Abstract
Within the context of inpatient psychiatric settings, the sexuality and sexual health of patients remains a controversial issue in both clinical practice and the research community. Specifically, practitioners’ views on sexuality range from those which regard sexuality as a potential distraction to ongoing psychiatric management, to views that attention to issues of sexuality and its expression is an important element of recovery-based care. To fully address this issue, this chapter will cover the history of sexuality within the context of the psychiatric unit, examine existing tensions between staff attitudes toward inpatient sexuality, discuss current hospital policies, and identify risks associated with sexual autonomy on the inpatient unit. Additionally, several issues relevant to sexual expression, namely, the impact of psychiatric symptoms, substance use, and psychotropic medication on sexuality, will be explored as it relates to the recovery model of mental health. In keeping with the principles of the recovery model, this chapter will also cover other factors that affect patient quality of life and sexuality, such as past and current research on different aspects of sexuality, reproductive health, and family planning in individuals admitted to an inpatient will be explored. The chapter concludes with the call for continued research and discussion upon the sexuality and sexual health of patients within inpatient psychiatric settings.
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References
Ahmed, A. O., Mabe, P. A., & Buckley, P. F. (2011). Recovery in schizophrenia: Perspectives, evidence, and implications. In M.S. Ritsner (Ed.), Handbook of schizophrenia spectrum disorders (Vol. III): therapeutic approaches comorbidity and outcomes (pp. 1–22). New York: Springer.
Ahmed, A. O., Marino, B. A., Rosenthal, E., Buckner, A., Hunter, K. M., Mabe, P. A. et al. (2016). Recovery in schizophrenia: what consumers know and do not know. Psychiatric Clinics of North America, 39(2), 313–330.
Apfel, R., & Handel, M. (1993). Madness and loss of motherhood: Sexuality, reproduction, and long-term mental illness. Washington, D.C.: American Psychiatric Press Inc.
Avellanet, Y., Ortiz, A., Pando, J., & Romaguera, J. (2008). Relationship between loss of libido and signs and symptoms of depression in a sample of Puerto Rican middle-aged women. Puerto Rico Health Sciences Journal, 27(1), 85–91.
Bahorik, A., Newhill, C., & Eack, S. (2013). Characterizing the longitudinal patterns of substance use among individuals diagnosed with serious mental illness after psychiatric hospitalization. Addiction, 108, 1259–1269.
Balakrishna, J., & Crisp, A. (1998). A pilot programme of sex education for inpatients with anorexia nervosa. European Eating Disorders Review, 6, 136–142.
Bang-Ping, J. (2009). Sexual dysfunction in men who abuse illicit drugs: a preliminary report. The Journal of Sexual Medicine, 6(4), 1072–1080.
Bargiota, S., Bonotis, K., Messinis, E., & Angelopoulos, N. (2013). The effects of antipsychotics on prolactin levels and women’s menstruation. Schizophrenia Research and Treatment, 1–10. doi:10.1155/2013/502697
Barlow, F., & Wolfson, P. (1997). Safety and security. A survey of female psychiatric inpatients. Psychiatry Bulletin, 21, 270–272.
Barr, M. (1912). The asexualization of the unfit. The duty of the hour. Alienist and Neurologist, 33, 1–9.
Bartlett, P., Mantovani, N., Cratsley, K., Dillon, C., & Eastman, N. (2010). You may kiss the bride, but you may not open your mouth when you do so: Policies concerning sex, marriage, and relationships in English forensic psychiatric facilities. Liverpool Law Review, 31, 155–176.
Baum, M., Rafie, C., Lair, S., Page, B., & Campa, A. (2009). Crack-cocaine use accelerates HIV disease progression in a cohort of HIV-positive drug users. Epidemiology and Social Science, 50, 93–99.
Bellack, A., Mueser, K., Gingerich, S., & Agresta, J. (2004). Social skills training for schizophrenia: A step-by-step guide. New York: The Guilford Press.
Bowers, L., Ross, J., Cutting, P., & Stewart, D. (2014). Sexual behaviors on acute inpatient psychiatric units. Journal of Psychiatric and Mental Health Nursing, 21, 271–279.
Brown, S., Reavey, P., Kanyeredzi, A., & Betty, R. (2013). Transformations of self and sexuality: psychologically modified experiences in the context of forensic mental health. Health, 18(3), 240–260.
Brown, S., Reavey, P., Kanyeredzi, A., & Batty, R. (2014). Transformations of sex and sexuality: Psychologically modified experiences in the context of forensic mental health. Health, 18, 240–260.
Buckley, P. (1999). Sexuality and serious mental illness. Amsterdam: Harwood Academics.
Buckley, P., Hogan, M., Svendsen, D., & Gintoli, G. (1999). Dilemmas of managing sexual activity among psychiatric patients. In P. Buckley (Ed.), Sexuality and serious mental illness (pp. 21–33). Amsterdam: Harwood Academics.
Bullock, C., & Beckson, M. (2011). Male victims of sexual assault: Phenomology, psychology, physiology. Journal of the American Academy of Psychiatry and the Law, 39, 197–205.
Carey, M., Carey, K., Weinhardt, L., & Gordon, C. (1997). Behavioral risks for HIV infection among adults with a severe and persistent mental illness: Patterns and psychological antecedents. Community Mental Health Journal, 33(2), 133–142.
Chapman, L., & Chapman, J. (1973). Disordered thought in schizophrenia. Englewood Cliffs: Prentice-Hall.
Cole, M., Baldwin, D., & Thomas, P. (2003). Sexual assault on wards: Staff actions and reactions. International Journal of Psychiatry in Clinical Practice, 7, 239–242.
Collins, P. (2001). Dual taboos: Sexuality and women with severe mental illness in South Africa. Perceptions of mental health care providers. AIDS and Behavior, 5(2), 151–161.
Collins, P., von Unger, H., & Armbrister, A. (2008). Church ladies, good girls, and loss: Stigma and the intersection of gender, ethnicity, mental illness, and sexuality in relation to HIV risk. Social Science and Medicine, 67, 389–397.
Crowe, M. (2004). Couples and mental illness. Sexual and Relationship Therapy, 19(3), 309–318.
Cutler, A. (2003). Sexual dysfunction and antipsychotic treatment. Psychoneuroendocrinology, 28, 69–82.
Dansky, B., Saladin, M., Brady, K., Kilpatrick, D., & Resnick, H. (1995). Prevalence of victimization and posttraumatic stress disorder among women with substance use disorders: Comparison of telephone and in-person assessment samples. International Journal of Addictions, 30(9), 1079–1099.
Deegan, P. (1996). Recovery as a Journey of the Heart. Psychiatric Rehabilitation Journal, 91–97.
Deegan, P. (1999). Human sexuality and mental illness: Consumer viewpoints and recovery principles. In P. Buckley (Ed.), Sexuality and serious mental illness (pp. 21–33). Amsterdam: Harwood Academics.
Deegan, P. & Drake, R. (2006). Shared decision making and medication management in the recovery process. Psychiatric Services, 57(11), 1636–1639.
Doak, M. (2000). ‘She will never get well while doing anything unnatural’: Women’s sexual deviance and institutional psychiatry in New York City, 1890–1920. Dissertation Abstracts International Section A: Humanities and Social Science, 60(8-A).
Dossenbach, M., Hodge, A., Anders, M., Molnar, B., Peciukaitiene, D., Krupka-Matuszczyk, I. et al. (2005). Prevalance of sexual dysfunction in patients with schizophrenia: International variations and underestimation. Journal of Neuropsychopharmacology, 8(2), 195–201.
Dolman, C., Jones, I., & Howard, L. (2013). Pre-conception to parenting: A systematic review and meta-synthesis of the qualitative literature on motherhood for women with severe mental illness. Archives of Women’s Mental Health, 16, 173–196.
Eklund, M., & Ostman, M. (2009). Belonging and doing: Important factors for satisfaction with sexual relations as perceived by people with persistent mental illness. International Journal of Social Psychiatry, 56(4), 336–347.
Farago v. Sacred Heart General Hospital. (1989). 562 A 2d 300 (Penn. 1989).
Foy v. Greenblott (1983) 141 Cal. App. 3d, Court of Appeals of California. Retrieved December 22, 2014 http://law.justia.com/cases/california/court-of-appeal/3d/141/1.html
Freeman, M., & Gelenberg, M. (2005). Bipolar disorder in women: Reproductive events and treatment considerations. Acta Psychiatrica Scandinavica, 112, 88–96.
Galbally, M., Roberts, M., & Buist, A. (2010). Mood stabilizers in pregnancy: A systematic review. The Australian and New Zealand Journal of Psychiatry, 44, 967–977.
Garte, S. (1989). Sexuality and intimacy in Vietnam veterans with post traumatic stress disorder. Psychotherapy in Private Practice, 7(2), 103–112.
Gibson, S., Brand, S., Burt, S., Boden, Z., & Benson, O. (2013). Understanding treatment non-adherence in schizophrenia and bipolar disorder: A survey of what service users do and why. BMC Psychiatry, 13(1), 1–12.
Gonzalez-Torres, M., Salazar, M., Inchausti, L., Ibanez, B., Pastor, J., Gonzalez, G., et al. (2010). Lifetime sexual behavior of psychiatric inpatients. International Society for Sexual Medicine, 7, 3045–3056.
Green, L., Elliot, S., Anwar, L., Best, E., Tero, M., Sarkar, A., et al. (2008). An audit of pregnant women with severe mental illness referred during the first two years of a new perinatal mental health service. Archives of Women’s Mental Health, 11, 149–158.
Haddad, P., & Sharma, S. (2007). Adverse effects of atypical antipsychotics: Differential risk of clinical implications. CNS Drugs, 21(11), 911–936.
Hall, R. (2013). Working with LGBTQ psychiatric inpatients: A spiritual resource guide. Dissertation Abstracts International, 73, 10AE.
Harley, E., Boardman, J., & Craig, T. (2010). Sexual problems in schizophrenia: Prevalence and characteristics. A cross sectional survey. Social Psychiatry and Psychiatric Epidemiology, 45, 759–766.
Harris, M. (1997). Modifications in service delivery for women diagnosed with serious mental illness who are also the survivors of sexual abuse trauma. In M. Harris & C. Landis (Eds.), Sexual abuse in the lives of women diagnosed with serious mental illness (pp. 3–20). Amsterdam: Overseas Publishers Association.
Hauck, Y., Rock, D., Jackiewicz, T., & Jablensky, A. (2008). Healthy babies for mothers with serious mental illness: A case management framework for mental health practitioners. International Journal of Mental Health Nursing, 17, 383–391.
Haverkamp, F., Propping, P., & Hilger, T. (1982). Is there an increase of reproductive rates in schizophrenics? Critical review of the literature. Archiv fur Psychiatric und Nervenkrankenheiten, 232, 432–450.
Hellewell, J. (2000). Tolerability and patient satisfaction as determinants of treatment choice in schizophrenia: A multi-national study of the attitudes and perceptions of psychiatrists toward novel and conventional antipsychotics (poster). Presented at the 13th European College of Neuropsychopharmacology Congress, Munich, Germany.
Henning, M., Kruger, C., & Fletcher, L. (2012). Syphilis sero-positivity in recently admitted and long-term psychiatric inpatients: Screening, prevalence, and diagnostic profile. South African Journal of Psychology, 18(4), 171–175.
Hirschberg, W. (1985). Social Isolation among schizophrenic out-patients. Social Psychiatry, 20(4), 171–178.
Howard, L., Kumar, C., Leese, M., & Thornicroft, G. (2002). The general fertility rate in women with psychiatric disorders. The American Journal of Psychiatry, 159, 991–997.
Hungerford, C., & Kench, P. (2013). The perceptions of health professionals of the implementation of Recovery-oriented health services: a case study analysis. Journal of Mental Health Training, Education, and Practice, 8(4), 208–218.
Johnson, S., Phelps, D., & Cottler, L. (2004). The association of sexual dysfunction and substance use among a community epidemiological sample. Archives of Sexual Behavior, 33(1), 55–63.
Kavanagh, D., O’Halloran, P., Manicavasagar, V., Clark, D., Piatkowska, O., & Tennant, C. (1997). The family attitude scale: Reliability and validity of a new scale for measuring the emotional climate of families. Psychiatry Research, 70, 185–195.
Keen, L., Dyer, T., Whitehead, N., & Latimer, W. (2014). Binge drinking, stimulant use and HIV risk in a sample of illicit drug using heterosexual Black men. Addictive Behaviors, 39(9), 1342–1345.
Kelly, D., & Conley, R. (2004). Sexuality and schizophrenia: A review. Schizophrenia Bulletin, 30(4), 767–779.
Kopelowicz, A., Mangano, R., & Caine, M. (1999). Teaching individuals with serious mental illness about friendship, dating, and sexuality. In P. Buckley (Ed.), Sexuality and serious mental illness (pp. 21–33). Amsterdam: Harwood Academics.
Kreyenbuhl, J., Nossel, I. R., & Dixon, L. B. (2009). Disengagement from mental health treatment among individuals with schizophrenia and strategies for facilitating connections to care: A review of the literature. Schizophrenia Bulletin, 35(4), 696–703.
Lagios, K., & Deane, F. (2007). Severe mental illness is a new risk marker for blood-borne viruses and sexually transmitted infections. Australian and New Zealand Journal of Public Health, 31(6), 562–566.
Lande, R., & Karamchadani, V. (2002). Chronic mental illness and the menstrual cycle. Journal of the American Osteopathic Association, 102(12), 655–659.
Leon, G., Lucas, A., Colligan, R., Ferdinand, R., & Kamp, J. (1985). Sexual, body image and personality attitudes in anorexia nervosa. Journal of Abnormal Child Psychology, 13, 245–258.
Loxley, W. (1998). Young injecting users and the risk of HIV/aids: Psychosocial and environmental constraints on safer drug using and sexual behavior. Perth, Australia: National Centre for Research into the Prevention of Drug Abuse, Curtain University of Technology.
Lyon, D., & Parker, D. (2003). Gender-related concerns of rural women with serious and persistent mental illnesses. Archives of Psychiatric Nursing, 27(1), 27–32.
Mandarelli, G., Parmigiani, G., Tarsitani, L, Polselli, G., Biondi, M., & Ferracuti, S. (2010). Competence to give informed consent in acute psychiatric hospitalizations. Preliminary results for a case-control study. European Psychiatry, 25, 691–691.
Mandarelli, G., Zangaro, S., Raja, M., Azzoni, A., Tatarelli, R., & Ferracuti, S. (2014). Competence to consent to sexual activity in bipolar disorder and schizophrenia spectrum disorders. Archives of Sexual Behavior, 41, 507–515.
Martin, N., Vega, F., & Montejo, A. (2003). Sexualidad y salud mental. In A. Montejo (Ed.), Sexualidad y salud mental (pp. 117–127). Barcelona: Glosa.
Martin, L., Perlman, C., & Hirdes, J. (2011). Social relationships and activities among married psychiatric inpatients with sexual difficulties. Journal of Sex and Marital Therapy, 37, 307–322.
Matevosyan, N. (2009). Reproductive health in women with serious mental illnesses: A review. Sexuality and Disability, 27, 109–118.
Matevosyan, N. (2010). Evaluation of perceived sexual functioning in women with serious mental illnesses. Sexuality and Disability, 28, 233–243.
Maurice, W., & Yule, M. (2010). Sex and chronic mental illness. In S. Levine (Ed.), Handbook of clinical sexuality for mental health professionals (2nd ed., pp. 469–481). New York: Routledge.
McCann, E. (1999). The expression of sexuality in people with psychosis: breaking the taboos. Journal of Advanced Nursing, 32, 132–138.
McCandless, F., & Sladen, C. (2003). Sexual health and women with bipolar disorder. Journal of Advanced Nursing, 44(1), 42–48.
McCann, E. (2000). The expression of sexuality in people with psychosis: Breaking the taboos. Journal of Advanced Nursing, 32(1), 132–138.
Miller, L. (1997). Sexuality, reproduction, and family planning in women with schizophrenia. Schizophrenia Bulletin, 23(4), 623–635.
Miura, Y., Mizuno, M., Yamashita, C., Watanabe, K., & Murakami, M. (2004). Expressed emotion and social functioning in chronic schizophrenia. Comprehensive Psychiatry, 45(6), 469–474.
Mizock, L., & Fleming, M. (2011). Transgender and gender variant populations with mental illness: implications for clinical care. Professional Psychology: Research and Practice, 42(2), 208–213.
Montejo-Gonzalez, A., Llorca, G., & Izquierdo, J. (1997). SSRI-induced sexual dysfunction: Fluoxetine, paroxetine, sertraline, and fluvoxamine in a prospective, multicenter and descriptive clinical study of 344 patients. Journal of Sex and Marital Therapy, 23, 176–194.
Mossman, D., Perlin, M., & Dorfman, D. (1997). Sex on the wards: Conundra for practitioners. Journal of the American Academy of Psychiatry and the Law, 25(4), 441–460.
Mugisha, F., & Zulu, M. (2004). High prevalence of high-risk behavior and the identification of predictors for sharing injecting materials among young drug users in Prague, Czech Republic. Central European Journal of Public Health, 4, 228–235.
Noffsinger, S. (1999). Sex and mental illness: Legal considerations. In P. Buckley (Ed.), Sexuality and serious mental illness (pp. 21–33). Amsterdam: Harwood Academics.
Ostman, M. (2014). Low satisfaction with sex life among people with severe mental illness living in a community. Psychiatry Research, 216, 340–345.
Ostman, M., & Bjorkman, A. (2013). Schizophrenia and relationships: The effect of mental illness on sexuality. Clinical Schizophrenia and Related Psychoses, 7(1), 20–24.
Ozcan, N., Boyacioglu, N., Enginkaya, S., Dinc, H., & Bilgin, H. (2013). Reproductive health in women with serious mental illness. Journal of Clinical Nursing, 23, 1283–1291.
Ozcan, N, Boyacioglu, N., Enginkayas, S., Dinc, H., & Bilgin, H. (2014). Reproductive health in women with serious mental illnesses. Journal of Clinical Nursing, 23(9/10), 1283–1291.
Pacheco, P., & Esteves, M. (2008). Drugs of abuse and sexual functioning. In E. Balon (Ed.), Sexual dysfunction: The brain-body connection (pp. 131–149). Switzerland: Karger.
Perlin, M. (2008). Everybody is making love/or else expecting rain: Considering the sexual autonomy rights of persons institutionalized because of mental disability in forensic hospitals and in Asia. Washington Law Review, 83(4), 481–512.
Perlin, M., Birgden, A., & Gledhill, K. (2009). ‘The witness who saw,/he left little doubt:’ a comparative consideration of expert testimony in mental disability law cases in common and civil law systems. Journal of Investigative Psychology and Offender Profiling, 6(1), 59–88.
Perry, B., & Wright, E. (2006). The sexual relationships of people with serious mental illness. Journal of Sex Research, 43(2), 174–181.
Peugh, M., & Belenko, S. (2001). Alcohol, drugs, and sexual function: A review. Journal of Psychoactive Drugs, 33, 223–232.
Quinn, C., Happell, B., & Browne, G. (2011). Talking or avoiding: Mental health nurses’ views about discussing sexual health with consumers. International Journal of Mental Health Nursing, 20, 21–28, 150–161.
Rosenberg, K., Bleiburg, K., Koscis, J., & Gross, C. (2003). A survey of sexual side effects among severely mentally ill patients taking psychotropic medication: Impact on compliance. Journal of Sex and Marital Therapy, 29(4), 289–296.
Royal College of Psychiatrists. (1996). Sexual abuse and harassment in psychiatric settings. London: Royal College of Psychiatrists.
Sautter, F., Armelie, A., Glynn, S., & Wielt, D. (2011). The development of a couple-based treatment for PTSD in returning veterans. Professional Psychology: Research and Practice, 42(1), 63–69.
Schnurr, P., Lunney, C., Fordshay, E., Thurston, V., Chow, B., Resick, P., et al. (2009). Sexual function outcomes in women treated for posttraumatic stress disorder. Journal of Women’s Health, 10, 1549–1557.
Schweitzer, K., & Chee, N. (2009). Sexual side-effects of contemporary anti-depressants: Review. The Australian and New Zealand Journal of Psychiatry, 43(9), 795–808.
Shamloul, R., & Ghanem, H. (2013). Erectile dysfunction. The Lancet, 381(9861), 153–165.
Singer, M. (2004). Being gay and mentally ill: The case study of a gay man with schizophrenia treated at a community mental health facility. Journal of Gay and Lesbian Psychotherapy, 8(3/4), 115–125.
Sit, D., Seltman, H., & Wisner, K. (2011). Menstrual effects on mood symptoms in treated women with bipolar disorder. Bipolar Disorders, 13, 310–317.
Smith, D. E., Wesson, D. R., & Apter-Marsh, M. (1984). Cocaine and alcohol-induced sexual dysfunction in patients with addictive diseases. Journal of Psychoactive Drugs, 16(4), 359–361.
Smith, A. M. A., Ferris, J. A., Simpson, J. M., Shelley, J., Pitts, M. K., & Richters, J. (2010). Cannabis use and sexual health. The Journal of Sexual Medicine, 7(2pt1), 787–793.
Stuber, J., Rocha, A., Christian, A., & Link, B. (2014). Conceptions of mental illness: attitudes of mental health professionals and the general public. Psychiatric Services, 65(4), 490–497.
Tang, Y., Gillespie, C., Epstein, M., Mao, P., Jiang, F., Chen, Q., et al. (2007). Gender differences in 542 Chinese inpatients with schizophrenia. Schizophrenia Research, 97(1–3), 88–96.
Tjaden, P., & Thoennes, N. (2000). Extent, nature, and consequences of intimate partner violence: Findings from the National Violence Against Women Survey. Washington, D.C: National Institute of Justice.
Torkelson, D., & Dobal, M. (1999). Sexual rights of people with serious and persistent mental illness: Gathering evidence for decision making. Journal of the American Psychiatric Nurses Association, 5(5), 150–161.
UN General Assembly. (2007). Convention on the rights of persons with disabilities: Resolution/adopted by the General Assembly, January 24, 2007, A/RES/61/106. Available at: http://www.un.org/disabilities/convention/conventionfull.shtml. Accessed July 5, 2014.
Van Sant, S., Ahmed, A., & Buckley, P. (2012). Schizophrenia, sexuality, and recovery. Journal of Ethics in Mental Health, 7, 1–5.
Welch, S., & Clements, G. (1993). Development of a policy on sexuality for hospitalized chronic psychiatry patients. Canadian Journal of Psychiatry, 41, 273–279.
Welch, S., Clements, G., & Moreau, M. (1999). Developing and implementing a policy for consensual sex between patients. In P. Buckley (Ed.), Sexuality among patients with serious mental illness. Amsterdam: Harwood Academic Publishers.
Westenburg, H., & Sandner, C. (2006). Tolerability and safety of fluvoxamine and other antidepressants. International Journal of Clinical Practice, 60, 482–491.
Wilson, R., & Baldwin, B. (1976). A pilot sexuality training workshop for staff at an institution for the mentally retarded. American Public Health Association, 66(1), 77–78.
Wright, E., Wright, D., Perry, B., & Foote-Ardah, C. (2007). Stigma and the sexual isolation of people with serious mental illness. Social Problems, 54(1), 78–98.
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Hunter, K.M., Ahmed, A.O. (2016). Sexuality and Sexual Health. In: Singh, N., Barber, J., Van Sant, S. (eds) Handbook of Recovery in Inpatient Psychiatry . Evidence-Based Practices in Behavioral Health. Springer, Cham. https://doi.org/10.1007/978-3-319-40537-7_3
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