‘It's just a peripheral issue’: A qualitative analysis of mental health clinicians’ accounts of (not) addressing sexuality in their work

Abstract

Sexuality, relationships, and intimacy are integral parts of many peoples’ lives, not negated by mental distress and illness. Yet typically, these needs are not addressed adequately in mental health settings. In‐depth interviews were conducted with mental health clinicians with an aim of exploring their perceptions and understandings of sexuality and sexual concerns within mental health settings. Participants were 22 mental health nurses, psychologists, and psychiatrists working with people across a range of settings in four Australian cities. Sexuality or aspects of this were often not addressed in clinical practice, and this was common across participants’ accounts. A critical thematic analysis was conducted to explore how participants made sense of or explained this silence in relation to sexuality. Two key themes were ‘Sexuality is hard to talk about’ and ‘Sexuality is a “peripheral issue”’. In positioning sexuality as a peripheral issue, participants drew on three key explanations (sub‐themes): that sexuality rarely ‘comes up’, that it is not pragmatic to address sexuality, and that addressing sexuality is not part of participants’ roles or skill sets. A third theme captured the contrasting perception that ‘Sexuality could be better addressed’ in mental health settings. This analysis indicates that, beyond anticipated embarrassment, mental health clinicians from three disciplines account for omissions of sexuality from clinical practice in similar ways. Moreover, these accounts serve to peripheralize sexuality in mental health settings. We consider these results within the context of espoused holistic and recovery‐oriented principles in mental health settings.

Affective and Sexual Needs of Residents in Psychiatric Facilities: A Qualitative Approach

“…Sexual relationships are common in PRFs, but a growing literature body confirms that mental health services have failed to address RPFUs' affective and sexual needs [17][18][19][20][21][22][23]. This is consistent with the findings of our qualitative study, where all the participants expressed affective and sexual needs.…”

Consumers living with psychosis: Perspectives on sexuality

“…This latter point supports Urry et al . 's (2019) view of the importance of service and system initiatives to improve clinical practice in this area.…”

“…2009; McCann 2003; Urry et al . 2019). This is particularly the case in relation to those diagnosed with specific conditions, for example, schizophrenia (Almeida & Murta 2019; McCann 2000; Volman & Landeen 2007).…”

Development of the Comfort with Sexual Behaviors Scale

“…A. Miller & Byers, 2010;Schover, 1981). In a recent study of why clinicians do not address sexuality with clients, participants stated that sexuality was difficult to discuss and that they saw it as a peripheral issue (Urry, Chur-Hansen, & Khaw, 2019). Counselors justified not discussing sexuality because they believed it was not practical to address sexuality, addressing sexuality was outside of clinicians' roles and/or skill set, and clients rarely brought it up (Urry et al, 2019).…”

“…In a recent study of why clinicians do not address sexuality with clients, participants stated that sexuality was difficult to discuss and that they saw it as a peripheral issue (Urry, Chur-Hansen, & Khaw, 2019). Counselors justified not discussing sexuality because they believed it was not practical to address sexuality, addressing sexuality was outside of clinicians' roles and/or skill set, and clients rarely brought it up (Urry et al, 2019). This is consistent with other literature that pointed to a lack of training on sexuality, deficits in clinicians' skills in addressing sexuality, a lack of clinician confidence in addressing client sexuality, and clinician discomfort with the topic of sexuality (Dermer & Bachenberg, 2015;Hanzlik & Gaubatz, 2012;S.…”