Sex and Sexuality Therapy and NDIS

Sex and sexuality therapy is available under NDIS for people with disabilities and mental health concerns. This article explores the issues.

On the 12 May 2020, the Guardian published news regarding a court ruling that found that NDIS participants ought to be able to use their NDIS funding under the reasonable and necessary definitions found in the Act 2013. The ruling like so many advocacy battles, followed years of struggles by the person seeking help for basic rights to health and access needs to services, principles that are already enshrined in the UN Convention on the Rights of People with Disability which is ratified and signed by the Australian Commonwealth.

Photo by Mahrael Boutros.

Rights Based Sexuality Policy.

In the meantime, during 2019, the Disabled People’s Organisations Australia published a joint statement in support of a rights based framework for sexuality in the NDIS. The statement suggests that, in history, dominant social beliefs imposed on people with disability as being asexual or hyper-sexual. They suggest people with disabilities were constantly denied full autonomy over their bodies.

The statement further claims that the NDIS perpetuates this sexuality stigma by failing to develop a sexuality policy for NDIS participants. They suggest such a policy needs to support participant’s sexual needs and goals throughout the appropriate adolescent and adult lifespan.

They recommend a positive person centred framework that places sex, sexuality and relationships within the context of disability supports. They want to see the policy including examples of participant’s NDIS Plan goals, like disability-inclusive sexuality and relationships counselling. Another goal might involve information and resources to support individual learning needs. Yet another goal could be support for dating and social sexual engagements. They also suggest that access to adaptive sex toys, sex therapy, and/or sex workers would be appropriate.

Photo by Ketut Subiyanto.

Improving Quality of Life.

The insightful statement from the Disabled People’s Organisations Australia includes key concepts around the rights of persons with disability in Australia sharing in common standards of living, quality of life, and having their developmental needs addressed with an equal measure to others while addressing their needs within the allied health and disability services contexts relevant to sex and sexuality.

They state what should be obvious, that people with disabilities do all the things that the majority of people in Australia do with their lives, sexuality, and their sex life. Dating, meeting casual sexual partners, being playful, sharing intimacy, sleeping with another person, enjoying loving bonds and partnerships, being single, living alone, cohabitating, marrying, having children… all are happening already among people with disability. But the social and systemic barriers and social-emotional struggles among the population to have and gain support for healthy lifestyles and basic human rights is ongoing.

Rightly so, the statement argues that sexuality, sexual expression, and intimacy fills deep human needs and builds a sense of quality of life and self-esteem. In our therapy experience, helping people with disabilities to navigate intimate relationships often brings up the trauma histories that are inherent in familial and social attitudes, beliefs, and practices. Hence, intimacy is a catalyst for healing and empowerment, and is often deeply important for females who still face particular social pressures on top of disability stigma.

Sexuality Counselling and Behaviour Support.

Counselling and relationship based behaviour support is recommended for participants who need help with understanding sex, sexuality, and sexual capacity, particularly after significant injury or where issues arise from existing diagnoses. Further issues like illness, disease, assault, sexual assault, and relationship conflicts can increase these needs with a sense of urgency. Gaining knowledge and acceptance of one’s body and abilities is key to moving forward, for anyone indeed, as for people with disabilities.

Building a positive sense of one’s sexuality, sex life, and identity can take years. In a society where these pathways have largely been ignored, overlooked, silenced, and stigmatised, part of the work we need to do is to address these mechanisms of prejudice. Clearly identifying the mechanisms for what they are is helpful and freeing. This frank mutual discussion can help families and NDIS service provider’s staff to engage in social remodelling that can encourage positive sexuality.

Photo by Dainis Graveris

Addressing Sexuality Goals in NDIS Plans.

Therapy provisions for sexuality could normally address sexuality specific goals in a person’s NDIS plan. In many cases participants can address sexuality concerns in the context of comprehensive therapy assessments and reviews. As a senior specialist therapy agency within the NDIS, we have long standing specialisations in sexuality and gender issues. Relevant to adult sexuality, and as a telehealth provider, we offer services under the categories of counselling therapies and behaviour support.

Privacy and Confidentiality.

It is completely up to the individual whether goals around sex and sexuality are disclosed or not in the NDIS service and planning contexts. Often participants do not want to disclose these issues, which makes dealing with the funding agency somewhat challenging. We further recommend that the NDIS carefully consider how to support a healthy lifestyle model of sex and sexuality while upholding rights to privacy and discretion in the funding planning process.

A primary issue of course is privacy and consent. In light of the media discussion, just because sexuality and sex workers may now be funded under the NDIS Plan does not mean that the individual would want this documented in their NDIS Plan itself. How the person wants to address and document these issues ought to be up to their informed consent.

NDIS funding reviews are terribly stressful times for many participants already due to the level of exposure they feel when personal disabilities and lack of capacity is discussed in front of strangers in the roles of NDIS Planners to argue, justify, and often beg for help. Surely, a less confronting and more equitable and effective protocol for funding reviews ought to be based on the best clinical and specialist advice combined with the life-goals and interests of the individual. A strength-based approach to funding reviews is not difficult to imagine or design, while attending to the central principles of the NDIS Act 2013 definitions of reasonable and necessary supports based on verifiable disabilities and functional capacity measures.

Photo by Dainis Graveris.

Relationship Support.

We note that behaviour support appears under the category of relationships, and sexuality-focused work is quite appropriate for this category as well. Because we are NDIS Registered in both therapy and behaviour support areas, people with behaviour support funding can access our services. The NDIA (the agency) normally manages behaviour support funding because clinicians in this area must be deemed qualified and registered with the NDIS Commission.

For years we have offered a range of value-added specialist needs to our participants within the scope of their NDIS funding. This is something that is uncommon in the sector, as many therapists and behaviour support practitioners tend to be early career members of their professions. No wonder that across Australia there would be a struggle to try to access therapists with specialisations in sexuality who work within the disability services sector – such things are rare at this time.

Photo by Anna Shvets.

Choice and Control.

While programs around capacity building for healthy lifestyle sexuality are needed among the population and among service providers, a range of allied health professionals and sex therapists also play an integral role in supporting an individual’s capacity. The development of life skills is necessary to explore and nurture a healthy and consensual sexual and romantic relationship. People with cognitive and Autistic layers of disabilities sometimes need ongoing or recurrent funding for counselling and/or behaviour support assistance that is built into their NDIS Plans to assist with maintaining healthy relationships, and when facing the developmental challenges of growing older and dealing with life’s difficult and crisis moments.

People with disability must be supported to exercise the right of choice and control over the supports they need to achieve the goals that they have identified. For many participants, NDIS goals around relationships have often remained quite generic and impersonal. Goals have not yet supported a healthy lifestyle model of sexuality and sexual experience.

While capacity building to apply a healthy lifestyle model of sexuality within NDIS planning processes is certainly possible to do in a quite supportive, open, and mutually enjoyable discussion – there is a far way to go in having all stakeholders on board with a strength-based healthy lifestyle model of sexuality. Especially where the national agency staff show a great deal of need for basic training let alone on issues of this more advanced nature. However, these objectives are not rocket science. This is indeed why the NDIS was set up in the first place. This pathway to empowering choice and control is at the heart of the individualised funding model.

Photo by cottonbro.


Featured Image Credit, Anna-Louise.

End.

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