Barriers and Facilitators to Accessing Sexual and Reproductive Health Services for People with Severe Mental Illness: A Systematic Review

Purpose
Despite increased prevalence of sexual and reproductive health problems among people with severe mental illness (SMI), uptake of sexual and reproductive healthcare in this group is poor. The reasons for this are unclear. Therefore, this review aimed to identify the barriers and facilitators to accessing sexual and reproductive health services from a service user perspective.

Methods
Three electronic databases were searched using key words for “sexual health” and “SMI”. Data were screened and extracted by two independent reviewers. The Joanna Briggs Institute Critical Appraisal Tools were used to assess quality of included studies.

Results
Five studies were included and underwent a narrative synthesis. They were on access to HIV care (n2), access to family planning methods (n2) and access to general sexual healthcare (n1). Barriers relating to HIV care included cost; barriers relating to family planning included lack of awareness and not considering the issue; barriers to general sexual healthcare included psychotic symptoms, mental health prioritisation, stigma, lack of sexual health focus in mental health programs, difficulty initiating conversations, knowledge, culture/religion/ethnicity, and finances.

Conclusions
Studies which examined access to HIV and family planning services did so in a way that limited participant responses. While only one study examined barriers and facilitators to accessing generic sexual health services, it did so robustly, although it focussed solely on young women and provided limited data on facilitators. Future work should focus on examining barriers, and facilitators, to accessing sexual healthcare in all people with SMI to better identify and address these challenges.