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Sexual safety on mental health wards

People with mental health conditions have just as much right as everyone else to safe and fulfilling sexual relationships. However, people affected by mental ill health can at times act in disinhibited ways or may lack the mental capacity to make sound decisions about relationships. They may also have experienced abuse in the past, which might have contributed to their mental ill health and which might leave them at risk of exploitation by others. These factors make it more likely that people engage in sexual behaviour that they would not when well or make them vulnerable to sexual abuse.

People whose mental ill health is so severe that they require care on a mental health ward are often at the most vulnerable point in their lives. Many will not have consented to being treated in hospital and will have been admitted against their will. Given this, mental health services have a heightened responsibility to protect people using inpatient care from harm.

In our report, The state of mental health services 2014 to 2017, we described mental health admission wards as a high-risk environment, citing rising rates of detention, high bed occupancy, frequent incidents of violence between patients and towards staff and increasing use of physical restraint.

Our analysis of incidents reported to the NHS National Reporting and Learning System suggests that sexual incidents are also commonplace on mental health wards. When we discussed our findings with people who have used services, they described the distress they experience when other patients speak to them using sexualised language, or when they observe other patients behave in a sexually disinhibited manner due to their mental ill health. Some told us that they had received unwanted sexual advances from other people or that they had engaged in sexual acts when mentally unwell that they have regretted afterwards. This distress is still very real for people after they leave hospital.

We would not wish for this work to have an impact on safe and fulfilling sexual relationships, as they are a part of a person’s human rights. But as the quality regulator, our priority is to ensure that people using health and care services are kept safe, that due consideration is given to their mental capacity and that their privacy and dignity are maintained.

Therefore in this report, as well as sharing our findings, we say what we think should be done to improve sexual safety on mental health wards. These recommendations include: clearer guidance to staff, training so that staff can better support the sexual wellbeing of patients, strengthening of the reporting system, and investment in the physical and therapeutic environment of wards so that they better promote sexual safety. We have developed these recommendations in consultation with people who use services and organisations that represent their views, as well as with providers of mental health services, national system partners and professional bodies.