Developing a Sexual Safety Framework for Mental Health Services in Ireland

Abstract Sexual violence is a major public health concern globally. In recent years (2020 - 24) an average of 450 incidents of a sexual nature in healthcare settings were reported to Ireland's healthcare system annually. The majority were reported in mental health services, followed by disability and older person's services. While it has been recognized that those living with mental illness are disproportionality impacted by sexual safety incidents during healthcare service provision, there remains a paucity of evidence on which to base policy and practice to prevent sexual harm in this population. A multidisciplinary group of health and social care professionals was formed to create a Sexual Safety Framework for Irish Mental Health Services (later extended to services for people with disabilities, and services for older people). The approach was mixed-methods 1) An analysis of data held on incidents of a sexual nature, 2) engagement with advocacy organisations for the population in scope and 3) engagement with staff at a series of sexual safety seminars. It was found that over 50% of reported incidents impacted mental health service users, and that staff required addition tools and guidance to prevent and manage such incidents. Advocates stressed the need for a rights based approach to sex and sexuality, balancing autonomy and protection. The resulting Sexual Safety Framework includes specific guidance for the prevention and management of incidents of a sexual nature in Mental Health Services among others. A contributory factors approach is used to assist in the design of protective interventions. This includes a consideration of potentially relevant situational factors, local conditions, organisational factors and external or general factors. Key messages • A context specific approach is needed to improve sexual safety among specific populations at risk of abuse. • Improved data on incidents of a sexual nature in healthcare settings enables the design of protective interventions.