Avia Collinder, Gleaner writer

While the sexual needs of the mentally-ill are largely ignored, institutional and national health policy must move towards addressing the desire of these individuals to love and be loved. This was the message conveyed by Dr. Joanna Bennett, guest speaker at the recently held mental health counsellors conference at the Jamaica Conference Centre, downtown Kingston, on June 16.

Bennett, a United Kingdom-based nursing professor, said that the mentally ill "want to be loved and desired", stating that clinical practice and health policy should reflect the support of this right. "The desire to love and be loved is important to the emotional well-being and the overall quality of life of the mentally-ill. This must be understood to address policies which impact negatively on an individual's sexuality," she stated.

"Sex is a normal part of our lives. Patients will have sex," the professor said, pointing out that U.K. studies show that 30 per cent of patients engage in sexual activity or intercourse which is consensual, but a much smaller proportion actually uses condoms.

"There is a risk of pregnancy and infection because of the lack of effective policy," the professor said. Practitioners, studies show, equally disapprove of hugging as well as sex. At the same time, she noted that, while practitioners disapprove of sex among patients, a 2003-2005 study shows that more than 100 women were raped, assaulted and harassed in institutional settings.

Staff abusing their power

"The sad thing is that we are not talking about sex between patients, but here are staff who abuse their power and even impregnate them," the professor said. "There is a right for two consenting adults to express themselves sexually. However, they also have the right to protection as vulnerable patients."

According to Bennett, attitudes towards the sexuality of the mentally-ill have come a long way. Historically, it was thought that masturbation was connected or led to madness and, in women, insanity was also viewed as a sexual dysfunction for which early treatments included hot water injected into the vagina. Homosexuality was also viewed as sociopathic behaviour. Today, however, Bennett noted, the giant leap forward in mental health reflects the view that those with mental illnesses have functioning libidos, and the ability and need to develop sexual relationships.

Area of concern

Another area of concern is the impact of medication - the side-effects of antipsychotic drugs and antidepressants and others which interfere with sexual function. Such drugs, Bennett said, lead to reduced libido, erectile dysfunctions, disruptions of the menstrual cycle, reproductive problems, and unusual breast milk production among other disorders. Some antipsychotics and antidepressants also cause breast enlargement in men and women.

As a result of medication, some patients are unable to perform sexually and further fail to develop relationships. "They develop self-blame along with shame, and this impairs the quality of their life," Bennett opined.

She also stated that mental health practitioners need to provide adequate information to their clients. "Patients often say when they are on the wards of various institutions, they receive information and condoms, but at the same time there really is a policy of no sex," she said.

Other issues relating to the sexuality of mentally-ill patients, the professor said, include lack of privacy during medical examinations, being forced to share physical space with too many persons, and women being forced to ask for sanitary products in front of others.

Among mental health practitioners, surveys show that there is greater approval of females over males initiating sex. They also disapprove of sex taking place anywhere other than in the bedroom.

Bennett said there is a therapeutic value in people supporting and comforting each other. In the U.K., some institutions recognising this have provided private spaces in which consenting adults can have sex. However, she noted, some people still believe sex among the mentally-ill is immoral.