Sexual Abuse in Institutions of Learning Disabled

Sexual Abuse in Institutions of Learning DisabledLiterature review that critically analyses the knowledgeable abuse of wad with learning disabilities in institutionsThere are a great many facets to the problem of sexual abuse of people with learning disabilities in institutions. The wide florilegium of learning disabilities, the wide scope for different types of sexual abuse and indeed the huge variety in the institutions themselves, means that on that point is non any merged standpoint or all-encompassing view that stub be taken on the subject. (Ryan J et al 1987). This review volition therefore consider distributively of these aspects in turn together with the literature associated with them and then attempt to draw conclusions from a critical evaluation of eachThe term learning disability is employ to cover a wide range of different clinical entities. Differing impairments due to differing aetiologies are truely lumped together under this one term. In the context of t his review, speciality of the various types of learning disability is cosmicly irrelevant and the only discriminating factor that may be relevant is the ground level of disability or impairment. For that background alone we shall consider all causes of learning disability and the conclusions reached will therefore largely be generalisations in the landing field.Approximately 2% of the UK population are soon classified as having a learning disability and this proportion has been slowly rising over time. In their comprehensive review of the subject, Xenitidis suggests that the reasons for this growth are reproduce and complex. (Xenitidis K et al 2000). Part of the reasons given are that the definitions and criteria for the diagnosis of a learning disability are progressively changing as our k presentlyledge of the area expands together with the fact that other relevant factors are changing such as the socio-economic conditions together with the fact that pre-term neonates who w ould previously been expected to die are now helped to survive but with an increased risk of cognitive impairment and learning disability (Aspray TJ et al. 1999).The McGrother shoot suggests that over a 35yr period from 1960 the prevalence of learning disability has increased at an average rate of 1.2% per year (McGrother C et al. 2001).One of the heavyies encountered in the context of sexual abuse is the problems that there are in discovering it. The typical person with a learning disability may make differing perceptions of right and wrong and therefore may not be in a spotlight to make a judgement about what is ascertaining. Other factors are that they have a greater difficulty in accessing professional help. (Wilson D et al 1999).Clearly this is little of a problem if we consider the group who are in institutions rather then those who live in the community, but against this is the argument that those in institutions generally course to be those with the greatest disability and therefore would intuitively be less able to draw attention to a potential problem. (Patja K. 2000)The literature in this area is not particularly extensive but there are a few high quality papers that stand out. The first is by Sequeira (Sequeira H et al 2003) which was a case controlled study (a rare construction in this particular area) which set out to consider any correlation among sexual abuse, genial health and behavioural problems in people with learning disabilities. The authors suggest that this is the first study to seek such a connection. They matched a surprisingly large entry cohort of 54 adults with learning disability in a residential setting who had suffered from sexual abuse with a similar cohort who had not been abused. The actual study was both carefully constructed and meticulously carried out. In broad terms the findings of the study were that there was a statistically significant correlation betwixt sexual abuse and mental illness and behavioural problem s together with symptoms of post-traumatic stress.Reassuringly, the authors found that the reactions to abuse were essentially the same as in the general population which suggests that when recognised, the symptoms were translucent to observers, but equally this implies that a significant amount of abuse is un strikeed. (Thompson D et al 1997).With the group with learning disabilities, the authors concluded that in addition, the study group tended to possess stereotypical behaviour patterns and that there was a positive correlation between the degree of abuse and the severity of the symptoms reported. We can confidently conclude therefore that there is a positive association between sexual abuse and both psychiatric and behavioural abnormalities in people who have learning disabilities.How does the design and architecture of institutions foster abuse?It has to be observed that an extensive literature search reveals no specific studies on the issues of institution structure and op portunities for abuse. There are a number of papers that refer tangentially to the issue however, and we shall assimilate the points raised in them. Brown, (1999) and Manthorpe (et al, 1999), both observe that institutions, both large and small, are not specifically immune from sexual abuse of their residents. They point to working practices that allow professionals a degree of privacy when dealing with residents in vulnerable situations. (Burke K 1999).It would be unlikely that anyone would disturb a nurse giving a patient a bath or a indemnify conducting an interview or examination of a patient. In this respect, it is not the actual architecture of the institution, it is the structuring of the working practice that fosters the possibility of abuse in this area. (Churchill J 1998).Some institutions have mixed sex dormitories and areas which can be difficult for nursing staff to monitor. Inter-resident abuse can therefore take place in areas which may be less easy to detect than t he open plan structure of many wards in general hospitals (Brown H et al 1997)Who are the perpetrators of abuse against people with learning disabilities?This is clearly a difficult area in which to be dogmatic, as one can cite evidence from various enquiries which have examined the issue and have implicated virtually all category of professional from medical staff, (COI 1969), through nurses (COI 1971), to care assistants and sub-contracted employees (DOH 2000). Equally, to be balanced, one has to also examine the recent spate of prosecutions form residential care plate workers that have been overturned in the appeal court where allegations of abuse have been found to be vindictive or fraudulent. (also COI 1978)What impact does power imbalance between carer and service user have over occurrence of abuse?Abuse, almost by definition, implies an abuse of power.(Northway R 1998).There is automatically an imbalance between those with learning disabilities and those in the general popu lation as, by the very nature of their disability, the majority of those with a learning disability are dependent on other carers for their own shelter and safety. (Pillemer K et al. 1993).This power imbalance is taken to a greater extreme when those (healthcare professionals) who are employed to care for their patients, and thereby are generally invested with a degree of trust give instructions to those who are more vulnerable. As Rogers points out, (Rogers AC 1997) the moment a nurse puts on a uniform or the doctor a white coat, they are invested with an automatic degree of authority and respect by the general population and possibly all the more so by those with learning disability, who may well have learned to be more deferential or respectful because these healthcare professionals are effectively the gatekeepers to their own credentials and well-being. (Sines D 1995)What can be done to reduce abuse in institutions?It is clearly important to be able to restore confidence in th e residential settings for the care of those with learning disabilities. One of the prime mechanisms of reduction is to place professional emphasis on detection of abuse together with implementation of management procedures that will minimise the potential for abuse. The recent governing body White Paper No Secrets (DOH 2000) has gone a long way into implementing such measures, and this, together with provincial measures in other parts of the UK (NAW 2000), presents guidelines which will help to prevent sexual abuse and also facilitate the investigation of such abuse when it is alleged.Professional bodies have publicly proclaimed a policy of Zero tolerance in this area and have encouraged the philosophy of whistle blowing (NMC 2002 a) it should be noted however, that a study commissioned by the same group, The Nursing and Midwifery council (NMC 2000 b) suggested that despite the guidance and directives given there is clear evidence that nurses, in particular, do not have sufficient knowledge or have received sufficient training in the area of prevention of sexual abuse to effect the recommendations in the Government White Papers.ReferencesAspray TJ, Francis RM, Tyrer SP, and Quilliam SJ 1999 Patients with learning disability in the community BMJ, Feb 1999 318 476 477Brown H Stein J 1997.Sexual abuse perpetrated by men with intellectual disabilities a comparative study. diary of Intellectual Disability Research 41 (3) 215-224.Brown H 1999,Abuse of people with learning disabilities. 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