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Type: Thesis
Title: Sexuality and Sexual Health in Mental Health Care Settings: Perceptions of Psychologists, Psychiatrists, and Mental Health Nurses in Australia
Author: Urry, Kristi Lauren
Issue Date: 2020
School/Discipline: School of Psychology
Abstract: Sexuality and sexual health needs are inadequately addressed in mental health settings. This is misaligned with the espoused recovery orientation underpinning mental health services in Australia, and with individuals’ self-identified needs and desire for support. How mental health clinicians currently understand and respond to sexuality and sexual health concerns is still not well understood. In this thesis, I aimed to explore how mental health clinicians in Australia perceived sexuality and sexual health, and to critically examine how they oriented toward these in their work. An exploratory qualitative design was selected to address these aims, guided by social constructionist and critical health psychology frameworks. A single dataset was generated via in-depth interviews with psychologists, psychiatrists, and mental health nurses working in Australia. Four critical thematic analyses were conducted in relation to this dataset, each driven by a different analytic aim. In Chapter Three, I provide a reflexive account of nondisclosure of sexual identity within the research interviews as a lens through which to read the four analyses presented subsequently, contributing to transparency and rigour within this thesis. Participants’ conceptualisations of sexuality and sexual health are presented in Chapter Four. There was no single shared conceptualisation of sexual health within or across disciplines, however conceptualisations were primarily biomedical, reductionist, and risk-oriented with a focus on (primarily heterosexual) sexual intercourse. Sexuality was mostly understood as sexual identity and rarely discussed beyond reference to non-heterosexual identities, contributing to the positioning of hetero-sex as normal. Participants tended to perceive sexuality as relevant within their clinical practice when they also perceived danger or risk in relation to this, and this is explored in Chapter Five. I demonstrate how participants drew on a neoliberal framework of (sexual) health and self-regulation to construct sexual danger, locating this within sexual expression itself or within distressed individuals who were perceived to lack self-regulation. Outside of perceived danger, sexuality was largely omitted from participants’ everyday practice, and this silence is examined across two analyses. In Chapter Six, I demonstrate how participants accounted for omissions of sexuality in their own and their colleagues’ everyday practice by deprioritising sexuality and locating it outside of mental health settings. In Chapter Seven, I examine how the institutional context in which participants learn and work shaped sexuality-related perception and practice, according to their own accounts. I argue that these workplaces and institutions produce and maintain a broader silencing and peripheralisation of sexuality within mental health settings. The discussion in Chapter Eight brings together the results from all four analyses and synthesises these with the broader literature to make recommendations for practice and future research regarding sexuality and sexual health in mental health settings. I argue that improved practice in mental health settings will not be facilitated through a continued focus on biomedical aspects of sexuality and on individual clinicians’ relevant knowledge, comfort, and competence. Rather, there is a need to broaden the approach to sexuality in both clinical practice and research, and to recognise the wider institutional contexts in which sexual and mental health care are conceptualised and delivered.
Advisor: Chur-Hansen, Anna
Khaw, Carole
Scholz, Brett
Dissertation Note: Thesis (Ph.D.) -- University of Adelaide, School of Psychology, 2020
Keywords: Sexuality
Sexual health
Mental health
Professional practice
Qualitative research
Provenance: This electronic version is made publicly available by the University of Adelaide in accordance with its open access policy for student theses. Copyright in this thesis remains with the author. This thesis may incorporate third party material which has been used by the author pursuant to Fair Dealing exceptions. If you are the owner of any included third party copyright material you wish to be removed from this electronic version, please complete the take down form located at:
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