The governance of sexuality in a Recovery‐oriented mental health service: Psychosis, consumers and clinical approaches

WHAT IS KNOWN ON THE SUBJECT: The intersection of sexuality and psychosis has a long history, yet research in this area has been minimal over the past few decades. Mental health clinicians practice from within the confines of a mental health system that is founded on a conflict between containment and care and that positions the consumer as an object of care. At the same time, mental health services often have a Recovery approach to care. This presents a difficulty and tension in mental health clinical work because the Recovery approach is opposed to positioning the consumer as an object. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE: The findings suggest that sexuality and sexual needs are common to both clinicians and consumers, and via identification, make the two groups more similar than different. Sexuality can problematize and so open up questions about the objectification of consumers. Consideration of consumers' sexuality and sexual needs can therefore work as a resistance to the dominant mental health approach and, in doing so, produce a more Recovery-oriented approach to treatment in terms of how the consumer is positioned. Other aspects of living that escape capture by the diagnostic system may also operate as organizing factors for a more subject-to-subject approach to treatment. THE IMPLICATIONS FOR PRACTICE: Focusing on sexuality and other aspects of living that escape capture by the diagnostic system can bring into question the way consumers are objectified by the psychiatric model of care. Abstract Introduction The Recovery approach introduced a radical shift in the positioning of consumers as subjects rather than objects of mental health treatment. While this approach has been internationally adopted, the practice of Recovery has been under-researched and a knowledge gap exists regarding the intersection of sexuality and psychosis. Aim The study aim was to investigate how sexuality was governed in a long-stay mental health rehabilitation facility that was Recovery-oriented. Method A case study methodology with a conceptual framework using Foucault's work on disciplinary power was used. Results The findings illustrated how mental health clinicians were caught between two main and incompatible models of care: a psychiatric one and a Recovery one. Discussion While the policy framework authorized a Recovery approach, clinicians practised surveillance, hierarchical observation and normalization, which are tenants of a psychiatric model of care. However, the study found that sexuality was an area that opened questions about the psychiatric model for clinicians. Consideration of consumers' sexual needs allowed the clinicians to think of consumers more as subjects like themselves than as objects to be treated. Implications for practice Consideration of consumers' sexuality opens up possibilities for questioning the objectification of the consumer via the psychiatric model.