An Exploration of Sexual Concerns and Expectations on Patients with Chronic Mental Illness

探討慢性精神病人的性關注與期待

10.3966/160857872016052201001

宋素卿(Su-Ching Sung)；林秀純(Su-Ching Sun)；燕翔(Hsiang Yen)

親密 ； 精神疾病 ； 精神病人 ； 性關注 ； intimacy ； mental illness ； psychiatric patient ； sexual concern

台灣性學學刊

22卷1期（2016 / 05 / 01）

1 - 24

英文

人類性議題對慢性精神病人及精神衛生專業人員而言，不論在倫理、法律、判斷及專業上皆有某種程度的困難性。為能夠處理疾病及健康上的性議題，精神衛生專業人員必須認知到個人的性是有價值的且是治療過程中的一部分。本研究目的為探討慢性精神病人的性關注，並提出建議協助精神衛生專業人員能夠幫助病人處理他們的性困擾。本研究以立意取樣方式選取台灣兩所醫院共115位精神病人為研究對象，採自填式問卷及一對一訪談方式收集資料。研究中並運用5題開放式問題及半結構式訪談收集病人對性表達的關注及期待。研究結果發現，71.3%的病人未曾接受過性方面的資訊，84.3%病人指出未曾接受過精神衛生專業人員與他們討論他們的性困擾。然而卻有66.1%研究對象認為他們的性困擾應該在醫院由精神衛生專業人員與他們討論。研究對象希望知道且獲得協助的最大性關注議題為「在性活動時如何擁有舒適及輕鬆的環境」、「如何向性伴侶表達他們對性的感受與困擾」及「如何知道及處理性伴侶在性活動時的情緒」。從內容分析中萃取出三個主題，分別為「性與親密的關注」、「性與親密關係發展的期待」及「性與親密關係討論的覺醒」。慢性精神病人希望未來能有機會可以擁有親密而圓滿的關係。如果精神衛生專業人員能夠更願意針對性進行溝通、提供性教育及鼓勵他們探索他們的感覺及提供相關資源，他們願意與專業人員討論他們的性困擾。本研究提出相關建議以協助精神衛生專業人員能夠幫助病人處理他們的性關係。

The issue of human sexuality presents patients with chronic mental illness and mental health professionals with some of the most difficult ethical, legal, judgmental, and professional problems. To deal with sexual components of illness and health, mental health, professionals must recognize personal sexuality as valuable and necessary part of treatment process. The aim of this study is to explore the sexual concerns of patients with chronic mental illness, and then provide suggestions to assist the mental health professionals to better help patients to manage their sexual concerns better. There were 115 psychiatric patients purposely selected with self-reported questionnaire and one-on-one interview from two mental hospitals in Taiwan. A semistructured interview, consisting of five open-ended questions exploring patients’ concerns and expectations regarding sexual expressions, was designed for the study. The study results revealed that 71.3% of the participants had not been given sexualityinformation, and 84.3% had not been approached by mental health professionals regarding their sexual concerns. However, 66.1% of participants thought their sexual concerns should be addressed with mental health professionals while they were in the hospital. The greatest sexual concern topics that participants wanted to know about and needed help with were ＂how to manage a comfortable and safe environment for sexual activity,＂ ＂how to express their sexual feelings and concerns to a partner,＂ and ＂how to know and manage a sexual partner’s emotional responses during sexual activity.＂ Furthermore, from content analysis, the three themes of ＂sexual and intimacy concerns,＂ ＂expectations of sexual and intimate relationship development,＂ and ＂awareness of discussing sexual and intimate relationships＂ emerged. Conclusion is that patients with chronic mental illness reported hoping to have opportunities to form intimate and fulfilling relationships in the future. They will willing to discuss sexual concerns if mental health professionals were able to facilitate communications about sexuality, provide sexual education, and encourage exploration of their feelings and resources. Suggestions are provided to assist mental health professionals to better help patients to manage their sexual relationship.

1. Sung, S.-C.,Yang, H.-C.(2009).The power display and meaning in premarital sexual interactions of adolescent girls.Formosan Journal of Sexology,15(1),81-98.
   連結：
2. Sung, S.-C.,Yeh, M.-Y.,Lin, Y.-C.(2010).An exploration of the nurses' perspectives and their current practice on sex consultation.Formosan Journal of Sexology,16(1),1-16.
   連結：
3. Agénor, M.,Collins, P. Y.(2013).Preventing HIV among U.S. women of color with severe mental illness: Perceptions of mental health care providers working in urban community clinics.Health Care for Women International,34(3-4),281-302.
4. Brothers, B. J.(Ed.)(1991).Intimate autonomy: autonomous intimacy.New York, NY:Haworth Press.
5. Brown, S. D.,Reavey, P.,Kanyeredzi, A.,Batty, R.(2014).Transformations of self and sexuality: Psychologically modified experiences in the context of forensic mental health.Health,18(3),240-260.
6. Davison, J.,Huntington, A.(2010)."Out of sight": Sexuality and women with enduring mental illness.International Journal of Mental Health Nursing,19(4),240-249.
7. Erikson, E. H.(1965).Childhood and society.London, UK:Penguin Books.
8. Gerhart, U. C.(1990).Caring for the chronically mentally III.Itasca, IL:F.E. Peacock.
9. Guimarães, M. D.,McKinnon, K.,Cournos, F.,Machado, C. J.,Melo, A. P.,Campos, L. N.,Wainberg, M. L.(2014).Correlates of HIV infection among patients with mental illness in Brazil.AIDS Care,26(4),505-513.
10. Kiely, K. M.,Butterworth, P.(2014).Mental health selection and income support dynamics: Multiple spell discrete-time survival analyses of welfare receipt.Journal of Epidemiology and Community Health,68(4),349-355.
11. Lincoln, Y. S.,Guba, E. G.(1985).Naturalistic inquiry.Newbury Park, CA:Sage.
12. McCann, E.(2010).The sexual and relationship needs of people who experience psychosis: Quantitative findings of a UK study.Journal of Psychiatric and Mental Health Nursing,17(4),295-303.
13. McCann, E.(2000).The expression of sexuality in people with psychosis: Breaking the taboos.Journal of Advanced Nursing,32,132-138.
14. Ostman, M.(2014).Low satisfaction with sex life among people with severe mental illness living in a community.Psychiatry Research,216(3),340-345.
15. Owen, S.,Khalil, E.(2007).Addressing diversity in mental health care: A review of guidance documents.International Journal of Nursing Studies,44,467-478.
16. Padron, J. M.(2008).HIV/AIDS/STD/HCV, coinfection, seroprevalence and education in severe mental illness: Health education pilot.The Psychiatric Quarterly,79(4),331-342.
17. Quinn, C.,Browne, G.(2009).Sexuality of people living with a mental illness: A collaborative challenge for mental health nurses.International Journal of Mental Health Nursing,18(3),195-203.
18. Quinn, C.,Happell, B.(2013).Talking about sexuality with consumers of mental health services.Perspectives in Psychiatric Care,49,13-20.
19. Quinn, C.,Happell, B.,Welch, A.(2013).The 5-as Framework for including sexual concerns in mental health nursing practice.Issues in Mental Health Nursing,34,17-24.
20. Raja, M.,Azzoni, A.(2003).Sexual behavior and sexual problems among patients with severe chronic psychoses.European Psychiatry,18,70-76.
21. Rochefort, D. A.(1989).Handbook on Mental Health Policy in the U.S..New York, NY:Greenwood Press.
22. Ryan, A.,Carryer, J.,Patterson, L.(2003).Healthy concerns: Sociology for New Zealand nursing and midwifery students.Auckland, New Zealand:Pearson Education New Zealand.
23. Scheid, T. L.,Anderson, C.(1995).Living with chronic mental illness: Understanding the role of work.Community Mental Health Journal,31(2),163-176.
24. Srivastava, A.(2013).Marriage as a perceived panacea to mental illness in India: Reality check.Indian Journal of Psychiatry,55(Suppl 2),239-242.
25. Steinke, E. E.,Patterson-Midgley, P. E.(1998).Perspectives of nurses and patients on the need for sexual counseling of MI patients.Rehabilitation Nursing,23,64-70.
26. Sung, S.-C.,Lin, Y.-C.,Hong, C.-M.,Cho, P.-P.(2007).An exploratory of psychiatric patients' needs and nurses' current practices related to sexual counseling.The Journal of Nursing,54,43-52.
27. Wood, A.,Runciman, R.,Wylie, K. R.,McManus, R.(2012).An update on female sexual function and dysfunction in old age and its relevance to old age psychiatry.Aging and Disease,3(5),373-384.