Sexual safety in inpatient settings – service response

The Chief Psychiatrist’s guideline on Promoting sexual safety, responding to sexual activity, and managing allegations of sexual assault in adult acute inpatient units establishes minimum standards to assist mental health service managers and clinical staff to protect consumers within their services, and to guide the appropriate staff response to incidents of sexual activity.

Need for local policies and procedures

Individual services are expected to develop local policies based on the guideline, promoting the recognition of sexual vulnerability among people using mental health services, and to actively manage sexual behaviour to minimise risk to individuals.

Sexual assault and harassment are serious matters and a consistent approach must be developed to ensure that all allegations are followed up immediately with an effective and caring response. Staff may be inclined to attribute a complaint to a patient’s illness or personality, while patients may find it difficult to disclose sexual activity for fear of repercussions – or may not even recognise what constitutes inappropriate behaviour.

Managing sexual activity

The management of allegations of sexual assault and harassment should be driven by the wishes of the victim or their chosen advocate, their rights to recovery and justice, and the duty of care of mental health services and staff. The Chief Psychiatrist’s guideline lays out a number of key principles for service managers in assessing, managing and reporting allegations, including:

• Clear procedures for reporting and investigating allegations of sexual assault and harassment must be established and staff trained in their application.
• Paramount consideration should be given to the safety, the physical and psychological needs of the patient, and their preferences for managing the allegation.
• The authorised psychiatrist and senior management must be informed of all allegations of sexual assault or harassment, and be involved in any decision to report the allegation to relevant authorities.
• Any investigation feedback should be provided to the victim, their family and carer, and any learning from a review should be used to inform and improve the unit’s practices.

Role of service managers and local policies

Service managers have a clear role in providing leadership and direction at all levels to promote a culture of sexual safety. This includes the establishment of policies and procedures that protect individuals’ physical and psychological safety, and underscore the fact that any sexual activity within an acute inpatient unit is inappropriate and unacceptable.

Local policies should safeguard against sexual activity and promote mutual respect between patients and staff by:

• considering the different needs of men and women in service planning and delivery, and regularly reviewing the safety of the physical environment
• establishing accessible complaints mechanisms and staff support to help patients speak out
• ensuring that staff education and training address issues of sexual safety and help staff develop their understanding of gender-sensitive practice and trauma-informed care
• compiling and reviewing regular reports on sexual safety incidents and any complaints about inappropriate sexual activity, personal safety or privacy issues
• implementing debriefing and support systems that facilitate the therapeutic functioning of the unit.

Promoting a safe environment

Managers of acute inpatient units can also promote practices that minimise risks and foster a safe environment, such as designating separate lounge areas and bathroom facilities for male and female patients, assigning same-sex patients to adjoining bedrooms, and increasing the observation of communal or outdoor areas.

Assessments of a person’s sexual vulnerability, including past abuse, should be included in all psychiatric and risk assessments, and additional protective measures and levels of nursing care assigned as appropriate.

On admission, all patients should be offered detailed orientations that emphasise their expected behaviour and include advice on keeping safe, summoning help and reporting any inappropriate behaviour from other patients or staff.

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