“Sex isn’t everything”: views of people with experience of psychosis on intimate relationships and implications for mental health services

Abstract

Background The experience of psychosis and associated discrimination can be a barrier to forming and maintaining romantic relationships. Sexual health interventions within mental health services often focus on contraception and reducing risk. There are no known studies that seek to understand what support, if any, people who experience psychosis want regarding psychosocial aspects of intimate relationships. Methods To address this gap in the literature, qualitative data was collected to investigate how people with experience of psychosis conceptualise romantic relationships and what support they would like in this area of their lives. Semi-structured interviews were conducted with 10 mental health service users (four women, six men) with experience of psychosis. Interviews were analysed from a critical realist social constructionism perspective using thematic analysis. Results Stigma was a prominent theme, described as impacting numerous aspects of romantic relationships. Power imbalance within services meant participants were wary of having conversations about relationships with professionals and identified a therapeutic alliance as a prerequisite. However, abusive relationships were highlighted as a needed area for support by services. Conclusion Services should be trauma-informed and help those in abusive relationships. The power and autonomy of people with experience of psychosis should be maintained in any discussions or interventions regarding intimate relationships. A strong therapeutic alliance is essential for any work in this area.

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

“…Together with limited existing research (e.g. Higgins et al, 2008Higgins et al, , 2009Hughes et al, 2018;Ussher et al, 2013;White et al, 2019White et al, , 2021, our findings indicate that interventions to improve sexuality-related practice in mental health settings need to consider the broader contexts in which clinicians learn and work. These findings are also relevant for broader health settings.…”

“…Many people experiencing mental distress and who may be accessing mental health services, including those with serious mental illnesses diagnoses, value sexual expression and intimate relationships (e.g. McCann et al, 2019; White et al, 2021). A person-centred, rights-based approach that orients toward personal recovery is now purported to underpin mental health services in many countries including Australia (e.g.…”

“…Indeed, sexuality-related needs can be wide ranging, spanning psychological, interpersonal, social, cultural and biological domains of sexuality and health (Weeks, 2010; World Health Organization, 2006). For example, sexuality-related concerns or challenges regarding the initiation and maintenance of intimate relationships, navigating sexual safety, and the negative impact of both pharmacological intervention and mental illness stigma on sexual function and intimacy are all commonly reported in the consumer-based literature (see McCann et al, 2019; Quinn & Browne, 2009; White et al, 2021). Despite this, sexuality-related needs across all domains continue to be inadequately addressed within mental health services globally (e.g.…”

“…Despite this, sexuality-related needs across all domains continue to be inadequately addressed within mental health services globally (e.g. McCann et al, 2019; Quinn et al, 2011; White et al, 2021).…”

“…Biomedical (or bio-psychiatric) discourses are also dominant in psychiatry and mental health systems more broadly (e.g. see Sercu & Bracke, 2017; White et al, 2021). Medicalized discourses are pervasive in shaping sociocultural understandings of and responses to mental distress.…”