Check Yourself Before You Wreck Yourself: Self-Care and Wellness Promotion

Wellness is multi-dimensional and directly related to every aspect of our lives. The concept of wellness is complex and spans our physical wellness to our emotional, social, and intellectual wellness. In fact, Substance Abuse and Mental Health Services Administration (SAMHSA) cites eight concentrated areas that comprise overall wellness: environmental, intellectual, emotional, financial, spiritual, social, occupational, and financial. Within these broad brush strokes, it is not surprising that some areas of wellness are overlooked, or even just more difficult to address due to lack of knowledge, skills, or ability. At times this can become a difficult venture if we lack the skills and resources required to meet difficult situations head on. As helping professionals, we seek to support individuals in developing, nurturing, and advocating for their own wellness promotion. In our work with individuals in recovery, we must be prepared with current and relevant information regarding all types of wellness, including information about sexual wellness.

The World Health Organization (WHO) suggests that sexual wellness is “a state of physical, mental, and social well-being in relation to sexuality. It requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination, and violence.” Many individuals in recovery are sexually active, viewing sex and intimacy as personal choices essential for their well-being and part of their own self-determination. Unfortunately, like many other aspects of health and wellness even in the general population, individuals may encounter barriers to learning about and expressing their sexuality in safe and inclusive psychiatric rehabilitation settings. Further, many practitioners and other service providers are unsure and uneasy in regards to addressing or discussing this type of material. Perhaps this is because many providers feel like these conversations will only focus on sexual activities; yet full sexual health and wellness encompasses reproduction, body image, gender identity, sexual orientation, communication, trauma, relationships, and expression.

To promote more comprehensive wellness and recovery, it is imperative that psychiatric rehabilitation (PSR) programs contextualize sexuality as part of the recovery process and as being vital to whole health and wellness. Recovery is the reawakening of hope, moving towards active participation in all aspects of life, and reclaiming a positive sense of self. Within our intimate lives, we must strive to promote the possibility of recovery, highlight an individual’s strengths, and support self-determination.

So how are we doing this? How do we operationalize this concept of holistic sexual wellness in our programs and our workplaces? Many providers suggest that lack of knowledge, comfort, skills, and their own attitudes towards their sexuality directly impacts the quality of services they are able to provide. Other providers indicate that conversations regarding sexuality could risk violating boundaries and be considered inappropriate. Without question, addressing this topic can be challenging, even for experienced clinicians. Think of all the skills required in negotiating a romantic or sexual partner, taking into consideration many of the challenges individuals in recovery overcome on a daily basis: cognitive impairments like inattention, poor concentration, and memory; difficulty with executive functioning; and limited, and low or impacted social skills such as difficulty recognizing social cues and  negotiation, all of which may contribute to the internal and external stigma that already exists for individuals living with disabilities.

Comprehensive programs to address sexual wellness, for individuals in recovery as well as the providers in partnership with them, require the same planning, practice, and tools as supported employment programs. For example, if you wanted to run a marathon, you would not show up on race day having never run, wearing brand new running shoes, and take off full speed towards the finish line. Unfortunately, this may happen when programs and providers begin to include conversations regarding sexual wellness into their existing offerings. Successful providers and programs interested in incorporating sex positive and wellness approaches should consider integrating some of these themes into current practices. They would also benefit from starting small and building momentum over time.

To accomplish this, consider these tips:

Check in with YOU: What knowledge, comfort, and skill level are you working with? Providers often make the mistake of engaging in conversations about sexuality that are outside of their own comfort or knowledge level. Sexuality is diverse, complex, and spans the entirety of our lives; there are many changes that occur with age, illness, and safety over time; and there are generational and cultural differences that when overlooked can affect the trust and sense of safety of the individual with whom you are working. Therefore, it is essential to take time to talk to your supervisor about what themes or topics typically come up and how best to handle them. Take this a step further and have the entire staff spend some time together discussing some common themes. This can include inviting in speakers or attending training on the diverse topics mentioned above.

Evaluate: Take a look at what you or your program are already doing. Sexuality may not be the first health topic to be addressed. Since many individuals in recovery have experienced trauma, there is a critical need to establish trust. It is often best to start small with general conversations about health and wellness and move into more complex conversations that involve sexuality. It is important not to scare individuals with fear tactics about illnesses like sexually transmitted infections; rather, support conversations that encourage prevention and health promotion. Consider hosting a health fair that includes a booth or a station that offers education about sexuality, reducing risks, and promoting wellness. Invite a guest speaker from a local health clinic!

Small Steps are Meaningful Steps: Even small-scale activities can make an impression. For example, consider changing the signs on single public bathrooms to be for “people,” rather than gender-specific space. Offer opportunities for both staff and service recipients to learn more about sexuality and sexual health. Promote groups and encourage skills building to support individuals in recovery to develop their ability to make and maintain meaningful relationships and friendships.

With even a few small changes, every program and provider can incorporate practices for sex positivity. Everyone deserves to live a long, healthy, and fulfilling life, rich with experience, information, and the right to make decisions about ourselves and our health. Sexuality is no exception. One resource immediately available to you and your programs is a webinar from the PRA Academy, Sexual Wellness in Psychiatric Rehabilitation Settings. This can serve as a starting point for you and your programs.