EMBARGOED UNTIL 1 OCTOBER 2004
Are patients in psychiatric wards having sex?
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.
The study
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.
Some sexual activity was ‘non-consensual’
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.’
Violations
of ‘no-sex’ policies
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.
Liability versus human rights
‘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.’
[ends]
Sexual activity among patients in psychiatric hospital wards [PDF 55k]
JRSM is the flagship journal of the Royal Society of Medicine. It has been published continuously since 1809. Its Editor is Dr Kamran Abbasi.
