A question of consent

CASE STUDY
The names of the service users have been changed
Situation: Martin Carter is 29 and has Down’s
syndrome. Craig Pearson is 34 and has moderate learning
difficulties, although his speech is difficult to understand. Both
men live in supported lodgings in the community, having spent some
of their adult life in council-run residential care. While living
in residential care Craig had occasionally exhibited inappropriate
sexual behaviour towards the  smallest and youngest women at a day
centre where he worked at the service user-run cafe. However, he
was referred for therapy, which appeared to stop this
behaviour.
Problem: Martin and Craig are great friends and
always do things together. It has always been clear that Craig has
been the stronger personality and Martin has usually gone along
with whatever Craig wanted. However, Craig has started to exhibit
strong sexual signals to Martin, and has been found locking himself
in Martin’s room. The men’s keyworkers, at first, considered their
relationship to be consensual as it involved holding hands,
touching and stroking in public. However, there are concerns that
Craig is using his strong influence over Martin to coerce him into
sexual activity that he does not properly understand. When
questioned, Martin says that things are fine. However, one night he
woke up screaming – saying that he wanted Craig to stop making him
“feel bad” and hurting him. The next morning he said he didn’t mean
to say anything and didn’t want anything bad to happen to
Craig.

Panel responses
Mike McCallam – joint commissionin manager, Banes learning
difficulties services
Most of us will appreciate the value of a meaningful and
long-lasting close friendship, which can often help to carry us
through our lives. Where would we be without our best friends? It
is well known that people with learning difficulties form fewer
relationships than others and have fewer opportunities to make new
friends. People supporting Martin and Craig need to respect their
relationship, and be sensitive to the possibility that any
intervention may have long-lasting consequences.

The two key issues are: first, what is the nature of their
friendship and is it of a sexual nature? And, second, is their
friendship an equal one and consensual? A trained practitioner,
such as a community nurse or psychologist, may be able to work with
Martin and Craig to explore these issues with them. Martin may need
additional support, through the use of an advocate to become more
assertive in his relationship with Craig.

Staff supporting Craig could increase their support and
observations to monitor for any signs of abuse or physical injury
if they suspect that Martin is coercing Craig into sexual activity.
If it is suspected that Craig is being forced into a sexual
relationship against his will, the matter should be fully
investigated using the local vulnerable adults procedure. This
investigation should also consider whether police should be
informed of a possible offence.

A sexual health worker may be able to provide advice and
information to staff or implement specific strategies with Martin
and Craig. It is important to establish their understanding of sex,
particularly the importance of consent and of practising safe sex
techniques. Organisations such as the Family Planning Association
have a range of useful resources and information that can be
accessed easily.

It is clear that Craig wishes to engage in sexual activity. Support
staff should explore what opportunities there are for Craig to meet
other people and form relationships where consenting sex would be
possible.

Craig’s behaviour towards the youngest and smallest women at the
day centre suggests an element of coercion and intimidation in his
behaviour and a re-referral for therapy may be appropriate to
resolve this.

Helen Thompson – social worker, Bridges CLDT
Martin and Craig have the option of agreeing to or
refusing input from the community learning difficulties team.
However, this input could be beneficial to both men.

Martin’s situation raises questions about whether he is a
consensual partner in this relationship or whether he has been
pressurised into sexual activity against his wishes. A psychologist
could assess Martin’s capacity to consent to Craig’s sexual
advances. Also, a community nurse or sexual health worker could
work with Martin and Craig to assess their understanding of sex. If
this input revealed that Martin was being coerced into actions
against his will the vulnerable adults procedure would need to be
invoked.

However, it is a basic human right to have a relationship. If
Martin and Craig choose to stay together, those working with them
need to ensure that they respond to their relationship in an
anti-discriminatory and non-oppressive manner. Advice on how to
have a safe and satisfying relationship may be of value and this
may involve looking at individual boundaries and sexual health.
Information would need to be given in an accessible format.

Martin and Craig should be treated as individuals. They each need
to be given the option of having their own keyworkers at the
supported lodgings, as well as having different members of the CLDT
representing them. This should promote the ability of both men to
disclose their views in confidential working relationships. Martin
and Craig may agree to join a self-advocacy group or have personal
advocates to enable them to express their wishes and feelings to
all those involved. Also, Martin may consider doing some
assertiveness training.

Martin and Craig always do things together and they may choose to
have joint services. The types of provision available would depend
on what they were assessed as being eligible for. Direct payments
could be used to employ a person to support them in the community.
Alternatively, both men may decide that they need some space from
each other and outreach or a holiday could provide this. They may
decide that they would like the opportunity to go out socially and
meet other people. Either way, the support network needs to ensure
that their relationship is not intruded upon insensitively.

User view 
It would be really hard for Martin to say anything to
anyone about what was happening, as Martin wouldn’t want to get his
friend Craig into any trouble, writes Daniel Hardy. 

The carers are a bit silly to think that Martin and Craig had made
a choice about this. I think they just assumed that both men were
all right about this kind of thing happening.

I work at Voice UK which works with people with learning
difficulties who have been abused and I think that this is abuse.
It is abuse of Martin by Craig. If Craig is making Martin do things
he doesn’t like then that is abuse. I also think that the staff are
making the abuse worse by not finding out whether it is really what
Martin wants.

Has anyone talked to both men about sex and relationships or talked
to them about what their rights are to say “no” to things they
don’t want to do.

I know that the Family Planning Association publish some really
good books and other materials for people with learning
difficulties and for support workers about explaining sex and
relationships. Support workers should look at these things with
Craig. And with Martin.

Martin needs to feel that he can say he doesn’t like what’s
happening without a lot of other bad things happening too. He might
feel that if he says something he will have to move house or that
Craig won’t be his friend any more.

I think everyone should sit down together and talk about what is
happening and come to an amicable agreement about it. If they can’t
sort it out between them then perhaps the police should be called
in.

I think Martin and Craig both need support. Martin needs support
because he is feeling really bad. Craig needs support to understand
that it his behaviour that is making Martin feel really bad. The
therapists at Respond (www.respond.org.uk) could help
both of them sort this out in their heads.

As for the staff, I hope they have learned not to make assumptions
about what we want from our lives. People make assumptions about us
all the time: that’s why the job that I do is so important –
telling other people with learning difficulties about their rights
in the criminal justice system.  Yes, we want to have
relationships. Yes, we want to have sexual relationships. But we
want them to make us feel good and happy, not sad and frightened. I
hope Craig and Martin can sort it out and be friends.

Daniel Hardy is equal access to justice project worker at
Voice UK, a national learning difficulties charity