Who decides when people can have sex? Australian mental health clinicians’ perceptions of sexuality and autonomy

Abstract

Sexuality is a central aspect of human experience but there is evidence that this is largely constrained, pathologised or ignored in mental health settings. We conducted in-depth interviews with 22 psychologists, psychiatrists and mental health nurses working across a variety of settings in four Australian cities. Sexuality was most often perceived as relevant in the mental health setting when it was simultaneously constructed as dangerous. Participants located this danger in sexual expression itself or within individuals who, because of mental illness, lacked the autonomy required to successfully engage in 'safe' sex. We discuss these findings and their implications for research and professional practice.

‘It's just a peripheral issue’: A qualitative analysis of mental health clinicians’ accounts of (not) addressing sexuality in their work

“…The view that sexuality and sexual expression is neither important nor relevant in the lives of people experiencing mental distress and illness was also common. This may be rooted in broader social anxieties regarding sexual expression in the context of mental illness (Quinn & Browne ) that also shaped participating clinicians’ perceptions of sexuality in their work (see Urry & Chur‐Hansen ).…”

A Qualitative Study on Sexuality and Sexual Experiences in Community Forensic Mental Health Patients in Queensland, Australia

“…A different interpretation that can be posited from the participants' notions of being satisfied with their current state of being sexually inactive, despite the incongruence with their desired level of sexual activity, and the aspect of lacking the motivation to pursue a relationship can be explained as a phenomenon of these people to have lost a sense of hope on matters of relationships and intimacy. Most people with an enduring mental illness will feel disempowered after being subjected to years of treatment under a legal framework, involuntary confinement, and experiences of other treatment interventions that they might perceive as a paternalistic approach ( 36 ). In the process of their treatment trajectory, patients lose hope and conform to an image of worthlessness and incapacity, becoming socially withdrawn and adopting a disabled role ( 37 ).…”

“…Intimate relationships have a protective effect on the quality of life and recovery ( 64 ), yet sexual health and sexuality in forensic patients have received scant attention, and there have been no large-scale studies focused on forensic community mental health patients concerning their sexual wellbeing. Previous studies on this topic focused on inpatient settings ( 36 , 84 , 85 ). Therefore, the current study aimed to qualitatively examine participants' sexuality and sexual experiences with major mental illnesses treated under the legal framework of a forensic order in a community setting.…”

Love and Romantic Relationships in the Voices of Patients Who Experience Psychosis: An Interpretive Phenomenological Analysis

“…Studies show a larger prevalence of sexual trauma among women with schizophrenia (Darves-Bornoz et al, 1995), and the risk that their experiences in this regard can be unseen and unreported (Rice, 2008). On the other side, the basic agency and freedom in choosing one's own expressions of sexuality should not be limited by overprotective attitudes of mental health professionals (Urry and Chur-Hansen, 2018). From an experiential perspective, sexual trauma can change the meanings ascribed to sexuality in general, especially causing one to reject it, or to resign from entering sexual experiences with other persons.…”