‘It’s Not Really a Part of Standard Practice’: Institutional Silencing of Sexuality Within Australian Mental Health Settings

Abstract

Research seeking to understand and improve sexuality-related practice in mental health settings has paid little attention to the institutional context in which clinicians’ practice is embedded. Through a social constructionist lens, we used thematic analysis to examine how 22 Australian mental health clinicians implicated the wider institutional context when discussing and making sense of sexuality-related silence within their work. Interviews were part of a study exploring participants’ perceptions of sexuality and sexual health in their work more generally. Broader silences that shaped and reinforced participants’ perceptions and practice choices were situated in professional education; workplace cultures; and the tools, procedures and policies that directed clinical practice. We argue that sexuality-related silence in mental health settings is located in the institutional context in which clinicians learn and work, and discuss how orienting to this broader context will benefit research and interventions to improve sexuality-related practice across health settings.

Australian health professionals’ perspectives on discussing sexual activity and intimacy with people who have had a heart attack: a qualitative study

“…Structural barriers to communication about sex and intimacy were frequent, consistent with previous research in this and other fields of medicine and nursing (Salehian et al 2017;Karani and McLuskey 2020;Urry et al 2022). Insufficient time and privacy, generic, out-dated or inappropriate resources, the lack of a protocol, and a lack of training were all obstacles.…”

“…Significant barriers to Australian health professionals providing the level of recommended care (Levine et al 2012;Steinke et al 2013) were identified. Australian clinicians are wrestling with similar barriers to effective communication as health professionals in other countries, and in other health care settings (Annerstedt and Glasdam 2019;O'Connor et al 2019;Karani and McLuskey 2020;Urry et al 2022).…”

“…Hyde et al (2020) similarly reported that health professionals waited for patients to initiate discussions, whereas patients expect health professionals to do so (East et al 2021). Clinician embarrassment, combined with fear of patient embarrassment, were identified as barriers among nurses in cardiac care (Karani and McLuskey 2020), oncology (Annerstedt and Glasdam 2019), chronic disease (O'Connor et al 2019) and mental health settings (Urry et al 2022).…”

Approaches for improving sexuality and sexual health care in mental health settings: A qualitative study exploring clinicians' own perspectives

“…These findings challenge the common emphasis in wider literature on a need for individual‐focused interventions including education. The problem of inadequate sexuality‐related care in mental health settings is embedded in the broader contexts where clinicians work and must therefore be addressed through that broader context (see Urry, In press). The insufficiency of educational interventions alone to achieve ‘service transformation’ has been acknowledged by researchers working to address other challenges in mental healthcare delivery (see McCloughen & Buus, 2020).…”

“…Sexuality and sexual health are challenging and complex areas of care within health and mental settings (Hughes et al, 2018). Within recovery‐oriented mental health care contexts, and in alignment with the World Health Organization (2015) working definitions, these are best understood as holistic and affirmative concepts that incorporate a range of domains including, but necessarily extending beyond , concerns related to physical illness, physical function, and reproduction (see Urry, In press). A holistic approach is also aligned with the reported experiences and needs of individuals engaging in mental health services (e.g., Evans et al, 2021; McCann et al, 2019).…”