Sexuality and sexual boundary violations in healthcare organisations: a qualitative focus group study in mental health and disability care in the Netherlands.

Fourteen different types of situations involving sexuality and sexual boundary violations were identified across four organizational levels in mental health and disability care.

• The four levels were: between clients, between clients and healthcare professionals, between healthcare professionals, and at the management level.
• Situations ranged from attraction and intimacy between clients and/or professionals, promoting sexual health of clients, gut feelings and speaking up, transgressive behaviour from clients and professionals, false accusations, and investigations into allegations.
• Data were collected through 15 focus groups with 56 total participants across three healthcare organizations in the Netherlands.
• Participants included client experts (former clients), healthcare professionals (psychologist, speech therapist, sexologist, personal coach), team leaders, managers, and directors.

The study used a qualitative focus group design involving multiple stakeholder perspectives across three healthcare organizations in the Netherlands.

• A total of 56 people participated across 15 focus groups.
• The study was conducted in mental health and disability care settings.
• Participants represented a range of roles including former clients, clinical professionals, and organizational leadership.
• The inclusion of 'client experts' (former clients) alongside management and clinical staff provided multiple levels of organizational perspective.

Situations involving sexuality and sexual boundary violations were found to be varied and complex, occurring at multiple levels of healthcare organizational interaction.

• The complexity of these situations spans interpersonal, professional, and organizational dimensions.
• The authors found that no single level of the organization is isolated from issues of sexuality and sexual boundary violations.
• The findings suggest that practical approaches require engagement from clients, professionals, and managers alike.
• Reflection and dialogue about experiences, opinions, and perspectives were identified as important mechanisms for addressing these situations.

Transgressive behaviour was identified as originating from both clients and healthcare professionals, indicating that sexual boundary violations are not unidirectional.

• Transgressive behaviour from clients toward professionals and from professionals toward clients were both captured as distinct situation types.
• The study also identified false accusations and investigations into allegations as relevant situational categories.
• Gut feelings and speaking up were identified as a distinct type of situation, suggesting informal sensing of violations plays a role in organizational dynamics.
• This bidirectionality highlights the complexity of defining and responding to sexual boundary violations in care settings.

Promoting the sexual health of clients was identified as one of the key types of situations in which sexuality plays a role in healthcare organizations.

• Sexual health promotion was listed alongside boundary violation scenarios as a distinct situational category.
• This finding situates sexuality not only as a risk factor but also as a legitimate aspect of client care requiring professional attention.
• The inclusion of a sexologist among participant professionals reflects organizational recognition of sexual health as a care domain.
• The study was conducted in mental health and disability care, populations for whom sexual health may present particular complexity.

The authors concluded that clients, professionals, and managers must engage in reflection and dialogue to develop practical approaches to sexuality and sexual boundary violations.

• The recommendation for dialogue spans all organizational levels, from client to director.
• The authors framed this as necessary given the varied and complex nature of the situations identified.
• The qualitative approach was chosen to explore perceptions and experiences rather than measure prevalence or outcomes.
• The study was set in the Netherlands, which may limit direct transferability to other national healthcare contexts.