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Revelj J, Hörberg U, Wallinius M, Rask M. Being Able to Be Yourself: The Lived Experience of Female Patients in Forensic Psychiatric Care. Issues Ment Health Nurs 2023; 44:816-824. [PMID: 37607315 DOI: 10.1080/01612840.2023.2234474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
People in Sweden who commit at least one crime and suffer from a severe mental disorder can be sentenced to forensic psychiatric care. The aim of this study was to describe and gain a greater understanding of the female patients' experiences of their life situation while being cared for in forensic psychiatric care. Interviews with 15 women were conducted and analyzed with a phenomenological hermeneutical method. The results showed the care and the care environment to be dualistic. The women had to be aware that a close neighbor could also be an enemy. They received care in an environment that was unknown, frightening but at the same time a place where they felt secure, and which was predictable.
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Affiliation(s)
- Jessica Revelj
- Department of Health and Caring Science, Linnaeus University, Växjö, Sweden
- Research Department, Regional Forensic Psychiatric Clinic, Växjö, Region Kronoberg
- Centre for Ethics, Law, and Mental Health, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Ulrica Hörberg
- Department of Health and Caring Science, Linnaeus University, Växjö, Sweden
| | - Märta Wallinius
- Research Department, Regional Forensic Psychiatric Clinic, Växjö, Region Kronoberg
- Centre for Ethics, Law, and Mental Health, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Evidence-based Forensic Psychiatry, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Mikael Rask
- Department of Health and Caring Science, Linnaeus University, Växjö, Sweden
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Betterly H, Musselman M, Sorrentino R. Sexual assault in the inpatient psychiatric setting. Gen Hosp Psychiatry 2023; 82:7-13. [PMID: 36893652 DOI: 10.1016/j.genhosppsych.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 02/22/2023] [Accepted: 02/27/2023] [Indexed: 03/11/2023]
Abstract
Sexual assault in the inpatient psychiatric setting is a significant problem with serious, lasting consequences. It is important for psychiatric providers to appreciate the nature and magnitude of this problem to be able to provide an appropriate response when faced with these challenging scenarios, as well as to advocate for the implementation of preventive measures. This article provides a review of the existing literature regarding sexual behavior in the inpatient psychiatric unit, describing the epidemiology of sexual assaults in these settings, and exploring the characteristics of both victims and perpetrators, with a particular focus on factors of relevance to the inpatient psychiatric patient population. Inappropriate sexual behavior in inpatient psychiatric settings is common, however the varying definition of such throughout the literature serves as a challenge to clearly identifying the frequency of specific behaviors. The existing literature does not identify a way to reliably predict which patients are most likely to engage in sexually inappropriate behaviors on an inpatient psychiatric unit. The medical, ethical, and legal challenges that such cases present are defined, followed by a review of current management and prevention strategies, and suggested future directions for research.
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Affiliation(s)
- Holly Betterly
- Resident Physician, Department of Psychiatry, Temple University Hospital, 3401 N Broad St, Philadelphia, PA 19140, USA.
| | - Meghan Musselman
- Assistant Professor of Psychiatry and Behavioral Science, Lewis Katz School of Medicine at Temple University, 3500 N Broad St, Philadelphia, PA 19140, USA
| | - Renée Sorrentino
- Clinical Assistant Professor, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
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Brand E, Tham C, Ratsch A, Heffernan E. Sexual knowledge of Queensland forensic mental health patients: A cross-sectional quantitative study. Front Psychiatry 2023; 14:1160277. [PMID: 37113546 PMCID: PMC10126372 DOI: 10.3389/fpsyt.2023.1160277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 03/28/2023] [Indexed: 04/29/2023] Open
Abstract
Forensic patients with serious mental illnesses (SMI) encounter significant challenges including active symptomatology, associated social and interpersonal impairments, psychotropic medication side effects and institutionalization, all of which negatively affect sexual functioning and possibly their acquirement of sexual knowledge. Evidence shows an increased prevalence of high-risk sexual behavior by this group however, there is an absence of literature examining the sexual knowledge of forensic patients. This quantitative cross-sectional study enrolled N = 50 patients currently under the treatment requirements of a Forensic Order and utilized the validated General Sexual Knowledge Questionnaire (GSKQ) to quantify the participants' sexual knowledge over the domains of physiology, sexual intercourse, pregnancy, contraception, sexually transmitted diseases, and sexuality. Male forensic patients scored lower than females on all domains of sexual knowledge. All participants had reasonable knowledge of physiology, sexual intercourse and sexuality; of concern were poor scores on pregnancy, contraception and sexually transmitted diseases. Thirty-five (70%) of the respondents indicated that they had some limited sex education, mostly at school. Only six (12%) received any sexual education from a health professional despite extensive contact with the forensic mental health services across many years. There is a need to assess the deficit in sexual knowledge of forensic patients in order to develop sexual health education, intervention and rehabilitative programmes that cater to the specific needs of this group to improve their sexual knowledge, encourage safe and positive sexual experiences, and enhance their quality of life.
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Affiliation(s)
- Elnike Brand
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- *Correspondence: Elnike Brand,
| | - Ching Tham
- Metro South Hospital and Health Services, Queensland Health, 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
| | - Edward Heffernan
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, 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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Landi G, Marchi M, Ettalibi MY, Mattei G, Pingani L, Sacchi V, Galeazzi GM. Affective and Sexual Needs of Residents in Psychiatric Facilities: A Qualitative Approach. Behav Sci (Basel) 2020; 10:E125. [PMID: 32756442 PMCID: PMC7464764 DOI: 10.3390/bs10080125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/23/2020] [Accepted: 07/27/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The affective and sexual needs of psychiatric patients are often under-considered, although they contribute significantly to their general well-being. Such topics are critical for Residential Psychiatric Facilities Users (RPFUs), whose daily life is paced by therapeutic settings. The aim of this paper is to better understand how sexuality and affectivity are expressed by the RPFUs at the Mental Health Department of Modena, within psychiatric residential settings. METHODS Adult RPFUs took part into two audio recorded focus groups. Digital transcripts were analyzed using MAXQDA software in order to perform qualitative narrative analysis, so as to develop a hierarchical code system a posteriori (derived from the data). RESULTS Eleven participants (eight RPFUs and three investigators) attended the first focus group, and eight participants (5 RPFUs and 3 investigators) attended the second focus group. 175 interventions were analyzed and coded under seven thematic areas: (a) contraception and sexually transmitted disease prevention (N = 17); (b) affective needs (N = 11); (c) personal experiences (N = 61); (d) regulation of sexual relations (N = 18); (e) Mental Health Professionals' (MHPs) openness towards the topic (N = 17); (f) MHPs' responses to RPFUs' sexual behaviors (N = 33); and (g) RPFUs proposals (N = 18). The highlighted topics suggest that affective and sexual relations commonly occur within residential psychiatric facilities, even if mental health services often fail to recognize and address RPFUs' affective and sexual needs as well as to provide effective solutions to manage them. CONCLUSIONS RPFUs expressed a request for support to fulfill their affective and sexual needs and dedicated spaces for sexual activities to relieve their discomfort, while MHPs highlighted a need for awareness, training, and shared problem-solving strategies.
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Affiliation(s)
- Giulia Landi
- Department of Mental Health and Drug Abuse, AUSL Modena, Via San Giovanni del Cantone, 23–41121 Modena, Italy;
| | - Mattia Marchi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giuseppe Campi, 287–41125 Modena, Italy; (M.M.); (L.P.); (V.S.)
| | | | - Giorgio Mattei
- Department of Economics & Marco Biagi Foundation, University of Modena and Reggio Emilia, Via J. Berengario, 51–41121 Modena, Italy;
| | - Luca Pingani
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giuseppe Campi, 287–41125 Modena, Italy; (M.M.); (L.P.); (V.S.)
| | - Valentina Sacchi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giuseppe Campi, 287–41125 Modena, Italy; (M.M.); (L.P.); (V.S.)
| | - Gian Maria Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giuseppe Campi, 287–41125 Modena, Italy; (M.M.); (L.P.); (V.S.)
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Abstract
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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Affiliation(s)
- Christopher Maylea
- Social and Global Studies Centre, RMIT University, Melbourne, VIC, Australia
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Dein K, Williams PS. Relationships between residents in secure psychiatric units: are safety and sensitivity really incompatible? PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.bp.106.011478] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Since the 1960s, Western society has adopted a more liberal attitude to sexuality. Choice of sexual partners, sexual preferences, attitudes and practices are increasingly a matter of individual choice and freedom. These changes, however, have had little impact on the lives of psychiatric in-patients (Eiguer et al, 1974; Akhtar et al, 1977; Taylor & Swan, 1999). ‘Mental illness,’ it has been suggested, ‘is one of the few disabilities where people run the risk of losing their freedom in order to receive in-patient treatment’ (Cook, 2000). This loss of liberty and rights becomes more pronounced in secure settings where mentally disordered offenders can spend a substantial part of their adult (sexual/reproductive) lives. Prisoners in some US state prisons (of medium and low security) are afforded conjugal visits from their married partners, in view of the rights of the latter. Paradoxically, detention in secure units, which we consider a therapeutic and not a punitive measure, places constraints on the formation of new relationships and the maintenance of previously existing ones. New relationships are, in our experience, viewed with more concern than previously existing ones.
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Quinn C, Happell B. Supporting the Sexual Intimacy Needs of Patients in a Longer Stay Inpatient Forensic Setting. Perspect Psychiatr Care 2016; 52:239-247. [PMID: 26010649 DOI: 10.1111/ppc.12123] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 03/17/2015] [Accepted: 04/08/2015] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To explore perceptions of nurses and patients regarding sexual intimacy in a long-term mental health unit. DESIGN AND METHODS Qualitative exploratory design including in-depth semi-structured individual interviews with 12 registered nurses and 10 long-term patients of a forensic mental health hospital. FINDINGS The theme of supporting sexual intimacy was identified and described in this paper and included the following subthemes for nurses: It depends on the setting, need for guidelines and consent, and for patients-it depends on the setting; and need for support. PRACTICE IMPLICATIONS The findings suggest that current guidelines regarding sexual intimacy in acute inpatient settings may not be appropriate in long-term facilities, with a need for guidelines to specifically address this setting. Furthermore, support for sexual intimacy needs of patients was identified as a strong need for patients and they believed not currently met. Nurses have an important role to play as part of their holistic approach to care and barriers to providing this aspect of care must be overcome to ensure patients' rights are respected.
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Affiliation(s)
- Chris Quinn
- Victorian Centre for Forensic Mental Health (Forensicare), Melbourne, Victoria, Australia.,Central Queensland University, Rockhampton, Queensland, Australia
| | - Brenda Happell
- Research Centre for Nursing and Midwifery Practice, University of Canberra, Faculty of Health and ACT Health, Canberra, Australian Capital Territory, Australia.
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Tiwana R, McDonald S, Völlm B. Policies on sexual expression in forensic psychiatric settings in different European countries. Int J Ment Health Syst 2016; 10:5. [PMID: 26848309 PMCID: PMC4741020 DOI: 10.1186/s13033-016-0037-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 01/09/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sexual expression by forensic psychiatric patients is poorly researched. METHODS Forensic experts representing 14 European countries were interviewed to explore the diverse ways in which sexual expression within forensic settings is handled. RESULTS No country had a national policy, although many had local policies or shared practices. Progressive approaches to patient sexuality were evident in nine of the countries sampled. The UK appeared the most prohibiting and excluding, its protocols apparently based on risk aversion and lack of emphasis or consideration of patients' sexual needs. CONCLUSIONS Uniform national policy supporting patients' sexual expression would provide significant improvements.
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Affiliation(s)
- Rajveer Tiwana
- />School of Psychology, University of Nottingham, Nottingham, NG7 2RD UK
| | - Stephanie McDonald
- />School of Psychology, University of Nottingham, Nottingham, NG9 2RD UK
| | - Birgit Völlm
- />Section Forensic Mental Health, Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Triumph Rd, Nottingham, NG7 2TU UK
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10
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Dein KE, Williams PS, Volkonskaia I, Kanyeredzi A, Reavey P, Leavey G. Examining professionals' perspectives on sexuality for service users of a forensic psychiatry unit. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2016; 44:15-23. [PMID: 26387770 DOI: 10.1016/j.ijlp.2015.08.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Very little is known about the sexual activities of psychiatric patients during their stay in hospital and beyond. In this article, we have explored how mental health professionals working within a forensic psychiatric unit construct the issue of patient sexuality in order to ascertain the range of sexual possibilities open to patients. Drawing on interviews with twenty four participants--psychiatrists and clinical psychologists (clinical staff), we examined how participants made sense of patient sexuality and their clinical judgments in relation to them. Using a thematic analysis, we were able to identify a number of relevant themes emerging, including a) what the limits of acceptable sexual behaviour were judged to be, b) discrimination against transgender and same sex relationships, c) vulnerability among female patients and therapeutic efficacy, and d) an abject fear of patient pregnancy. Furthermore, a general concern throughout was the putative professional conflict between the clinical and ward staff. Further discussion regarding the potential for clearer policy on patient sexuality and further training for professionals is developed in the final section.
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Affiliation(s)
- Kalpana Elizabeth Dein
- North London Forensic Service, Chase Farm Hospital, The Ridgeway, Enfield, Middlesex, EN2 8JL, United Kngdom
| | - Paul Simon Williams
- North London Forensic Service, Chase Farm Hospital, The Ridgeway, Enfield, Middlesex, EN2 8JL, United Kingdom
| | - Irina Volkonskaia
- Brockfield Regional Secure Unit, Basildon, Essex, SS11 7XX, United Kingdom
| | - Ava Kanyeredzi
- Child and Woman Abuse Studies Unit, London Metropolitan University, Ladbroke House, 62-66 Highbury Grove, London, N5 2AD, United Kingdom.
| | - Paula Reavey
- Department of Psychology, London South Bank University, 103 Borough Road, London, SE1 OAA, United Kingdom.
| | - Gerard Leavey
- Compass Centre for Mental Health Research and Policy, Northern Ireland Association for Mental Health, 80 University Street, Belfast, BT7 1HE, United Kingdom
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Quinn C, Happell B. Sex on show. Issues of privacy and dignity in a Forensic mental health hospital: Nurse and patient views. J Clin Nurs 2015; 24:2268-76. [DOI: 10.1111/jocn.12860] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Chris Quinn
- Victorian Centre for Forensic Mental Health (Forensicare); Fairfield VIC Australia
| | - Brenda Happell
- Synergy, Nursing and Midwifery Research Centre; University of Canberra; Faculty of Health; Canberra ACT Australia
- ACT Health; Canberra Hospital; Garran ACT Australia
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12
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Quinn C, Happell B. Consumer sexual relationships in a forensic mental health hospital: perceptions of nurses and consumers. Int J Ment Health Nurs 2015; 24:121-9. [PMID: 25522062 DOI: 10.1111/inm.12112] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The management of consumer-related risk is paramount in a secure forensic mental health facility. However, the consequent risk aversion presents a major barrier to consumers forming sexual relationships in a manner that is open and accepted. Investigation of the views of nurses working in forensic mental health settings on this topic is limited, and even more so for consumers of services. This qualitative exploratory study was undertaken to elicit the views of consumers and nurses about forming sexual relationships within this long-term and secure setting. Individual in-depth interviews were conducted with 12 nurses and 10 consumers. The benefits of, and barriers to, sexual relationships was identified as a major theme, and these findings are the focus of this paper. Nurse responses included the subthemes 'supportive factors' and 'potential dangers', reflecting their qualified support. Consumer responses included the subthemes '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. More open discussion about this commonly-avoided issue and the education of nurses and other health professionals is required.
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Affiliation(s)
- Chris Quinn
- Victorian Institute for Forensic Mental Health, Australia
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13
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Quinn C, Happell B. Exploring sexual risks in a forensic mental health hospital: perspectives from patients and nurses. Issues Ment Health Nurs 2015; 36:669-77. [PMID: 26440869 DOI: 10.3109/01612840.2015.1033042] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Patients utilising forensic mental health inpatient services experience a range of sexual risks, including vulnerability to sexual exploitation and exposure to sexually transmissible infections. However, there is a paucity of research exploring the issue of sexual risks from the standpoint of patients and the nurses who work closely with them in inpatient secure settings. This article presents findings from a qualitative exploratory study, which investigated the views of patients and nurses about sexual relationships in forensic mental health settings. Risk was a major theme arising from the data and is the focus of this article. Subthemes from nurse participants included sexual safety, sexual vulnerability, unplanned pregnancies, and male sexuality issues. Subthemes from patients included risks associated with sexual activity, access to information and sexual health care, unplanned pregnancies, vulnerability, and male sexuality issues. Knowledge about these sexual risks by patients and nurses were well articulated, however information and assistance were considered by patients to be less than satisfactory in improving their knowledge or in providing the support they considered important to reduce sexual risks. The issue of risk needs to be addressed, and nurses would be well placed to contribute; however they require education to improve their ability to provide sexual health education to patients along with strategies to ensure patients receive the support and services they require to reduce their exposure to sexual risks.
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Affiliation(s)
- Chris Quinn
- a Forensicare, Fairfield, Australia, and Central Queensland University , Rockhampton , Queensland , Australia
| | - Brenda Happell
- b University of Canberra and ACT Health, Synergy, Nursing and Midwifery Research Centre , Woden , Australia
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14
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Kastner S, Linden M. Relations between patients in psychiatric and psychotherapeutic inpatient care: a literature review and conclusions for clinical practice and research. Int J Psychiatry Clin Pract 2014; 18:222-8. [PMID: 25012894 DOI: 10.3109/13651501.2014.943242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE In psychiatric inpatient units patients live closely together, which facilitates mutual interactions. Patient relations are part of the therapeutic milieu, which is an important factor in helping patients to recover. Types of patient relations are nonbinding superficial encounters, working alliances, personal relations like close partner relationships, or sexual contacts. Intimate relations between patients are scientifically and in clinical practice, a rather, neglected topic. METHODS A data search was conducted using the PubMed/MEDLINE databases with the key terms "patient relations" or "intimate relations between patients". RESULTS Depending on the type of relation and inpatient unit, prevalence rates of 1.5-30% for intimate relations between patients in psychiatric hospitals are reported. Such relations can have beneficial effects, like the feelings of bonding or being liked, but also negative consequences, like burdening, worsening of the illness, treatment complications, or direct harm to the patient. CONCLUSION Only a few units have development guidelines. It is the responsibility of the therapeutic staff and the hospital management to support a helpful therapeutic milieu, including positive patient interactions, and to protect as far as it is possible patients from negative encounters.
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Affiliation(s)
- Sabrina Kastner
- Research Group Psychosomatic Rehabilitation at the Charité University Medicine Berlin and Department of Behavioural and Psychosomatic Medicine at the Rehabilitation Centre Seehof , Teltow/Berlin , Germany
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15
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Steinberg R, Rittner C, Dormann S, Spengler-Katerndahl D. [Responsible dealing with sexuality. Recommendations in a clinical institution]. DER NERVENARZT 2011; 83:377-83. [PMID: 21607802 DOI: 10.1007/s00115-011-3296-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Sexuality is excluded in house regulations, guidelines, instructions and regulations in German hospitals. The English literature does not show much more, but more often the wish for clear guidelines is formulated. Under the guidance of the clinical Ethics Committee a paper with recommendations was prepared, which comprises regulations for responsible handling of sexuality in the Pfalzklinikum. This includes sexuality of acute patients in psychiatry, nursing home inhabitants, forensic patients and above all patients in the department of child and youth psychiatry. The right of self-realization on the one hand, the staff's responsibility for patients with limitations in the determination of one's intent on the other hand and the rules for staff members define the range of the paper.
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Affiliation(s)
- R Steinberg
- Pfalzklinikum für Psychiatrie und Neurologie, Weinstr. 100, 76889, Klingenmünster, Deutschland.
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