5. Sexual Safety within care contexts

Audio transcript:

I am a safeguarding practitioner working within an integrated healthcare trust. I would define sexual safety as our individual and personal boundaries being maintained and respected. The limits of these boundaries are individual to each of us and we should be confident that regardless of our circumstances our safety, privacy and dignity are priorities for those providing us with care and support.

Sexual safety is important to women in inpatient care because admission can mean an individual it at their most vulnerable and that their capacity to make informed decisions is likely impaired and in this circumstance, risks can increase. Safeguarding women in these circumstances should be of the highest priority.

I support sexual safety in my practice by listening and responding to situations in order to assist and support clinicians to provide the safest possible environment.

My five take home messages for professionals and women in terms of sexual safety are: that everyone has the right to have their sexual safety respected and maintained. That women could think about completing an advanced statement that incorporates sexual safety and how they would prefer professionals to respond to sexual safety concerns, should their capacity be impaired at any point. That professionals should listen, validate and respond to disclosures, incidences and concerns, we need to let women know that we have heard them and that we will work with them to maintain their sexual safety and address any concerns. That we shouldn’t be afraid to ask questions, we should be respectful and non-judgemental but not put off talking about sexual safety. Everyone has individual boundaries when it comes to sexual safety, so we shouldn’t make assumptions about where these boundaries lie. That professionals should think ‘family’ and consider the wider safeguarding concerns and context. Sexual safety can effect more than just the woman that you are working with.

Audio transcript:

Hello, I’m a consultant psychologist, I’ve been working in the field of forensic mental health of complex trauma and safeguarding since the late 90’s, specialising in services for women. I would define sexual safety as the freedom to act, to think, to talk, to connect with others and the freedom to achieve without discomfort or fear.

It’s a recognition that, without attention the personas rights to bodily integrity can be undermined. Sexual safety is important to women receiving inpatient care because when needing help the most is when women might feel least able to find a clear voice for their own rights. Many of the women receiving inpatient care will have experienced developmental abuse, sexual abuse or trauma.

I support sexual safety in my practice by recognising this fact and supporting the services I work with to formulate illness and risk with trauma in mind, as well as promoting the ongoing need for gender sensitive services.

Five take home messages for professionals and women in terms of promoting sexual safety. Well firstly stigma – don’t allow blame and shame to erode sexual safety rights for everyone. Secondly trust, focus on trust though honest respectful dialogue. Thirdly know that the body remembers and that touch can be associated with implicit memories, disconnected from conscious thought, so think about this when collaborating on crisis care plans for example. Forth take home message is about gender. Staff gender is often something that women want to be able to talk about when they are care planning in an inpatient setting, so do this with awareness, sensitivity and without offence. Fifthly and finally, power, be aware of the role of power within working relationships and those on the ward, it’s often unspoken power dynamics and the way we respond to these that can erode sexual safety.

Audio transcript:

I am a mental health nurse with experience working on a PICU (Psychiatric Intensive Care Unit) Acute, Forensics and a health based place of safety. I also have my own lived experience of mental health. I would define sexual safety as the right for a person to feel safe from sexual harm. Psychological and physical safety is important for healing to take place and I think without that a person is less likely to recover from their difficulties.

I believe feelings of safety are unique to the individual, so we should work with our patients to find out what it means to them and work to create a culture together where any incident of sexual violence is not tolerated and a person feels safe and able to speak up if they do not feel safe and know that steps will be taken to protect them from further harm and that they will be believed.

Sexual safety is important to women in inpatient care because I know that up to or above 50% have experience of sexual harassment, assault or abuse prior to coming in to mental health services or hospital. Hospital should be a place that promotes recovery, but unfortunately too many women are re-traumatised by lack of understanding about triggers and the impact of things such as restraint or one to one observations.

Thankfully sexual safety incidents are relatively rare and there is growing awareness of iatrogenic trauma and the acknowledgement that there are times when we may think we are helping but we are actually causing harm.

I support sexual safety by working with key stakeholders to champion change. I work with other professionals and encourage them to overcome their personal barriers and talk to patients about sexual safety. We should put our professional duties above any personal discomfort.

Five take home messages. Number one; sexual safety is everyone’s business. Number two acknowledge that a perpetrator can be another patient, a relative, a colleague, or in the case of iatrogenic trauma - ourselves. Number three; assume trauma, a person should not have to disclose previous abuse for you to have discussions around preferences of key workers, whether they want to be on a single sex or mixed a sex ward, to know that if as a last resort they do need to be therapeutically held or restrained how this can be done in a way that causes the least harm. Number four, know your local services and resources, charities, independent sexual violence advisors and domestic violence help services. Number five; don’t exclude minority groups. Minority group’s have unique needs that make them both at a higher risk and less likely to disclose sexual violence. Take into account a person’s culture, religion, sexual orientation whether they are transgender or transitioning or whether they have learning difficulties or other needs when considering any intervention and how to keep your ward safe.

Audio transcript:

(I work for a sexual health service). not narrated.

Sexual safety is important. I believe it is a Trust obligation to provide an environment that is both physically and psychologically safe.From working in sexual health services and speaking to service users and staff over the years, I know that sex and sexual health can be difficult to talk about. There is a lot of shame, blame, fear and embarrassment, but I’ve also witnessed the incredible impact on individuals when a safe and supportive environment is provided. Somethings I think are important are as follows:

• Everyone has the right to good sexual health: We know that research has demonstrated that people who experience mental health issues traditionally have poor sexual health.
• Staff don’t need to be experts, we just need to be able to start conversations about sexual health and use services in the city. There are some excellent agencies which can provide support, including Sexual Violence support services, the Health shop and the integrated sexual health service. In addition to this, the safeguarding team have produced some great guidance around sexual safety.

• Understanding consent is important. There has been a lot more information in the media recently about consent and what this means. It’s important to consider this on an individual level and what factors may affect it.

  Within my service we have lots of conversations around consent, that consent is given by choice and this decision can be withdrawn at any time. We know that if somebody is pressured into engaging in sexual acts when they are scared or afraid that they are unable to give consent. We also have conversations about the impact of alcohol and other drugs on someone’s ability to provide consent.

  Consent isn’t anything to do with the clothes that someone wears or how they act. It’s not the absence of the word, “no”. It is given in the full understanding of what is involved and that the person has the capacity and the freedom to give it.

• I think it’s important we are conscious of the language we use within services. I’ve heard people talk to service users about times when they have ‘put themselves at risk’ or made ‘unwise choices’, also recognising attitudes concerning deserving and undeserving victims and survivors.

As an organisation, we need more training around sexual health and sexual safety, especially with regards to language and the confidence to discuss this. We need to understand fears and concerns about reporting and clear structures in place for dealing with disclosures and supporting staff following incidents. Also any work regarding sexual health and sexual safety should be inclusive of all genders and sexualities.

Audio transcript:

Hello,