Hidden problem

Gender-based violence against women with learning disabilities has been hidden and under-researched, according to a recent report from People First (Scotland) and Scottish Commission for People with Learning Disabilities (SCLD).

One woman told the researchers: ‘If I knew what it was, I would have reported it straightaway.’

But even when women did understand what was happening and tried to get help, the report found that they faced inconsistent support at a local level, found it difficult to get justice, and ran into difficulties with complex legal systems when they reported the abuse.

University of Kent professor in learning disabilities Michelle McCarthy is an expert in personal and sexual relationships of people with learning disabilities and says there is a lack of research on gender-based violence in this group.

She says: ‘Perpetrators of violence will exploit any weaknesses or vulnerability in their victims.’

They might exploit someone’s low self-esteem, lack of confidence, social isolation or loneliness, which leads to a desire for companionship and intimacy, she explains.

‘Perpetrators will exploit the fact that women with learning disabilities often lack knowledge about how to leave relationships, where they could go and what sources of support there might be.’

Independent living

Much of her research on gender-based violence has been conducted in women with mild learning disabilities living independently in the community.

‘These women may have been poorly parented and perhaps have chaotic family backgrounds. They do not always have good role models about healthy relationships,’ she says.

Picture credit: iStock

‘They first have to understand that what is happening to them is wrong. They need to be able to say: “I shouldn’t have to put up with this. Is there anyone who could help me? Where can I go?”’

Nurses in all settings should be aware of the risks that women with a learning disability could be experiencing gender-based violence, Professor McCarthy says.

Many women in this situation do not have an assigned social worker, nor will they be supported by a community learning disability nurse team unless there is a specific issue.

‘Unless that’s the case, they are more likely to see a practice nurse or a nurse in the emergency department. If someone is attending a sexual health clinic, that is a chance to talk about relationships and what is going on. If a woman is pregnant or having a baby, then midwives might have the opportunity.’

Power imbalance

Professor McCarthy advises nurses to be particularly aware of the possibility of abuse if a woman with a learning disability is in a relationship with a person who does not have a learning disability.

‘Staff should be alert to the possibility that there could be a power imbalance in this relationship, and that things might not be okay,’ she says.

Another red flag is if the relationship appears to be moving quickly. ‘The pattern in my research is clear – the man will move in with the woman early in the relationship before the woman wanted that. Women have described to me how they felt railroaded when they barely knew the man.

‘If a nurse has an ongoing relationship with a patient, and the patient is becoming more isolated than she was before she knew the man she is with, that could be a red flag.’

Gaining trust

Nurses should not expect women to open up the first time they are asked if everything is okay at home – or even after a few enquiries, she stresses.

‘If you have an ongoing relationship, let them know you are there to talk. Gently probe if you can – at least you have sown a seed in her mind that there are people who could help if she feels able to talk.’

The report Unequal, Unheard, Unjust: But Not Hidden Anymore is the first part of a two-year project funded as part of the Scottish Government’s Equally Safe strategy to prevent and eradicate violence against women and girls. Its recommendations include better data collection, establishment of an advocacy service and better training for justice services. It also calls for an accessible and inclusive public awareness campaign on how women and girls with learning disabilities can access support when experiencing gender-based violence.

Michelle Mair, SCLD’s gender-based violence project adviser and a learning disability nurse, says gender-based violence has been a hidden problem.

‘Looking at the research, it is clear that women with learning disabilities are much more at risk, and much more needs to be done,’ she says.

Opportunities to learn

There are opportunities for learning disability nurses to pick up when a woman has experienced gender-based violence, she says, but it is not always straightforward.

Until last year, Ms Mair worked in a community-based learning disability team for one of Scotland’s health and social care partnerships, where every new patient referred to them underwent a health assessment.

‘We asked every patient if they had experienced abuse or any form of gender-based violence. But it came through in our research that a lot of people do not realise they are being abused until later on.’

Ms Mair suggests that nurses asking whether someone has experienced gender-based violence, should explain the term.

How nurses should do that depends on the person’s preferred method of communication, says Ms Mair.

‘We might ask: “Has anyone hurt you?” or: “Has anyone done things to you that you didn’t want them to do?” or rephrase the question to make sure the person understands.’

All women, not just those with learning disabilities, can find it difficult to talk about abuse, she says, so using tools such as dolls or allowing people to draw pictures can also help to find out what is happening – and it helps build up trust.

‘Trust is a massive factor, because women have said that they have not been believed or not been taken seriously when they have reported abuse.’

If a learning disability nurse suspects abuse, they can talk to the person about it and signpost them to support, but again, this is not straightforward.

‘We asked every patient if they had experienced abuse or gender-based violence. A lot of people do not realise they are being abused until later on’

Michelle Mair, gender-based violence project adviser and a learning disability nurse, Scottish Commission for People with Learning Disabilities

‘Specialist services for women who have experienced abuse might not have expertise in women with learning disabilities,’ Ms Mair says. ‘You might need to do a lot of partnership working. It would depend on the priority for the woman.’

Reporting harm

Ms Mair says nurses need to be honest, and that includes saying there is a possibility that they will have to report what they have been told, using local protection processes, if an adult or a child is at risk of harm.

Nurses can also help people cope with the emotional impact of surviving gender-based violence, for example by signposting them to peer support groups or even setting one up.

‘People who have been involved with peer support groups find them useful,’ she says. ‘They feel able to share the experiences not just of what happened to them, but their experience of accessing support and justice – and to be able to give each other advice and support each other.’

Find out more

Office for National Statistics (2019) Disability and Crime: UK 2019.

People First (Scotland) and Scottish Commission for People with Learning Disabilities (2023) Unequal, Unheard, Unjust: But Not Hidden Anymore.

Robb M, McCarthy M (2022) Managing risk: social workers’ intervention strategies in cases of domestic abuse against people with learning disabilities. Health Risk & Society. 25, 1-2, 45-60. doi.org/10.1080/13698575.2022.2143169

This is an abridged version of an article at rcni.com/LD-gender-based-violence