Sexuality in chronic and/or severe mental illness is not a widely researched or widely discussed topic. This is surprising, as there are many issues involved here that are important for the clinician. For example, patients with chronic psychiatric illness can be sexually exploited, or, at the other extreme, may themselves be sexual offenders. There are other risks, such as infection or unwanted pregnancies.
In this book, which is part of the Chronic Mental Illness series, Buckley (a psychiatrist) has brought together contributions by a group of diverse professionals. The first chapter, by the editor and three collaborators, sets the scene, dealing with the parameters of sexual behaviour in people with serious mental illness. Clinical and survey data are cited which show that many patients with severe mental illness have active sex lives. A much smaller number show inappropriate or predatory sexual behaviour. The authors note that the actions of the latter group, often the subject of media publicity, have overshadowed the needs of the majority.
Patricia Deegan's chapter gives a consumer perspective, based on a focus group discussion. One of the points she highlights concerns the effects of medication on sexual functioning. It is not uncommon for patients not to be informed about these effects. The need for clear policies with regard to sex and romance in mental hospitals is also addressed, and the tendency to locate the problem in the patient alone is challenged.
Other topics discussed include the legal aspects of sexuality and mental illness. A key issue here is competence to give informed consent to contraception. The topic of sexual assaults in hospital settings is also discussed. As any charge nurse knows, ‘managing’ sexual activities in inpatient settings is an important part of running a ward. There are complex issues, such as the conflict between the responsibility to protect vulnerable patients and the duty to promote patients' rights. A chapter is devoted to an account of one hospital's (Riverview Hospital in British Columbia) work on developing a policy for consensual sex between in-patients. Education about dating, friendship and sexuality is also covered. The chapter on psychotropic medication and sexual dysfunction deserves mention. Sound advice is given on the diagnosis and management of medication-induced sexual dysfunction. However, distinguishing illness-associated sexual dysfunction from medication-induced dysfunction is a notoriously difficult task, and this is acknowledged.
Overall, this book goes some way in filling a gap that has existed in the literature for some time. It certainly succeeds in high-lighting some crucial, often difficult, issues. As the topics covered are broad, the book should appeal to a wide audience, including psychiatrists, psychologists, nurses, administrators and lawyers — and, of course, patients themselves and their advocates. Readers of whichever category will find these pages educative — both as a source of information and, more importantly, as a stimulus for discussion and debate.
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