'Hiding in plain sight': Exploring the complexity of sexual safety within an acute mental health setting

Perspectives of Mental Health Nurses About Sexual Safety in Acute Inpatient Mental Health Units

The overall aim of this study is to explore the views of mental health nurses (MHNs) about the sexual safety of consumers receiving care in acute inpatient units. In Australia, people accessing mental health inpatient units have reported feeling unsafe while receiving care including experiences of sexual harassment and abuse from other patients. There has been no study to date that has explored the views of the MHNs providing care. An explorative descriptive qualitative study. Data were collected through semi-structured interviews involving n = 8 MHNs working on a metropolitan acute inpatient unit recruited using purposive convenience sampling. Data were analysed using thematic analysis. The findings of this study highlighted the themes of 'It's everyone's job to keep the patient safe', 'Going over expectations', 'Impact on patients' and 'Built environment'. Participants in this study believed that the sexual safety of patients in the inpatient unit is everyone's responsibility and that it was important during the admission process to ensure patients are aware of how to both seek help if needed and ensure that their actions or behaviours do not pose sexual safety concerns in others. Ensuring sexual safety in the mental health inpatient units is a complex issue that requires evidence-based multipronged interventions involving all key stakeholders within the units.

Combining rules and dialogue: exploring stakeholder perspectives on preventing sexual boundary violations in mental health and disability care organizations

Background

Sexual boundary violations (SBV) in healthcare are harmful and exploitative sexual transgressions in the professional–client relationship. Persons with mental health issues or intellectual disabilities, especially those living in residential settings, are especially vulnerable to SBV because they often receive long-term intimate care. Promoting good sexual health and preventing SBV in these care contexts is a moral and practical challenge for healthcare organizations.

Methods

We carried out a qualitative interview study with 16 Dutch policy advisors, regulators, healthcare professionals and other relevant experts to explore their perspectives on preventing SBV in mental health and disability care organizations. We used inductive thematic analysis to interpret our data.

Results

We found three main themes on how healthcare organizations can prevent SBV in mental health and disability care: (1) setting rules and regulations, (2) engaging in dialogue about sexuality, and (3) addressing systemic and organizational dimensions.

Conclusion

Our findings suggest that preventing SBV in mental health and disability care organizations necessitates setting suitable rules and regulations and facilitating dialogue about positive aspects of sexuality and intimacy, as well as about boundaries, and inappropriate behaviors or feelings. Combining both further requires organizational policies and practices that promote transparency and reflection, and focus on creating a safe environment. Our findings will help prevent SBV and promote sexual health in mental health and disability care organizations.

Safety for women when accessing mental health services: a scoping review of the link between safety and recovery

Objective A sense of safety and recovery from mental health issues seem to be interrelated concepts but, to date, there has been no review of studies exploring the links between safety and recovery for women accessing mental health programs. This review aimed to identify current knowledge and knowledge gaps regarding the experiences of women and their personal safety when accessing mixed-gender and women's mental health programs. Methods A scoping review methodology was used. Four electronic databases (Medline, PsycINFO, AMED, and CINAHL) were searched, covering the period from January 2000 to December 2019, to identify relevant peer-reviewed articles, which were screened for inclusion. Key search terms included ('women' or 'female' or 'gender') and ('recovery' and 'mental health programs') or ('community mental health' or 'community mental health centres/or community mental health centre') and 'safety'. Results Twelve studies were identified, 10 of which were from English-speaking countries (five from the UK, three from Australia, two from the US) and two from European countries, indicating there is limited literature directly relevant to women with mental health issues and their personal safety while using mental health services. Safety from assault and harassment and finding safe and supportive connections were commonly reported as crucial to the process of recovery for the women with mental health issues across these studies. Conclusions Based on the identified knowledge gaps, this paper advances the argument for more research to inform gender-specific service provision. What is known about the topic? Service guidelines identify the need for gender-sensitive practices in mental health services, yet women continue to report experiences of sexual or other forms of harassment while in acute and subacute mental health programs. What does this paper add? This study identified the current knowledge regarding the experiences of women when accessing mental health programs. In particular, a sense of feeling safe in services was crucial to the process of recovery for women with mental health issues. What are the implications for practitioners? This study contributes to the body of knowledge informing health professionals who work within these mental health programs and highlights the need to meet women's needs to feel safe when accessing services.

Consumers living with psychosis: Perspectives on sexuality

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.

What mental health nurses have to say about themselves: A discourse analysis

Mental health nursing is largely invisible within public discourse. When mentioned at all in news media, it is usually a signifier of an occupation connoting where a nurse works. There is rarely a presumption of expertise in any sphere or articulation of a unique skill set or defining features which differentiate the mental health nurse from other nurses. This paper sought to examine the professional discourse around mental health nursing as inferred from a review of papers published in the International Journal of Mental Health Nursing in 2019. A discourse analysis of full-text papers (n = 117) was undertaken exploring references to mental health nurses or nursing and what this communicated about the field. The discourse clustered around three themes: The invisible or absent mental health nurse, ambiguous and blended identities, and a group of low attributed value and sophistication. There were few examples of authors presenting mental health nurses in a way which counters stereotypes of the dominant discourse about mental health nurses as a lesser skilled occupational group. Academics, editors, authors, and practitioners are urged to contribute to the construction of discourse around mental health nursing expertise which differentiates it from other branches of nursing and other distinctive disciplines.

How does the environment influence consumers' perceptions of safety in acute mental health units? A qualitative study

AIMS AND OBJECTIVES

To explore how the physical and social environment of acute mental health units influences consumers' perception and experience of safety.

BACKGROUND

Acute mental health units are places in which consumers should feel safe. Not all consumers, however, feel safe in this environment. Little is known about what contributes to consumers' feelings of safety in this setting.

DESIGN

The study used a qualitative descriptive design, influenced by naturalistic enquiry. Data were analysed using thematic analysis and are reported according to the COREQ checklist.

METHODS

Fifteen people who had experienced admission to an acute mental health unit were individually interviewed.

RESULTS

Having a supportive environment enhanced consumers' perception and experience of safety. A supportive environment was experienced when consumers had privacy, felt safe from other consumers and had meaningful activities to participate in within the acute mental health unit. In contrast, having their privacy breached by other consumers made participants feel unsafe. Many participants were fearful of other consumers, and felt unsafe and unable to protect themselves. Lack of meaningful activities led to boredom and contributed to consumers feeling unsafe.

CONCLUSIONS

Personal spaces should address consumers' privacy needs without compromising staff access. Staff presence enhances consumers' feelings of safety, but this need can be heightened when consumers are unable to alert staff when they feel unsafe. Meaningful activities link consumers to their lives outside of the hospital and can enhance recovery.

RELEVANCE TO CLINICAL PRACTICE

Understanding how the acute unit environment is perceived by consumers can assist nurses and managers to promote feelings of safety among consumers. Feeling safe can, in turn, optimise recovery.