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Awareness and management of psychosexual and relationship problems in mental health services

Published online by Cambridge University Press:  02 January 2018

Kiran Rele
Affiliation:
Assertive Outreach and Recovery Team, the Lodge, Kendray Hospital, Doncaster Road, Barnsley S70 3RD, email: [email protected]
Kevan Wylie
Affiliation:
Porterbrook Clinic, Sheffield
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Abstract

Type
The columns
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
Copyright © Royal College of Psychiatrists, 2008

Knowledge of psychosexual development and competency in the assessment and treatment of psychosexual disorder should be core components of psychiatry residency curriculum and psychiatric training (Reference Scheiber, Kramer and AdamowskiScheiber et al, 2003; Reference Nnaji and FriedmanNnaji & Friedman, 2008). Research indicates that many psychiatric training schemes fail to teach a broad range of human sexuality issues and that expert supervision and clinical training opportunities are lacking (Reference VerhulstVerhulst, 1992).

We undertook a study that monitored the assessment and training in psychosexual and relationship problems in general mental health services (Reference Rele and WylieRele & Wylie, 2007). We devised a questionnaire that asked psychiatry trainees to report their perception of competency in dealing with service users’ sexual dysfunction and relationship problems, the need to discuss potential sexual side-effects before and after starting psychotropic medication and the importance of a readily available psychosexual disorder clinic. In addition, we enquired about the emphasis, or otherwise, on psychosexual disorders and sexual health problems in general, both in medical school and during current psychiatric training. All psychiatry trainees (both basic and higher specialist trainees in adult and old age psychiatry) in the mid-Trent rotation were invited to complete the questionnaire.

Only 24% of trainees reported that they routinely ask service users about psychosexual history; of these, 65% felt comfortable about taking a detailed psychosexual history. The majority of participants (81%) felt they have received inadequate training and did not feel competent dealing with service users with a psychosexual disorder. Only 30% of trainees reported asking service users about sexual health side-effects when on psychotropic medication. All trainees preferred to refer the person to a local psychosexual disorder clinic (if available) rather than treat them themselves. To our knowledge, this was the first survey on competency of UK-based psychiatric trainees in taking a sexual and relationship history and management of sexual dysfunction of their patients.

Taking a sexual and relationship history should be an integral part of any psychiatric assessment. Nnaji & Friedman (Reference Nnaji and Friedman2008) have failed to highlight the importance of a healthy relationship in their paper. Healthcare professionals need to be alert to the possibility of a sexual problem in service users and should be competent enough to be able to discuss it. Training in sexuality should be introduced in medical schools as a part of the undergraduate curriculum and a core part of psychiatric training curriculum, and trainees should be tested for their competency in dealing with sexual dysfunctions.

References

Nnaji, R. N. & Friedman, T. (2008) Sexual dysfunction and schizophrenia: psychiatrists' attitudes and training needs. Psychiatric Bulletin, 32, 208210.Google Scholar
Rele, K. & Wylie, K. (2007) Management of psychosexual and relationship problems in general mentalhealth services by psychiatry trainees. International Journal of Clinical Practice, 61, 17011704.CrossRefGoogle Scholar
Scheiber, S. C., Kramer, T. A. M. & Adamowski, S. E. (2003) The implications of core competencies for psychiatric education and practice in the US. Canadian Journal of Psychiatry, 48, 215221.Google Scholar
Verhulst, J. (1992) The sexuality curriculum in residency training. Academic Psychiatry, 16, 115117.CrossRefGoogle ScholarPubMed
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