Homerton nurse wins national award for revolutionising approach to sex and intimacy in mental health
PUBLISHED: 12:09 09 July 2019 | UPDATED: 12:47 09 July 2019
It's fair to say Rachel Luby did not expect to win the Mental Health Nursing award at the industry's top bash last week.
The clinical lead practitioner on a forensic mental health ward at the John Howard Centre in Homerton is on a mission to transform sexual health, intimacy and expression in the sector.
East Ender Rachel, 31, only became interested in the subject a year ago, making her award from the Royal College of Nursing Institute even more impressive.
"It's amazing," she said. "I didn't expect to win at all. Some of the nominees worked on things like suicidal care plans. But on reflection they were all doing stuff that is part of their job."
And that's the difference. Rachel, like all nurses, had no sexual health training, but was inspired to change the systematic reluctance to discuss sexuality when a patient was denied access to the porn DVDs included in his care plan.
"He was very much like: 'I'm a sexual being. I may be in hospital but that doesn't have to go away'," she said. "Some of the patients have sexual offences in their history, but he didn't. And even those that do, a lot of it is a symptom of their illness or a lack of education about consent. I told him I thought the policy needed to be changed. I realised we don't consider it. We just think they can put the whole notion of sex or relationships in a box and then reopen it when they are discharged. The problem was no one was willing to talk about sex - staff or patients.
"I designed a questionnaire asking how confident people were talking about sexual health or intimacy. Patients said they would be more confident if staff approached them and the staff said they would be more confident if the patient brought it up.
"It took me five months to convince the team it was something we needed to be doing."
Rachel rounded up a team of doctors, nurses, psychologists and occupational health staff at the centre, which is run by the East London NHS Foundation Trust (ELFT). The result was a project called Let's Talk About Sex.
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"Some patients have been in over a decade," she said. "They won't know where to meet people when they leave. Discussions on consent are also important because they may not have had sexual education in school."
Usually six of the 16 patients on Rachel's rehab ward turn up, and 12 agreed to screenings. She has also secured sexual expression care plans for everyone.
Next she wants to run sessions in the learning disabilities ward, where most patients have no experience of sex ed and many are convicted sex offenders.
"There's a real need to get to the basics of consent and appropriateness," Rachel said. "When we look at sexual violence on the ward it's about frustration, or not understanding, or they are projecting feelings they have but can't communicate properly."
Rachel's project hasn't cost the NHS a penny. It's done during work time and she secured sexual health training for all nurses by volunteering to do HIV testing with outreach workers at charity Positive East. Another charity, Brook, trained those interested in signing patients up for screenings.
Rachel decided to train after experiencing her own struggles with mental health. Her ultimate goal now is to offer everyone admitted to ELFT a sexual health assessment and screening. No trusts currently offer screenings to mental health patients as a matter of course.
That's despite NHS and government research showing people with serious mental illnesses (SMIs) are more like to have STIs and blood-borne viruses than the general population. They are also at much higher risk of domestic and sexual violence.
Rachel added: "A lot of people with SMIs don't want to engage or even have a smear, and that should be part of our role, to promote sexual health. That way when they are discharged and going back into the population they aren't doing it with STIs."
"Dozens" of mental health trusts across the country have been in touch with Rachel in the last week hoping to use her model, as well as two in Australia.
"I think my project has opened a lot of eyes for people working in mental health," she said.
"We take urine samples for diabetes and UTIs and do drug testing. That makes sense with older people but a 25-year-old is more likely to have an STI. What's stopping us from saying: 'Would you like us to send it off and check?' It's so simple. In that sense it's a shame I won the award, because it's something we should be doing anyway."