Relationships and Identity
Scope of this chapter
As long as it is done legally, everyone has a basic human right to form relationships with anyone they choose, to be whoever they want to be and to express themselves anyway they wish. This includes the people that we support.
It is important that we uphold those human rights and do not put measures in place that restrict people from making free choices unless it is absolutely necessary to keep them safe.
Relevant Regulations
Regulation 9: Person-centred care
Regulation 9A: Visiting and accompanying in care homes, hospitals and hospice
Regulation 10: Dignity and respect
Regulation 13: Safeguarding service users from abuse and improper treatment
Related Chapters and Guidance
- Accessing the Community
- Anti-Harassment and Bullying
- Choice and Control
- Communicating Effectively
- Culturally Appropriate Care and Support
- Dignity and Respect
- Mental Capacity
- Preventing Abuse and Neglect
- Promoting Independence and Strengths
- Promoting Individual Wellbeing
- CQC: Promoting sexual safety through empowerment
- Skills for Care: Supporting personal relationships guide
Amendment
Section 9, Training and Development was updated in July 2024 to include the LGBTQ+ learning framework from Skills for Care.
Relationships are the connections that we make with other people.
Meaningful relationships are important to us all. They promote mental wellbeing and enrich quality of life. We would be very lonely and isolated if the only relationships we ever had were with professionals or services.
Family: Family relationships are the only type of relationship that we cannot choose for ourselves. They are the people that we are related to through birth or marriage.
Friends: Friends are people that we come to know and like, and who like us back. They understand us and we understand them. They trust us and we trust them. If things don’t work out between friends, one or both friends can decide to end the relationship.
Romantic/Intimate: A romantic relationship is a personal and sexual connection and bond between 2 people. Often, there is a sense of dependency on the other person.
Existing relationships: These are the relationships that we already have. They could be good relationships, but they could also be problematic or harmful.
Future relationships: These are the relationships that we want in the future. It could be that a relationship partner has already been identified e.g., "I want to be friends with Carol". However, it could just be the type of relationship that is known e.g., ”One day I want to get married”.
Identity is how we see and describe ourselves to others. For example, 'I am a Christian', 'I am gay', 'I am West Indian'. Our most meaningful relationships are often linked to the community of people to which we have a shared identity. They allow us to express ourselves freely and be true to who we are.
In order to understand the support that a person may need from the service to maintain or form relationships and to be themselves we need to talk about relationships and identity before the service begins.
Although we need to understand a person’s needs, discussions may not need to be explicit in the same way as they would be for e.g., health needs. For example, "Now we are going to talk about your relationships". Neither should they be structured against a ‘list of topics’ to talk about. It is normally better to talk about relationships and identity as part of the natural conversation already taking place.
It is important to recognise that relationships and identity are private things and people may not want to talk about them with us. This is their choice and must be respected. To force a conversation could be seen as an invasion of privacy.
Some people may want to talk but may not feel able to because they do not yet know and trust us. Therefore, initial information may be limited and become more enriched over time. This may also require us to adapt the nature of the support being provided over time.
Talking about relationships and identity is therefore something we should do often and build into everyday conversation.
The specific things that we talk about will vary depending on what the person tells us and their individual circumstances. If something does not seem appropriate or relevant to ask don’t ask. For example, if someone is happily married, don’t ask them what their sexuality is.
Whatever a person tells us we must be non-judgmental, regardless of whether we identify or agree with their relationship or lifestyle choices. This is in line with the core principles and values of equality and diversity.
The ways in which a person may need support will vary based on their specific needs. The following are just some examples:
Accessing a community
A community is any group of people that is important to the person and therefore part of who they are. For example, a religious community, a sporting community, LGBT community, a hobby group, or a support group.
There is a chapter of this Handbook dedicated to supporting access to community.
Self-expression
Self-expression covers everything a person may want to do to be true to express their identity.
Samira likes to wear a Sari every Sunday but due to reduced dexterity she needs support to wear it. Staff have learned how to support her and make sure they allow time each Sunday morning to do this.
Tom has Autism. He identifies as being LGBT and would like to go to a LGBT bar nearby but is also very anxious about it as he has never been before. His support worker arranges a taxi for them, and they go together the first few times. Tom starts to make friends at the bar and after a few weeks no longer needs support.
Peter likes to express himself by wearing make-up and female clothing from time to time. If he is going to wear a dress, Peter also likes his legs to be shaved. Peter is a wheelchair user and needs support with all personal care.
Professional support with identity
Some people struggle with their identity and can need support from a health professional. For example, if someone has gender identity issues. The person’s GP will be able to signpost or refer the person to any specialist services that can support them.
Managing sexual disinhibition
Sexual disinhibition is when a person expresses themselves in ways that are inappropriate or offensive to others.
For example:
- Removing their clothing;
- Masturbating;
- Using offensive sexual language.
Sexual disinhibition is normally caused by a condition that has affected the brain’s ability to regulate behaviour. For example, a learning disability, dementia, brain damage or mental health issue.
If a person is known to be sexually disinhibited, the service will need to take steps to maintain their dignity and reduce the risk of allegations against them or even criminal prosecution.
There may be triggers for the behaviours, or the person may need some time and space to express themselves privately and safely.
If the person has the mental capacity to decide how they are going to act, no restrictive measures can be put in place (unless they become subject to restrictions under the Mental Health Act 1983). If they lack capacity, it may be possible to use restrictions, but this must be authorised under the Mental Capacity Act 2005.
See: Mental Capacity
Safe to be me, produced by Age UK in partnership with Opening Doors London, helps managers and staff understand how to support older people who are lesbian, gay, bisexual or transgender (LGBT) and helps training providers ensure courses include discussions and scenarios relating to the needs of people who are LGBT.
See: Safe to be me
Manor Community have developed a flexible learning resource to help providers supporting people of working age to improve LGBT+ inclusivity for staff members and people drawing on their care and support.
Also see Section 9, Training and Development.
This section applies when there are no concerns about the relationship or the person’s mental capacity to consent to that relationship.
Staff must give people privacy, space and time to enjoy their relationships.
People should be able to see anyone they have a relationship with whenever they want to, and not be restricted by the availability of staff support.
The following are just a few examples of the ways that people may need support:
- Support staying in touch with people, or to arrange to see them;
- Support to use online dating websites or apps safely;
- Support to arrange transport or to get somewhere in the community;
- Support to get ready - hair, make-up etc.;
- Some people may always need support to ensure their needs are met or that they are safe;
- Support with sexual health. For example, access contraceptive or STI services;
- Support to maintain dignity e.g., closing doors, drawing curtains, advice about appropriate public behaviour;
- Support to access relationship education services e.g., community nursing.
If the person lives in a care home, Regulation 9A of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 requires that, unless there are exceptional circumstances, the person must be able to receive visits from anyone they wish to see and not be discouraged from taking visits outside the care home.
Capacity and consent to sex is a complex area of law.
If anyone is concerned that a person may be having, or about to enter into a sexual relationship that they cannot consent to, a safeguarding concern must be raised.
See: Disclosure and Raising a Concern
The local authority will be able to advise on urgent action the service can/should lawfully take to reduce risks. They can then formally assess mental capacity and make any applications to Court that are necessary.
Harmful relationships are those that have a serious effect on wellbeing. For example, abusive or neglectful relationships.
For guidance about whether a relationship may be harmful, see:
If staff are concerned that someone is in a harmful relationship, they must not ignore this.
Ask the person if they are OK. Do they want to talk about it, or to make a complaint to the police?
If the safeguarding duty applies, a safeguarding concern must be raised.
To enable the people we support to feel safe, secure and supported, it is important that we have a good relationship with them.
However, the nature of this relationship must only ever be a working relationship. We are in a position of trust and to have any other kind of relationship would be an abuse of this trust.
Staff must not share information about their own personal circumstances or problems with people, or ask them for advice etc.
If we bump into a person or their family when outside of work it is fine to have a short, general conversation but not to socialise.
If anyone has any concerns about the above, they should speak to a manager or the registered person.
Skills for Care and Supported Loving have developed a package of training materials to help providers develop the skills and knowledge needed to support people with personal relationships.
The trainer materials include PowerPoint slides which are supported by a lesson plan, training facilitator guide and learner handouts and worksheets.
The programme includes a brief introduction, followed by four modules that can be delivered individually or as a complete package. The training areas are:
- Understanding sexuality and relationships: barriers, benefits and the impact of staff values;
- Roles, regulations and the law;
- Sexual safety and autonomy;
- Practical approaches to relationships and sexuality support.
Both the guide and training materials are focused on enabling staff and services to offer support in a way that respects peoples’ choices and values whilst keeping them safe.
To find out more and access all the materials see: Supporting personal relationships.
The Supported Loving network has produced a series of guides to help support people with issues surrounding sexuality and relationships.
See: Supported Loving toolkit.
This learning framework from Skills for Care builds knowledge and understanding of LGBTQ+ issues and can support managers to create learning programmes which will enable the service to better support LGBTQ+ people in later life.
The framework includes:
- A background on LGBTQ+ issues and awareness;
- A look at health and wellbeing issues later in life, including research about LGBTQ+ inequalities;
- Information on providing personalised care and support covering topics of intersectionality, supporting people with dementia or HIV, and understanding intimacy and sexuality later in life; and
- Recommendations for leadership, education, and service development to continue to improve care and support in this area.
See: LGBTQ+ Learning Framework.
Further resources for LGBT can be found above in Section 4, Resources for LGBT.
Last Updated: June 25, 2024
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