“Always worried”- Experiences of Informal carers about Sexual Safety of their relatives on acute in-patient units

<title>Abstract</title> <p>Sexual safety is an under-explored dimension of patient safety in acute mental health inpatient settings, particularly from the perspective of informal caregivers. This qualitative study explored caregivers’ experiences and concerns regarding the sexual safety of their relatives during inpatient admissions. An exploratory, qualitative, descriptive design was employed. Five informal caregivers of individuals with mental illness who had received care in an Australian metropolitan inpatient unit participated in semi-structured interviews. The data were analyzed using an inductive thematic analysis. Three themes were identified: “Only when she leaves,” reflecting heightened perceived vulnerability during admission; “Always worried-burden of care,” describing persistent anxiety and emotional strain related to safety concerns; and “We have to tell them again,” highlighting repeated advocacy and communication gaps with healthcare staff. Carers reported that concerns about sexual safety extended beyond overt assault to include environmental risks, lack of privacy, and inadequate monitoring, contributing to ongoing distress and influencing decisions regarding hospital engagement. The findings indicate that responsibility for sexual safety is often perceived as shifting to carers rather than being embedded within care systems. These results underscore the need for trauma-informed system-level approaches that prioritize sexual safety, improve communication with caregivers, and strengthen safeguarding practices in mental health nursing care and inpatient service delivery.</p>