This review of the literature set out to summarise the current status of knowledge and clinical practice in the area of relationships and sexuality for people with learning disabilities, which the review authors describe as an area that is complex and challenging.
Services for people with learning disabilities have undergone a move towards personalisation, person-centred approaches and inclusion, but the authors suggest that despite this, there is little evidence of change in practice in relation to the area of relationships and sexual expression.
Reponses in published surveys of supporters and providers have shown development of a greater awareness of sexuality as a central part of personal identity, but this has not yet manifested itself in less restrictive or prohibitive attitudes in organisations.
Studies have reported that staff and managers have a fear of possible legal sanction and struggle with what they describe as ethical and moral conflicts. Where the views of people with learning disabilities have been reported, they confirm the view that despite small changes in some areas, the prevailing experience is one of restriction.
Training and educational programmes have been developed recently which challenge restrictive attitudes, but there has been little rigorous or systematic evaluation of their effectiveness in the literature, in terms of their capacity for enhancing knowledge or their impact on behaviour and capacity to make sexuality-related decisions.
The authors conclude that there remains a need for education of caregivers and for more discussion of the issues at a societal and policy level.
They suggest that self-advocacy in disability services provides a vehicle to enable greater opportunities for relationship experiences and to prevent undue risk of harm. They point out however that such self-advocacy requires organisational support which is the key challenge for service providers.
Relationships, sexuality and decision-making capacity in people with an intellectual disability, McGuire, B et al., in Current Opinion in Psychiatry, 24, 5, 398–402