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Boons L, Jeandarme I, Denier Y. Toward an Integrated Sexual Policy in Forensic Psychiatry: A Mixed Method Pilot Study. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:2509-2527. [PMID: 38902489 DOI: 10.1007/s10508-024-02873-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/15/2024] [Accepted: 04/19/2024] [Indexed: 06/22/2024]
Abstract
Forensic inpatients reside for long periods in restricted environments, which do not support the presence of sexual experiences or the expression of existing needs. However, sexuality and sexual health are important aspects in the overall recovery from mental illness. Given the lack of national policies, management decisions are bestowed upon individual institutions and staff members. This research aims to describe the current sexual policies in 32 forensic psychiatric wards in Flanders (the Dutch-speaking part of Belgium), varying from low to high security, and explore the perspective of forensic inpatients regarding such policies. The research questions were answered using a survey that questioned the different forensic units. Only 56% of the wards had a sexual policy at the hospital level. Results showed no significant differences in the applicable sexual policies between the security levels, but individual differences and inconsistencies exist in the rules and agreements applied among different wards. Subsequently, 15 semi-structured in-depth interviews with inpatients were conducted using a phenomenological approach. Most of the respondents were dissatisfied with their sexuality and experienced various barriers in meeting their sexual wants and needs. The results have an added value for clinical practice and lead to recommendations in the development of an integrated sexual policy.
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Affiliation(s)
- Lena Boons
- Department of Criminal Law and Criminology, KU Leuven, 3000, Louvain, Belgium.
| | - Inge Jeandarme
- Department of Criminal Law and Criminology, KU Leuven, 3000, Louvain, Belgium
| | - Yvonne Denier
- Department of Public Health, KU Leuven, Louvain, Belgium
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Nolan H, O'Donoghue B, Simmons M, Zbukvic I, Ratcliff S, Milton A, Hughes E, Thompson A, Brown E. The development of a novel sexual health promotion intervention for young people with mental ill-health: the PROSPEct project. BMC Health Serv Res 2024; 24:262. [PMID: 38429748 PMCID: PMC10905889 DOI: 10.1186/s12913-024-10734-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 02/15/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Young people with mental ill-health experience higher rates of high-risk sexual behaviour, have poorer sexual health outcomes, and lower satisfaction with their sexual wellbeing compared to their peers. Ensuring good sexual health in this cohort is a public health concern, but best practice intervention in the area remains under-researched. This study aimed to co-design a novel intervention to address the sexual health needs of young people with mental ill-health to test its effectiveness in a future trial undertaken in youth mental health services in Melbourne, Australia. METHODS We followed the 2022 Medical Research Council (MRC) guidelines for developing and evaluating complex interventions. This involved synthesising evidence from the 'top down' (published evidence) and 'bottom up' (stakeholder views). We combined systematic review findings with data elicited from qualitative interviews and focus groups with young people, carers, and clinicians and identified critical cultural issues to inform the development of our intervention. RESULTS Existing evidence in the field of sexual health in youth mental health was limited but suggested the need to address sexual wellbeing as a concept broader than an absence of negative health outcomes. The Information-Motivation-Belief (IMB) model was chosen as the theoretical Framework on which to base the intervention. Interviews/focus groups were conducted with 29 stakeholders (18 clinicians, three carers, and eight young people). Synthesis of the evidence gathered resulted in the co-design of a novel intervention consisting of an initial consultation and four 60-90-minute sessions delivered individually by a young 'sex-positive' clinician with additional training in sexual health. Barriers and supports to intervention success were also identified. CONCLUSIONS Using the MRC Framework has guided the co-design of a potentially promising intervention that addresses the sexual health needs of young people with mental ill-health. The next step is to test the intervention in a one-arm feasibility trial.
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Affiliation(s)
- Hayley Nolan
- Orygen, 35 Poplar Road, 3052, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, Australia
| | - Brian O'Donoghue
- Orygen, 35 Poplar Road, 3052, Parkville, Melbourne, Australia
- University College Dublin, Dublin, Ireland
- Department of Psychiatry, Royal College of Surgeons, Ireland, Ireland
| | - Magenta Simmons
- Orygen, 35 Poplar Road, 3052, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, Australia
| | - Isabel Zbukvic
- Orygen, 35 Poplar Road, 3052, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, Australia
| | - Sophia Ratcliff
- Orygen, 35 Poplar Road, 3052, Parkville, Melbourne, Australia
| | - Alyssa Milton
- Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
- ARC Centre of Excellence for Children and Families over the Life Course, Sydney, Australia
| | - Elizabeth Hughes
- Research Centre for Applied Health, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland
| | - Andrew Thompson
- Orygen, 35 Poplar Road, 3052, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, Australia
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Warwick, United Kingdom
| | - Ellie Brown
- Orygen, 35 Poplar Road, 3052, Parkville, Melbourne, Australia.
- Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, Australia.
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Brand E, Ratsch A, Nagaraj D, Heffernan E. The sexuality and sexual experiences of forensic mental health patients: An integrative review of the literature. Front Psychiatry 2022; 13:975577. [PMID: 36226109 PMCID: PMC9548579 DOI: 10.3389/fpsyt.2022.975577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Sexuality is an integral aspect of the human experience that defines an individual. Robust research, substantiated by the World Health Organization, demonstrates that healthy sexuality improves mental health and quality of life. Despite this level of global advocacy and clinical evidence, sexuality and sexual health as determinants of health have been largely overlooked in the mental healthcare of patients being treated under the requirements of a forensic order (forensic patients). In this review, the authors have evaluated the literature related to the sexual development, sexual health, sexual knowledge and risks, sexual experiences, sexual behavior and sexual desires of forensic patients to inform policy and clinical practice. Furthermore, the review explored how forensic patients' sexual healthcare needs are managed within a forensic mental healthcare framework. The paper concludes with recommendations for service providers to ensure that sexual health and sexuality are components of mental health policy frameworks and clinical care. Methods An integrative review was utilized to summarize empirical and theoretical literature to provide a greater comprehensive understanding of the sexuality and sexual experiences of forensic patients. This included identifying original qualitative, quantitative, or mixed-method research, case reports, case series and published doctoral thesis pertaining to the research topic. Results Twenty-one articles were selected for review. We grouped the review findings into three main themes: 1) Forensic patient themes, 2) Forensic mental health staff themes and 3) Forensic mental health organization themes. The review demonstrated scant information on the sexual healthcare needs of forensic patients or how health services manage these needs while the patient is in a hospital or reintegrating into the community. Conclusion There is a dearth of evidence-based, individualized or group approaches which clinicians can utilize to assist forensic patients to achieve a healthy sexual life and it is recommended that such services be developed. Before that however, it is essential to have a clear understanding of the sexual healthcare needs of forensic patients to identify areas where this vulnerable population can be supported in achieving optimal sexual health. Urgent changes to clinical assessment are required to incorporate sexual healthcare as a component of routine mental healthcare.
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Affiliation(s)
- Elnike Brand
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Angela Ratsch
- Wide Bay Hospital and Health Service, Research Services, Hervey Bay Hospital, Hervey Bay, QLD, Australia
- Rural Clinical School, The University of Queensland, Brisbane, QLD, Australia
| | - Dinesh Nagaraj
- Community Mental Health and Addiction Services, Waikato District Health Board, Hamilton, New Zealand
| | - Edward Heffernan
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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Mirsepassi Z, Raisi F, Shahvari Z, FirooziKhojastefar R, Yahyavi ST. Evaluating family knowledge about sexual health in patients with severe mental illness: a qualitative study in Iran. BMC Psychiatry 2022; 22:174. [PMID: 35272647 PMCID: PMC8908587 DOI: 10.1186/s12888-022-03788-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 02/16/2022] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Although paying more attention to sex education in patients with severe mental illness is recommended in the literature, the role of families has not been specifically clarified. AIM: This study aims to explore family knowledge about sexual health in patients with severe mental illness in Iran. METHODS We conducted a total number of 21 interviews with 4 patients, 5 families, 7 psychiatrists, 1 general practitioner, 2 nurses, and 2 psychologists through purposive sampling. The text was analyzed using conventional qualitative content analysis. RESULTS The family knowledge about patients' sexual health is described in three subcategories: 'informal sources for knowledge acquisition', 'common myths, and 'inappropriate reaction to the patients' needs". CONCLUSIONS Family sex education should be integrated into a comprehensive rehabilitation program to promote sexual health in patients with severe mental illness. Family members should be aware of the necessity of accurate information about patients' sexual concerns.
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Affiliation(s)
- Zahra Mirsepassi
- grid.411705.60000 0001 0166 0922Department of Psychiatry, Roozbeh Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Firoozeh Raisi
- Department of Psychiatry, Roozbeh Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Zahra Shahvari
- grid.510409.90000 0004 6092 1266Department of Nursing and Midwifery, Gachsaran Branch, Islamic Azad University, Gachsaran, Iran
| | - Reihaneh FirooziKhojastefar
- grid.411705.60000 0001 0166 0922Department of Psychiatry, Roozbeh Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyyed Taha Yahyavi
- grid.411705.60000 0001 0166 0922Department of Psychiatry, Roozbeh Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Lai DWL, Chan KC, Daoust GD, Xie XJ. Hopes and Wishes of Clients with Mentally Illness in Hong Kong. Community Ment Health J 2021; 57:1556-1565. [PMID: 33507470 PMCID: PMC7841978 DOI: 10.1007/s10597-021-00779-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 01/12/2021] [Indexed: 11/24/2022]
Abstract
Recovery is a progressive process involving support to people with mental illness to take control of their life through the enhancement of motivation, self-drive, and responsibility. Drawing on qualitative interviews with 61 patients with mental illness aged between 40 and 75 in the community or residential settings, this study examined the wishes and hopes of clients who were in recovery. Participants described wishes and hopes for autonomy and independence in finances, accommodation, and health; stable housing or accommodation; meaningful occupation or employment; 'giving back' to society by serving others; intimate relationships; and gaining back 'lost time.' Wishes and hopes were motivating factors contributing to physical, mental, and social health over time, motivating clients with mental illness to live happily. To foster recovery, mental health practitioners should consider the identification and fulfilment of wishes and hopes in health and social care programs for this unique client group.
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Affiliation(s)
- Daniel W L Lai
- Faculty of Social Sciences, Hong Kong Baptist University, Room 1325, 13/F Academic and Administration Building, Baptist University Road Campus, Hong Kong, China.
| | - K C Chan
- Department of Social Work, The Chinese University of Hong Kong, Hong Kong, China
| | - G D Daoust
- Department of International Relations, The University of Sussex, Brighton, UK
| | - X J Xie
- International Social Service Hong Kong Branch, 130 Hennessy Rd, Wan Chai, Hong Kong, China
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McCann E, Donohue G, de Jager J, Nugter A, Stewart J, Eustace-Cook J. Sexuality and intimacy among people with serious mental illness: a qualitative systematic review. ACTA ACUST UNITED AC 2020; 17:74-125. [PMID: 30629043 DOI: 10.11124/jbisrir-2017-003824] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The aim of this systematic review was to synthesize the best available qualitative evidence on the experiences and support needs of people with serious mental illness (SMI) regarding sexuality and intimacy within hospital and community settings. The objectives were to explore intimate relationship experiences of people with SMI, to uncover potential obstacles to the expression of sexuality and to present recommendations for mental health policy, education, research and practice. INTRODUCTION Mental health services worldwide have seen major transformations in recent years through deinstitutionalization programs and more enlightened ways of organizing and providing mental health care. However, in terms of social and emotional wellbeing, issues persist for people with SMI, particularly relating to intimacy and the expression of sexuality. This systematic review may assist service providers to determine ways that they may better support people in establishing and maintaining satisfying intimate relationships and the full expression of their sexuality. INCLUSION CRITERIA This review explored the intimacy and sexuality experiences, perceptions and concerns of people over the age of 18 years who were living with a SMI in hospital or community settings. This review considered studies that focused on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research. METHODS The databases MEDLINE, CINAHL, PsycINFO, Embase and Web of Science were utilised in the review. The search included studies published from 1995 up to and including February 6, 2018 and were limited to those in the English language. Each paper was assessed by two independent reviewers for methodological quality using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research. Any disagreements that arose between the reviewers were resolved through discussion. Data extraction was conducted by two independent reviewers using the standardized qualitative data extraction tool from JBI. The qualitative research findings were pooled using JBI methodology. The JBI process of meta-aggregation was used to identify categories and synthesized findings. RESULTS Based on the thematic findings from the 21 studies, three synthesized findings were extracted from 10 categories and 83 findings: 1) the complexity of individual sexual experiences, 2) the clinical constructs of sexuality and 3) family and partner involvement. CONCLUSIONS Having fulfilling and satisfying sexual and relationship experiences is a fundamental human right that can enhance an individual's quality of life. Being aware of the potential stresses and challenges that having a SMI can have on a relationship and involving partners in the treatment, may help to promote intimacy and recovery. Practitioners can use these findings to guide future policy, education and developments in practice. Further research is required to develop and evaluate interventions that target the identified barriers and help people with SMI to fulfil their unmet sexuality and intimacy needs.
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Affiliation(s)
- Edward McCann
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland.,Trinity Centre for Practice and Healthcare Innovation, Trinity College Dublin: a Joanna Briggs Institute Affiliated Group
| | - Grainne Donohue
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland.,Trinity Centre for Practice and Healthcare Innovation, Trinity College Dublin: a Joanna Briggs Institute Affiliated Group
| | - Jose de Jager
- Maastricht University, Medical Centre, Maastricht, The Netherlands
| | - Annet Nugter
- Mental Health Service Organization, GGZ Noord-Holland-Noord, The Netherlands
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Southall DJL, Combes HA. Clinical psychologists’ views about talking to people with psychosis about sexuality and intimacy: a Q-methodological study. SEXUAL AND RELATIONSHIP THERAPY 2020. [DOI: 10.1080/14681994.2020.1749255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Daniel J. L. Southall
- Clinical Psychology, Science Centre, Stoke-on-Trent, Staffordshire University, Hull, UK
- Humber NHS Foundation Trust, Hull, UK
| | - Helen A. Combes
- Clinical Psychology, Science Centre, Stoke-on-Trent, Staffordshire University, Hull, UK
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Quinn C, Platania-Phung C, Bale C, Happell B, Hughes E. Understanding the current sexual health service provision for mental health consumers by nurses in mental health settings: Findings from a Survey in Australia and England. Int J Ment Health Nurs 2018; 27:1522-1534. [PMID: 29575550 DOI: 10.1111/inm.12452] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2018] [Indexed: 11/26/2022]
Abstract
Nurses in mental health settings avoid talking to consumers about sexual health concerns. It is unclear whether this avoidance prevents the provision of sexual healthcare. The present study gathered information about how mental health nurses respond to sexual health issues within their routine practice, what issues they address, and their view on their role in promoting sexual health for consumers. A cross-sectional study using an electronic survey questionnaire, originally generated from a previous study in the united kingdom, was employed. The study occurred in four National Health Service Trusts in England and a national call for participants in Australia. Participants were nurse clinicians (n = 303) who self-selected by completing surveys available via email and newsletters containing links to the survey. The results demonstrated that mental health nurses do not routinely include sexual health in their practice and are poorly prepared in knowing what to do with a sexual health issue, and what services to assist consumers to use. In conclusion, it has been well established in the literature that mental health consumers experience high sexual health needs that potentially impact on health and recovery. Mental health nurses are ideally placed to promote sexual health and refer consumers to sexual health and family planning services. Training to improve the confidence and responsiveness of mental health nurses to sexual health is an urgent need.
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Affiliation(s)
- Chris Quinn
- Nursing and Practice Development Unit, Forensicare, Fairfield, Victoria, Australia.,University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Chris Platania-Phung
- SYNERGY: Nursing and Midwifery Research Centre, University of Canberra and ACT Health, Woden, Australian Capital Territory, Australia
| | | | - Brenda Happell
- SYNERGY: Nursing and Midwifery Research Centre, University of Canberra and ACT Health, Woden, Australian Capital Territory, Australia
| | - Elizabeth Hughes
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
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Hughes E, Edmondson AJ, Onyekwe I, Quinn C, Nolan F. Identifying and addressing sexual health in serious mental illness: Views of mental health staff working in two National Health Service organizations in England. Int J Ment Health Nurs 2018; 27:966-974. [PMID: 29150893 DOI: 10.1111/inm.12402] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/16/2017] [Indexed: 11/30/2022]
Abstract
People with serious mental illness (service users) have needs related to sexual health and sexuality, yet these have been poorly addressed in mental health services. In the present study, we report the current practice of mental health professionals in relation to sexual health. Focus groups conducted in two mental health trusts explored routine practice in relation to discussing, assessing, and planning care in relation to sexual health. A thematic analysis identified seven themes: (i) sexual health provision is a complex issue; (ii) mental health staff are aware of sexual health needs; (iii) current provision regarding sexual health is 'neglected'; (iv) barriers to sexual health provision; (v) enabling a discussion around sexual health; (vi) sexual health provision is a role for mental health professionals; and (vii) training needs. Mental health staff are aware of complex issues related to sexual health for service users, but this is mainly seen through the lens of risk management and safeguarding. We need to develop the mental health workforce to be able to incorporate sexual health into routine health care.
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Affiliation(s)
- Elizabeth Hughes
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK.,South West Yorkshire Partnership National Health Service Foundation Trust, Wakefield, UK
| | - Amanda J Edmondson
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Ijeoma Onyekwe
- Tees, Esk, and Wear Valleys National Health Service Foundation Trust, Darlington, UK
| | - Chris Quinn
- Forensicare, Melbourne, Victoria, Australia.,Nursing and Midwifery Research Centre, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Fiona Nolan
- School of Health and Human Sciences, University of Essex, Essex, UK
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Brown M, McCann E. Sexuality issues and the voices of adults with intellectual disabilities: A systematic review of the literature. RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 74:124-138. [PMID: 29413427 DOI: 10.1016/j.ridd.2018.01.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 01/05/2018] [Accepted: 01/17/2018] [Indexed: 05/20/2023]
Abstract
BACKGROUND There is a growing and evolving research evidence base regarding sexuality issues and adults with intellectual disabilities. Individuals can face challenges, including the right to express their sexuality and to access necessary education and supports. AIMS This systematic review explores sexuality experiences, the views and opinions of adults with intellectual disabilities and highlights areas for future practice developments. METHODS AND PROCEDURES A comprehensive search of relevant databases from January 2006 to December 2016 was carried out. Included studies had to address specific criteria including: peer reviewed papers, the use of appropriate research methods, and focused exclusively on the individual views and opinions of people with an intellectual disability. The search of relevant databases yielded 230 hits. Following the application of explicit inclusion and exclusion criteria, 23 papers were deemed suitable for the review. OUTCOMES AND RESULTS The data were analysed and key themes were identified that included: autonomy v's risk of harm, knowledge and sexuality, relationships and intimacy, self-determination and taking control, and encouragement and supports. CONCLUSIONS AND IMPLICATIONS Adults with intellectual disabilities need education and support to express their sexuality and to meet individual needs.
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Affiliation(s)
- Michael Brown
- School of Nursing and Midwifery, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK.
| | - Edward McCann
- School of Nursing and Midwifery, Trinity College Dublin, Ireland
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McCann E, Donohue G, de Jager J, van Os J, Nugter A, Stewart J, Eustace-Cook J. Sexuality and intimacy among people with serious mental illness in hospital and community settings. ACTA ACUST UNITED AC 2018; 16:324-327. [DOI: 10.11124/jbisrir-2017-003450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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