Let’s Talk About Sex
For Young Adults with a Mental Illness, Learning to Navigate the World of Sex and Relationships Is Vital
Young adulthood is the time many individuals first become sexually active. It can become problematic when an individual who is just coming of age sexually must also deal with the first manifestation of mental illness. So while counseling all young adults on issues of sex and relationships is essential, it becomes even more critical when that individual has been diagnosed with a mental illness.
Amy Marracino, LCSW, is a team supervisor at the Department of Mental Health and Addiction Services, Young Adult Services Division in Connecticut, one of the few programs in existence today specifically targeted to help young adults, ages 18-25 cope with mental illness:
“Counseling young adults on issues of sexuality is important, in addition to helping them to deal with their psychological issues,” she says. “They are at a developmental stage where they are still trying to discover who they are and how to develop age appropriate relationships. At the same time, because of their mental health issues, they are more vulnerable – their ability to make sound decisions may be compromised and they are at greater risk of being abused and exploited.”
Sexual Abuse and Mental Illness
It is all too easy for young adults with mental illness to become victims of sexual abuse and exploitation. Their lack of experience combined with impaired judgment makes for a dangerous combination. In the euphoric stages of bipolar disorder, for example, many patients may exhibit hypersexuality or promiscuity. Insufficient understanding of their condition and its inherent dangers can therefore leave many mentally ill young people at risk.
Young adults with a mental illness need to be educated on what constitutes a healthy relationship – what is acceptable behavior and what is not – in order to protect both themselves and others.
Risky Behavior and Unintended Consequences
The impaired judgment and loss of inhibitions that accompany some serious mental illnesses can lead to other unforeseen complications as well—and these complications can be deadly. Young adults may become promiscuous, binge drink or abuse drugs as a result of an uncontrolled mental illness, and find themselves at increasing risk for a variety of sexually transmitted diseases, including the incurable herpes virus and deadly HIV.
Young women are at greater risk for an unplanned pregnancy at a time in their lives when they are not equipped to handle the responsibilities of raising a child. Additionally, loss of inhibitions and impaired judgment also place these individuals at greater risk of becoming victims of violent crimes such as sexual assault and forced prostitution.
“Young adults with psychiatric illness may be at increased risk of engaging in high-risk or unsafe behaviors, such as during episodes of mania or psychosis, which may increase their risk of victimization by others,” explained Ms. Marracino. “So within the context of treatment, it is important to provide young adults with support and education around age and developmentally appropriate relationships, including sexual relationships.”
Medication and Side Effects
Given how dangerous uncontrolled mental illness can be, it is important for young adults to be treated as soon as possible, and medication is often a critical part of treatment. Some medications though, may have sexual side effects and young adults need to be educated about these potential problems in advance.
There is anecdotal evidence suggesting, for example, that some individuals (both male and female) taking antipsychotics suffer some loss of sexual function. This loss of function can run the gamut from decreased libido and inability to orgasm to premature ejaculation and impotence. Moreover, consumers are likely to stop taking their medications altogether if it interferes with their sex lives.
“Medication non-compliance is a serious problem with young adults, so the more information they have about the potential side effects beforehand, the more likely they will continue on a course of treatment,” said Amy Marracino.
“Young adults also need to be aware that side effects can usually be fixed by an adjustment of their medication,” she added. “It is more dangerous to stop using the medication altogether, so patients need to be counseled to let a member of their treatment team know about any problems, so they can be addressed as soon as possible.”
More studies need to be done, but there is also evidence to indicate that switching from typical to atypical antipsychotics can leave women at an increased risk of pregnancy. This is because the older antipsychotics have been shown to suppress the hormone prolactin, which in turn impacts the female ability to ovulate and menstruate. Second-generation antipsychotics on the other hand, do not suppress prolactin and therefore do not negatively impact fertility. Sexually active young women therefore should speak to their doctor about the increased (and decreased) risk of pregnancy from certain medications.
Unfortunately, specialized programs for young adults with mental illness in the U.S. are few and far between – and programs specially geared to help young people understand issues of sex and relationships within the context of mental illness appear to be non-existent altogether. Many, having transitioned out of the child mental health system, are simply lumped into adult mental health programs, usually with individuals considerably older than they are. Richard Giugliano, Ph.D., Director of Mental Health and Rights of Passage transitional living program at Covenant House in New York City, and an advocate for supported mental health programs specifically for young adults, states:
“A practice that would be completely unacceptable on a college campus—having persons aged 18 to 25 years old room with persons aged 40 to 45—is accepted practice in the mental health system, even though it violates the basic principles that underlie the organization of social relationships.”
Mentally ill young adults are therefore at a disadvantage, not only in terms of the issues they already face with their illness, but also because of the lack of age-appropriate treatment. So where else can a young person go for help? Amy Marracino has this to say:
“Young people can start by seeking out a trusted adult — someone they feel safe and comfortable talking to — someone like a guidance counselor, social worker, or medical doctor. That person can then make a referral to a mental health professional or organization they can trust. They can also call Infoline to connect with community resources focused on young adult issues.”
The Internet is another place to turn for help, especially if an individual is not yet comfortable speaking about their issues openly. Message boards such as PsychForums.com, for example, allows members to anonymously discuss hundreds of mental-health-related topics, including issues of sexuality.
In the end though, states and communities must first acknowledge the need then begin to develop treatment programs geared specifically towards mentally ill young adults.
“Young adults with mental illness will continue to be neglected as a group, and therefore more vulnerable, unless they are recognized as a population with specific psychosocial needs,” said Dr. Giugliano. “States need to establish bureaus of young adult services and partner with nonprofit agencies, such as Covenant House, to help those young adults who are suffering, and to provide the care, the education, and the opportunities they need in order to develop as full persons.