Sexuality and Personal Relationships

1. Introduction

Every adult has a right to develop a range of relationships, explore their sexuality and enter into consenting sexual relationships of their own choice (see Section 6, Consent). This is regardless of any issue including their age, ability or sexuality. Some adults with care and support needs can make  and maintain relationships without help, but others may need staff support, including creating opportunities to socialise. It is important that support is given to adults to develop consenting relationships as appropriate, whilst at the same time protecting them from exploitation or abuse.

Sexuality and personal relationships can be a complex legal and ethical area, This is an area which is normally a private for most people, but in cases where statutory agencies and the legal system are involved they may need to influence this area of peoples lives. It is important that any intervention is carefully considered and discussed with the adult, their family and involved professionals before being implemented sensitively. This is vital to ensure the dignity and rights of the adult are respected.

2. Rights and Responsibilities of Adults who use Services

Adults who use services have the right to make choices in relation to their sexuality. Staff members, therefore, must understand that all adults with mental capacity have the right to:

• privacy;
• have and enjoy a personal relationship;
• take risks and make mistakes in personal relationships;
• express sexual need, appropriately, if they wish;
• receive education about relationships, sex and sexuality, counselling and sexually transmitted diseases, contraception and safer sex education and have the opportunity to discuss any issues they so wish;
• be sexually active;
• marry or cohabit;
• make an informed choice about whether or not to have children;
• not be exploited, abused or subjected to degrading treatment.

Adults must also be supported by staff to understand that, as well as having rights as outlined above, they also have certain responsibilities such as:

• to respect other people views and feelings;
• not to break the law;
• not to impose their own personal views of sexuality on other people;
• not to coerce or exploit others more vulnerable than themselves.

3. Staff Roles and Responsibilities

Relationships, sexuality and sexual health training will be made available to staff, to ensure they feel competent and comfortable to address such issues in the context of their role. This may include receiving external support, advice and guidance as appropriate.

The amount and level of training required by staff will be dependent on the nature of the service and the demographics of the adults receiving interventions for their care and support needs.

All decisions on interventions in relation to an adult’s sexual relationships and sexuality should always be discussed within the multi-disciplinary team, in conjunction with the adult and their family as appropriate. Staff should not intervene alone in such issues. Assisting a person with a learning disability to masturbate for example, could constitute a criminal offence of indecent assault.

Current or ex members of staff must not have a sexual and / or personal relationship with any adult who uses the service (see Allegations against People in a Position of Trust).

4. Recording

These important decisions and discussions should be fully recorded on the adults file including any risks identified and actions to mitigate these

The adult’s care and support plan should detail the level and type of support they user may need in order for them to develop and maintain friendships and relationship, such as travel arrangements, access and use of the telephone and internet for example.

Keyworkers should assist service users to maintain a diary of family and friends’ birthdays and other special events, and support them to send cards if they choose to.

Staff should always be mindful that they have a duty of care to ensure adults who use the service remain safe and free from exploitation and abuse.

5. Personal Relationships and Friendships

Adults should be given opportunities to develop and maintain personal relationships, should they so wish. Staff should enable them to develop their social networks to encourage the opportunity for meeting others, to gain self-confidence and to form new friendships and relationships.

6. Consent

See Mental Capacity

Every adult has the right to make their own decisions and must be assumed to have capacity to do so, unless it is proved otherwise.

As mental capacity is deemed to be decision specific, an assessment of someone’s capacity must be based on the actual decision to be taken at the time it needs to be taken.

Where one or both people who develop a sexual relationship have care and support needs which may impact on their mental capacity, for example a learning disability or early stage dementia, the multi-disciplinary team – in close consultation with the adult / couple – should determine they are both able to and do consent to the relationship and that there is no evidence of exploitation.

In cases where it is difficult to establish their capacity to consent, the multi-disciplinary team must assess the risks to the individuals as well as their rights.

During any discussion the adults must be fully involved, their views sought and their potential for decision making maximised. This may include the use of advocates and different communication tools, and meeting in a place of their choosing. All decisions reached by the couple (or on their behalf) must be fully documented within their care and support plans (see Section 4, Recording).

7. Education

Adults with care and support needs who are likely to enter into relationships, particularly those with mental capacity issues, need to have effective education from suitably trained professionals – agreed by the multi-disciplinary team – regarding sexuality and personal relationships in order to:

• reduce their vulnerability to sexual abuse;
• decrease the likelihood of them expressing any inappropriate sexual behaviour; and
• enable the development of appropriate relationships.

Training may also include a wide range of issues related to:

• friendships and sexual relationships;
• families, marriage, the human body, menstruation, contraception, masturbation;
• sexual intercourse, pregnancy, childbirth, HIV / AIDS and other sexually transmitted diseases, homosexuality, protection from sexual abuse.

Training can be delivered on either a one to one basis, in a group or both.

Staff should not offer advice or guidance in this area, unless they are trained to do so.

8. Sexual Abuse / Sexual Harassment

Sexual abuse includes rape, indecent exposure, sexual harassment, inappropriate looking or touching, sexual teasing or innuendo, sexual photography, subjection to pornography or witnessing sexual acts, indecent exposure and sexual assault or sexual acts to which the adult has not consented or was pressured into consenting (Care and Support Statutory Guidance, Department of Health and Social Care). Some of these are sexual offences – including rape, harassment and behaviours to which there should be an immediate response from the service.

Sexual harassment can involve any behaviour, verbal or physical of a sexual nature that is repeated and unwanted, causes, humiliation, offence or distress.

It is important to recognise that anyone can be a perpetrator; they may be another adult who uses services or someone in a position of trust and / or power, such as a member of staff (see Allegations against People in Positions of Trust).

If at any time any person suspects an adult is being abused in any way, see Safeguarding Adults from Abuse and Neglect, which informs staff of action they should take to safeguard the adult and any others involved. Staff should also consult their local Safeguarding Adults Board procedures on what actions to take when abuse is suspected, alleged or disclosed.

Adults with care and support needs who are victims of sexual abuse or harassment have the same rights to redress within the law as other members of the public and should also be supported to access counselling and therapeutic services available for victims of sexual abuse.

Adults who use services but who also perpetrate sexual abuse still have a right to care and support. It may be that they are not prosecuted for their offences or may receive non-custodial sentences. This will be a decision for the police in conjunction with the multi-disciplinary team and should be discussed with the victim, the perpetrator and their families.

Via the multi-disciplinary team, staff should ensure the perpetrator receives appropriate interventions and services to address their care and support needs, and their offending or inappropriate behaviour.