It is generally acknowledged that people with learning disabilities are at increased risk of abuse and the author notes that this may be due both to the environments within they live and personal characteristics that may heighten their risk. However, studies into this area are beset by a number of methodological challenges including the use of different definitions of abuse and under-reporting making comparison between studies challenging and leading to differing levels of incidence and prevalence.
This is a retrospective study in which all referrals to a psychology service between September 2009 and September 2011 were reviewed. All psychologists working within the service were presented with a list of clients they had supported during this period and asked to identify (to the best of their knowledge) which of them had experienced abuse. To be included in the study, details of the abuse needed either to be recorded on the clients file or to have been disclosed to the psychologist. No requirement was stipulated requiring the abuse to have been ‘proven’ and/ or the perpetrator to have been prosecuted.
Having identified clients meeting the inclusion criteria the psychologists were then asked to complete a ‘continuation sheet’ on which they were asked to record the category of abuse (for example psychological or physical), whether this had been a one off or recurring event, and some details regarding the gender and relationship of the perpetrator to the client. These forms were then analysed by the researcher.
During the study period 695 clients were referred to the psychology service (397 men and 298 women) and of these 25% (n = 175) had experienced some form of abuse.
- Fifty seven per cent (n= 100) of those who had experienced abuse had experienced one episode
- 33% (n= 57) had experienced two
- 10% (n = 18) had experienced three.
No clients had experienced more than three episodes and in total 268 episodes of abuse were recorded.
Of the 175 people who had experienced abuse
- 46% (n = 81) were men and 54% (n= 94) were women.
- Twenty three per cent (n = 40) had been referred to the service following abuse
- 76% (n = 133) disclosed abuse to their psychologist.
The most common form of abuse recorded was
- emotional at 28% (n= 74),
- sexual at 25% (n = 66),
- physical at 21% (n = 56),
- neglect at 12% (n = 33),
- financial at 5% (n=14)
- institutional at 5% (n = 13)
- bullying at 4% (n = 12).
The male clients were abused by both men and women but were most likely to be abused by both men and women working together.
In contrast women with learning disabilities were most likely to be abused by men.
The relationship of the perpetrator to the client was most likely to be
- family member (53% n=160),
- staff (13% n = 33),
- acquaintance (11% n= 29),
- another service user (5% n=15),
- their partner (5% n= 14)
- a stranger (4% n = 4%).
Overall women with learning disabilities were significantly more likely to be abused than men with learning disabilities.
The author of the study recognises the limitations of the study particularly the fact that the sample was a clinical sample (referred for therapy) rather than a population sample and therefore a higher incidence of abuse might be expected. Also any retrospective study is reliant upon what is written in case files and/ or the memory of those involved.
The need to directly ask people with learning disabilities about their experiences of abuse and the need for prospective studies is therefore noted.
In addition most of the clients referred would be considered to have mild or moderate learning disabilities whilst those with severe/ profound learning disabilities are also known to be at heightened risk of abuse.
Finally it is noted that often different forms of abuse co-exist but within this study they were categorised separately. However, despite these limitations the findings regarding the incidence of abuse and the identity of perpetrators broadly reflect the wider literature.
The researchers point to their findings that although the number of women who abuse is relatively low this study has highlighted that women do commit abuse. In addition it is of interest that whilst many people were referred to the psychology service for other reasons they disclosed abuse in the course of their therapy. The author therefore recommends that psychologists should routinely screen for abuse.
There are some methodological limitations to this study but these are recognised by the author and the fact that the findings broadly reflect other studies strengthens the overall evidence that is growing in relation to both the nature and extent of abuse experienced by people with learning disabilities.
Its main contribution, however, lies firstly in the fact that it provides evidence that women can be perpetrators of abuse thus challenging the commonly held stereotype of abusers as being predominantly male.
This has important implications as unfortunately all too often people with learning disabilities are not believed when they disclose abuse and there is the potential for this disbelief to be greater when the alleged perpetrator is female (due to predominant social views of women as caring).
This then links to the second key issue to emerge from the study namely that known abuse is probably only the tip of the iceberg – the majority of clients were referred for therapy for reasons other than abuse and yet disclosed abuse in the course of therapy.
This suggests that we may still not be considering abuse as a potential trigger for psychological distress and behavioural change.
This study reminds us to be alert to the possibility of abuse and the recommendation that we routinely screen for abuse may be helpful – but only if we then have the therapeutic services available to provide the required support.
Olivia Hewitt, (2014) “A survey of experiences of abuse”, Tizard Learning Disability Review, Vol. 19 Iss: 3, pp.122 – 129 [abstract]