Personal View: Personal services or dangerous liaisons: should we help patients hire prostitutes?
Authors: James Barrett
Journal: BMJ (2004)

Iwas first asked to see Mr Cooper (not his real name) in my capacity as a psychiatrist. The general practitioner's referral letter said he was a man in his 80s, frail, catheterised, demented, and displaying “inappropriate sexual behaviour.” I visited Mr Cooper at his local authority residential home.

It seemed that Mr Cooper had persistently been asking female members of staff to have sex with him. The problems seemed to have begun when Mr Cooper's regular visits from an elderly female friend had ceased.

Although rather deaf and undoubtedly frail Mr Cooper did not have significant cognitive impairment. He volunteered that his visitor had been providing him with paid sexual services, and that since this was no longer possible he wanted to hire another prostitute. He said his deafness and poor vision had now made it difficult for him to do this for himself, and he had consequently sought help from the staff. He had been firmly refused. I gathered that after a stalemate of many months he could think of nothing to do other than proposition the staff.


A side room was allocated and the staff made aware of the special “therapist”


I spoke to the manager of the residential home. The staff already suspected the true nature of the visits from the elderly woman. The staff were clear that they were not going to comply with his request. It was thought probably to be illegal. They did not want to let “someone like that” on to the premises. Some felt it to be exploitative of women; others that it would be likely to offend other residents. Some staff found it repugnant, and all maintained that they would not, in any case, know how to go about procuring the services of a prostitute.

I pointed out that Mr Cooper was simply proposing spending his own money as he saw fit and was likely to have sex in a manner invisible to the other residents and thus was unlikely to cause offence. Even were they to find out, I argued, this was not a reason to prohibit it.

Nothing was resolved that day. The matter was to be discussed at some higher level of management. The staff seemed disappointed that I was not going to prescribe some drug to lower Mr Cooper's libido. I in my turn was astonished that they had seen bromide, or its modern equivalent, as the answer to the situation.

I was telephoned by the head of social services for elderly people. The legal advice was that the crime of procurement would not have been committed if staff at the residential home were to call prostitutes on Mr Cooper's behalf. The advisers said that it was Mr Cooper's right to spend his money in whatever lawful way he thought proper. However, they would not countenance him entertaining a prostitute at the home.

Paradoxically, social services were afraid that having sex regularly with a prostitute might curb his troublesome behaviour and that once he had spent his modest life savings on prostitutes they would be obliged to continue to pay out of social services money, as it would have been shown to be the best way to control his behaviour. It was pointed out to me that this arrangement might precipitate unhelpful headlines in the papers.

Finally, it seemed that his family's view had been sought (whether with his consent I do not know). It seemed that his children had no objection, having known for years that this had been his habit, even when their mother had been alive.

His situation deteriorated. An extra male staff member was hired, devoted solely to following him around all day to prevent him from making improper suggestions. Both the staff member and Mr Cooper found this constant observation trying.

Later, staff at the residential home obtained the telephone numbers of prostitutes, and one agreed to meet Mr Cooper at a neutral venue. The staff were still divided, although the man who had followed Mr Cooper's every tottering step for many weeks was reported to be relieved. Mr Cooper had been tremulous with anticipation, and the cab had already been summoned, when the liaison was called off by social services. There had been a second change of plan. Social services now took the view that the prostitute was a sort of therapy, and they would only continue the “therapy” if it was initiated in an NHS hospital and was shown to have a beneficial effect on his behaviour in an inpatient setting.

I spoke to the ward manager. He felt that it did not seem the best use of resources but could see no other solution. A side room was allocated and the staff made aware of the special “therapist” who it was planned would call the day after his admission to the hospital.

Fate intervened. Mr Cooper developed pneumonia and died. I wonder whether the months of indecision, close observation, and frustrated tension contributed to his decline. Surely we can do better than this? And surely we must make plans—because Mr Cooper's circumstances will recur elsewhere, if they have not done so already.