Supported Loving toolkit

Rights vs risk

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This toolkit page is about balancing the rights of individuals we support, to explore their intimate lives with the management of any associated risks.

Supported Loving toolkit

What are our rights around our intimate lives?

Everyone has the same rights regardless of disability, mental ill-health or background etc.
The law says that everyone has the same capacity to consent and make decisions about their intimate lives, unless proven otherwise through a formal capacity assessment, and the right to enjoy their private lives freely (including personal relationships, romantic, sexual, or otherwise) without restriction.
We all start out from the same position, legally, as equal sexual citizens.

What do we mean by risk?

Risk is:

an unavoidable aspect of day-to-day life - every action or decision carries with it an element of risk depending on what is happening
the possibility that something bad, or dangerous, will happen
a crucial element of making choices and weighing-up personal decisions, important for autonomy and a voice in how we live our lives.

We like this definition of positive risk-taking from Gloucestershire County Council: A Positive Approach to Risk and Personalisation, "Positive risk management does not mean trying to eliminate risk. It means managing risks to maximise people’s choice and control over their lives."

All relationships, therefore, carry elements of risk. Every interaction with another person could lead to a negative outcome. Types of risk can include:

physical risk – assault or robbery
emotional or psychological risk – coercion or gaslighting
sexual health – STIs, lack of pleasure, enjoyment, mutuality or poor boundary setting
exploitation
meeting a stranger online
breaking the law.

A vast majority of interactions with others, in properly supported relationships, can lead to chances for joy, nurturing and happiness. Nobody should be denied the opportunity to make those choices. Our role in supporting people includes respecting and upholding their rights, not prohibiting or limiting them.

What are the most common challenges faced in this area and how best to support people to overcome them?

As a result of their disability

People are less likely to have had access to representative and inclusive relationships and sex education (RSE), and other non-judgmental information. Even with support, issues include:

Information does not match an individual's communication strengths and needs, including repeating information.
Only including information appropriate to LGBTQ+ identities if staff feel it is necessary.
Not being accepted or treated as being able to take personal responsibility over your own life.
Learned acquiescence (accepting without protest)- reduces individual autonomy over relationships and access to sexual health services and support.
No opportunity to discuss 'risky' situations or topics. Some relationships or circumstances may be perceived as being inherently “riskier” than others. They may not be included in RSE. This could include 'kink' or supporting individuals within the LGBTQ+ community. If there is no opportunity for an individual to discuss these topics, for whatever reason, then the potential for risk and/or referrals to safeguarding is that much greater.

Due to restrictions from others

Staff’s restrictive approaches can stem from:

Insufficient training.
No organisational policies.
Fear.
Relationships not being prioritised.
Thinking it is acceptable to express personal attitudes, views, and opinions.
Deciding, defining or projecting an impression or image of what an individual’s sexual attraction or identity might or ought to be. This particularly affects relationships or situations perceived as 'riskier', such as those that are non-heterosexual, may involve 'kink', are intimate or sexual rather than platonic/romantic, and are non-monogamous relationships.
Presuming that individuals lack capacity to make decisions about their relationships.
Attitudes that relationships should be ‘perfect,’ and that someone should not have a relationship if it might fail.

Families can act restrictively due to reasons such as:

Reluctance to engage with RSE, perhaps due to beliefs or myths.
Not seeing their relative as a sexual citizen, as adult enough or having capacity to understand and experience a relationship.
Unaccepting of their relative’s identity or obstructing their expression of it.
Do not support social contacts.
Fear and worry.

Health/social care professionals often fail to:

recognise the importance to the individual of relationships, whether platonic or intimate
deliver RSE
support existing relationships.

There are societal/environmental challenges which include:

RSE not being given priority.
Human rights not being recognised or supported properly.
Law: There are laws that specifically apply such as – Sexual Offences Act/Mental Capacity Act/Human Rights Act. Also, the case law relating to is constantly evolving, including “capacity to engage in sexual relations.” There are often tensions between protecting rights to intimate relationships and the need to protect vulnerable people.
Accommodation that people live in often includes a lack of privacy, restrictive tenancies, and single bed policies.

How best to support people in this area

Put the individual, their wishes and aspirations at the heart of our work.
Promote autonomy and agency.
'Containing the risk' does not proactively safeguard someone. Start with their wishes.

Work/information around risks should include:

minimising risks
supporting self-management
exploring decision-making ('risky' decisions/consequences)
negotiating skills
consent
sexual health – pleasure/safe words/e-safety/trying something new.
law
LGBTQ+ relationships – reduces known risks
creating an individual plan where appropriate.

Join Nigel Hodges for a webinar, which explains how to develop bespoke RSE sessions and allow participants opportunities to think about decisions they might take about their relationships.

Do...

create an open, shame-free culture where the individual’s wishes are the starting point
acknowledge that the individual’s wishes are of equal importance to yours and everyone else's.

Don't...

make decisions for individuals - allow them to make decisions by giving non-judgmental information
remove all risks.

Case study

Simon has a profile on Grindr where he sends lots of intimate images of himself to lots of different men.

Risks to Simon, from the other men involved:

STIs.
Physical risk – assault, including ‘date rape’ drugs, chemsex (using drugs to enhance sex).
Exploitation – sexual, financial.
Poor sexual experience – lack of mutuality, enjoyment, fulfilment.
Impact on emotional or mental health – potential lack of connection or commitment.
Coercion, lack of negotiation.
Misunderstanding of intentions.

Risks to Simon, from his support staff/provider

Lack of appropriate support to access support and information.
Criticism.
Lack of support for advocacy.
Restrictions potentially leading to secrecy/greater risk-taking.

Risks to the other men involved:

STIs.
Lack of mutuality.
Physical risk – assault.
Misunderstanding of intentions.

Risks to his support staff/provider:

Professional risks arising from failure to support proactively.
Complaints from Simon, Simon’s family/support network, or from the men he engages with; reputational/professional.

The greatest risks are still arguably for Simon! How could they be minimised whilst still allowing him to enjoy exploring his intimate life and sexual expression?

Open and supportive culture – positive provision of support to access information and services appropriate to Simon (ie LGBTQ+ inclusive sexual health services).
Signposting proactively to appropriate, independent advice/support services.
Opportunities, space, and time for Simon to explore relationships with other men; what consent and mutuality means to him, different kinds of relationships and sexual expression, discussion of romantic or partner relationships.
Simon needs space to explore his own happiness, self-acceptance (as potentially a gay man or a man who has sex with other men).
Staff need support and a policy.
Positive workplace culture - can staff be out? Does Simon know any other LGBTQ+ people – and in what context? (ie non-sexualised/hook-up).
Does he have the means and opportunity to confidently bring someone home? (Double bed, appropriately rights-based tenancy, the ability to tell a staff member if he wants support).

Top tips

Ask:

What does the individual want to achieve?
How can staff support them to achieve this?

Remember:

Everyone has the same rights.
Not all decisions have to result in a ‘positive’ outcome.
A ‘positive’ for somebody being supported may not be the same as their staff’s perspective.
Positive risk-taking is safeguarding the individual.
Restricting people increases risk!

Nigel Hodges, semi-retired Learning Disability Nurse, specialising in sex and relationships.

Nigel also runs Supported Loving's reflective learning group.

The views expressed in the Supported Loving toolkit are not necessarily those of Choice Support.

Resources

Justin Hancock (2021) “Can We Talk about Consent?”

Very readable book aimed at mainstream 14+. Extremely useful for practitioners to reflect on their practice around consent. Highly recommended.

Dr Kelly Asagba, Professor Jan Burns and Dr Sophie Boswell (2019) “Sex and Relationships Education for Young People and Adults with Intellectual Disabilities and Autism.” (Pavilion)

Resource pack – particularly useful for those starting to set up groups but also useful for more experienced practitioners to reflect on their practice.

Mental Capacity Act Code of Practice

Note: following the Mental Capacity (Amendment) Act 2019, this document is scheduled to be revised following the changes made by the Act.

Alex Ruck-Keene (2019) “Capacity, social media and the internet.”- Sums up the current legal position.

“Is it ok? Sexual Exploitation, what it is and what to do about it.” (Carlisle Mencap)

Mental Capacity Act

Human Rights Act

TED talk on sexual citizenship by Gill Leno

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