Sexual Relationships between Consenting Mental Health Patients in a Forensic Psychiatric Hospital: Exploring Possible Barriers and Benefits

Investigators: Chris Quinn & Brenda Happell

Rationale and aims:

  • The aims of this research are to explore the views of nurses and patients towards sexual relationships between consenting mental health patients in a forensic hospital.
  • The Chief Psychiatrist’s guidelines (Department of Health Services 2009) do not adequately speak to the sexual relationship needs of patients in longer stay environments.
  • Despite policy that prohibits sexual activity in inpatient settings, patients continue to have sex. With some studies reporting between 30 -49% of patients in inpatient settings are sexually active, with sexual activity occurring in lounge rooms, toilets, stairwells, behind buildings and behind bushes.
  • The aim of the study is to better understand from a nurse and patient point of view the benefits and barriers to patients in a forensic mental health hospital forming sexual relationships with each other, and from this look at policy that can better support the sexual relationship needs of people in longer term inpatient care.

Methodology:

  • The research utilises an exploratory qualitative research approach with two even gendered participant groups. Interview guides were utilised for each group.
  • The nursing staff IV covered views on patient sexual relationships, the impact they may have, and the reaction to the relationship amongst staff patients and family members. The patient guide covered views on sexual relationships and staff and family reactions.

Results and conclusions:

  • Benefits of, and barriers to, sexual relationships was identified as a major theme
  • Nurse responses included the sub-themes: supportive factors and potential dangers, reflecting their qualified support.
  • Consumer responses included the sub-themes: therapeutic; feeling normal; restrictions and barriers; and lack of support and secrecy.
  • The importance of sexual relationships was clearly articulated, as was the difficulties in forming and maintaining them within the forensic setting.
  • The need for a private and dignified place for patient intimacy was one major theme to emerge from this research from both nurse and patient participants. A disparity is reported between the level of support reported by nurse participants with the experience of the patient participants
  • Support for sexual intimacy needs of patients was identified as a strong need for patients and one they felt was not currently met
  • Findings suggest that nurses and patients have knowledge regarding sexual risks, however information and helpful assistance for patients is considered by patients to be less than satisfactory in improving their knowledge and the support they require to reduce risks

Clinical Implications and research translation:

  • The findings will assist in providing valuable insights from both patients and nursing that will help to inform the development future policy and procedural guidelines for services, clinicians, and patients, that are underpinned by contemporary evidence based research.

Publications

Quinn, C., & Happell, B. (2015). Consumer sexual relationships in a Forensic mental health hospital: Perceptions of nurses and consumers. International Journal of Mental Health Nursing, 24(2), 121-129. doi: 10.1111/inm.12112

Quinn, C., & Happell, B. (2015). Sex on show. Issues of privacy and dignity in a Forensic mental health hospital: Nurse and patient views. Journal of Clinical Nursing, 24(15-16), 2268-2276. doi: 10.1111/jocn.12860

Quinn, C., & Happell, B. (2015). Supporting the sexual intimacy needs of patients in a longer stay inpatient forensic setting. Perspectives in Psychiatric Care. doi: 10.1111/ppc.12123

Gascoyne, S., Hughes, E., McCann, E., & Quinn, C. (2016). The sexual health and relationship needs of people with severe mental illness. Journal of Psychiatric and Mental Health Nursing, 23(5), 338-343. doi: 10.1111/jpm.12317