Assessing the sexual health of mental health service users

Module overview 

This module discusses the reasons why nurses should be more open in consultations with mental health service users in regard to sexual health. A step-by-step model that assists nurses in their interventions with service users on issues of sexuality is explored, and each stage of the model is explained. Although predominantly directed at mental health nurses, the main principles in this module could be adapted and applied to other care contexts, such as adult nursing. Keywords diversity, mental health, mental health service users, patient safety, public health, sexual health, sexuality Aims Sexuality and sexual health should be viewed as an integral component of holistic patient assessment. 

The module aims to encourage the reader to consider sexuality and sexual health as essential to a full nursing assessment.

 Intended learning outcomes 

After reading this module and completing the time out activities you should be able to: 

 Outline the significance of sexuality and sexual health to the comprehensive assessment of patients’ physical and psychological healthcare needs.

 Establish a correlation between those with mental health problems and high-risk sexual behaviours.

 Examine the effect of prescribed medications and recreational drugs on an individual’s sexual function and sexual activity.

 Describe the need for improved perception of sexual health assessment and the role of the nurse in applying an evidence-based interventions model to this area. 

 Introduction When assessing service users’ care needs, the nurse should consider the physical and psychological effects of diagnosis, illness and treatment (Verschuren et al 2013). Nurses should strive to assess patients in a holistic way, incorporating all internal and external factors that may influence health and wellbeing. 

A biopsychosocial approach (Engel 1980) to assessment enables exploration beyond the effects of illness on the individual and includes social or environmental factors that influence a person’s illness and recovery (Figure 1). Consequently, a holistic view of the care needs of the individual can be formed, informing plans for addressing barriers to mental health care (Olsson et al 2012). Figure 1. The biopsychosocial model

There are many factors that can influence a person’s health and wellbeing, and nurses should explore these with the individual to best help them meet their identified care needs. 

Communication skills are important in the assessment process to relay information accurately and to build a strong rapport with service users based on confidentiality, trust and empathy. 

Nevertheless, there are some aspects of a person’s wellbeing that are more difficult to ascertain and approach than others, such as sexual health (Webb and Askham 1987). Sexual health and wellbeing are no less important than any other aspect of assessment, however they may be overlooked possibly because they can be disconcerting issues to discuss (Gott et al 2004, Olsson et al 2012, Moore et al 2013, Stein et al 2013).

 Learning Points 

 A biopsychosocial approach to assessment includes social or environmental factors that influence a person’s illness and recovery. 

Communication skills are important in the assessment process to relay information accurately and to build a strong rapport with service users based on confidentiality, trust and empathy.

 Sexuality, sexual identity and sexual orientation 

Sexual identity and sexual orientation are characteristics that define who we are as individuals and how we are viewed by others and society in general. We live in a sexually diverse society where an individual’s sexual identity and sexual orientation are often openly defined. This is especially evident in the younger adult population, due in part to a reduction in stigma and a more prominent sexual equality agenda (Equality and Human Rights Commission 2015). However, this is not always the case and the nurse should be mindful of people’s views on the subject before embarking on any in-depth discussion.

 There are many factors that can influence an individual’s view of sexuality and sexual orientation. This view may have been formed as a result of life experiences, parental influences, cultural beliefs and/or spiritual beliefs (Webb and Askham 1987, Higgins et al 2009). 

Higgins et al (2005) emphasised that when we deal with areas of sexuality we draw firstly on our own sense of comfort, values, biases and prejudices. In terms of assessment and nursing care, sexuality has an established presence in historical nursing models such as Maslow’s (1943) hierarchy of needs and Roper et al’s (1980) activities of living, indicating its importance in terms of health and wellbeing. Some terminology relating to sexuality is defined in

 Box 1 Terminology relating to sexuality

Sexual identity The pattern of a person’s biologic sexual characteristics, including chromosomes, external and internal genitalia, and hormonal composition.

 Gender identity A person’s sense of maleness or femaleness. This usually develops at two to three years of age. 

 Sexual orientation The object of an individual’s sexual impulses, for example heterosexual, homosexual and bisexual. Sexual orientation may develop in conflict with gender identity.

 Transgender An umbrella term for an individual whose gender identity is incongruent with his or her biological sex (gender dysphoria). (Shives 2012)