Clinical psychologists' views about talking to people with psychosis about sexuality and intimacy : a Q-methodological study

Sexuality and intimate relationships are crucial to individual wellbeing, yet individuals experiencing mental health difficulties struggle to access social and relationship opportunities. Despite recent efforts to improve access to sexual health services in the United Kingdom, people with mental health difficulties report the lowest sexual satisfaction in population studies. For people with psychosis, concepts of sexual relationships are dominated by research that focuses on physiological side-effects of antipsychotic medication or perceptions that sufferers engage in deviant sexual practices. There is a paucity of research exploring the psychological and social barriers that prevent people with psychosis from developing intimate relationships from a lived experience perspective. This qualitative literature review and thematic synthesis includes nine articles and identifies five overarching factors that limit prospects for people with psychosis, including psychological and social barriers, lack of external support, concerns about the content of relationships, personal barriers and systemic barriers. A major barrier is the indirect traumatising and distressing psychological consequences caused by side-effects of antipsychotic medication that are frequently overlooked by mental health professionals. Findings are conceptualised within recovery models of mental health care. Implications for clinical practice include the need for specific assessment tools and support for professionals to explore sexual and relationship needs with service-users.