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The attitudes of staff toward the sexuality of adults with learning disabilities
within a medium-secure hospital within the United Kingdom were examined
using qualitative research methods. Four interviews were conducted with staff
members of both sexes from differing occupations. Interviews were transcribed
and analyzed using a method adapted from Worthen and McNeill (1996). The
analysis revealed that staff members generally held liberal attitudes with re-
spect to the sexuality and masturbation. However, with respect to sexual inter-
course, homosexual relationships, and the involvement of adults with learning
disabilities in decisions regarding their own sexuality, less liberal attitudes
were detected. Concern was also noted with respect to the attitudes of female
staff members towards the sexuality of adults with learning disabilities who
have committed sexual offences. Training issues were also identified and impli-
cations for the service were discussed.
KEY WORDS: sexuality; attitudes; learning disabilities; secure unit; qualitative methods; sexual
offending.
INTRODUCTION
METHOD
Participants
1.49). Staff included reported that they had been working in the field of learn-
ing disabilities for a mean of 9.5 years (SD ⳱ 5.5). Those recruited were em-
ployed as a consultant psychiatrist, senior care-worker, advocacy worker, and a
domestic staff member. The psychiatrist and domestic staff member were male,
while the senior care-worker and advocacy worker were female.
Initially, the names of all staff employed by the medium-secure unit were
collected along with their job titles. These staff were sorted into four groups, 1)
professional, 2) care-worker, 3) non-clinical staff, and 4) support services. One
name from each profession was then drawn at random. These persons were then
approached and asked to participate in the study. Two of the people initially
approached declined to participate. Two further names were then drawn at ran-
dom and these people were asked to participate.
Each participant who consented to participate completed a demographic
questionnaire, which asked for details regarding their age, sex, martial status,
qualifications, and years working within the learning disabilities sector. Follow-
ing this, each participant completed a 40–60 minute audio-recorded semi-struc-
tured interview developed by the first author. Following the interview, partici-
pants were debriefed as to the purpose of the study. The researchers, following
a review of the current literature, developed the semi-structured interview.
Topics or themes were grouped into eight sections, and questions were used as
prompts (Table 1). Participants were told that there were no right or wrong
answers and that the interview will not be used to judge the participant in any
manner.
All interviews were then transcribed, and analyzed according to the mod-
ified method described by Worthen and McNeil (1996; Table 2), which was
based on the methods described by Giorgi (1985, 1989). Briefly, transcribed
data were broken down into individual meaning units to facilitate analysis.
Each participant’s transcript was examined until themes emerged about how the
participants felt with respect to the sexuality in people with learning disabilities.
Following this, group analysis was completed which allowed further findings to
emerge with respect to the attitudes of participants concerning the sexuality of
people with learning disabilities.
The analysis revealed the existence of ten themes at the level of the gen-
eral meaning structure. These results indicated that overall staff appeared to
Staff Attitudes Toward Sexuality of Adults with Learning Disabilities 141
Table 1. The Eight Sections and Questions that Formed the Semistructured Interview
Theme Questions
1. Understanding of the term “sexuality.” —What does the word “sexuality” mean to
you?
2. General attitude towards sexuality and —What do you think about sexuality with re-
people with learning disabilities. spect to people with learning disabilities?
—What are your own views on people with
learning disabilities making decisions about
their own sexuality?
3. Differences the sexuality of people with —Do you think the sexuality of people with
learning disabilities. learning disabilities is different from people
without learning disabilities?
—In what way?
4. Expression of sexuality in people with —What are your views on patients expressing
learning disabilities. their sexuality?
—Should patients be allowed to: a) mastur-
bate, b) have relationships (homosexual and
heterosexual), c) have sexual intercourse
(homosexual and heterosexual), where
should they do this? d) have access to con-
traception, e) have children, and f ) have ac-
cess to pornography?
—Is there any aspect of their sexuality that
you feel they should not be allowed to ex-
press?
5. Staff understanding of patient’s sexuality. —What do you think patients understand about
their own sexuality?
—Should they be taught/advised about issues
regarding their own sexuality?
—What should or shouldn’t they be taught?
—Whose job is it to do this?
6. Staff experience of dealing with sexuality —Have you had to deal with the sexuality is-
issues. sues of patients whilst you have been work-
ing here?
—How did you deal with this?
—How did you feel about discussing or deal-
ing with this?
—What influenced how you dealt with this?
—Is there anything that would have helped
you in this/these situation(s)?
—How often would you say you have to deal
with sexuality issues in your work here?
7. Staff training. —Have you attended training on sexuality?
—Did you find this useful?
—What issues do you think would be useful
or helpful to cover on training regarding
sexuality issues?
—What are your ideas on how best to do this?
8. Awareness of hospital policy on sexuality —Are you aware of hospital policy on sexu-
and relationships. ality and relationships?
—Does this influence how you deal with these
issues?
142 Yool, Langdon, and Garner
Table 2. Worthen and McNeill’s (1996) a) Seven-Step Qualitative Model for Individual Analysis
and b) Four-Step Model for Group Analysis
endorse a liberal attitude regarding the need of sexuality for all people, includ-
ing those with a learning disability. Additionally, a liberal oriented view was
detected with respect to the recognition of masturbation as an expression of
sexuality, and the privacy that masturbation warrants.
These findings appear consistent with the findings of previous studies
Staff Attitudes Toward Sexuality of Adults with Learning Disabilities 143
where attitudes toward the sexuality of people with learning disabilities were
reported as shifting towards the liberal (Adams et al., 1992; Holmes, 1998;
Murray & Minnes, 1994; Toomey, 1989).
However, a less liberal attitude was detected with respect to sexual rela-
tionships between clients. Also, a less liberal attitude was evident concerning
the inclusion of clients in the decision-making process with respect to decisions
about their sexuality, and homosexual relationships. The overall view that sex-
ual relationships between clients were not permitted was detected. This view, to
some degree, may be associated with the medium-secure context in which staff
work, and the population of sex offenders which are resident within the unit.
Each of the ten themes are reported and discussed below.
These results are suggestive of a general liberal view toward the sexuality
of all people and may be a reflection of the changes that have taken place in
societal attitudes toward sexuality.
Three factors were detected through the analysis which impact the expres-
sion of sexuality. These factors were, a) the presence of a population of sex
offenders within the secure unit, b) the ability of adults with learning disabil-
ities to provide consent to engage in a sexual relationships, and c) risk of and
vulnerability to exploitation.
This theme was evident from the following comments:
Their options are limited because we can’t have people having ultimate relations be-
cause of all the difficulties it would cause with respect to consent. We also can’t have
people who have offended sexually attacking vulnerable people.
Permitting sexual relations in a medium-secure environment is problematic because
it is difficult to allow sex-offenders to have a consenting relationship without disclosing
their past.
The most important thing is the fact that we do have a large number of sex of-
fenders and be it same sex or opposite sex or whatever, there’s got to be those things
144 Yool, Langdon, and Garner
about consent. Again, I would say that some of our patients would have problems in
understanding appropriate consent and in giving valid consent.
Another thing that gives me concern really is these people are generally quite a
vulnerable group of people and a number of them have been in exploitative relation-
ships, be it sexual, financial or even parental.
These results suggest that the participants are aware of the difficulties that
impaired sociosexual skills may have upon the appropriate expression of sexu-
ality. However, the participants did not suggest that these difficulties may be
tackled to some degree with appropriate treatments, such as sex education pro-
grams.
This theme suggests that staff may have some insight into the impact a
learning disability might have on the decision making process and some recog-
nition of the importance of advocacy was detected. However, including an indi-
vidual in the decision making process is very important to help ensure that the
individual’s view is expressed correctly and rights are not compromised un-
justly.
Staff Attitudes Toward Sexuality of Adults with Learning Disabilities 145
This theme appears to contradict Theme Four. If staff endorse the belief
that people with learning disabilities understand their own sexuality in a manner
similar to that of non-learning disabled adults, then excluding them from deci-
sions about their own sexuality, dependent upon their ability, seems illogical.
This result has been previously suggested (Coleman & Murphy, 1980), and
was evident from the following interview extracts.
Yes, not over the dinner table but of course they must be allowed to masturbate.
Yes, and they must be given privacy to do this; masturbation has to be done in a client’s
own personal private space and not in communal areas.
Theme Nine: Nonclinical Staff Members Were Unsure About Whether It Was
Important for Them to Attend Training Regarding Sexuality
None of the participants had attended training on sexuality and all were
not aware of the hospital policy regarding sexuality and relationships.
Participants indicated that they were not clear about whether they should
attend training sessions on sexuality as noted through the following statements:
I think if [the hospital] felt it was important to attend sexuality training then they would
have invited us along.
Training should cover the rules and regulations we need to abide by. Training should get
across the fact that sexuality is a common need and nobody should be excluded from it.
Training is important for teaching staff how to help clients’ express their sexuality ap-
propriately.
This result is important and suggests that staff have some understanding of
the areas that need to be addressed through a training program.
The only apparent difference between participants was that female partici-
pants spoke about the importance of acknowledging their feelings about sex
offenders who have abused children, especially if they had children of their
own. This is a very important issue, and highlights the importance of ensuring
the provision of psychological support for staff who have to work with clients
who have committed sexual offences.
With respect to clinical vs. non-clinical staff, the only difference detected
was that non-clinical staff were unsure about having to attend training on issues
of sexuality. This may reflect an organizational opinion that non-clinical staff
may not have to encounter sexuality issues through the course of their duties.
However, one non-clinical staff member reported during the interviews that a
client had kissed them while they were carrying out their duties.
Previous research has suggested that professionals as opposed to direct
care staff may have more positive attitudes toward the expression of sexuality
by those with learning disabilities (Murray & Minnes, 1994). This finding was
not replicated as part of this study. The main reason for this is that the study did
not set out to investigate this finding further, but instead, was interested in
examining the difference between clinical and non-clinical members of staff.
Selection of Staff
Staff Training
The staff interviewed during the current study expressed a collective opin-
ion as to what should be covered in training programs on the sexuality of adults
with learning disabilities. These included policies and procedures, the rights of
learning disabled persons to express their sexuality, and teaching staff to facili-
tate and support the appropriate expression of sexuality. These findings are
consistent with the training program suggested by others where policies, train-
ing and guidelines are linked (Harvey, 1983). The current results also suggest
that training regarding homosexual relationships and sexual behavior beyond
that of masturbation would be appropriate.
One of the most remarkable findings of the current study was that none of
the participants were familiar with the local policy regarding the expression of
sexuality and relationships. This result is of concern as the possibility that staff
may act in such as manner as to contravene existing policy exists. Clearly, there
is a need to ensure that staff have a working knowledge of policies and pro-
cedures with respect to sexuality and relationships. Perhaps the most effective
method to ensure this is through a staff training program.
Future Research
Previous research has indicated that staff attitudes may have an impact
upon the outcome of sociosexual training programs (Chapman & Pitceathly,
1984; Mitchell et al., 1978). Sex education forms a part of sex-offender treat-
ment programs for people with learning disabilities (e.g., Rose et al., 2002), and
these programs may be carried out within a medium secure context. Given the
potential impact that working with sex offenders may have upon staff members,
and the relationship between staff attitudes and sociosexual training programs,
further investigation of the possible impact that staff attitudes may have upon
sociosexual training programs, or sex offender treatment groups, within a me-
dium-secure context, is warranted.
CONCLUSION
Overall, the results of the current study suggest that staff held liberal atti-
tudes with respect to the sexuality and masturbation. However, less liberal atti-
Staff Attitudes Toward Sexuality of Adults with Learning Disabilities 149
tudes, with respect to sexual intercourse, homosexual relationships, and the in-
volvement of adults with learning disabilities in decisions regarding their own
sexuality, were detected. Staff who are female also raised concern with having
to work with sex offenders. Additionally, staff were not aware of hospital policy
with regard to sexuality and relationships amongst clients. The findings have
implications for staff selection, staff training, and decision making with respect
to issues concerning the sexuality of clients.
ACKNOWLEDGMENTS
We would like to thank the staff who participated in this study. No respon-
sibility for actions taken as a result of information contained within this docu-
ment is accepted by the authors, The University of East Anglia, or Partnerships
in Care Ltd.
REFERENCES
Adams, G., Tallon, R.J., Alcorn, D.A: Attitudes towards the sexuality of mentally retarded and non-
retarded persons. Educ Train Ment Ret, 17: 07–312, 1992.
Brantlinger, E.A.: Measuring variation and change in attitudes of residential care staff towards the
sexuality of mentally retarded persons. Men Retard, 21: 17–22, 1983.
Brantlinger, E. A.: Influencing staff attitudes: In Mental Handicap and Sexuality: Issues and Per-
spectives, A Craft (ed). Kent: Costello, 1987.
Cambridge, P.: A practice and policy agenda for HIV and learning disabilities. BJLD, 22: 134–
139,1994.
Chapman, J. W., Pitceathly, A. S.: Sexuality and mentally handicapped people: Issues of sex educa-
tion, marriage, parenthood, and care attitudes. Ment Retard, 21: 17–22, 1984.
Coleman, E.M., Murphy, W.D.: A survey of sexual attitudes and sex education programmes among
facilities for the mentally retarded. Appl Res Ment Retard, 1: 269–276, 1980.
Craft, A.: Mental Handicap and Sexuality: Issues and Perspectives. Kent, Costello, 1987.
Giorgi, A.: Phenomenology and psychological research Pittsburgh, Duquesne University Press,
1985.
Giorgi, A.: One type of analysis of descriptive data: Procedures involved in following a scientific
phenomenological method. Methods, 1: 39–61, 1989.
Haavik, S. F., Menninger, K. A.: Sexuality, Law and the Developmentally Disabled Persons. Bal-
timore, Brooks Publishing, 1981.
Harvey, R. S.: The sexual rights of mentally handicapped people. A Brit Inst Ment Han, 11: 123–
125, 1983.
Holmes, M.: The evaluation of staff attitudes towards the sexual activity of people with learning
disabilities. Brit J Occu Ther, 61: 111–115, 1998.
McKinnon, K., Carey, M. P., Cournos, X.: Research on HIV, AIDS and severe mental illness:
Recommendations from the NIMH National Conference. Clin Psychol Rev, 17: 327–331,
1997.
Mitchell, L., Doctor, R. M., & Butler, D. C.: Attitudes of caretakers towards the sexual behaviour of
mentally retarded persons. Am J Ment Def, 83: 289–296, 1978.
Murray, J. J., & Minnes, P. M.: Staff attitudes towards the sexuality of persons with intellectual
disability. Aust NZ J Dev Disabil, 19: 45–52, 1994.
150 Yool, Langdon, and Garner
Rose, J., Jenkins, R., O’Connor, C., Jones, C., Felce, D.: A group treatment for men with intellec-
tual disabilities who sexually offend or abuse. J Appl Res Intellect, 15: 138–150, 2002.
Saunders, E. J.: Staff members’ attitudes towards the sexual behaviour of mentally retarded resi-
dents. Am J of Ment Def, 84: 206–208, 1979.
Toomey, J. F.: Final report of the Bawnmore Personal Development Programme. Res Dev Disabil,
14: 129–144, 1989.
Worthen, V., McNeill, B.: A Phenomenological investigation of “good” supervision events. J of
Couns Psychol, 43: 25–34, 1996.