On the back of the recent SBS Insight program, I thought I’d open up a discussion about supporting people with disability and their decisions around sex. 

We know that everyone has the same right to sexual expression, activity and fulfilment. And we know that under the person-centred model, we must support everyone’s right to choice and control over every aspect of their lives. But talking to someone about sex and supporting decisions about sex can be a challenging or confronting aspect of a disability practitioner’s job.

As a worker at the frontline, you will likely have your own beliefs and ethics around sex and sexuality based on your own experiences and who you are as a person. There may also be legal considerations or obstacles to supporting your client’s decisions which can add another layer of complexity. The topic of sex is further complicated by the fact that it’s generally a private matter. For example, we don’t necessarily discuss all details, logistics, needs or fantasies with our family and friends, let alone in the workplace with peers, colleagues or clients.

So how do we ensure we are professional, appropriate and respectful when supporting the sexual needs and decisions of people with disability?

In NSW, Family and Community Services’ (FACS) Ageing, Disability and Home Care’s (ADHC) Clinical Innovation and Governance team (CIG) is delivering its Core Standards program which provides training and education to disability practitioners. Val Lehmann-Monck is one of the CIG team. A practicing occupational therapist, she has a wealth of experience and knowledge around supporting the rights of people with disability to live a sexually fulfilling life.

“First and foremost it is essential to acknowledge the key principles of the Disability Inclusion Act and the United Nations Conventions which state that a person with disability has the right to make choices, and that we all must respect that right,” says Val.

“But I appreciate that for individuals working in the sector, it might not be that easy. I can think of many reasons why a support worker or allied health professional might find it difficult to broach the subject of sex. They may not feel they have the necessary expertise or training, they may be conflicted because of their religious or cultural beliefs, they may be embarrassed or they may feel, like others in society, that people with disability might not actually have sexual needs or desires,” she continues.

“There are many more reasons but one of the most common is that they are unaware of their employer’s policy around sex and sexuality and therefore can be reluctant to even open up the subject for discussion for fear of opening a ‘can of worms”.

One of many options for some people with disability is to choose to see a sex worker. Rachel Wotton is a sex worker with extensive experience working with people with disability and is on the management committee of Touching Base. Touching Base developed out of the need to assist people with disability and sex workers to connect with each other, focusing on access, discrimination, human rights, legal issues and the attitudinal barriers that these two marginalised communities can face. It also delivers education and training to service providers and carers. 

Rachel agrees with Val’s view that clarity around a support worker’s role in matters of sex and sexuality and clients must come from their employers.

“Policies around peoples’ rights should be clear and consistent at an organisational level. A support worker should keep their own morals and beliefs at the door if they conflict with that worker’s role to create a safe and supportive environment for people with disability to be independent and individual adults,” says Rachel.

From her perspective as a sex worker with extensive knowledge of the unique and varied aspects of a support worker’s role, Rachel states training is the key. “Support workers need training around procedures and awareness when it comes to supporting clients in matters of sex and sexuality, and this training should occur during the induction process.”

Rachel stresses the importance of consent, “it’s the foundation of everything. And communication is the key to establishing consent – verbal or non-verbal. If the correct permissions around sex do not exist between the person with disability and their support worker they may not approach the subject at all. The correct training will help establish the proper communication.”

“It’s quite simple; when considering a client’s sexual needs, it’s always best to ask them – what do they think, what do they want?” Rachel states.

The rewards for using your training to support your client’s goals around sex and sexuality can be enormous. Val recalls that in her training to be an occupational therapist sexuality was covered over the years as an important activity of daily living, as well as a big part of everyone's being.  So much so that it was written into the models that guide therapy practice. 

"As a new and young therapist I was asked to run an accommodation service for young adults with intellectual disability just leaving home. Sexuality was par for the course and didn't faze me a bit due to the confidence I had from my undergraduate training. I remember a great example of local community support when a bank manager rang me and asked to meet with me.  It transpired that one of the residents, a very butch looking young man, John* had a love of wearing expensive, beautiful ladies underwear and tried it on and bought it from the local lingerie boutique. When he couldn't afford it he would ask his bank manager next door to the shop to explain to the sales ladies when John would have saved up enough to buy it on term deposit.  No one seemed to find this challenging, but eventually the manager asked me to take over the budgeting role.”

“I tried to find less expensive options for John, including ‘opportunity shopping’, but he really liked the top of the range clothing.  Sadly, later John had some self-harming behaviours around his sexual identity and again I took this in my stride and called in a male psychology colleague with a good interest and knowledge of sexuality to support John. All went well, John felt understood and accepted and no one felt embarrassed or threatened”.

“The most important reason for including sexuality in a practitioner’s work is because it may be a priority for the person with disability they support,” concludes Val.

So sex and sexuality may well be the ‘last taboo’ for the sector but it is a topic we need to get comfortable with, and quickly. If not, an essential part of life most of us take for granted will be out of the reach of people with disability.

In future blogs and news stories, NDP will continue to explore issues of sex and sexuality involving your work as a disability professional including training and policies, communication, legislation around accessing the services of sex workers, sexual identity, consent and abuse and neglect, behaviour support and reproductive rights.

* Name changed to protect identity

Useful Links:

Family Planning NSW
ADHC Core Standards program – Sex and Sexuality
Touching Base
Scarlet Road
Insight program - SBS
Sex work laws around Australia – from SBS site
United Nations Convention
Disability Inclusion Act 2014