Policies on Sexual Expression in Forensic Psychiatric Settings in Different European Countries

Background

Sexual expression by forensic psychiatric patients is poorly researched.

Methods

Forensic experts representing 14 European countries were interviewed to explore the diverse ways in which sexual expression within forensic settings is handled.

Results

No country had a national policy, although many had local policies or shared practices. Progressive approaches to patient sexuality were evident in nine of the countries sampled. The UK appeared the most prohibiting and excluding, its protocols apparently based on risk aversion and lack of emphasis or consideration of patients’ sexual needs.

Conclusions

Uniform national policy supporting patients’ sexual expression would provide significant improvements.

Summary of responses to online questionnaire

Country	Application of policy rules	Direction	Other forms of expression allowed	Patient/visitor interaction	Resources available to patients	Staff training	Patient awareness and involvement
Belgium	Hetero- & homosexual relationships treated the same Same policies regardless of case history	Sexual intercourse prohibited inside institution Romantic/non-sexual relationships between patients prohibited Patients can marry	Holding hands Access to sexually explicit DVDs, magazines & novels	Patients not allowed into each other’s bedrooms Visitors allowed unsupervised access to patients’ bedrooms ‘Blind eye’ turned to potential sexual activity with spouse No conjugal visiting suite	Sexual education Condoms/contraception	Provided	No written policy; patients informed verbally Patients have opportunity to complain about policy Patient perspective not considered
Denmark	Hetero- & homosexual relationships treated the same Decided on case-by-case basis	Sexual relationships with existing long-term partner permitteda Sexual and non-sexual relationships between patients prohibited Patients can marry	Access to sexually explicit DVDs, magazines & novels	Patients not allowed in each other’s bedrooms Visitors not allowed in patients’ bedrooms Conjugal visiting suite available	Condoms/contraception	No specific training	No written policy; patients informed verbally Patients have opportunity to complain about policy Patient perspective not considered
Finland	Hetero- & homosexual relationships treated the same Same policies regardless of case history	Sexual relationships permitteda between patients or between patient and outside partner, including prostitutes Non-sexual relationships supported and seen as positive and prosocial Patients can marry	Kissing Hugging Caressing Massage Holding hands Access to sexually explicit DVD’s, adult magazines, erotic novels & pornographic websites	Patients not allowed into each other’s bedrooms Visitors not allowed into patient bedrooms No conjugal suite Visits take place in visiting area and can be unsupervised	Relationship counselling Sexual education Condoms/contraception	No specific training	No written policy; patients informed verbally Patients have opportunity to complain about policy Patient perspective not considered
FYR Macedonia	Homosexual relationships not taken into consideration Decided on case-by-case basis	Sexual relationships permitteda between patient and existing long-term partner Sexual relationships between patients prohibited Non-sexual relationships allowed Patients cannot marry	Kissing Hugging Caressing Massage Holding hands Access to adult magazines	Patients allowed supervised access to each other’s bedrooms Visitors allowed unsupervised access to patient bedroomsa	Relationship counsellinga Condoms/contraception	No specific training	Not available for patients to see Patient perspective not considered
Germany	Hetero- & homosexual relationships treated the same Decided on case-by-case basis	Sexual relationships permitteda between patient and existing long-term partner, and new partner outside the institution, including prostitutes Sexual relationships between patients prohibited Non-sexual relationships alloweda Patients can marry	Kissing Hugging Caressing Massage Holding hands Access to adult magazines & erotic novels	Patients allowed unsupervised access to each other’s roomsa Visitors allowed unsupervised access to patient bedroomsa Conjugal visiting suite available	Relationship counselling Sexual education Condoms/contraception	Provided	Policy readily available for patients to see Patient perspective not considered
Latvia	Hetero- & homosexual relationships treated the same Same policies regardless of case history	Sexual intercourse prohibited within unit Sexual relationships permitted with partners from outside the institution Non-sexual relationships alloweda Patients can marry	No form of sexual expression allowed	Patients not allowed into each other’s bedrooms Visitors not allowed into patient bedrooms Conjugal visiting suite available in some facilities	None	Not known	Policy available for patients to see Patient perspective not considered
Netherlands	Hetero- & homosexual relationships treated the same Decided on case-by-case basis	Sexual relationships permitteda between patient and existing long-term partner, and new partner outside the institution, including prostitutes Non-sexual relationships alloweda Patients can marrya	Kissing Hugging Caressing Massage Holding hands Access to sexually explicit DVD’s, adult magazines, erotic novels alloweda	Patients allowed unsupervised access to each other’s bedrooms Visitors allowed unsupervised access to patient bedroomsa Conjugal visiting suite available	Relationship counselling Sexual education Condoms/contraception	General training provided	Policy available for patients to see Patient perspective not considered
Spain	Not known	Sexual relationships permitteda between patient and existing long-term partner Non-sexual relationships alloweda Patients can marry	Kissing Hugging Caressing Massage Holding hands Access to erotic novels	Patients not allowed into each other’s bedrooms Visitors not allowed into patient bedrooms Conjugal visiting suite available	Sexual education	No specific training	Not readily available for patients to see Patient perspective not considered
Switzerland	Hetero- & homosexual relationships treated the same Same policies regardless of case history	Sexual relationships discouraged amongst patients Sexual relationships permitted between patient and existing long-term partner, and new partner Non-sexual relationships alloweda Patients can marry	Kissing Hugging Caressing Massage Holding hands No access to sexually explicit DVD’s, adult magazines, erotic novels or pornographic websites	Patients not allowed into each other’s bedrooms Visitors not allowed into patient bedrooms Sexual activity with partners allowed when patient is on leave	Relationship counselling Sexual education Condoms/contraception	Provided	Not readily available for patients to see Patient perspective considered in drafting of shared practice
United Kingdom	Hetero- & homosexual relationships treated the same Officially, decided on case-by-case basis but in practice policy implemented uniformly	Sexual relationships between patients and between patient and partner outside the institution prohibited Patients can marry	Minor forms of physical contact but no intimate or extended contact Access to erotic novels alloweda	Patients not allowed into each other’s bedrooms Visitors not allowed into patient bedrooms Conjugal visiting suite not available	Relationship counselling Sexual educationa	No specific training	Abbreviated version available for patients to see Patient perspective not considered

adepending on circumstance

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By:  Rajveer Tiwana, Stephanie McDonald, and Birgit Völlm

School of Psychology, University of Nottingham, Nottingham, NG7 2RD UK

School of Psychology, University of Nottingham, Nottingham, NG9 2RD UK

Section Forensic Mental Health, Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Triumph Rd, Nottingham, NG7 2TU UK

Rajveer Tiwana, Email: ku.oc.oohay@anawit_reevjar.

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