Meeting the Challenge of Sexual Wellness in Psychiatric Rehabilitation Programs

A healthy sexual life is a vital part of oneself throughout every life phase. Sexual wellness, however, can be influenced by a myriad of factors, ranging from attitudes towards sexual activity and sexual behavior, to socioeconomic status and culture. Typically, sexuality is often only discussed within limited constructs of anatomy, physiology, reproduction, or illness. The World Health Organization (WHO) suggests that health is more than the absence of disease or illness; that wellness must include the vibrant variety found in expressing health and wellness. Within this more holistic concept of health, sexual health, too, is encompassed within the totality of mind, body, spirit, and relationships to others. Like the WHO, PRA contextualizes this holistic approach to sexuality within recovery in the Certified Psychiatric Rehabilitation Practitioner (CPRP) practice domain #7, Diversity and Cultural Competency. By adopting a more positive approach  towards sex, one is open to discussing sexual wellness in terms of pleasure, bonding, discovery, spirituality, relationship development, and improved emotional and physical health.

Many individuals who experience psychiatric disabilities are sexually active, viewing sex and intimacy as personal choices essential for their well-being and part of their own self-determination (Cook, 2000). Unfortunately, like many other aspects of health and wellness, numerous barriers prevent people in recovery from learning about and expressing their sexuality in safe and inclusive environments. Without information about risk reduction and skills for developing sexual relationships, individuals are more vulnerable to serious consequences to their sexual health: higher risks for sexually transmitted infections, including HIV/AIDS; reproductive tract infections; unplanned pregnancy; undetected cancers; and experiences of sexual dysfunction. Further, an individual’s sexual health can be influenced by the experience of mental health symptoms, other co-occurring physical illnesses, and past abuse or violence. Relating interpersonally can sometimes be difficult for all individuals, including those living with psychiatric disabilities. For example, avoidance of eye contact and inability to manage casual conversation are two typical social skill impairments related to some psychiatric disabilities. Since both of these skills are essential to establishing intimacy and building relationships, some individuals in recovery with limitations in these skills may appear less desirable to potential partners. Finally, people with psychiatric disabilities generally receive very little assistance and support from service providers for expressing their sexuality, especially practical assistance with social skills and support for sexual activity.

Despite advances in this area, many psychiatric rehabilitation (PSR) practitioners and providers continue to be unsure about addressing sexuality, feeling uneasy discussing explicit or very personal information. Ideas about sexuality and individuals in recovery are quite polarized and often include stigma. On one end, some harbor views that people with disabilities are neither interested in sex nor capable of experiencing sexual desires. At the other end of the spectrum, people with disabilities are viewed as being overly interested in sex and out of control of sexual behaviors as they relate to symptoms. Accurate information, free of stereotypical perceptions, must be available to every person so he/she can develop a healthy view of who he/she is as a sexual being. The Sexuality Information and Education Council of the United States (SIECUS) believes that all individuals have the right to comprehensive sexuality education that addresses the socio-cultural, biological, psychological, and spiritual dimensions of sexuality by having access to information; exploring feelings, values, and attitudes; and developing communication, decision-making, and critical-thinking skills. Sexually healthy adults should be able to appreciate one’s own body; seek information as needed; understand sexual health (e.g. gender-specific health needs, prevention behaviors); interact with all genders respectfully and appropriately; affirm one’s own sexual orientation; affirm one’s own gender identity; express love and intimacy in appropriate ways; develop and maintain meaningful relationships; communicate effectively with self and others; identify sexual feelings without necessarily acting on them; and finally, express one’s sexuality throughout life.

To promote more comprehensive wellness and recovery, it is imperative that PSR programs contextualize sexuality as part of the recovery process and vital to wellness. Recovery is the reawakening of hope, moving towards active participation in all aspects of life, and reclaiming a positive sense of self. Sexual wellness is a fundamental aspect of recovery. Regaining a sense of sexual identity for a person who becomes disabled as an adult may be a critical component of rehabilitation. As PSR practitioners, it is essential to know what resources are available, keeping in mind that age is not necessarily an indicator of education on sexuality and wellness. Familiarizing ourselves with websites, digital media, help-lines, and support groups, as well as how to access them, is critical to facilitate and allow for informed conversations. Helping individuals navigate information, resources, and workshops and classes allows individuals to develop positive sexual knowledge, improve physical and emotional health, and increase confidence and self-determination.

References:
Cook, J. A. Sexuality and People with Psychiatric Disabilities. Sexuality and Disability, 18(3), 195-206 (2000).
Lucksted, A. (2004). Lesbian, Gay, Bisexual, and Transgender People Receiving Services in the Public Mental Health System: Raising Issues. Journal of Gay & Lesbian Psychotherapy, 8(3-4), 25-42 (2004).
Razzano, L. A., et al. Predictors of Mental Health Services Use Among Lesbian and Heterosexual Women. Psychiatric Rehabilitation Journal, 29(4), 289-298 (2006).

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