Mental Health and the Issue of Consent

If you have read previous articles on this site, you will probably have noticed that we emphasise the importance of consent — basic understanding of consent, different models of consent (e.g. SSC and RACK), the complications and legality of consent in BDSM settings, and more.

Consent is the important red line that exists between BDSM and abuse, and it is important that we see that such a line matters. It’s the basis for negotiating the distance and intimacies we allow when we let others approach our body, and our mind.


There is a misconception that there is only one red line of consent, a kind of universal experience, but in the real world each individual will have their own red lines and ways of negotiating these. Some people see being hugged as a breach of consent, others hug strangers without giving it a second thought.

When you interact with others, you need to see your own red lines as well as your partner’s. You need to monitor both those lines and keep adjusting your actions accordingly, and that monitoring is continuous. What might be off limits at one time is not necessarily off limits at another time, what is no-go with one person might be OK with another, and any mind-altering substance (such as alcohol or drugs) can give a dangerous false sense of where the lines are and need to be carefully accounted for.


The interplay between mental health issues and consent affects who is responsible and how to form better negotiations.

For everyone, moods affect our decision making. For example, someone who is very angry may make skewed and irrational decisions. Not that there are ever any absolute rational and neutral decisions, but if we’re aware of our own mental state, we can minimise the irrationality when it comes to decision making and negotiation.

How does it work for individuals who are dealing with mental health issues such as emotional instability, depression, anxiety or BPD? How do we gain (to some extent) consent or negotiate consent with someone who are dealing with Mental Health issues?


Yes it can be done. But it is important to be very aware of the circumstances and tread carefully and consciously. Do be aware, also, that sometimes people who are dealing with mental health issues don’t know they are. They don’t know that they are depressed or that their levels of anxiety are high. Use your eyes, use your ears, use your instinct.

Here’s 4 key considerations. They won’t make things safe, but they may make things safer.

1. Do not make assumptions, and body language is not enough!

Try to make negotiation as clear as you possibly can. Would you like to be whipped? What do you mean exactly by whipped? Have you tried it before? Do you know what it is? Would you like to just do some experiments without giving up your control? What do you mean by oral sex? Is it the rough deep throat or a simple licking?

You need to make it very clear to your partner in order to give them an accurate picture of what they are consenting to. Don’t go for a kiss and assume they want to be fucked. As much as you like a cup of tea, it doesn’t mean that they like a tea enema or tea water boarding.

In fact, don’t go for a kiss just because you’ve had some subtle flirty eye contact. Individuals dealing with any form of mental illness has difficulties functioning in everyday life, so you need to make it clear to them what you are up to.

2. Responsibility isn’t equally distributed.

The responsibility of a session isn’t equally distributed between two (or more) parties. The individual who is mentally healthy does take greater responsibility in making sure negotiation of the consent and progress and changes in that are clear and observed. Both parties have responsibility, and it is certainly the responsibility of anyone with mental health issues to disclose those, but once they are disclosed it’s important that the other party seeks to understand them and what they mean.

The person who is healthy needs to take up more responsibility in making sure everything goes alright. And if the person isn’t confident enough to take up that amount of responsibility, then they really aren’t confident enough to enter into a session with that partner.

3. The safeword – (is not enough)

Some individuals with mental health issues may already have some similar activities involving pain, for instance self-harm. In my opinion, As long as it is done correctly without any damages to the body it can be cathartic and helpful in dealing with intense moments.

For that reason, response to pain may be different than normal individuals. It doesn’t mean it’s substandard to the norm, it is just different.

You probably need to watch carefully what is happening, and stop in intervals to check in more frequently. Again, nothing is absolutely safe but there are small things that we can do to minimise the risk.

4. Aftercare – (is also not enough)

Mood and emotions often fluctuate more for people dealing with mental health issues, and many intense BDSM activities to some extent result in mild dissociation, that we call subspace or Topspace.

Individuals with mental health issues may need more hugs, more cuddling in the bed or need company to take a physical walk, in order to walk themselves back to reality. You will probably also need to check in (intensively) in the following days to make sure he/she is doing okay. If you sniff anything wrong (suicidal thoughts, intense mood swings), you need to provide as much care as you possibly can.


FetLife – Mental Health and issues of consent
• Deviance and Desire – Consent Archives
• NCSF(National Coalition of Sexual Freedom) – Consent and BDSM: The State of The Law
Elephant Journal – Green Eggs and Consent

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