Ways I have found to support clients with brain injury with sexual expression
I have worked in health and social care for the past 21 years, initially as a support worker, then as an occupational therapist for the past 17 years. I have worked with adults with learning disabilities, neurological impairments, and acquired brain injuries. The fact remains that the topic of sexual expression is generally not raised by health or social care workers.
My role for the past 10 years has been as a brain injury case manager assisting clients and their close ones with sourcing and coordinating services. As everyone knows the human brain is very complex. It has about 100 billion neurons (nerve cells) with trillions of connections between. When this amazing structure is damaged the way this affects the individual has many, many possibilities.
Some of my clients have become less inhibited and less concerned with safety as a result of their brain injury. With these people I have discussed and recommended contraception, and sometimes arranged for a support worker/PA to accompany them on outings to help to keep them safer.
Other clients become more passive as a result of brain injury. With some of these people I have worked with them, their families, and support workers on increasing their social contacts by attending courses, attending day services, going on holidays, taking part in work experience and voluntary work, and suggesting they try a dating website, or groups like Outsiders, a social, peer support and dating club, www.outsiders.org.uk.
One of my male clients is in his mid twenties, is a wheelchair user and needs support to initiate, plan and complete many tasks and activities. He is charming and has a sense of fun. He recently met a young woman at his day service, asked her out and they dated for a few months. His support worker drove them to places they wanted to go, gave them private time at my client’s home (he was within calling distance to attend to any needs), and helped my client plan and organise dates. This was my client’s first girlfriend and he really enjoyed having that relationship. I have never seen him so enthusiastic and talkative as during that time.
I do not think that health and social care workers readily ask clients about sexual expression. One way I have found to raise the topic is to use the Quality of Life after Brain Injury (QOLIBRI) questionnaire, www.qolibrinet.com. This asks how satisfied and how bothered the client is with various elements of their life. It specifically asks “How satisfied are you with your ability to feel affection towards others, for example your partner, family, friends?”, “How satisfied are you with your relationship with a partner or with not having a partner?”, and “How satisfied are you with your sex life?” amongst other questions. I have found this can be a good starting point for discussing intimate relationships and sexual expression. One of my male clients in his mid twenties opened up about how he had a girlfriend several years earlier and would like to have another girlfriend at some point. We discussed trying a dating website but he was not ready at that time. We had an open discussion about other options such as seeing a sex worker but this did not appeal to him at that time. Other clients I have worked with have readily told me they have seen sex workers and we have openly discussed this and how to select responsible sex workers (e.g. from TLC in the UK, Touching Base in Australia or a recommended escort agency or individual who specialises in disabled clients.). The TLC website offers advice for disabled clients, www.TLC-Trust.org.uk.
Some of my colleagues have discussed client situations with me when they or someone involved with the client has concerns about the client’s safety and wellbeing regarding their sexual expression as they know I have an interest in this area. We have discussed that the client is entitled to make decisions including unwise decisions just like everybody else when they have the mental capacity to make that particular decision. We have discussed ways to try to keep the client safer. We have discussed useful resources such as the Sexual Health and Disability Alliance www.shada.org.uk which includes useful information about the law amongst many other topics, the Sexual Respect Tool Kit, www.sexualrespect.com, and the Sex and Disability Helpline: www.outsiders.org.uk/outsidersclub/helpline.
Eliot Lamb BSc (Hons) Occupational Therapy
Brain Injury Case Manager/ Occupational Therapist
1st February 2016