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Sex- The Last Taboo For Mental Health And LD Professionals And Patients

August 10, 2018

As a junior doctor working in psychiatry, I’m always struck by the honest answers and insight my patients share with me, offering a glimpse into how their mental health affects every aspect of their lives – from their finances and their diets to their sleeping patterns, careers and even dog-walking routines.

Healthcare professionals can be pretty candid, too – and good at talking about taboo subjects like death, poo, mental health and criminal behaviour. Yet sex is still a conversational hurdle we don’t manage well. Perhaps we’re too prudish to discuss it or perhaps we naively presume that if our patients don’t mention their sex life it’s because it isn’t relevant or important.

But it is. Loss of libido and anorgasmia are among the most oft-cited side effects of medication that lead people to stop taking their tablets. Families of patients with intellectual disabilities or those managing mental health symptoms like psychosis, frequently voice their concerns about appropriately managing their sexual needs as an addendum at the end of an appointment. Sex, older age, serious mental illness and intellectual disabilities remain the last bastions of stigma in our society.

Everyone has a right to explore their own personal and sexual identity. Human instinct has programmed all of us to be drawn to comfort, love, security and acceptance, but for some people balancing this instinct alongside innate biological urges is difficult. One young person under our psychiatric care had been experimenting on their own with a sex toy and ended up at our local A&E requiring surgical intervention. Another patient met up with a prostitute they’d contacted through the internet and was mugged, losing their bank cards and wallet.

Sex education for people with intellectual disabilities and significant mental illness is still subpar. Research has shown that they are at a significantly increased risk of contracting STIs – and a 2008 study in Wolverhampton, following teenagers from a school for those with moderate learning difficulties, showed that within 18 months of leaving school, 40% of the girls were pregnant.

At the other end of the age spectrum, as dementia rates in the UK increase, some studies suggest that up to 25% of people with dementia can behave in a sexually inappropriate way. When sexual disinhibition escalates as part of someone’s cognitive decline it can be difficult for families. Patients have asked us for assistance in hiring prostitutes and on our elderly mental health wards we have patients sexually propositioning each other under the belief that someone is their spouse; issues surrounding safeguarding, capacity and consent are constantly ongoing.

Across the world, there are varying approaches to addressing this issue in an accessible and inclusive way across the age and LGBTQ+ spectrum. One NHS psychiatrist told me about his experiences working in India, where he could refer patients to a sex clinic as part of their recovery or care plan. At this clinic a trained sex worker and psychologist teach male and female patients about anatomy, relationships and social skills within the realms of sexuality.

It’s the norm in Holland for health and social workers to advocate for a patient’s unmet sexual needs – and care packages can involve access to a vetted prostitute to cater to these requirements. In New South Wales, Australia, prostitution was decriminalised in 1979 – and this has contributed to the inception of charitable foundations focused specifically on providing safe, practical sex education for people with mental and physical disabilities.

In the UK, we often rely on support from organisations like Mencap and Enhance the UK to provide community education and support, and from a mental health perspective, things are managed on a case-by-case basis. There’s a lack of formal guidance in this area, so doctors and patients will often sit down together with key workers or community psychiatric nurses to work out the best way to safely support people’s needs, especially vulnerable young people, whether it be though arranging some quiet time or enabling access to materials and resources such as simple sex toys or access to pornography in private.

It’s more complicated for progressive cognitive decline in later life; medication is an ethical minefield and there’s a distinct lack of relevant evidence-based research. Some anecdotal evidence suggests the benefit of distraction techniques such as arts and crafts, cuddly toys or puppetry to keep wandering hands busy, but it’s not much of a long-term fix.

People with mental ill health shouldn’t be denied a sex life. Severe mental ill health or intellectual disability don’t mean someone automatically lacks the capacity to make related decisions – there are huge numbers of people with intellectual disabilities or mental illness in consenting, loving and fulfilling relationships – but for some people, extra support or adapted sex education enables them to explore their own identity safely.

We have a duty of care as healthcare professionals to educate and support our patients in an open-minded way across all aspects of their life – and sometimes that means we need to ask difficult questions.

2 Comments leave one →
  1. August 10, 2018 3:38 pm

    Sarah Simons

    “what I’ve learnt in the two years since I qualified as a doctor”

    >”I’m always struck by the honest answers and insight my patients share with me”

    … until they find out that the quack publishes ALL of their fraudulently obtained sensitive personal information on ‘leaky as a sieve’ NHS porn sites accessible by just about ANY Public Sector vermin.. EVEN RECEPTIONISTS.

    The Computer Misuse Act –

    Misconduct in Public Office –
    (loads of others too)


    “Lots of things are frustratingly out of our control in medicine but enabling a good death shouldn’t be one of them.”


    Homicide: Murder and Manslaughter –


    “Some people are sh*t & you’ll find yourself caught up in a safeguarding case & completely despair for humanity. Remember that for the small no. of perpetrators, there’s a vast army of amazing healthcare staff, emerg services, social workers, lawyers etc. Remember these people.”

    ? So people who *dare* to try and complain about quacks (…”yourself caught up in a safeguarding case”) are “sh*t” and the victims are “perpetrators”.

    But don’t worry… “Remember” quacks have a “vast army” of criminal filth “healthcare staff, emerg services, social workers, lawyers etc.” to cover-up and protect you.


    “As a junior doctor working in psychiatry”

    I could only find ONE Sarah Simons on the GMC register –

    GMC Reference Number – 7523332
    Has got – BM BS 2016 University of Nottingham
    (BM BS – Bachelor of Medicine, Bachelor of Surgery)

    **ZERO** Psychiatry Qualifications.

    just from the above text –

    “mental illness”
    “mental illness”
    “mental ill health”
    “mental ill health”
    “mental illness”

    and here –
    “ill” **SIXTEEN** times.

    Well PTSD and all the panic/anxiety/stress/harm are INJURIES…
    from violent crime and 9 years of Hate Crime, Abuse and Torture from YOUR “vast army” (you fuc*ing clueless quack).

  2. August 14, 2018 12:01 am

    That quacks “vast army” strikes again –

    “guilty of gross negligence manslaughter”

    ***”The little boy had Down’s syndrome and a heart condition”***

    “She had been suspended from the medical register for a year in June 2017, but the General Medical Council (GMC) appealed against the decision and claimed it was ‘not sufficient to protect the public’ and she was struck off completely in January 2018….

    Today, Lord Chief Justice Lord Burnett, the Master of the Rolls Sir Terence Etherton and Lady Justice Rafferty allowed Dr Bawa-Garba’s appeal against that decision and said her name should be restored to the medical register forthwith”

    “see what lessons can be learnt”
    Public Sector speak for ‘COVER-UP’.

    How do you know that the NHS Quack that you’re seeing has any RELEVANT qualifications at all?
    … and isn’t already a disabled child killer?

    Record everything… Google everything.

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