Mental health consumers are sexual beings; however, their sexual desire, capacity, and ability to maintain previous sexual patterns can be altered by their illness or by the effects and side-effects of medications. The sexuality of consumers has been poorly addressed, and the limited evidence suggests that mental health nurses remain ambivalent to including sexuality in their care. This paper presents the findings of a research project investigating the practices of mental health nurses in assessing and supporting the sexuality of consumers. A qualitative, exploratory approach underpinned individual interviews with 14 mental health nurses from inpatient and community settings. The participants acknowledged the importance of sexuality; however, most were reluctant to enquire about consumer concerns and tended to either ignore the issue or refer it to another clinician. Four themes were identified: talking about or avoiding sexuality concerns with consumers; sexuality is not an important priority; refer to others, as talking about sexuality is not 'my' job; and sexuality is poorly addressed by others. It is important that barriers to the assessment and discussion of sexuality are identified, and measures are taken to overcome them.

This article is a review of the literature examining the sexuality of mental health consumers and the role of mental health nurses. A search identified 72 English articles on the topic. The evidence clearly indicates that sexuality is a critical aspect of who we are as individuals, and of how we view ourselves, but discussion of this topic is neglected by mental health nurses. Discussion focuses upon the wide acceptance of sexuality as a legitimate area for nurses to address in their care, and addresses mental health nurses' lack of knowledge about sexuality, conservative attitudes, and anxiety when discussing sexual issues. Consumer sexuality is poorly assessed in mental health, and is infrequently explored by mental health nurses. The result is that issues of sexuality for the consumer continue to affect many areas of their lives, including their relationships and ongoing commitment to treatment. The nurse-consumer relationship provides an opportunity to take sexual history into consideration, promote safe sexual practices, discuss sexual problems, and educate clients about sexual issues. This literature review identifies the need for further discussion of this topic and for research to point the way ahead for this important but neglected area of mental health nursing.

People with serious mental illness (service users) have needs related to sexual health and sexuality, yet these have been poorly addressed in mental health services. In the present study, we report the current practice of mental health professionals in relation to sexual health. Focus groups conducted in two mental health trusts explored routine practice in relation to discussing, assessing, and planning care in relation to sexual health. A thematic analysis identified seven themes: (i) sexual health provision is a complex issue; (ii) mental health staff are aware of sexual health needs; (iii) current provision regarding sexual health is 'neglected'; (iv) barriers to sexual health provision; (v) enabling a discussion around sexual health; (vi) sexual health provision is a role for mental health professionals; and (vii) training needs. Mental health staff are aware of complex issues related to sexual health for service users, but this is mainly seen through the lens of risk management and safeguarding. We need to develop the mental health workforce to be able to incorporate sexual health into routine health care.

Forensic mental health nursing is a recognized field of nursing in most countries. Despite a growing body of literature describing aspects of practice, no publication has been found that captures the core knowledge, skills, and attitudes of forensic mental health nurses. One group of nurses in Australia have pooled their knowledge of relevant literature and their own clinical experience and have written standards of practice for forensic mental health nursing. This paper identifies the need for standards, provides a summary of the standards of practice for forensic mental health nurses, and concludes with how these standards can be used and can articulate to others the desired and achievable level of performance in the specialty area.

Available evidence informs us that sexual health concerns of consumers are commonly avoided within mental health services. This paper describes the findings of a qualitative exploratory research project. This research was conducted in three stages, all involving in-depth interviews with 14 nurses working in a mental health setting. Stage 1 involved an exploration of participants' views about including sexual concerns in their practice and included an educational intervention designed to encourage sexual inclusivity in practice. Stage 2 involved follow up interviews 4-6 weeks later to discuss the effectiveness of the intervention and whether practice change had resulted. Stage 3 was conducted two years later with the aim of determining the extent to which practice changes had been sustained. The themes emerging throughout the research emphasised five main stages in the nurses' experience: avoidance; awareness; applying; approval; and acknowledgement. Avoidance of the topic was commonly noted in the early stages of the research. The education program led to awareness raising of sexual concerns and approval towards the importance of this area to which lead to applying it to practice. This ultimately resulted in acknowledgement of the need for sexual concerns to become part of mental health nursing practice. These five stages are represented in the Five A's for including sexual concerns in mental health nursing practice, the framework developed by the first author.