Sexual health education for people with mental health problems: what can we learn from the literature?

Abstract

Research into sexual risk behaviour among people with 'severe' mental health problems suggested that they are likely to engage in high-risk sexual behaviour, for a number of reasons, putting them at risk of sexually transmitted diseases. The aim of this review is to describe approaches, content and outcomes of sexual health education programmes, developed and implemented for people with mental health problems. A literature review from 1980 to 2005 was carried out using the electronic databases CINAHL, PsycINFO, British Nursing Index, Pubmed and Medline, and the Cochrane library was also searched. The literature search was confined to papers written in English. The keywords 'sexuality', 'sexual health education', 'sexual health promotion', 'HIV', 'sexually transmitted disease' were combined with 'mental illness', 'chronic mental illness''severe mental illness''persistent mental illness''psychiatry', 'mental disorder', 'education interventions' and 'evaluation'. A vast amount of literature was recovered on sexual risk behaviour in people with severe mental health problems, and sexual dysfunction as a result of prescribed medication. As the focus of the review was on sexual health education, this literature was omitted. Although the literature on sexual health education for people experiencing mental health problems was sparse, 14 studies were located that either described or evaluated sexual health education programmes. Most sex education programmes focused on topics such as HIV and other sexually transmitted diseases, negotiating safe sex and skill development in condom use. Findings suggested that the people who attended benefited from sexual health education programmes, facilitated in a sensitive and supportive manner. Education tended to produce a reduction in sexual risk behaviour as opposed to complete cessation. Nevertheless, it is appropriate to consider integrating such education with service provision. The results of the review provide guidance to service providers and mental health nurses wishing to develop and evaluate sexual health education programmes for service users. Areas for future research are also identified.

L’éducation à la citoyenneté sexuelle des usagers de services en santé mentale

“…Des services en santé mentale ont dispensé des programmes d'éducation sexuelle aux usagers. Higgins et al (2006) ont recensé quatorze études portant sur l'éducation à la santé sexuelle des personnes souffrant d'une maladie mentale. Ils ont pu constater que les programmes ont été béné-fiques puisque les études rapportent une diminution des comportements sexuels à risque chez les participants.…”

The effectiveness of sexual health interventions for people with severe mental illness: a systematic review

“…with human immunodeficiency virus (HIV). 2,19,20 HIV infection rates among people with SMI have been estimated to be approximately 6.9%, much higher than rates for the general US population for the same time period, estimated to be 0.4%. 18 The HIV infection range among those with SMI is reported to be 3-23%, with the highest rates found among those with SMI and substance abuse disorders.…”

“…36,37 Mental health nurses and other professionals working with people with SMI would be well placed to include sexual health as part of their contribution to health promotion. 20 A study by Apantaku-Olajide et al 38 used a survey questionnaire to determine mental health patients' attitude to psychotropic medication for sexual dysfunction and found that participants were willing to discuss their sexual problems with health-care professionals. However, staff may require specific training in order to deliver such interventions.…”

“…20 McCann 26 states that although there have been many initiatives in the UK to make health and social care more responsive and inclusive, the sexual needs of individuals with psychosis appear to remain marginalised and neglected. In this study of 30 people with schizophrenia living in community, 90% of clients felt some need in relation to sexual expression and only 10% of staff recognised sexual expression as a need in their clients.…”

“…The cost-effectiveness literature they identified also showed mixed results. Higgins et al 20 undertook a review on sexual health education. The authors identified six studies that were descriptive or anecdotal, three using post-evaluation or pre-post-evaluation designs and five studies with a randomised intervention design.…”