Vulnerable people's sexual health

Who is a vulnerable person? It's a person who is in receipt of, may be in need of, community care services by reason of mental or other disability, age or illness, and who may be unable to take care of or protect themself from significant harm or exploitation.

This covers a lot of people - many of whom have a learning disability - a term which again, covers a lot of different types of disability. For instance, Down's syndrome, cerebral palsy, Aspergers, autism, dyslexia, foetal alcohol syndrome, fragile X syndrome, Tourettes, and Prader-Willi are just a few you may have heard of. Each person and syndrome has different characteristics and we must remember to treat vulnerable people as unique individuals whose needs may not fit into a check-list or standardised guidelines. There is more recognition today of the human right of people with a learning disability to form relationships and express their sexuality, as stipulated in Article 8 of the Human Rights Act (Liberty, 2009). It is a qualified right which means that the right to respect in these areas can sometimes be infringed.

View the video 'Alice's story' and think about how you might respond if you were the member of nursing staff involved in this situation. To read a transcript of the audio in this video, select the link Alice's story (Word 15KB).

How you can help

In health care we always need to keep people's human rights in mind. When supporting vulnerable people, we need to be particularly mindful that we pay due regard to:

• Bodily integrity - a breach of human rights may occur if someone is forced to have medical treatment or is forcibly restrained.
• Personal autonomy - our right to make our own decisions.
• Sexuality - a right to express ourselves as a sexual being.
• Personal identity - for instance the new gender of a transgendered person - if this is not recognised it breaches Article 8.
• Personal information - holding, using or disclosing personal information about someone is covered in Article 8.

People with learning disabilities are often stereotyped and this can affect their sexual wellbeing. For instance, they are described as always remaining childlike, asexual and unable to understand their sexual desires or control their sex drive - they are potential deviants, don't encourage them with sex education! However, people with learning disabilities have the same sexual needs and desires as those without disabilities, and 60 to 90% of young people want to marry and have children in the future. At the same time they can be vulnerable to abuse or exploitation.

How can I support the sexual health needs of a person with a learning disability?

In Alice's case, she maybe presenting with a health problem associated with a urine infection or sexual activity. She may go on to need an intimate examination, or may, at a later date, be invited for a smear. Here are some of the things that are essential or helpful:

• Every health care worker should have child protection and vulnerable person training - is your knowledge up to date?
• Find out who the support worker is - or the person who knows your patient or client well. He or she may be able to provide important relevant information, e.g. about capacity to consent, how to communicate effectively. In Alice's case, provide more information about the nature of her relationship with 'Jimmy'.
• Find out what words this person uses for parts of their body - speak the same language, and assess their communication skills - check their glasses or hearing aid are available if needed.
• Keep explanations simple and repeat key messages.
• How friendly does the clinical environment you work in appear to a person with a learning or other disability? Think about the need for privacy, toilet facilities and large, bright signs. But minimise distractions during the consultation, e.g. interruptions.
• Provide information such as easy to read leaflets with pictures and large print, and an accompanying leaflet for carers.
• Other audio or visual resources will aid teaching or explaining things - use diagrams, photos, anatomical models.
• Do appointment times suit the patient/client? Would a double appointment prevent rushing and allow for communication which needs to be at a pace to suit the client?
• Do policies and protocols reflect the needs of people with learning disabilities or other special needs?