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Facilitating ‘safe’ relationships after brain injury: Its not all about sex

This article explores the impact of acquired brain injury on developing and maintaining relationships. It discusses the importance of promoting intimacy and communication, and provides guidance on assessing capacity and consent to sexual relationships. The article also highlights factors that can restrict intimacy after brain injury and suggests ways to foster relationships in clinical settings.

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Facilitating ‘safe’ relationships after brain injury: Its not all about sex

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  1. Facilitating ‘safe’ relationships after brain injury: Its not all about sex Dr Siobhan Palmer, Clinical Neuropsychologist St Georges Hospital, London & Independent Practioner

  2. AIMS Impact of ABI developing or maintaining relationships Case studies: a framework for identifying concerns Appropriately promoting intimacy and relationships within our clinical settings

  3. Intimacy Intimacy is about how we communicate closeness in language and behaviour Intimacy is part of the human condition: “...verbal, visual, tactual and olfactory communication which expresses love...”

  4. What is intimate communication?

  5. Non verbal intimacy? Are these intimate? Touching on the arm Holding hands Going for coffee Cuddling Sex Shopping Kissing on the cheek Eye contact Laughing

  6. Sex, intimacy and ABI:are sex and intimacy different?

  7. Factors that restrict intimacy after ABI • Capacity • Impact of the brain injury on function • Social values, expectations and cultures?

  8. Assessment of capacity to consent to sexual relationships • The principles for assessing mental capacity are outlined in the Mental Capacity Act 2005 • The criteria are set out through the various Sexual Offences Acts and subsequent case law • Case law is evolving to guide how the definitions with the capacity and the sexual offences legislation are to be interpreted.

  9. Choice Sexual Offences Act(s) • In England, Wales and Northern Ireland a person is able to consent to sexual relationships “if a person ‘agrees by choice and has the freedom and capacity to make that choice’”.

  10. Understanding: ‘the facts’ An individual lacks capacity to choose if they lack sufficient understanding of the nature of the act or the reasonably foreseeable consequences of what is being done or for any other reason. An offence will have taken place if the victim did not consent, or the accused had no reasonable belief that they consented.

  11. Capacity to consent to sexual relationships • Choice: Understand he/she has a choice and can refuse sexual relations • The Facts: Relevant information includes whether he/she understands the mechanics of the act, that there are health risks involved (STIs) and that sex between a man and a woman may result in the woman becoming pregnant • Most adults with ABI will pass this test.

  12. If the individual lacks the mental capacity to make the decision themselves, entering into a sexual relationship is not a decision that can be made on their behalf on a best interests basis (excluded decision)

  13. Capacity is an appropriate question; it may not be the answer If the individual has the capacity to make the decision for themselves are there any legal barriers or safeguarding concerns relating to their chosen activity/partner are there any practical or organisational barriers to prevent them expressing their rights/choice

  14. Framework for thinking about personal and environmental factors influencing development and maintenance of relationships after brain injury Environmental factors: opportunities Culture & wider beliefs Capacity: choice & facts Brain injury factors Relationship narratives

  15. Project Sakinah: Stop Family Violence Now. http://projectsakinah.org/Home.aspx

  16. Facilitating relationships

  17. Areas of assessment • Relationship context pre and post morbid, power... • Brain injury specific factors Cognitive, behavioural, physical, emotional • Capacity & legal considerations Choice, knowing the facts • Culture Family & staff values, Organisational factors • Environmental factors Are there opportunities to meet others?

  18. Framework If lacks capacity to make a choice about sexual relationships are there other forms of intimacy and personal contact that may meet an expressed need?

  19. Framework for thinking about personal and environmental factors influencing development and maintenance of relationships after brain injury

  20. Assessment

  21. Summary • Sex and intimacy are different • Can be difficult to know initially, which is the main priority for the individual • Framework provides a guide for thinking through the issues • Give information and support to make choices (as you would for any capacity issue) • Being isolated can have a negative impact on functional outcomes • Human relationships; one of the most strongly motivating rehabilitation goals

  22. “A handy checklist”

  23. Web resources • Social • http://www.outsiders.org.uk • http://tbisurvivorsnetwork.ning.com • Dating • http://www.enabledating.co.uk • http://www.brainline.org/ tips on dating • Sexual Health and Disability Alliance • www.shada.org.uk • TLC Trust: helping professional sex workers and other service providers cater to the needs of the sexually dispossessed: • http://www.tlc-trust.org.uk • http://www.touchingbase.org (Australia)

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