A Qualitative Study on Sexuality and Sexual Experiences in Community Forensic Mental Health Patients in Queensland, Australia

Abstract

This qualitative study reports on the sexuality and sexual experiences of community-based forensic mental health participants. The findings indicate that these participants feel the need for intimacy and want to engage in sexual activity more often than their neurotypical Australian peers. Participants identified their mental health and the side effects of compliance with prescribed psychotropic medications were barriers to achieving their desired level of sexual activity. Participants supported the notion that mental health teams were positioned to assist patients navigate the psychological, cultural, education and physical barriers to achieving sexual health and wellbeing. We propose several interventions to support these participants and other community forensic mental health patients in attaining healthy relationships, understanding their sexual health, and gaining more fulfilling sexual experiences. These interventions, which include sex education, upskilling in socialization and communication, and regular medication reviews, could be delivered as part of the holistic care provided by mental health teams. Mental health clinicians should be offered appropriate training to assess patients and have discussions related to sexuality, sexual experiences and sexual health needs.

The sexuality and sexual experiences of forensic mental health patients: An integrative review of the literature

“…This finding was supported by both Ravenhill et al ( 34 ) and Hales et al ( 29 ) who point out that forensic patients experience sexual feelings, sexual desires, interests and hopes for current and future sexual experiences and relationships. Further evidence of the “normality” of sex was reported by Brand et al ( 35 ) with 12 out of 14 community forensic mental health patients describing a desire for sex with a regular partner. Their desired ideal of sexual intimacy ranged from having sex at least twice per week to having sex daily (an average of 3.71 times per week).…”

“…Despite the longevity of hospitalization, Ravenhill et al ( 34 ), reported that patients maintain their pre-admission sexual orientation. According to Brown et al ( 2 ), and further illustrated Brand et al ( 35 ), Brand ( 36 ) active positive and negative symptoms of SMI, and significant sexual side effects of psychotropic medication further amplify sexual difficulties and negative sexual experiences.…”

“…Nine papers focused exclusively on forensic inpatients, one on forensic outpatients ( 35 ) and two on a combination of in and outpatients ( 32 , 36 ).…”

“…The authors relate this to poor interpersonal skills, social withdrawal, lack of self-confidence, low self-esteem, guilt and feelings of shame. Challenges in socializing and communication skills were reported as a significant barriers to sexual intimacy by community forensic mental health patients ( 35 ), and this theme of a deficit in sexual intimacy was identified as a strong unmet need for most forensic patients ( 26 ) with inpatients pointing to the lack of privacy, private space and private time as the most significant barriers for them to engage in positive sexual experiences ( 24 , 25 ). Patients associated this loss of privacy with the losses of autonomy, individuality and control in the forensic inpatient population ( 35 , 36 , 42 ).…”

“…According to Koller and Hantikainen ( 28 ) as well as Brand et al ( 35 ) forensic patients associate relationships with security, trust, care, a feeling of being loved and a deeper emotional quality. Dein and Williams ( 38 ), Hales et al ( 29 ) and Quinn and Happell ( 24 ) reported that several forms of intimacy from affection, connection, and relationships to actual sexual activity were perceived as therapeutic and supportive by forensic patients in their recovery.…”