Adults with learning disabilities’ experiences of disclosing abuse, who access community learning disability teams, in Southeast England, UK

Abstract

BackgroundThere is a high prevalence of abuse experienced by the learning disability (LD) population, with a clear impact of abuse on individuals. Several theoretical frameworks support the importance of disclosure in the recovery process, with regards to shifting self-blame and guilt and creating new narratives for these experiences. The key facilitators and barriers to disclosure and responses received have been studied for individuals without LDs, however there is a paucity of research in this topic area for the LD population.Rapid reviewA rapid review of the experiences health and social care professionals working with adults with LDs who have been abused highlighted variability in the care provided to this cohort. This was due to differences in the implementation of policy and procedures, the influence of relationships between professionals, service users and their families, perceptions of LDs, and clinicians’ own knowledge and thresholds, and confidence in their clinical expertise.Aim and methodThe aim of the empirical study was therefore to explore adults with LDs ‘ experiences of disclosing abuse. Semi structured interviews were conducted remotely, due to Covid-19, with five participants with LDs who had experienced historical abuse, and were open to Community Learning Disability Teams (CLDTs) in Southeast England, UK. A reflexive thematic analysis was used to analyse the data.Results and conclusionsFour themes were generated ‘Abuse is discovered not disclosed’, ‘Exposure of the abuse triggers a set response’, ‘Carrying the burden of what happened’ and ‘Finding a way out’, under the overarching theme of ‘The Journey of Disclosure’. The themes suggested disclosure occurred on a non-liner timeline, not at one timepoint, with abuse not being disclosed but identified by others, a lack of power and control over the process for participants and the importance of accessing the right support. Facilitators and barriers were identified, some unique to those with LDs, such as the influence of clinicians’ knowledge, or lack of, not only about abuse but also LD on the identification of abuse e.g. the role of diagnostic overshadowing, and the potential additional complexity of relationships for adults with LDs. Other facilitators and barriers were in line with previous research for those without LDs, such as trust, being listened to and believed. Several areas for future research are highlighted, such as the experiences of adults with LDs who may have different communication abilities e.g. use of augmented technology, adults with LDs from Black and Asian racialised communities who experiences of abuse and disclosure may be different, and further exploration of the experiences of disclosing specific types of abuse. The clinical and policy implications are discussed, such as reinforcing the need for professionals to receive training in the area of supporting individuals with LDs to disclose abuse and responding appropriately.