Practice panel: Sexual urges clash with religious beliefs

A man with learning disabilities is finding his sexual urges challenged by his mother’s strong religious convictions. Our multidisciplinary team from Bath and North East Somerset advises

CASE STUDY

SITUATION
David Lowe is a 19-year-old man with moderate learning disabilities who lives at home with his mother, Irene. She has brought him up alone after the death of her husband and David’s father 17 years ago. Friends from her local church provide a supportive network. David stays in respite care every weekend – funded by Irene, who simply “gets to the end of her tether” by Friday.

PROBLEM
David tends to masturbate excessively despite Irene telling (and often shouting at) him that “God will see him in hell for doing that”. It is because he is indiscriminate in where he masturbates that Irene rarely allows David out while in her care. Irene’s Sunday group regularly prays for David and holds prayer meetings at Irene’s house. Now David has forged a friendship with another man, 35-year-old Bryan, at the respite care home. They had been found masturbating each other in the toilets, bathrooms and lounge area.

However, as both men are considered capable to consent, the home wants to work with them to conduct their sexual activity in a more responsible and private way. When the home invited Irene to a care plan meeting to talk through these issues she was so shocked she fainted. She and her church friends are now taking legal advice, protesting outside the care home and are accusing Bryan of sexual abuse and the home of neglecting their duty of care to David – “a strict Christian” for whom homosexuality is “abhorrent”.

THE PANEL
Bath and North East Somerset – Learning disabilities team

PANEL RESPONSES

Deborah Wales
Social services should offer David a community care assessment of his needs, possibly leading to a more outcome-based service. It appears that he only receives privately funded respite support. As David’s father died when he was two he has probably spent most of his life without a male role model, and may prefer to form a relationship with someone nearer his own age, rather than continue with someone 16 years older than him.

We only have David’s mother’s say that he is a “strict Christian”. The community care assessment could provide further investigation into his views and beliefs. David also may benefit from having an advocate to support him to explore these.

Consideration needs to be made as to whether vulnerable adult procedures should be launched. Irene shouts at David and emotional abuse is present. It is also said that she “rarely allows him out”, which could amount to curtailing his liberty and be contrary to the Human Rights Act 1998.

The home’s management might also consider taking legal advice. By protesting outside the home, Irene and her church friends could be damaging the reputation of the home. Such protests might also be upsetting and intimidating the residents. Perhaps the organisation running the home could talk to the leaders of the church, who could act as arbitrators between all parties.

Irene could have a carer’s assessment. This could lead to frank and honest discussions about David’s sexuality and her fears and concerns. Equally, Irene could receive support from a counsellor, or possibly a psychologist. She could attend the local carers’ network group who may be able to support her to accept David as an adult who can make informed choices. She needs to be made aware that homosexuality is not illegal for consenting adults, but that it is illegal to discriminate against a person on the grounds of their sexuality. Organisations such as www.outsiders.org.uk can provide information for parents of people with learning disabilities about sexual matters.

As Bryan is being accused of abuse and is emotionally involved with David, the home also needs to ensure that he is being supported throughout this process.

Sharon Day
The home in which David receives respite care should have a policy detailing how it will support people with relationships and sexuality. Section 15 of the National Minimum Standards Care Homes Regulations focuses on relationships. This states that service users should be assisted to “develop and maintain intimate personal relationships with people of their choice” and that “information and specialist guidance are provided to help the service user make decisions”.

The staff team at the home would benefit from the expertise of their local community learning disabilities team (CLDT) which could give advice on developing such policies from a multidisciplinary perspective. The CLDT could also support the staff team to follow a “consent framework” and develop risk assessments and management strategies.

David is considered capable of consenting to perform sexual acts with Bryan. The home needs to document the way in which they have arrived at this decision and use the Mental Capacity Act 2005 to inform its practice. This could include calling on an independent mental capacity advocate to work with David to establish his wishes.

Once capacity to consent has been verified this should be recorded accurately. Support should also be given to David and Bryan to determine their understanding of their relationship. For example, have they made a positive choice to enter a homosexual relationship, or is this the only outlet they have to express their sexuality?

David and Bryan also need advice about how to conduct their relationship, for example doing so in the privacy of their own rooms. They would each benefit from having one-to-one support to explore these issues. This could be provided by a specialist sexual therapist, nurse or psychologist.

Regarding David’s “excessive” masturbation, it may be that this is purely for pleasure and he is responding to the hormone levels of a 19-year-old. If so, he needs to be given advice so that he can develop an understanding of suitable places to masturbate. However, there could also be physical causes, possibly an infection is causing him discomfort and he is trying to relieve this. David should be supported to visit his doctor to have this ruled out.

The user view
A difficult situation with no easy answers, write volunteers with learning disabilities working with Voice UK. However things become much clearer if we put David first.

First, where is David’s advocate? If he doesn’t have one he needs one, and quickly. His advocate can support David to think through some of these big life decisions and support him to make choices about where he lives, with whom he has sex and what faith he believes in. An advocate would be someone outside this situation who has no interest other than supporting David to make choices about his life – not a relative, not someone from the home, not a social worker. Someone just for David.

From reading the case study it would seem David needs to have a much louder voice when it comes to the way decisions are made about him.

His mother also needs a lot of support. We are aware that parents are often dismissed as troublemakers and people who interfere with professional decisions. It might be that if his mother is saying she is at the end of her tether by Friday she might well be finding things difficult for the rest of the week too.

Clearly, her faith is deeply held. However, tough though this is to accept, it is David we are talking about here. Perhaps both of them could meet a counsellor either separately or together to help them think about their relationship and what David having a sexual life means for them both.

It might be the church has been misinformed. Someone from the home needs to explain the difficulties inherent in public protests of this nature. Has any of the protesters even thought about the damage being done to people living at the home either permanently or for respite care? Staff and residents need support to manage what is essentially a PR nightmare and an infringement of their privacy. A legal solution through injunctions sounds tempting but may well make things worse. The home’s HQ needs to understand this.

What other support is available during the week? Could David access direct payments and sort out some activities? Could David go to work? There are many schemes which support people with learning disabilities to find employment or education.

David is in an impossible situation. He will not want to upset his mother – it is likely that he just wants it all to stop. His mother also just wants it to stop and wants someone to support her to understand what is going on.

Everyone is in an emotionally charged situation and someone, or a group of people, needs to work out a plan quickly to calm things down. We wish the professionals well, and hope that David can find support to make decisions. And we hope that his mother finds the peace she deserves.

● This response was written by people with learning disabilities and their supporters who are volunteers at Voice UK, a national learning disability charity. Because of the sensitive nature of this case they have asked to remain anonymous.

● The names of service users have been changed

Further information
A Life Like Any Other


This article appeared in the 31 May issue of the magazine, under the headline “When a leap of faith is needed”