“You Don’t Even Get a Hug”: Sexuality and Relational Security in Secure Mental Healthcare

Ravenhill, James P.; Reavey, Paula; Brown, Steven D. and Boden-Stuart, Zoë (2024). “You Don’t Even Get a Hug”: Sexuality and Relational Security in Secure Mental Healthcare. In: Ravenhill, James P.; Reavey, Paula; Brown, Steven D. and Boden-Stuart, Zoë eds. Relationships and Mental Health: Relational Experience in Distress and Recovery. Cham: Springer International Publishing, pp. 237–256.

DOI: https://doi.org/10.1007/978-3-031-50047-3_13

Abstract

Relational security in secure mental healthcare can be conceptualised as an outcome of social climate—the physical conditions of the wards and the social relationships that play out within them. Staff knowledge and understanding of patients is seen as key to maintaining relational security, by facilitating staff responsivity and personalised care. Discussions of relational security focus principally on patients’ therapeutic relationships and less so on their relationships with other patients and visitors, which are policed closely within discourses of appropriateness and vulnerability. Patients’ needs and desires for emotional and physical intimacy are typically overlooked in daily ward life, academic enquiry, and clinical praxis. This chapter describes the experiences of two patients interviewed for our research into intimate and sexual relationality in forensic mental healthcare facilities in England. A case is presented for the development of policies that honour the intimate relational and sexual needs of people in secure care. It is argued that an absence of such policies and a culture of stringent sexual regulation produce disordered sexualities, enacted by patients in subversive and secretive ways. This poses a threat to relational security and is conducive to neither the formation of effective intimate relationships nor recovery from mental distress.

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