Talking About Sexuality With Consumers of Mental Health Services Chris Quinn, RN, DAS (Nurs), Cert PN, Grad Dip (MHN), and Brenda Happell, RN, RPN, BA (Hons), Dip Ed, BEd, MEd, PhD Chris Quinn, RN, DAS (Nurs), Cert PN, Grad Dip (MHN), is a PhD Candidate, Institute of Health and Social Science Research and School of Nursing and Midwifery, CQUniversity Australia, Rockhampton, Queensland, Australia; and Brenda Happell, RN, RPN, BA (Hons), Dip Ed, BEd, MEd, PhD, is Engaged Research Chair in Mental Health Nursing and Director, Institute for Health and Social Science Research and School of Nursing and Midwifery, CQUniversity Australia, Rockhampton, Queensland, Australia. Search terms: BETTER model, consumer, mental health nursing, sexuality Author contact: b.happell@cqu.edu.au, with a copy to the Editor: gpearson@uchc.edu Conflict of Interest Statement The authors report no actual or potential conflicts of interest. This study was funded by the Gold Coast Hospital Foundation. First Received August 16, 2011; Final Revision received February 15, 2012; Accepted for publication February 22, 2012. doi: 10.1111/j.1744-6163.2012.00334.x PURPOSE: To explore nurses’ perceptions of how consumers of mental health ser- vices have responded to mental health nurses discussing sexuality with them. DESIGN AND METHODS: Qualitative exploratory design including in-depth indi- vidual interviews with 14 mental health nurses in Australia on two occasions. Nurse participants were taught the BETTER model in the first interview and were asked to use this in their practice. FINDINGS: In the second interview nurse participants described the model as useful and consumer responses as very positive. PRACTICE IMPLICATIONS: The findings suggest the BETTER model is a simple and effective intervention that can assist mental health nurses to include sexuality as part of nursing care. Throughout history, civilizations have attempted to contain and control sexual behaviors in the effort to define what is considered normal sexuality for their society (Goodwach, 2005). At times containment and control of sexuality resulted from religious beliefs where right from wrong has been defined within a religious context (Foucault, 1998). During the nineteenth century, normal sexuality, the act of having sex to create a family, was considered a right belonging to married couples (Goodwach, 2005). Sexual activity other than that of intercourse between married couples was consid- ered unnatural and deviant (Leiblum & Rosen, 2000), and as a demonic force that could destroy families and society (Fran- coeur & Hendrixson, 1999). Around this time sexuality moved from the control of the church and came under the scrutiny of medicine, where medical treatments have been prescribed for what is regarded as normal and abnormal sexuality (Foucault, 1998). Masturbation was understood as a primary cause of mental illness (Price, 2009), and loss of semen was thought to be debilitating with potential for madness or death (Price, 2009). Mental illness in women was attributed to a disease of their womb, and they were labeled as having “hysteria” (Keel, 2005). The surgical sterilization of women was viewed as a potential cure. In the early twentieth century sexual promis- cuity was identified as a cause of insanity (Francoeur & Hen- drixson, 1999; Kelly & Conley, 2004). By the 1970s, there was a belief in psychiatry that sexual activity could contribute to the development of schizophre- nia and therefore discussing sexuality concerns with consum- ers was considered inappropriate (Kelly & Conley, 2004). It was not until 1974 that homosexuality was removed from the Diagnostic and Statistical Manual of Mental Disorders as a result of the powerful influence society had upon the medical profession because of the changing values and beliefs of Western society (Goodwach, 2005); homosexuality was no longer considered as an emotional or social problem (Deegan, 2001; Tate & Longo, 2004). Today, society generally remains uncomfortable and ambivalent about the idea that people with disabilities might want or actually have sex (McInnes, 2003), and the notion that these people might seek intimate relationships has been met with disapproval (Earle, 2001; McInnes, 2003). The sexual and relationship needs of consumers can be negatively influenced by the prejudicial and discriminatory attitudes of Perspectives in Psychiatric Care ISSN 0031-5990 13 Perspectives in Psychiatric Care 49 (2013) 13–20 © 2012 Wiley Periodicals, Inc.