Common questions about intimate relationships and people with mental health issues
CrossCurrents
By Hema Zbogar
This Q&A is based on an interview with Dr. Janos Botschner, chief researcher with the Canadian Mental Health Association (CMHA),
Waterloo Regional Branch and Wellington-Dufferin Branch in Ontario. Botschner is involved with the People Acquiring Intimate
Relationships (PAIR) project, which helps people with serious mental health issues pursue personal relationships.
Describe the PAIR project.
In 2003, CMHA, Waterloo Regional Branch received a three-year grant from the Ontario Trillium Foundation to develop a service
to support people with significant mental health issues who wanted to pursue intimate relationships. During the development
phase, we did in-depth interviews and focus groups with people with significant mental health problems to find out how they
think of intimacy and its role in their well-being. We piloted the service in Waterloo Region and Wellington and Dufferin
counties. We are now about to implement the service components in London, in partnership with CMHA, London-Middlesex, and
in Toronto, with the Centre for Addiction and Mental Health. In the past year, PAIR has also carried out a self-help education
series across Ontario, focusing on various aspects of intimate relationships.
What are some of the relationship myths/ stereotypes about people with mental health issues?
One myth is that people with mental health issues can't or shouldn't get involved intimately with anyone. This often comes
from focusing on deficits like lack of motivation or on medication side-effects like impotence. Others believe that people
with mental health issues can't handle relationship stresses and that a break-up will provoke a crisis. Still others think
people with disabilities shouldn't reproduce because they wouldn't be able to care for their children or that the children
would inherit the problem.
Many service providers don't ask about intimacy because they assume it isn't relevant or that they need special training to
explore the topic. If they do ask about relationships, they tend to focus on friends and family, not intimacy and sexuality.
But people tell us they want to discuss these issues with their case managers, social workers and psychiatrists. Questions
about the impact of medication on sex drive and performance can be as important as how it affects appetite or concentration.
Do people with significant mental health issues have different relationship needs than other people?
Needs vary. But the literature tells us a lot about the impact of psychiatric disorders on people's ability to engage with
others. For example, some people benefit from having casual acquaintances that allow them to withdraw from time to time. Because
they may have few friends and family, they may struggle to meet people in ways that promote the development of intimate relationships.
People with histories of abuse may be reluctant to consider an intimate relationship with someone of the same gender as the
perpetrator. And medications can represent a trade-off between psychological and sexual function. Some people we've spoken
with had given up on the idea of ever resuming sexual activity because of medication side-effects.
Other challenges involve how people with mental health issues are treated by society.
Defining a person's entire identity in terms of an illness label is stigmatizing and can lead to low self-worth and motivation,
along with reduced access to valued resources, and risk of poverty and homelessness. Imagine having someone over for a date
if you live in a cramped space or shared accommodation? Where would you even get the money to spruce up your wardrobe, take
someone to a movie or go out for a meal?
Why are intimate relationships important?
Our experience at CMHA over the last 10 years suggests that personal relationships can be a key factor in recovery success.
Because of social isolation, stigma and disruptive periods of hospitalization, people with significant mental health issues
often find it difficult to develop and maintain personal relationships. Helping them develop meaningful relationships can
enhance a quality of life to which everyone is entitled. In our research on the role of relationships within the experience
of recovery, my colleague John Sylvestre at the University of Ottawa and I argue that along with having a home and a meaningful
occupation, significant personal relationships constitute a foundation for recovery, as well as being a social determinant
of health in their own right.
What have you learned about the intimate relationship needs and goals of people with serious mental health issues?
We're learning that engagement or re-engagement with the world of intimate relationships is as variable as the people in-volved.
But common features are emerging. One is that a person may make rapid progress in some areas, for example, meeting people
online, going on dates, but may be very cautious and unsure in other areas, particularly around readiness for or interest
in sex. People involved in PAIR are experiencing benefits in three areas: relational experiences with others; opportunities
to express different aspects of themselves; and self-awareness and motivation, developing a sense of personhood that goes
beyond the label of mental illness and engaging in more self-advocacy with health care providers. Health care providers need
to help their clients engage with the world of relationships, which involves viewing and supporting clients as whole persons.
PAIR participants are showing us that this is a central feature of intimate personal relationships. It's also a useful reminder
for participants in all kinds of relationships that involve intimate disclosures.
For more information about PAIR, contact Janos Botschner at botschnerj@op-i.ca or Don Roth at CMHA, Waterloo Regional Branch, at rothd@cmhawrb.on.ca.
Centre for Addiction
Bookmark