relationships
- Staff could benefit from better training around relationships to help them provide good support to people.
- People with learning disabilities should be better informed of their rights in this area to know when they are being restricted and feel confident to raise concerns if they are not being supported correctly
Further reading
Bates, C., Terry, L. and Popple, K. (2017) Supporting people with learning disabilities to make and maintain intimate relationships, Tizard Learning Disability Review, Vol. 22, 1 pp. 16 – 23.
Bates, C., Terry, L. and Popple, K. (2016) Partner selection for people with intellectual disabilities, Journal of Applied Research in Intellectual Disabilities. (Early View).
Dr Claire Bates is an Honorary Research Associate at The Tizard Centre, University of Kent.
