By Kristi Urry
Health researchers love to talk about risk and danger, and so do I. Risk and danger are often important issues that require a lot of thought, especially in the context of sexual health and mental health. But I wonder if we spend too much time focusing on all the bad stuff about sex and not enough on the good; too much time on the deficits and not enough on the opportunities. In my PhD research I’ve been exploring issues of sexual expression in mental health settings and I often find myself wondering, usually while deep-diving in the relevant sexual health literature, where is the pleasure, the intimacy, and the relation to self and others?
It’s not just research; service providers seem to be focused on risk, too. I recently published an article that explores Australian mental healthcare providers’ preoccupation with risk and danger regarding sexuality and sexual health in the mental health setting (1). This perceived danger was couched in a) a non-negotiable idea that service users must engage in ‘safe sex’, which itself required knowledge and responsibility for the self and others, and b) a perceived lack or reduction of capacity to be responsible in the context of mental illness experiences. So ‘safe’ sex became unavailable and sexual expression inherently risky in the context of mental illness. This danger was not clear cut, but it was the potential for danger that most often brought sexual expression into relevance in the mental health setting. If there was no perceived risk then there was no problem when it came to sexual expression.
This focus on risk and danger is not unreasonable. Sexual expression can be associated with a range of negative consequences and harms that are biological, physical, psychological and even social. People who are engaged in mental health services may well be more ‘at risk’ when it comes to sexual expression. But by service providers focusing almost exclusively on risk, service users are also at risk of not having their sexual health related needs met by providers and by researchers.
When researchers have asked mental health service users what their main needs are regarding sexual health they don’t just talk about risk and danger. For them, it’s about intimacy and the need for support in initiating and maintaining relationships. It’s about intimate partner violence, which is something that cannot be addressed with condoms and restriction of ‘risky’ sexual expression. It’s about stigma related to mental illness and their exclusion from romantic and sexual relationships.
Yet the most common, most funded research continues to focus on sexually transmitted infections and HIV transmission, unwanted pregnancy and ‘immoral’ sexual expression. Everything risky, dangerous and taboo; and everything sexy that goes with it.
This preoccupation with risk and danger in mental health research and practice is intended to be beneficial but it’s also harmful. Mental health service users’ needs regarding intimacy, relationships and self-expression continue to go unmet in mental health settings. It also perpetuates broader social understandings that sexual expression and intimacy don’t belong or can’t be ‘right’ within the mental illness experience.
Risk is important in sexual and mental health research, but it’s not the whole picture if we listen to mental health service users. Let’s talk about intimacy, pleasure and relationships too.
(1) Urry, K., & Chur-Hansen, A. (2018). Who decides when people can have sex? Australian mental health clinicians’ perceptions of sexuality and autonomy. Journal of Health Psychology, doi:1359105318790026. http://journals.sagepub.com/doi/abs/10.1177/1359105318790026?journalCode=hpqa