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Dallas Daily News
Counselors for mentally ill realizing
clients' need for intimacy
Experts say strong relationships
may help, not hinder, patients
November 26, 2006
By DAWN FALIK
The Philadelphia Inquirer
PHILADELPHIA – James Leftwich wants
a girlfriend, wants to get married, wants the same kind of "normal"
life most others desire.
For years, he was encouraged not to
try. Because of his schizophrenia and depression, those closest to
him thought it would be too much for him to handle.
Now the librarian from New York
runs a dating and support Web site aimed at those with serious
mental health problems.
"It's harder for a person with a
mental illness, but they shouldn't give up on the goals they used to
have before they were diagnosed," Mr. Leftwich says.
For decades, family members, case
workers and physicians have encouraged people with severe mental
health issues – bipolar disorder, schizophrenia and major
depression, among others – to stay away from intimate relationships.
Too much stress. Too much stigma. Too much risk.
A few researchers, however, are
suggesting that just the opposite might be true. Over the last few
years, they have publicly supported the idea that being in a good
relationship can provide stability, companionship and support, just
as it does in what they call the "non-diagnosed" community.
"They want the same thing that
everyone else does," says Michael Blank, assistant professor of
psychiatry at the University of Pennsylvania School of Medicine, who
is overseeing several studies involving safe-sex practices among the
mentally ill.
But the idea of more discussion
about relationships and sex has proved to be a tough sell. Those
within the system and those who study it say that most people don't
think about the mentally ill being sexual at all.
"Providers have their own ideas and
attitudes about sexuality and their clients," says LaKeetra
McClaine, a research specialist at the University of Pennsylvania
Collaborative on Community Integration. "Most of them just assume
their clients are asexual."
They're not.
The HIV infection rate among people
with serious mental illness is almost seven times higher than in the
general population, according to a 2002 Penn study. And people with
mental illness were more likely to have multiple partners at one
time, shorter relationships, and were sexually intimate sooner,
researchers at Indiana and Purdue Universities reported in May in
the Journal of Sex Research.
But sex and relationships, intimate
and otherwise, just aren't on the agenda.
Patients surveyed say their doctors
usually don't mention the sexual side effects of medications.
Overloaded case workers focus on jobs, housing and medication needs
– not holding hands and seeing movies.
"I think sex is an embarrassing
topic for the therapist as much as anyone else," said Joseph Rogers,
president and chief executive officer of the Mental Health
Association of Southeastern Pennsylvania, who has bipolar disorder.
"I never got much counseling or direct support. They don't have
someone handing out advice for the lovelorn."
Armed with the high infection rates
for HIV, researchers are trying to find ways to get information to
those who need it.
One University of Pennsylvania
study of 24 caseworkers and 300 clients at a mental health facility
is looking at the effectiveness of a safe-sex education program.
Although the study doesn't end
until 2008, the response so far has been mixed.
Vernell Rainey has been a mental
health case worker for more than 18 years. At Hall-Mercer Community
Mental Health Center in Philadelphia, she has 18 clients, all of
whom are diagnosed with a psychiatric illness.
"We're considered their mother,
father, sister, aunt, doctor, lawyer and Indian chief," she said in
a call monitored by public relations staff.
Before taking part in the
University of Pennsylvania study, Ms. Rainey said it never occurred
to her to bring up sexual issues.
"We might have asked if they had
children, but we're just so wrapped up in other thoughts, we never
thought of them having relationships," she said.
Now each client goes through a
year-long program about safe sex and sexuality. The center also
holds talks about living with a mental illness. Partners, family and
friends are encouraged to come.
Ms. Rainey said that she has no
problems talking about condom use or other sexual issues, but some
of her coworkers are a little uneasy. One male coworker asks for
help when demonstrating condom use to his female clients, Ms. Rainey
says.
Everyone agrees that mental
illness, like any serious disorder, adds challenges to developing
and maintaining relationships. Even those on medication have
"breakthrough moments," said Eric Wright, co-author of the
Indiana/Purdue study.
"Mental illness affects the way you
perceive the world and how you perceive the people who care about
you the most," said Mr. Wright.
It's not always easy for a partner
to understand when someone hears voices or has major mood swings or
becomes paranoid.
Even so, Mr. Wright said, one study
found that psychiatric patients who were allowed to get married were
also less likely to be hospitalized.
Because sexuality in the mental
health community is just starting to be researched, it's unclear
whether those who partner with other "diagnosed" people are better
off. Many only date those in the community because that's who they
know, says Ms. McClaine.
Mari Bennett, diagnosed with
bipolar disorder, says she's dated both – with good and bad results
either way. Married twice, she lives in a transitional living
program in Norristown, Pa.
It was her therapist who suggested
she start dating again. Now she's seeing a "non-diagnosed" lawyer
who knows all about her illness
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