Sexual assistance for disabled people

Care workers for people with a mental disability are regularly confronted with (not always verbal) questions, needs and feelings in the sexual field from people with a mental disability. This is because:

• In spite of the nature of their disability, they often develop ‘normally’ into sexually adult persons with the accompanying needs and feelings in this area.
• Due to the nature of their disability, they are (often) unable to marry, but still look for ways (of escape) in order to give expression to their sexual needs and feelings.
• With personal care and guidance, actions (close) to the body (or: in the intimate area) are regularly carried out (= functional intimacy).

In society as well as in healthcare, sexuality has been increasingly emerging from the taboo sphere. Instead of that, the questions, needs and feelings of those with a mental disability are being increasingly considered as part of the total package of care or guidance demands.

No difference

The Bible makes no difference between people with or without a handicap. The Biblical vision on intimacy and sexuality applies just as much for people with a handicap; even if this results in restrictions and/or unfulfillable desires. Although it is often not easy for a carer to deal with this in a ‘relaxed’ manner, it does not mean that we may just ignore their questions, feelings and/or needs in this field. Here are some suggestions for giving guidance in the sexual experience of people with a mental disability:

Respect the physical privacy of people with a disability and help them to defend that.
Try to ensure that when giving care, functional intimacy from one or both parties does not change into sexual harassment or sexual involvement (when a ‘spontaneous’ hug or touch develops a sexual undertone). On the other hand, beware of being too constrained. People with a low mental level often have hardly any realisation of being male or female and contacts are mainly through body language. Constrained reluctance with regard to physical contact is a serious deprivation for them.

Respect the spatial privacy of people with a mental disability and help them to defend that.

These people must be able to be themselves as much as possible within the confines of their private areas (bedroom, shower, toilet); also as far as their physical privacy experience is concerned. So never enter such spaces without knocking, and teach him or her (make sure) that the shower or toilet are locked.

Be aware of sexual stimuli

Avoid your choice of clothes or behaviour from being unnecessarily stimulating for them. In consultation with him or her or their (legal) representative, keep sexually stimulating matters (images, articles etc.) away from them.

Try to discover the underlying question

Do not ignore sexual questions, needs or feelings of those with a mental disability, but try to find out the reason behind it. Examples: One of them says they want to marry, but she only wants to wear a nice dress like her sisters (in law) wore on their wedding day, and is not attracted to the other sex. Another says to want a relationship, but wants nothing more than attention, cosiness and/or acknowledgement. Yet another frequently masturbates, but does so out of boredom or frustration; by offering extra activities this behaviour can be reduced.

Make sexuality a topic for discussion

Do not make an unnecessary taboo of topics that are connected with the sexual experience of people with a mental disability. Timely information, tuned to his or her level and needs, can help prevent the client from being ‘taken by surprise’ and/or (as a result) starting to exhibit inappropriate behaviour due to his or her sexual development. Strengthen his or her self-esteem – he or she may be seen with his or her physical presence – but also encourage a 'healthy' sense of embarrassment. Positive self-esteem strengthens sexual resilience, helping to prevent situations involving abuse.

Communicate in an open manner towards parents or (legal) representatives, but beware of negation/evasive behaviour (‘No, our child doesn't do that.’). Respect as much as possible the physical or spatial privacy experience of people with a mental disability.

Act professionally

Be conscious of your professional responsibility, but also its limits. You are not always responsible for what you feel responsible for or for what others think you are responsible for! Important principles in this respect are the individual guidance targets and agreements in the care or guidance plan of the person entrusted to your care.
Do not blindly follow your own, personal feelings and emotions, but think and act rationally and objectively. Do not hesitate to let colleagues watch over your shoulder. Compare yourself with your peers (‘Do you think I tackle this issue properly?’). Name and discuss issues in a team (‘Would you like to consider this or that issue with me?’, ‘I need your advice for this or that.’). If the situation is a complex one, it may be sensible to engage other professionals, such as a remedial educationalist or a psychologist.