TLDR Commentary TITLE What are the support needs of women with learning disabilities who have been abused? ABSTRACT Purpose: In discussing some of the issues arising from the article by X, this commentary aims to draw readers’ attention to the various support needs women with learning disabilities may have. Design/methodology/approach: Critical analysis based on review of literature and the author’s research and practice based experience. Findings : Women with learning disabilities have similar support needs to other women who have experienced violence and abuse. However, in order to get their needs met, they need access to information, support from professionals and to share experiences with other women. Originality/value: This commentary encourages readers to view the abuse of women with learning disabilities in a broad social context and to use all the knowledge available to protect and empower individuals, whilst at the same time demanding social changes to end discrimination and abuse. KEYWORDS Women with learning disabilities Violence and abuse Support needs TLDR Commentary What are the support needs of women with learning disabilities who have been abused? Accessible information As for other women who experience rape, domestic violence or abuse, women with learning disabilities are likely to have a whole range of short and long term needs. As the paper by X demonstrates, the need for accessible information is foremost amongst them. Not too long ago, accessible information was thin on the ground, but today there are many examples of leaflets, books, videos, audio files, which have been produced by, with and for people with learning disabilities on the subject of abuse. (A list of some of these is found below). The central messages of these resources tend to be:  that the individual was not to blame for their abuse  that what happened to them is commonly experienced by others too  to encourage them to take action to stop the abuse or remove themselves from risk  to explain what kinds of help and support are available and how they can access these. The value of such accessible information cannot be overstated. Without such information putting their experiences in context and alerting them to the existence of support agencies, women with learning disabilities are left to cope alone and thus remain vulnerable to further abuse. Seeking help Using the telephone as a first point of contact When accessible information encourages women with learning disabilities to seek help, telephone numbers are usually given so that people can access that support. However, X’s paper highlights the difficulties some women with learning disabilities have with automated phone systems which require the caller to listen to a range of options , before selecting the right one. This same difficulty is also highlighted by learning disabled researchers from RESPOND in their research on disability hate crime (Mantovani and Wallis 2014). If services are striving to meet their legal obligations under the Equality Act 2010 (which encompasses previous anti-discrimination legislation, including the Disability Discrimination Act 1995), then they are failing some disabled people if they cannot get past the first barrier they face. Just as some organisations provide easy read versions of their written information as a reasonable adjustment, then perhaps they need to consider ‘easy dial’ versions for their telephone services? Indeed the Equality and Human Rights Commission specifically states that “when you provide services over the telephone, you must make reasonable adjustments for disabled people who would otherwise face a barrier to accessing the service” (Equality and Human Rights Commission 2014:32) and provides guidance for statutory and voluntary organisations in doing so. What kind of help can women with learning disabilities expect? There are undoubtedly some excellent specialist services available to women with learning disabilities who have been abused. These tend to be learning disability specific services, such as RESPOND (which provides psychotherapy, advice support, training) or Beverly Lewis House (a specialist Refuge for women with learning disabilities who have been abused). However, not all women with learning disabilities can use the relatively few specialist services available, therefore generic domestic violence or sexual assault services must make every effort to ensure women with learning disabilities can access them. Evidence suggests that best practice is achieved when disability equality training is provided in mainstream domestic violence services and domestic violence training is provided in learning disabilities services (Woodin and Shah 2011). When health and social care professionals are not adequately trained in domestic violence issues, they often do not act on the knowledge they have about their clients’ experiences of abuse. If the information about abuse is gained in indirect ways and the women do not specifically ask for help in escaping a violent relationship, then little or nothing may be done. This has been shown in relation to women with learning disabilities (McCarthy, Hunt and Milne-Skillman in press), women with physical and sensory impairments (Hague et al 2011) and women in the general population (SafeLives 2015). Yet NICE guidelines clearly state that staff in a variety of services, especially those working with vulnerable adults, should be trained to ask service users about experiences of violence and abuse and that this should be seen as a “routine part of good clinical practice” (2014:12). A recent international study looking at violence against disabled women (including women with learning disabilities) in four European countries (Austria, Germany, Iceland and the UK) gathered evidence from women who had experienced violence and those who provide services to them. Austria, Iceland and the UK were criticised for not paying adequate attention to, or providing sufficient services for, disabled women who had experienced violence. Germany, on the other hand, was praised for its 2007 National Action Plan on Violence Against Women. The report singles out the UK government’s austerity agenda and cuts to public services as having a particularly negative effect on abuse services to disabled women (Planitzer 2011). The negative effects of service cuts were identified by women with learning disabilities themselves in a recent study of their domestic violence experiences (McCarthy, Hunt and Milne-Skillman in press). Health and social care professionals have a role in making women with learning disabilities aware of relevant laws and how they can seek legal help. For example, knowledge of the Domestic Violence Disclosure Scheme – commonly known as Clare’s Law – could be very useful to women with learning disabilities when they begin a new relationship, if they are worried about their partner’s behaviour. However, the process of applying for disclosure, as well as the rights and responsibilities attached to it are not at all straightforward and so, once again, the need for accessible information and support is clear. Women’s groups Whilst the support of professionals in the statutory and voluntary sectors is crucial for women with learning disabilities who have been abused, it is important not to overlook more informal and naturally occurring supports too. Friends and family have an obvious role to play in helping women to overcome negative experiences. Women’s support groups for women with learning disabilities are also potentially very valuable and for decades they have been advocated as a safe and confidential space for women with learning disabilities (Millard 1994, McCarthy 1999). More recently, examples can be found in the literature of practitioners using the women’s group model to help women overcome abusive experiences (Peckham et al 2007, Martin et al 2012, Walter Brice et al 2012). As well as providing the opportunity for individual women to discuss private and personal issues, a well facilitated group can enable the sharing of experiences, so that women make the connection between what happened to them and broader social problems (eg understanding that rape is common, or that the Police often do not respond effectively to domestic violence). The international study referred to above reported that women with disabilities found this kind of intervention helpful: “In all countries most women reported that peer support groups, empowerment groups and peer counselling were helpful. They also valued opportunities to provide support to other women in similar situations to their own.” (Woodin and Shah 2011:7) The reality for many women with learning disabilities who have experienced violence or abuse is often that they are socially and psychologically isolated and lack information about the fact that help exists and how to access it. It is therefore incumbent upon those who support women with learning disabilities to enable them to reflect on what has happened, to become aware that help is available and how to access it and to develop some protective skills for the future. Examples of relevant accessible resources ARC easy read information on mate crime http://arcuk.org.uk/safetynet/files/2012/08/Friend-or- Fake-Booklet.pdf Cambridgeshire Domestic abuse and Sexual Violence Partnership have produced posters for people with learning disabilities. Can be downloaded from here http://www.cambridgeshireandpeterboroughccg.nhs.uk/downloads/CCG/Adult%20Safeguarding/Do mestic%20Abuse%20Poster%20men%20and%20women%20versions.pdf Don’t Put Up With It! A video for women with learning disabilities about domestic violence. Can be seen online here https://vimeo.com/116967832 1 Don’t Put Up With It! A leaflet for women with learning disabilities about domestic violence. Can be downloaded from here http://www.kent.ac.uk/tizard/research/research_projects/domviolence.html?tab=accessible- resources Easy Health have collected together a whole range of accessible resources on abuse http://www.easyhealth.org.uk/listing/abuse-(leaflets) Enable Scotland easy read leaflet on surviving sexual abuse http://www.enable.org.uk/enabledirect/publications/Documents/FL%20- %20Abuse_booklet_easyread.pdf RESPOND easy read information on abuse http://respond.org.uk/easy-read/what-is-abuse-1/ Surrey Police easy read leaflet on internet safety http://www.surrey.police.uk/Portals/0/pdf/easy- read/internet_safety_July13.pdf 1 Hard copies of the DVD can be obtained, free of charge, from the author. http://arcuk.org.uk/safetynet/files/2012/08/Friend-or-Fake-Booklet.pdf http://arcuk.org.uk/safetynet/files/2012/08/Friend-or-Fake-Booklet.pdf http://www.cambridgeshireandpeterboroughccg.nhs.uk/downloads/CCG/Adult%20Safeguarding/Domestic%20Abuse%20Poster%20men%20and%20women%20versions.pdf http://www.cambridgeshireandpeterboroughccg.nhs.uk/downloads/CCG/Adult%20Safeguarding/Domestic%20Abuse%20Poster%20men%20and%20women%20versions.pdf https://vimeo.com/116967832 http://www.kent.ac.uk/tizard/research/research_projects/domviolence.html?tab=accessible-resources http://www.kent.ac.uk/tizard/research/research_projects/domviolence.html?tab=accessible-resources http://www.easyhealth.org.uk/listing/abuse-(leaflets) http://www.enable.org.uk/enabledirect/publications/Documents/FL%20-%20Abuse_booklet_easyread.pdf http://www.enable.org.uk/enabledirect/publications/Documents/FL%20-%20Abuse_booklet_easyread.pdf http://respond.org.uk/easy-read/what-is-abuse-1/ http://www.surrey.police.uk/Portals/0/pdf/easy-read/internet_safety_July13.pdf http://www.surrey.police.uk/Portals/0/pdf/easy-read/internet_safety_July13.pdf References Equality and Human Rights Commission (2014) What equality law means for your voluntary and community sector organisation (including charities and religion or belief organisations). 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