Healthcare providers in psychiatric wards are faced with two conflicting ideas when assessing the incidence of sexual activity.
The European Convention on Human Rights emphasizes the individual’s ‘right to respect for the private life,’ which is generally interpreted as the right for two consenting adults to express themselves sexually. They are also responsible for protecting their vulnerable patients from sexual exploitation and unwanted disease and conception. Dr James Warner of Imperial College London explores the issue in the October issue of the Journal of the Royal Society of Medicine.
Previous staff-based reports suggest sexual encounters among patients in UK psychiatric wards is common, but no earlier formal study has been undertaken to provide patient input. Dr Warner and colleagues studied eleven wards at three psychiatric units across West London through patient questionnaires. Ward staff also answered a separate questionnaire about their opinion on likely sexual activity among their patients.
The study’s findings reveal a ‘remarkably high’ amount of sexual activity on the wards. Dr Warner reports ‘no relation between length of stay, diagnosis or ward type and levels of invitation,’ leading to the conclusion that ‘all patients may be vulnerable to sexual exploitation.’ He writes, ‘Although all sexual intercourse was rated as consensual by respondents, some sexual activity was non-consensual.’
In spite of the no-sex policy instituted on all the wards surveyed, the study found that a variety of sexual acts had been carried out in all eleven wards. Of 100 respondents, ten reported having sexual intercourse, eight without contraception. Six respondents ‘said the sexual intercourse took place within a long-term relationship established on the ward,’ and three respondents reported it on more than five occasions. Patients had sexual intercourse in the bedroom, dayroom, toilet and in stairwells and gardens. ‘No respondents reported having sex with staff members,’ the author writes. The study concluded that there were 12 incidences of unwanted invitations or actual sexual activities reported, none of them ending in sexual intercourse.
‘Although this is a relatively small study, it highlights an important ethical and clinical dilemma,” says Dr Warner. He adds, ‘We were surprised by the high rates of sexual activity reported by patients’ and stresses that this ‘demands attention.’ For patients that are unable to consent to sexual activity and those detained under the Mental Health Act 1983, sexual activity may be illegal. ‘Health care providers have an obligation to protect them from sexual exploitation,’ the article claims. However, for patients who are able to consent, ‘any attempt at policing sexual activity might violate the European Convention on Human Rights. The problem is that an individual with mental illness may fluctuate in their ability to consent to sexual activity.’ In addition to these conflicting pressures, ‘health care trusts may be held responsible if a patient under their care becomes pregnant or develops a sexually transmitted disease.’ Dr Warner acknowledges the ‘near-impossible task in balancing the issues’ and advises hospitals to revise their policies and ‘ensure that condoms and contraceptive advice is available.’