Sexuality and Sexual Health

Hunter, Kristin M.; Ahmed, Anthony O.

doi:10.1007/978-3-319-40537-7_3

Cited by 4 publications

(6 citation statements)

References 76 publications

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“…Issues of sexuality in secure mental healthcare have been overlooked historically in both clinical praxis and the academic literature (Brown et al 2014;Hunter and Ahmed 2016;McCann, 2010;Ruane and Hayter 2008). However, as many as 30% of people in secure mental healthcare report participating in some kind of sexual activity during their time as psychiatric inpatients, often in contravention of policies banning such contact (Warner et al 2004).…”

Section: Introductionmentioning

confidence: 99%

Sexuality, risk, and organisational misbehaviour in a secure mental healthcare facility in England

Ravenhill

Poole

Brown

et al. 2020

Culture, Health & Sexuality

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Sexuality in secure mental healthcare has been overlooked in both clinical praxis and academic research. In the UK, there exist no formal policies to inform staff approaches to managing inpatient sexuality. The limited research that has been undertaken in this field has found that often, prohibitive approaches are favoured, which may affect how inpatients conceptualise and experience their sexuality in the long-term. The aim of this study was to identify discursive constructions of inpatient sexuality, as articulated within semi-structured group interviews with inpatients and ward staff from a secure mental healthcare facility in England. The analysis identified constructions of inpatient sexuality within two overarching and conflicting discourses: one of the normalcy and legitimacy of sexual expression in human experience; and the other of risk, wherein sexuality needed to be regulated and obstructed. Inpatients' expressions of sexuality could often only be conceptualised in terms of "organisational misbehaviour", acts that violated the implicit norms and codes of the institution. It is suggested that recoding inpatient sexuality as misbehaviour could have implications for inpatients' long-term recovery.

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Section: Introductionmentioning

confidence: 99%

Sexuality, risk, and organisational misbehaviour in a secure mental healthcare facility in England

Ravenhill

Poole

Brown

et al. 2020

Culture, Health & Sexuality

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“…Recovery is aligned with a rights discourse and with the principle of least restrictive practice. Moreover, a recovery approach encompasses the idea that sexual expression is a fundamental basic right, regardless of ‘disability’ (Hunter & Ahmed 2016). Given this, the lack of privacy afforded consumers in our study contravened their right to sexual expression and policies that promote a recovery‐oriented approach to treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Risk‐taking might raise a concern about the capacity of consumers to give consent. Informed consent needs to be considered for each consumer and not as a blanket measure for an entire residential population (Hunter & Ahmed 2016). The study reported here received ethical clearance to proceed.…”

Section: Discussionmentioning

confidence: 99%

Consumers living with psychosis: Perspectives on sexuality

Evans

Quinn

McKenna

et al. 2020

Int J Mental Health Nurs

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Mental health clinicians work within a recovery framework that is rights based and emphasizes positive and respectful approaches to working with mental health consumers. Mental health nurses’ practice is also predicated on holism and inclusiveness, yet consumers’ sexuality is sometimes neglected and rights in this area overlooked. Also overlooked is sexuality as an area for investigation, particularly from a consumer perspective, even though it constitutes part of consumers’ broader remit of sexual health. This paper reports findings from a case study where consumers were asked about their ability to negotiate and sustain sexual expression while residing in a long‐stay mental health rehabilitation facility. There were three main findings. First, the physical space of the facility, inclusive of consumers’ bedrooms, was policed by mental health clinicians with ongoing intrusions into consumers’ privacy, which inhibited their sexual expression. The creation of barriers to sexual expression is counter to polices that promote recovery. Second, consumers reported significant medication‐related weight gain which negatively affected their self‐image and sexual sense of self. Third, the consumers spoke about their sexuality in ordinary, everyday language devoid of any hallmark of psychosis. This highlights the importance of relating to consumers about their sexuality and sexual needs from a humane rather than technical framework. Further, it foregrounds the relational aspect of the mental health nurses’ role rather than the technical aspect. Yet sexuality is a topic that is often neglected, indicating that an upskilling of the mental health nursing workforce is required, to strengthen communication and relationship skills.

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“…This inability to engage in mature debate is also noted by Hunter and Ahmed (2016): The question – should hospitalized patients be allowed to express themselves sexually in socially acceptable ways? – is one that elicits knee-jerk responses among practitioners, patients, and consumer advocates .…”

Section: Introductionmentioning

confidence: 99%

“…The risk of harm from sexual assault is not, and should not be, underestimated. The emotional and psychological harms, the potential to retraumatise, the negative impact on recovery, the risk of sexually transmitted diseases and unwanted pregnancy are all very serious consequences (Hunter and Ahmed, 2016). These concerns were also raised by long-stay forensic consumers, who identified sexual activity in acute settings as potentially very harmful (Quinn and Happell, 2016).…”

Section: Introductionmentioning

confidence: 99%

The capacity to consent to sex in mental health inpatient units

Maylea

2019

Aust N Z J Psychiatry

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Objective: Discussions of capacity to consent in mental health care usually revolve around capacity to consent to treatment. This paper instead explores the issue of capacity to consent to sexual activity in a mental health inpatient setting as a way of exploring capacity from a different perspective. This is not a purely theoretical exercise, with both consensual sexual activity and sexual assault commonplace in mental health inpatient units, current policy and practice approaches are clearly not working and require re-examination. Methods: Four key frameworks are explored: human rights law, mental health law, the criminal law and the law of tort governing the duty of care. These frameworks are explored by highlighting relevant case law and statutes and considering their potential application in practice. This is undertaken using the state of Victoria, Australia, as a case study. Results: The four frameworks are shown to be consistent with each other but inconsistent with contemporary policy. All four legal frameworks explored require clinicians to take a case-by-case assessment to ensure that a person’s right to make their own decisions is preserved ‘ unless the contrary is demonstrably justified’ or where it is ‘ legally demanded’. While Victorian inpatient units attempt to enforce a blanket ban on consensual sexual activity in inpatient settings, this ban may be without legal basis and may be in breach of both human rights and mental health law. Conclusion: In policing the lawful bodily interactions of their patients and pushing sexual activity out of sight, clinicians may be breaching their duty of care to provide sexual health support and risk creating an environment in which the therapeutic relationship will be sacrificed to the enforcement of institutional policy. Clinicians and policymakers must understand the relevant legal frameworks to ensure that they are acting ethically and lawfully.

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Sexuality and Sexual Health

Cited by 4 publications

References 76 publications

Sexuality, risk, and organisational misbehaviour in a secure mental healthcare facility in England

Sexuality, risk, and organisational misbehaviour in a secure mental healthcare facility in England

Consumers living with psychosis: Perspectives on sexuality

The capacity to consent to sex in mental health inpatient units

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