Disfigurement is a general term used to cover any condition, mark or scar that affects the appearance of someone’s face or body. This includes cleft lips, birthmarks and burns. Not everyone with a disfigurement will want to have their condition referred to in this way – they may prefer terms such as ‘visible difference’. Just under 1% of the UK population has a facial disfigurement.
What are the different types of disfigurement?
Although the Equality Act only protects people against discrimination on the basis of a ‘severe disfigurement’, seemingly minor issues can come under the umbrella term of disfigurements, such as acne, eczema and psoriasis.
More severe and noticeably ‘disfiguring’ conditions might include:
- Facial fractures (for which reconstructive surgery is particularly challenging)
- Facial paralysis (from a stroke or loss of muscle tone, known as Bell’s palsy)
- Cleft lip or palate
- Vitiligo (depigmentation of the skin)
- Craniofacial conditions (e.g. neurofibromatosis)
How do disfigurements get treated?
Depending on the nature of the disfigurement, there may be different treatments to reduce the appearance of, in the case of birthmarks, hyperpigmentation. These would include creams to camouflage the birthmark. There are also medicines which can reduce blood flow to the skin and reduce colouration in this way.
For disfigurements such as alopecia and hair loss, available treatments are largely ineffective owing to the fact that they require self-funding (they are not available on the NHS) and only work as long as the treatment is kept on top of. This is expensive and therefore not a viable option for most people.
Although the appearance of burns and disfigurements resulting from facial fractures and conditions such as neurofibromatosis can be reduced with reconstructive surgeries, these rarely resolve the condition completely.
Owing to the fact that a disabling disfigurement under the Equality Act 2010 is a ‘severe’ one, these, by definition, cannot be treated. For example, long-term scarring from severe burns and self-harm scars.
There are a few ways to determine whether an employee has a ‘severe’ disfigurement, or to confirm a disfigurement which requires reasonable adjustments:
The employee may or may not wish to disclose their disfigurement. Regardless, questions regarding the nature of their disfigurement and what extra support they may need can be broached sensitively. For example:
- For how long have they been affected? If they have been recently disfigured, there may be an additional impact on their mental and/or physical health which will require consideration.
- Have they required adjustments in the past? Unconscious bias testing has shown that many people will assume a cognitive impairment in someone with a disfigurement, although the majority of people with a disfigurement will have the same intellectual function as an able-bodied person.
- A ‘severe’ disfigurement is classified by law to include any disfigurement which has a ‘substantial adverse effect’ on the person’s ability to go about their day-to-day life. Therefore, a general discussion surrounding how the employee’s condition affects them will help determine whether their disfigurement is of a ‘severe’ enough nature as to require accommodation by the employer.
What reasonable adjustments are possible for employees with disfigurements?
Employers have a legal duty to make reasonable adjustments for employees with disfigurements if they know, are aware of, or could ‘reasonably be expected to know’ that the employee has a disfigurement. Most employees will tell their employer what reasonable adjustments they need. They often involve simple changes in the way an employer might usually do things.
If the employee does not disclose a health issue or disability which may affect their performance up front, an employer should broach the subject sensitively if they suspect that there may be a disability behind the employee’s reduced performance. Reasonable adjustments can then be made in accordance with the employee’s needs, including, in the case of disfigurements:
- Flexible working hours to accommodate treatment and appointments, such as phased returns to work after surgeries and later starts if getting ready for the day takes longer.
- Additional breaks to allow the employee to reapply camouflage make-up or to manage side effects from medication such as lapses in concentration, etc.
- Assistive technology if the disfigurement affects the hands or eyes, for example, which could make the use of a computer more difficult.
- Raising awareness so that colleagues understand the employee’s disfigurement and can help ensure the employee feels comfortable at work
- Making the employee aware of the workplace harassment policy so that they feel comfortable reporting and instances of bullying towards them as a result of their disfigurement.
Changing Faces – charity providing advice, support and psychosocial services to anyone in the UK with a mark, scar or condition which makes their body appear different, and challenging the discrimination faced by people with visible differences (0300 012 0275).
Birthmark Support Group – charity providing support and information for anyone living with a birthmark, as well as raising awareness in schools and among medical professionals so that identification of complications and treatments is improved (07825 855 888).
The Katie Piper Foundation – charity dedicated to improving the lives of burns survivors through expanding the reach of rehabilitation services and supporting survivors in their mental and physical recovery (0300 365 0055).
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