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Case study

Situation: Helen Toner, 24, is a woman with learning difficulties and a physical disability that prevents her getting around on her own. She lives with her mother and stepfather. Her father left two weeks before she was born and has never seen her. Helen regularly becomes agitated and this usually results in her shouting and lashing out. She attends a day centre, which is based at an old adult training centre, three days a week. There she takes part in relaxing therapies and anger management courses as well as learning life skills.

Problem: The centre has a popular sensory room. One lunch time, when both of Helen's key workers - one of whom would normally sit with her through lunch - were off sick, it was felt best to leave Helen in the sensory room to relax until other staff were available. However, during the unsupervised time, Helen was sexually assaulted by another service user. Because the incident involved two service users no action was taken. The manager and staff did not even tell the family what had happened. Helen herself disclosed the attack to her stepfather only after a week-long period of intensive agitation. Despite protests from Helen's family over the service's inaction, the manager refused to exclude the alleged perpetrator. The family was told, however, that they could remove Helen if they were not happy.

Panel responses

Lisa Loveridge
The service provider seems to have ignored multi-agency policies and procedures. It is clear that:

• The incident should have been reported immediately to the relevant social services team manager.
• Risk should have been assessed straight away.
• Consideration should have been given to informing the police.
• There should have been an investigation.

A case conference could then have been called to examine how further incidents could be prevented and to decide what action to take against the alleged perpetrator. The conference would have taken account of Helen's views and those of her parents, and would have prevented the day service manager from having sole responsibility for what happened.

As Helen's social worker, I would be aggrieved that I had not been told about the incident and would pursue this. I would also argue for swift implementation of the vulnerable adults policy. If Helen or her parents remain unhappy, they should make a formal complaint through any independent complaints advocacy service commissioned by the local authority.

Helen's situation raises several questions:

• How does the local authority know whether its vulnerable adults policy is being implemented effectively?
• Would health colleagues, dealing with Helen's distress, take their concerns forward through the policy's multi-agency co-ordination group?
• What training is given to providers about the vulnerable adults policy?
• Do all organisations require that their staff undertake the training?
• Would the alleged perpetrator have had any understanding of the consequences of their actions?
• How might the authority assess the risk presented by the alleged perpetrator?

Few people have the skills to assess that risk. Specialist help from support organisation Respond (www.respond.org.uk), or local psychologist could be sought. But I wonder whether the vulnerable adults policy has a budget for such help or whether it is a priority?

Linda Walz
Helen should be given the chance to see someone separate from the day service, such as a psychologist, to talk about the incident and her feelings. It is not clear how Helen communicates, but the therapist would probably need to use a range of materials (for example, booklets, photographs, symbols) to help her discuss an incident that has left her disturbed.

It would be useful to explore Helen's understanding of sexuality and sexual relationships to consider whether she was able to give consent to sexual activity. It would be important to explore the power relationship between Helen and the alleged perpetrator and to clarify whether she would have the skills to communicate her consent or lack of it in that situation.

Helen needs the opportunity to tell her story - to be believed - and for the incident to be taken seriously by those in authority as well as her family. Her parents may also need support to deal with the shock and possible feelings of guilt for sending their daughter into a situation where she was vulnerable to abuse.

Helen would also benefit from work on fundamental issues such as understanding and communicating her feelings, and assertiveness in general. People with learning difficulties often have little experience of being expected or allowed to discuss unpleasant emotions.

Through discussions with the therapist, or perhaps an independent advocate, Helen should be helped to consider what she would like to happen next with regards to the alleged perpetrator and the day service and, if this cannot happen, be supported to understand why.

Surveys of people with learning difficulties who have been sexually abused, although somewhat flawed as they pre-date "No Secrets" and take no account of hidden abuses, indicate that the perpetrator is most likely to be another person with learning difficulties and known to the victim. The day service manager needs to ensure that other clients are not at risk.

Staff may also need training on the legal aspects of sexual relationships between people with learning difficulties, consent and roles associated with working with vulnerable people. The community learning difficulties team could provide this so that any issues arising can be followed up.

User view  

In the past few years three of us have been sexually abused, write Pasquelina Cerrone, Colin Gear, Kathleen Franklin, Cheryl Priestley and Keith Taylor. This is on top of discrimination, emotional, and physical abuses we experience all the time. The sexual abuse is the worst, especially as we didn't get support. One of us was raped and has permanent injuries. She was told to keep it a secret. The second made a formal complaint to the police and her housing association about a sexual assault in her home. The assailant, who bragged to others about "trying to get it off with a thick girl", did not live on her estate, so nothing was done.  

The third person had support to talk to police after being sexually assaulted in a public place. The police said they would check the CCTV cameras and get back to him. Instead, they called social services asking for an appropriate adult - so much for his right to choose his support. Not wanting support from a stranger, he dropped the charges.  

The sexual abuse isn't the only abuse here. How the day centre treated Helen is disgusting. They dumped her in the sensory room. Being short-staffed is not Helen's problem. After all, she pays for her "care". They knew she couldn't protect herself. Dumping Helen is the first abuse.  

The second is the sexual assault; a very serious crime. By not treating this crime as would be done for a person without a disability, the day centre carries on the patronising stereotype that we are all perfect or that we don't have enough brains (competence) to commit or understand a crime. The truth is that some people with learning difficulties, just like some without, do bad things. Helen should be supported to file a criminal case. If there is not enough evidence, she should file a civil claim against the day centre for not protecting her.  

The third abuse is blaming Helen - the victim - by suggesting she leave the day centre rather than her attacker.  

When the three of us were sexually abused, none of us received counselling. We didn't get our rights, even when we went to the police. We just had each other. All of us still are really scared from what happened to us.  

We know how Helen feels. 

Pasquelina Cerrone, Colin Gear, Kathleen Franklin, Cheryl Priestley and Keith Taylor are members of Milton Keynes People First and would like to thank support group Voice UK for its advice. Voice UK can be contacted on 0870 0133965.