Malgré son importance pour la qualité de vie et le rétablissement, la santé sexuelle reste largement négligée dans les parcours de soins psychiatriques. Cet article présente CARES (Compétences Affectives, Relationnelles et Émotionnelles en santé Sexuelle), un programme psychoéducatif groupal innovant visant à développer les compétences affectives, relationnelles et émotionnelles mobilisées dans la vie intime des personnes vivant avec un trouble psychique, et en décrit la construction, les fondements théoriques et les premiers apports cliniques.

Le programme a été élaboré selon une démarche participative et partenariale, articulant modèle du rétablissement, apports de la cognition sociale et évolution contemporaine de l’éducation thérapeutique du patient.

L’analyse des besoins cliniques en réhabilitation psychosociale a mis en évidence des difficultés fréquentes en matière de vie affective et sexuelle, ainsi qu’un déficit d’espaces sécurisés pour les aborder. La construction de CARES a initié une dynamique institutionnelle, notamment sur les effets indésirables sexuels des psychotropes et de l’intégration de la santé sexuelle dans les pratiques de soins.

CARES constitue une intervention innovante, transdiagnostique et participative, destinée à soutenir le pouvoir d’agir et l’accès aux droits dans la vie intime. Son déploiement nécessite un ancrage institutionnel solide et le développement de la formation des professionnels.

Sexual health, as defined by the World Health Organization, encompasses affective, relational and reproductive dimensions and constitutes an integral component of overall health. Despite this, it remains insufficiently addressed in psychiatric care pathways. Individuals living with severe mental disorders frequently report difficulties in discussing intimate and sexual concerns with healthcare professionals. Persistent stigma, limited professional training and a predominant focus on symptom stabilization contribute to the marginalization of these issues in routine practice, potentially reinforcing social isolation and health inequalities. Traditional biomedical approaches insufficiently address the relational and identity-related aspects of intimate life. Similarly, patient education programs often prioritize adherence and symptom control over psychosocial and recovery-oriented objectives. Research in social cognition has highlighted the importance of emotion recognition, theory of mind and emotional regulation in interpersonal functioning, including intimate relationships. These processes, frequently altered in psychotic and mood disorders, represent relevant targets for psychosocial rehabilitation. Internationally, a limited number of group interventions have addressed romantic and intimate relationships among individuals with mental disorders. Preliminary studies suggest feasibility and potential benefits for social functioning and recovery-related variables. However, structured, recovery-oriented and institutionally integrated programs remain scarce, particularly in the French context. No validated transdiagnostic intervention currently integrates sexual health, social cognition and participatory recovery principles. The CARES program (Compétences Affectives, Relationnelles et Émotionnelles en santé Sexuelle) was developed in response to this gap.

CARES was developed within a psychosocial rehabilitation unit through a structured and iterative process. Clinical needs were identified using standardized assessments of quality of life and self-perceived difficulties, which repeatedly highlighted affective and sexual concerns when systematically explored. The program is grounded in an integrative framework combining: recovery models emphasizing connectedness, identity reconstruction and empowerment; social cognition research focusing on emotional processing and mentalization; contemporary participatory approaches to patient education; multidisciplinary collaboration, including peer support involvement. Development involved peer support workers, mental health professionals specialized in psychosocial rehabilitation and cognitive remediation, a general practitioner specialized in gynecology, as well as institutional and community partners.

CARES includes one individual pre-program interview and one post-program interview, in addition to eight weekly group sessions. The program is co-facilitated by mental health professionals trained in psychosocial rehabilitation and by a peer support worker. One session dedicated to sexual anatomy and physiology is conducted in separate groups according to biological sex to facilitate discussion of anatomical content. This session is co-led by a nurse or advanced practice nurse and a general practitioner specialized in gynecology, with female professionals leading the women's group and male professionals leading the men's group. The remaining sessions are conducted in mixed groups. Sessions address stages of intimate relationship development, emotional identification and regulation, communication, consent, access to reliable sexual health information and prevention of violence. Specific exercises target social cognitive processes implicated in interpersonal functioning. Pedagogical tools include structured workbooks and experiential activities supporting reflective processes. A first cohort is currently engaged in a feasibility phase. Initial observations suggest satisfactory acceptability among participants and institutional stakeholders. Secondary institutional effects have been observed, particularly increased attention to sexual side effects of psychotropic medications and interdisciplinary discussions on the topic.

This preliminary phase presents several limitations. Participation is voluntary and may introduce selection bias. Evaluation partly relies on self-reported measures, which may be subject to social desirability bias. The strong involvement of the development team may limit generalizability. No longitudinal or controlled outcome data are yet available. Future research should include quantitative and longitudinal evaluations, comparative designs and strengthened user participation in assessment procedures to determine clinical effectiveness and conditions for broader dissemination.

CARES seeks to integrate affective and relational dimensions of sexual health into psychosocial rehabilitation through a structured, participatory and recovery-oriented framework. By combining social cognitive targets, experiential knowledge and institutional collaboration, the program addresses an area frequently neglected in mental health services. Further empirical evaluation is required. Nevertheless, CARES contributes to the recognition of intimate life as a clinically relevant and legitimate dimension of recovery-oriented mental health care.