Working with men with an intellectual disability who have been sexually abused
What we know about the prevalence of experiences of violence, abuse and exploitation
There is no national, systemic disaggregated data, studies or research that provides information on the prevalence, nature, location and impact of violence against people with disabilities in Australia (Frohmader & Sands, 2014). However, what studies have been completed identify high rates of victimisation compared to the general population (Murray and Powell, 2008).
In the past, people with intellectual disability have been portrayed as lacking the cognitive ability and insight to provide reliable evidence to support an allegation of sexual assault, to make a statement or appear in court as a reliable witness. People with intellectual disabilities face additional barriers to making a disclosure and receiving adequate support. Previously, where disclosure has been made there are suggestions that responses were inadequate and harmful.
The Royal Commission into Institutional Responses to Child Sexual Abuse recognised the increased prevalence of sexual abuse amongst people with physical and intellectual disabilities, and individual and institutional failure to adequately investigate, protect and provide appropriate support. A public hearing was held in Sydney from the 11th to the 22nd July, 2016, into responses of disability service providers to allegations of child sexual abuse.
Findings for Case Study No. 41 are now available. View the Report of Case Study No. 41: Institutional responses to allegations of the sexual abuse of children with disability.
There is a developing body of evidence highlighting the high rates of sexual assault and crime committed against men and women with intellectual disabilities. Evidence that people with intellectual disabilities are at high risk of crime in general provides a context in which to better understand and respond. Evidence of high rates of victimisation include:
- Indications are that between 50% - 99% of people with an intellectual or psychosocial impairment will experience sexual assault in their life time (French 2007).
- MacDonald (2008) cites research into the criminal victimisation of people with intellectual disability which shows that:
- People with an intellectual disability are more likely than their non-disabled counterparts to have been victims of multiple instances of domestic violence or sexual abuse.
- Compared with the general population, people with intellectual disability are:
- 2.9 times more likely to be assaulted.
- 10.7 times more likely to be sexually assaulted.
- 12.7 times more likely to be victims of robbery.
- Children with any type of disability are 3.4 times more likely to be abused compared to children without disabilities.
- People with intellectual disability are 1.5 times more likely to become victims of crime than people without disabilities.
- Up to 90% of women and 40-60% of men with intellectual disability are likely to experience sexual violence (WWILD, 2012).
- An examination of victimisation rates indicated that people with an intellectual disability have a 13.3% probability of being victimised compared to a 9.8% probability for the non-disabled population (Wilson & Brewer, 1992).
- A study by the National Police Research Unit and Flinders University of 174 people with intellectual disability indicated a prevalence rate of assault as three times more likely to be physically assaulted and ten times more likely to be sexually assaulted than non-disabled people (Cattalini, 1993, p.12; Wilson & Brewer, 1992).
- Men with learning or physical disability report an increased risk of sexual abuse or assault (French, 2007; Mitra et al., 2011; Murray & Powell, 2008; Sobsey, 1994).
- Men with a disability are 4.4 times more likely to report lifetime sexual violence (Mitra & Mouradian 2011).
These statistics probably underestimate the incidence of sexual violence towards people with intellectual disability. There is a particular absence of data on the abuse of people who are non-verbal or unable to disclose or report sexual abuse, contributing to the challenges of establishing true rates of sexual assault.
Working with people with disabilities
A commitment to working with men with intellectual disabilities who have been sexually abused involves developing an enhanced awareness of the ways in which people with intellectual disabilities are understood and responded to.
Throughout history, people with intellectual disability have at times been treated in degrading, paternalistic, hostile, disrespectful and cruel ways. They have been institutionalised, marginalised and systematically pathologised. Historically, in western countries, they have been grouped together with other 'socially deviant' groups such as people with physical disabilities, genetic disorders, epilepsy, and mental illness: it was only in the 19th century that the medical profession begin to separate people who were considered 'insane' from those whom were considered to be 'idiots', 'imbeciles', 'morons', 'feeble-minded' or 'mental defectives' (Wright & Digby, 1996). Societal views about this group throughout the 20th/21st centuries have included a broad spectrum of beliefs ranging from the Eugenics Movement 1900s, which supported the sterilisation and euthanasia of people with intellectual disability (Goggin & Newell, 2005), to current times, where the rights of people who have a disability to live good lives as valued members of their community are recognised through the Commonwealth Disability Discrimination Act 1992, and the UN Convention on the Rights of People with Disability (UN, 2006).
While there have been significant shifts towards a greater acceptance and understanding of people who experience intellectual disability, in reality there is a wide variety of societal, community and individual views of disability that range from medical model to social model of disability. For example, people generally are sometimes fearful of interacting with people with an intellectual disability, due to inexperience, lack of understanding and pervading negative social views, which may be a consequence of an historical context of institutionalisation, segregation, medical model of disability perspectives, and other forms of social exclusion.
It is not surprising then, that people with intellectual disabilities are often excluded from the types of counselling and personal supports available to others, and professionals working in these roles may have the same misunderstandings and inexperience with this group as the wider population.
To understand social and theoretical perspectives on disability, it is most important to understand the contrasts between the medical and social models of disability.
The medical model of disability
The Medical Model of Disability emerged as science took over from religion in the explanation of natural phenomena, where disabilities are seen as 'diseases' or 'illnesses' to be cured by doctors. Issues relating to the disability are viewed as deficits, deemed to reside within the individual, and the lives of people with disabilities and their supports are determined by 'professionals' or doctors (Cocks 2006, Evans 2014). People with disability are thought to be abnormal and are in need of being fixed or cured. Therefore, disability is a tragedy and people with disability are to be pitied. The medical model of disability is all about what a person cannot do and cannot be (PWDA, 2010). Common assumptions underpinning attitudes in society towards people with disabilities (Cocks, 2006), include:
- thinking of people as partial, limited, objects of charity and in contrast putting people on a pedestal,
- seeing disability as a sickness to be fixed,
- stereotyping people as a menace to themselves and society,
- attributing 'special' talents to people with disabilities,
- restricting the social circle of people with disabilities to other people with disabilities, and
- locating the problem within the individual rather than in societal attitudes or in the built environment.
The social model of disability
The Social Model of Disability has been created by people with disabilities themselves, out of their own experience. It sees disability as barriers imposed on people with impairments by society; that it is result of interactions between individuals living with impairments and an environment filled with physical, attitudinal, communication and social barriers. It does not deny the reality nor the impact of the impairment. Accordingly, it addresses the physical, attitudinal, communication and social environmental changes that enable people living with impairments to participate in society on an equal basis with others (PWDA, 2010). It acknowledges the disabling effects of society for people with disabilities, such as the absence of human rights, poor physical access, lack of personal assistance, and discrimination across all life areas (Bigby & Fyffe, 2009). It identifies structural barriers to participation as socio-political disablers and that an ability to participate in the spatial, economic, political and social life of one's community is a prerequisite to citizenship (Milner & Kelly, 2009). The social model of disability is now the internationally recognised way to view and address disability. The United Nations Convention on the Rights of Persons with Disabilities 2006 (CRPD) marks the international shift in attitudes and approaches towards people with disability.
Definitions of intellectual disability
The American Psychiatric Association (APA, 2013), in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-V-TR), defines intellectual disability as follows:
- Significantly sub-average intellectual functioning - an intelligence quotient (IQ) of approximately 70 or below;
- Concurrent deficits or impairments in adaptive functioning in at least 2 of the following areas: communication, self-care, home living, social/interpersonal skills, use of community resources, self-direction, functional academic skills, work, leisure, health, and safety;
- Onset before age 18 years.
- Intellectual disability involves impairments of general mental abilities that impact adaptive functioning in three domains, determining how well an individual copes with everyday tasks:
- The conceptual domain includes skills in language, reading, writing, math, reasoning, knowledge, and memory.
- The social domain refers to empathy, social judgement, interpersonal communication skills, the ability to make and retain friendships, and similar capacities.
- The practical domain centres on self-management in areas such as personal care, job responsibilities, money management, recreation, and organising school and work tasks.
Reference: DSM V: Intellectual disability fact sheet
The Queensland Criminal Law Code 1899 (December 2011) uses the term "person with an impairment of the mind' person". Specifically the interpretation (p.40) states: "A person is an 'intellectually impaired person' if the person has a disability –
- that is attributable to an intellectual, psychiatric, cognitive or neurological impairment or a combination of these; and
- That results in –
- A substantial reduction of the person’s capacity for communication, social interaction and learning; and
- The person needing support."
Reference: Queensland Criminal Law Code
Self-definitions are valuable because they give us insights into the impact of intellectual disability on individuals. Such perspectives enable people without an intellectual disability to gain an appreciation of their experience. The following self-definitions are from constituents of Community Living Program (1994) and past WWILD group members (Spork, 1994, pp. 11-14):
- (I'm) someone who takes a while to learn things.
- I think it's being slow, and they think very simple.
- I've got a disability and it takes me longer to work things out. But just because it takes me longer doesn’t mean that I can't do it!
- I have a learning disability which means I have had to have a lot of strength to get by day by day.
- I have a learning difficulty and am no different from you. I can be hurt and I can be happy.
- Sometimes you can't even see the disability inside you. You can’t tell.
- The public don't understand. Some people with intellectual disability, it could be the way they look or they might have some sort of behaviour problem and the public just make fun of it.
- I feel mind disabilities are worse than physical disabilities. You can’t touch the mind. When you see a disabled person, you can see a person when they’re physically disabled, and you ask questions like 'Why is she walking like that?' You can see with your eyes what's wrong with the person but in your mind you cannot see a person with a mind disability.
- I feel that I have a slowness in my mind but I think my mind thinks for itself. It does everything that other people do but I do not have a job because the doctors told me that stress would trigger off something in my brain and that's too high of a risk for me to take.
- Well as far as I understand about intellectual disability, it means you might be 28 years old, you might only have the brain of a 20 year old or something. And sometimes I don’t always act my age and might do abnormal things. With my learning disability and that. And so it's, yeah y'know, it's not always easy to cope with.
- Not being listened too, he talks to me like a child.
- Being stupid, no good, worthless.
- I have a pension – I can't work.
- I can't do things.
- They don't understand.
- I can't make any decisions.
Somewhere between 70 and 90 percent of people with an intellectual disability are in the 55-70 IQ range, otherwise known as the 'mild' intellectual disability group (AIHW 2008, IDRS 2009, WWILD 2012). 'Mild', however, is an unfortunate term that minimises the seriousness and challenges of living with intellectual disability in our society (M. O'Connor, personal communication, 28 April 2011).
Common lived experiences
For a wide range of systemic and structural reasons, people with intellectual disabilities in Australia are over represented in nearly every area of disadvantage (WWILD, 2012, p.10), such as:
- The criminal justice system as victims and offenders.
- High rates of alcohol and other drug use.
- Insecure housing, couch surfing or homelessness.
- Poor physical and mental health.
- Involvement with child protection services either as children or parents.
- Lack of appropriate education and employment opportunities, high levels of unemployment.
- Vulnerability to ongoing sexual, financial, physical, emotional exploitation and abuse.
- Social isolation and exclusion - lack of supportive/positive relationships.
- Self-harm, suicide ideation.
For many people with intellectual disability, a complex combination of these factors can significantly increase vulnerability. Many of these contributors to poverty are also the consequences of poverty – therefore creating a poverty cycle that is difficult to break. Practitioners need to be aware of the complex challenges that may be affecting people. For instance the daily concerns about money, and the practical/emotional effects of this, can impact on individual’s ability to prioritise therapeutic support. Being cognisant of this will assist in identifying and prioritising flexible and meaningful supports.
Gender and disability
Gendered analysis within the intellectual disability research literature has typically focused on issues faced by women and girls with intellectual disability (Wilson et al., 2010). This gendered analysis has usually drawn from a range of perspectives within the paradigm of feminist theory (Wilson, et al, 2010). This analysis argues that women with intellectual disabilities face both gender and disability related discrimination due to their status as women, alongside their experiences of disability, often referred to as a 'double disadvantage' (Collins & Valentine, 2003).
Morris (1993) identifies that gender and disability operate as structures of oppression for both men and women with disabilities; that this happens in different ways, primarily because of the way in which dependence and independence are key parts of the social meanings of what it is to be a man or woman. As noted above, the incidence of sexual abuse for men with intellectual disability is higher than the general male population, due to vulnerability, with the majority of reported perpetrators, for childhood experiences, being male (Murray & Powell, 2008).
“Researchers and practitioners might reflect on how the lives of men and boys with intellectual disability are influenced by masculinity/ties in critical areas of; fathering; male physical expression; sexual expression; men’s health; underweight and obesity” Wilson NJ., Shuttleworth, R., Stancliffe R., & Parmenter T. (2012). Masculinity theory in applied research with men and boys with intellectual disability. Intellectual and Developmental Disability, 50 (3), 261-72.
“... we urge researchers to open up the concept of intersectionality to accommodate a range of differences in bodily, cognitive, intellectual and behavioral types (impairments) in their interaction with various masculinities and to show more explicitly how context and life phase contribute to this dynamism.” Shuttleworth, R.; Wedgwood, N. & Wilson, N. J. (2012). The Dilemma of Disabled Masculinity. Men and Masculinities, 15 (2), 174-194.
Gendered issues are not exclusive to women and girls, yet a similar body of work looking at the male experience of intellectual disability and how it may differ to that of women is largely absent (Wilson et al., 2010). It is important to recognise that men with intellectual disabilities can and do experience social constructions of masculinity as oppressive. In today’s cultural context, to be a disabled man is to fail to measure up to the general culture's definition of masculinity of strength, physical ability, status, authority and autonomy (Morris, 1993). Shuttleworth, Wedgewood & Wilson (2012) says that masculinity and disability have a history of being seen in conflict, "because disability is associated with being dependent and helpless whereas masculinity is associated with being powerful and autonomous".
In the professional context, it is important to recognise that gender and disability can operate as structures of oppression for both men and women with intellectual disabilities. Both men and women with disabilities will experience a conflict between constructed identities as masculine/feminine and identities as disabled, or, perhaps more likely, have their masculinity and femininity (and sexuality) completely denied. By considering the role of society's construction of gender you can develop a more complex understanding of the individual client’s lived experiences as a man or woman with intellectual disability.
“Men with intellectual disabilities report a complex biopsychosocial relationship with masculinity, that can include a positive experience of male ‘mutuality’, of male warmth, banter and belonging, from engaging with other males” Wilson, N. J., Parmenter, T. R., Stancliffe, R. J., & Shuttleworth, R. P. (2013). From diminished men to conditionally masculine: sexuality and Australian men and adolescent boys with intellectual disability. Culture, Health & Sexuality: An International Journal for Research, Intervention and Care, 15 (6), 738-751.
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