Long term with mental health
THE INTERPRETATION OF federal law (Omnibus Budget Reconciliation Act, 1987) by some states protects the sexual rights of those with serious and persistent mental illness (SPMI) who live in long-term psychiatric facilities. This law, along with other laws enacted on an individual state level, allows those with SPMI the right to privacy for intimate relationships. Legally, consensual sexual relationships between adults are a right in our society. But, when adults with SPMI who live in psychiatric facilities wish to engage in consensual sexual relationships, it is often considered to be a clinical problem (Buckley & Hyde, 1997). As a mental health consumer advocate, Deegan (1999) suggests that the sexual activity is not the problem; rather the problem is the failure of the facility to allow for private and dignified expression of sexuality.
Sexual activity is often prohibited by organizational policy, ignored by staff, or at times dealt with in ways that cause humiliation or increased restrictions for the residents involved (Buckley & Robben, 2000). The issue of consensual sexual relationships between adults with SPMI becomes a highly charged, emotional issue. Questions of competency, morality, and liability abound. It is in this atmosphere that decision-makers in psychiatric facilities must address the issues involved in balancing patient rights with the responsibility of protecting the resident population. It is paramount for decision-makers to distinguish between the needs of long and short-term residents of psychiatric facilities. Mossman, Perlin, and Dorfman (1997) state “long-term facilities must respond to different needs and conditions to allow patients opportunity for dignified living” (p. 454). Ford, E., Rosenberg, M., Holsten, M. and Boudreaux, T., 2003. Managing sexual behavior on adult acute care inpatient psychiatric units. Psychiatric Services 54, pp. 346–350. Full Text via CrossRef | View Record in Scopus | Cited By in Scopus (4)Ford, Rosenberg, Holsten and Boudreaux (2003) also make a clear distinction in the different issues involved in managing sexual behavior in acute care adult inpatient units. The focus of this study is on decisions made about the development and implementation of sexual policies in long-term facilities.
Literature review
Legal issues
From a legal perspective, Fiesta (1997) states, “all providers of long-term care … must confront the problem of finding ways to balance the individual liberties of their residents against the obligation to protect residents from the harms that can be associated with sexual activity …” (p. 82). Sy (2001) stated that “… service care providers in institutions cannot feasibly provide enough supervision to prevent rape and, at the same time, not over supervise to avoid violating a patient’s privacy rights” (p. 548). To protect the rights of the residents and the responsibilities of the facility, sexual policy development and implementation is essential. Penner (1991), declares “there is no question … that residents of long-term care facilities, whether competent or incompetent, single or married, have the right, unless medically contraindicated, to engage in consensual sexual activities” (p. 11). Penner bases this opinion on his interpretation of Medicare requirements for long-term care, which gives each long-term care resident specific rights as a resident of the facility and citizen of the United States. Two key concepts to keep in mind regarding the legal perspective on this issue are that “… mental illness does not automatically presume incompetence” ( Weiss, 1990, p. 26), and those with mental illness do not lose their rights to privacy and intimacy when they are long-term care residents.
Perceptions of resident sexual behavior
Historically, the sexual activity of persons with SPMI living in psychiatric facilities was denied or ignored. There were no sexual policies or sexual education programs because it was believed that either people with SPMI were asexual or that if they did attempt involvement in a consensual sexual relationship, it was somehow inappropriate and needed to be stopped. Part of the confusion regarding what is “appropriate” or “inappropriate” may be due to staff members judging sexual activity by social definitions versus making decisions based on policy (Mossmann et al., 1997).
Commons, Bohn, Godon, Hauser, and Gutheil (1992) studied professional mental health staff attitudes towards sexual behavior between residents in a psychiatric care facility. They, too, found that decisions were not based on professional norms or legal standards. Instead, the decisions were influenced more by conventional norms. The Commons et al. (1992) study identifies the need for clear policy guidelines to assist professional staff in their decision-making responses.
McCann (2000) studied the sexual and relationship needs of people with SPMI who were being cared for in hospitals and being prepared to return to community living. The researcher found that human sexuality was an area that was not adequately addressed, particularly in the psychosocial rehabilitation setting. Yet, in the psychosocial rehabilitation model and the recovery model (Deegan 1999 and Thompson and Strand 1994), the hallmark of care is to emphasize wellness and de-emphasize pathology in normalized settings (Bell, Wringer, Davidhizar, & Sammuels, 1993) where adult-to-adult decision-making is employed.
Tags: Long term