MAJOR THEME

SUB-THEME

KEY STATEMENT

1. Physiological interplay

Sex being a basic physiological human need

· “Mental illness is just like any other illness, it is just that the brain is affected… but in terms of their sexual life, they are still active, so no wonder you find that most of the times, some of the patients will have sexual advances towards the opposite sex.”

· “Yes I have seen them having sexual gratification. They masturbate…. playing with their private parts.”

2. Medical factors affecting sexual behaviour

Mental disorder and drugs given affect sexual activities

· “If the patient comes in with mania, definitely you expect that patient to be hypersexual. If the patient comes with depression, of course you expect that patient to have Anhedonia, they will have no interest in any sexual activities.”

· “Some clients become sexually active or sexually inactive because of the drugs that they take, they have got side effects that affect libido. You find that some will make them high, others will make them low.”

3. Differences in demographic characteristics of nurses as well as clients affect therapeutic relationships between clients and nurses

Educational level and work specialty affecting nurses’ perceptions

Age of the nurse affects nurses’ perceptions

Gender of nurses and clients affecting therapeutic relationship

· “I think one of the factors is education….if you are knowledgeable, you understand that these people are also human beings and what is just affected is their thinking capacity, but otherwise, the rest of their body is just working normally.”

· “Also age, when you have old age, when you are mature enough you will be able to know that it is normal, for someone to have sex.”

· “If a person of opposite sex enters a ward in psychiatric unit, especially when a male enters female ward, the female patients will start advancing sexually. They will even be saying things such as “I want my husband, it is you who has come, you are my husband, come here.” So they are also human, and they have sexual desire.”

4. Deficient health system and environment as a cause of sexual misdemeanour

Staff shortage causes sexual misdemeanour by patients

Poor record keeping causes disruption in patient history analysis

· “Due to the low staffing levels that we have, it really creates a negative impact. You find that as they make advances some female staff are alone on duty and have small stature, they cannot even defend themselves. So as the male clients make advances this staff cannot defend themselves and they can be raped. Even the male staff working in the female wards, they can be enticed.”

· “There is a problem everywhere…it is very important that records are kept intact because we deal with the history of the patients… it is very important that the records are intact in case a patient is transferred. Maybe Smart care is more important than what we have now, it is very important that we have that.”

5. Existence of social stereotypes

Presence of labelling theory in the community against mental patients

· “These people in the communities, when they just see a mental patient maybe in the neighbourhood….they always say... Take them so that they can be castrated, because it is them who rape people. They feel their school going children are not safe by having a male patient just living nearby their home or those who roam the street. Sometimes they will tell the relatives to the patient to be locking up the patient so that they are not having access to the sex.”

6. Need for psychosexual support and advocacy by the nurses

Need to provide non-judgemental care

Recognising sex as an aid to recovery

Human rights advocacy

· “When the time comes if they marry, they are free to have sex, and we shouldn’t judge, and the community should not perceive it wrongly to say she is not supposed to get married…. as long as they are educated, they are counselled, they can manage to take care of a home and take care of the spouse, the patient has got the right like anyone of us.”

· “And also sex plays an important role in stabilising our patients because if you look at the functions of sex, it is not just for reproducing but it also helps to relieve some stress.”

· “These are people like any other; we shouldn’t deprive them the conjugal rights.”