Ressentis des professionnels de santé sur la sexualité des patients hospitalisés en psychiatrie : une étude qualitative

Abstract

Objectives

Questions concerning the sexuality of patients in psychiatric hospitals have come to light, particularly since the introduction of mixed gender patients in these institutions in the 1960s. Although the concerns about mixed gender are less topical, there are questions about the approach used toward sexuality in psychiatric hospitals. Today, even in a desire to protect patients, it is no longer acceptable to prohibit sexual relations on the wards in general, without considering the patient's clinical condition. A global study of the sexuality of patients in psychiatric hospitals is necessary. Initially, our study will focus on the attitudes of caregivers about the sexuality of patients. The main objective of this article is to present a thematic analysis of the discourse of health care professionals interviewed about the sexuality of adult patients hospitalized in psychiatry wards, focusing particularly on their feelings. The secondary objectives are to understand the problems encountered in daily practice by health professionals and to identify possible areas for improvement.

Methods

The study was carried out in three centers, and a total of 18 caregivers were included. The criteria for participation were to be a health professional who cared for or had treated adult patients on psychiatric wards. For this study, we favored qualitative research because it focuses on the subject's discourse, which will allow us to concentrate on the feelings of the caregivers interviewed.

Results

First of all, the theme of persistent taboos that we initially encountered must be qualified. In fact, although sexuality is often discussed only if the health care team is confronted with it in the department, it appears that it is increasingly possible to discuss it. Second, we noted the prevalence of the themes of vulnerability and consent in the discourse of health professionals. These themes are directly linked to those of difficulty and anxiety, which were also highlighted during the data analysis. This suggests that it is difficult for health care providers to assess whether a patient has consented to engage in sexual activity, especially for those hospitalized under duress. Sexual violence is a major concern for caregivers. How best can they protect vulnerable patients while respecting their privacy and rights? Furthermore, we found a certain heterogeneity in the way care was provided. There are differences within the same institution, but also within the same department, depending on the caregivers. The study also allowed us to identify variations in the way patients are treated and the way they feel, depending on their gender, with men often being considered as predators and women as victims. Among the subjects interviewed, there was an unanimous desire to have access to training concerning the sexuality of patients. Finally, the subject of sexuality raises other issues such as the rights of hospitalized patients and restrictions of freedom imposed during hospitalization and also the position of the health care team with respect to a patient's intimacy and communication between the medical and paramedical teams. Many aspects of this issue where there is a need for improvement must be studied, particularly training, which seems essential to enable caregivers to feel more comfortable and to offer better quality care to patients. The training on dealing with sexuality is inseparable from the training on the rights of hospitalized patients. Other areas for improvement have been identified, such as the implementation of workshops on sexuality in the wards or the development of multidisciplinary protocols in the event of a reported sexual assault or significant doubt on the part of the health care team regarding possible violence where the victim is not able to call the health care team or notify the competent authorities.

Conclusion

In this qualitative approach to the sexuality of patients hospitalized in psychiatry, we have seen that the attitudes of health care providers concerning sexuality have evolved considerably because of new legislation and a change in the way society views this issue. Nevertheless, professionals seem to have difficulty in assessing the capacity to consent to sexual intercourse in patients who present a significant degree of vulnerability due to the psychological disorders they may be suffering from. In addition, we feel it is important to emphasize the need for training in the promotion of sexual and emotional health, the prevention of sexual violence and the management of sexual violence. Also, the establishment of multi-professional discussion forums on the issue of sexuality in patients with psychiatric disorders should be supported. Finally, we believe that this study should be supplemented by a qualitative analysis of the discourse of patients hospitalized in psychiatric institutions to better understand the areas of care that should be developed in the future, from the perspective of a global approach to the person suffering from mental disorders.