1. Policies on Sexual Expression
in Forensic-Psychiatric Settings in Different European Countries
Rajveer Tiwana1, Stephanie McDonald1 & Birgit Völlm 2,3
1) School of Psychology - The University of Nottingham
2) Section of Forensic Mental Health, Division of Forensic Psychiatry and Applied Psychology – The University of Nottingham
3) Nottinghamshire Healthcare NHS Trust
Thematic analysis of interviews
Theme 1: Views on sexual expression
Germany and Netherlands consider patients’ sexual expression as part of their identity and supporting recovery. However, in the UK, sexual expression is deemed mostly problematic and risky.
Theme 2: Screening procedures
Strict screening procedure if a patient wants to have sexual intercourse with their partner from outside the institution in Germany and Netherlands.
Theme 3: Safe sex
The most progressive policies, such as Germany and Netherlands, were also those most proactive in promoting safe sex procedures, including free access to contraception.
Theme 4: Private space
In Switzerland, Netherlands and Germany there are rooms for private intimate time. However, in the UK they see the hospital as a ‘public place’ and therefore do not allow any sexual activity at all.
Theme 5: Opinions
The general public’s view on patients’ sexuality tends to be restrictive and punitive in all countries.
Theme 6: Future practice
Switzerland and UK indicated that comparing their own policies with other countries’ could help learn from and consider adapting measures to their own institutions.
INTRODUCTION
Key findings from online questionnaire:
RESULTS
Sexuality is an integral part of someone’s identity
Patients’ sexual expression may be important to their psychological well-being and recovery
Sexual expression in forensic settings poses particular challenges
The UK takes a very restrictive approach – prohibiting most sexual activity of patients
   
This study aimed to explore national and local policies for forensic care in different European countries  
Country
Overall direction of policy/practice re sexual relationships
Belgium
Sexual intercourse prohibited inside the institution – however, spouses have unsupervised access to patients’ bedrooms – ‘blind eye’ approach
Denmark
Sexual relationships permitted between patient and existing long-term partner
Sexual relationships between patients prohibited
Finland
Sexual relationships permitted between patients or between patient and outside partners, including prostitutes
FYR Macedonia
Germany
Sexual relationships permitted between patient and existing long-term partner or new partner outside the institution, including prostitutes
Sexual relationships between patients prohibited (but patients have unsupervised access to each others’ bedrooms)
Latvia
Sexual intercourse within unit prohibited
Sexual relationships with partners from outside the institution may be allowed if conjugal suite available
Netherlands
Spain
Switzerland
Sexual relationships permitted between patient and existing long-term partner or between patient and new partner outside the institution
Sexual relationships are discouraged amongst patients
United Kingdom
Sexual relationships between patients and between patient and partners outside the institution prohibited
No conjugal suites, no unsupervised access to patients’ bedrooms by other patients or visitors
Procedure
Online questionnaire on policies and practices on patient sexual expression in forensic-psychiatric settings
Semi-structure phone interviews with selected experts
Participants
All participants have extensive experience working in secure forensic-psychiatric hospitals and were familiar with relevant policy or guidelines in their country
10 participants completed the online questionnaire (from Belgium, Denmark, Finland, FYR Macedonia, Germany, Latvia, Netherlands, Spain, Switzerland, United Kingdom)
5 experts were interviewed by telephone (Germany, Netherlands, Switzerland, 2 from UK – high and medium secure care)
METHODS
No country had a national policy on sexual expression in forensic-psychiatric patients
UK only country which does not allow any sexual expression either between patients or between patients and outside partners, even long-term spouses in stable relationship
All (except UK) countries either conjugal visiting suites or unsupervised assess to patients’ bedrooms by visitors
Most ‘lenient’ countries: Germany, Finland, Netherlands: Sexual activity between patients and outside partners allowed, including prostitutes in certain circumstances
DISCUSSION & CONCLUSIONS
The lack of national policy in all countries is problematic in terms of consistency pf approach, fairness and safeguarding
The UK stands out as being the most restrictive country. More nuanced and supportive policies in other European countries could provide significant benefits for patients in terms of psychological well-being and recovery
None of the countries with more permissive policies reported problems with this approach
Current UK practice is ethically and legally problematic and requires urgent debate and development
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