latest health care news

Keeping it in mind

Laurence Webb, Pride in Practice co-ordinator at the LGBT Foundation, outlines how NHS staff, from doctors to receptionists, can help prevent crises and support the mental health of LGBT people.

In 2014, Greater Manchester Building Health Partnerships found that one in five lesbian and bisexual women and one in 14 gay and bisexual men had deliberately harmed themselves in the past year. The research also found that lesbian, gay and bisexual (LGB) people are twice as likely as heterosexual people to commit suicide and that half of trans people have attempted suicide. The vast majority (92%) of LGB people said they had experienced a mental health problem, whilst 88% of trans people reported depression, 80% experienced stress, and 75% experienced anxiety. 

Lesbian, gay, bisexual and trans (LGBT) people often experience stressors which can contribute to poor mental health. Almost half (44%) of LGB people have experienced verbal bullying in their workplace, 15% have experienced physical bullying and 46% have been treated in a negative way. Over half of trans people have struggled with employment due to their trans status and 80% of trans people have experienced physical, emotional or sexual abuse from a current or former partner. 

Disproportionate health risks 

Psychosexual issues are notable for LGBT communities. Trans women and gay and bisexual men who are living with, and recovering from, prostate cancer very often experience barriers when trying to access mainstream support services. This can make their experiences more isolating and their overall recovery more difficult. For trans women specifically, a lack of a specialist service provision which fully meet the requirements of a patient who may have undergone gender reassignment surgery is an added barrier. Prostate Cancer UK acknowledges that for GBT people, “anxieties surrounding sex, support, and experiences in the healthcare system are significant. Without specific support in a GBT-friendly environment, those affected by prostate cancer may find it more difficult to engage with support services and manage their condition”.  

Identifying with a sexual orientation or sexuality outside of what is usually considered to be ‘the norm’ and not having that orientation represented positively or at all in mainstream media, education and services can have an impact on someone’s psychosexual development. The widespread objectification of trans people by society leaves trans people vulnerable and at increased risk of being exploited in a number of situations. 

While being LGBT does not cause mental health issues and mental health issues do not cause people to be LGBT, it remains a fact that LGBT people are disproportionately likely to experience poor mental health. This is due to a variety of overlapping and interacting stressors, sometimes referred to as minority stress, which include interpersonal discrimination (for example, family rejection), poor social support (for example, being isolated in a rural community), and low socioeconomic status, (for example, the mass underemployment of trans women). 

A history of failures 

Mental health services don’t have the best history when it comes to treating LGBT people with respect and dignity. Conversion therapy (treatment to ‘cure’ people of being LGBT) was still offered on the NHS up until 1980, and the World Health Organization didn’t remove homosexuality from its list of mental illnesses until 1993. ‘Transsexualism’ remains listed under Mental and Behavioural Disorders in the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD – 10), despite a wider public understanding of trans identities and repeated calls from trans people to move gender dysphoria to a different section of the ICD that demonstrates it is separate from mental illness. 

In February 2016, psychotherapist Dominic Davies penned an open letter stating that he was resigning from the British Association for Counselling and Psychotherapy (BACP) over their indication that they would not be signing up for a revised Memorandum of Understanding on Conversion Therapy, which would be extended to include trans and asexuality. He cited a previous case where an undercover journalist had been offered ‘gay cure’ therapy from a BACP senior accredited therapist as an indicator that both a clear memorandum and further training was necessary, asking the important question: “How are therapists supposed to be able to deliver competent and ethical therapy without specific training about gender, sexual and relationship diverse clients?” 

Worryingly, the 2012 Trans Mental Health Study found one in five transgender people had felt the need to harm themselves after negative experiences in a healthcare environment, indicating that the very services that should be supporting trans patients may in fact be increasing their distress. 

Treating a crisis 

At LGBT Foundation we’ve found that people in crisis benefit from being able to get an immediate response, for example, through our helpline or pop-in service. 

When people in crisis access services, they need professionals not to assume that they are not LGB and/or trans. This is, unfortunately, a common occurrence and assumptions can devalue or invalidate the patient’s identity and lead to them feeling more isolated. When speaking to a therapist, a person in crisis needs to know that they can talk openly and honestly about their life and their experiences, which many cannot do if incorrect assumptions are made. 

If someone is experiencing domestic violence and abuse from a same gender partner, it is important not to assume that the abuser is their friend or family member, or that the abuse itself is not as urgent, as dangerous or as valid because they are in a same-sex relationship. 

It is important for professionals not to make assumptions that if their patient is LGB and/or trans, that their mental health issues are the consequence of or are causing their sexual orientation and/or trans status. 

Preventing a crisis 

To support the needs of LGBT people living with a mental health condition, all staff who work with patients, including psychotherapists, psychiatrists, nurses and reception staff, would benefit from receiving comprehensive and up-to-date LGBT awareness training to help them increase their understanding, build their confidence and deliver a reflective and respectful service to LGBT patients. This training should be delivered nationally by experts who work directly with LGBT people, such as the LGBT Voluntary and Community Sector (VCS).   

Although specialist services provided by the VCS, such as LGBT Foundation’s Improving Access to Psychological Therapies (IAPT) and counselling services, are important and must be funded, they can’t replace core services and mainstream services still need to be fully inclusive and culturally competent. Not all LGBT people want to use a specialist service for everything, and all patients should have the option of being able to choose the service that best fits their needs without having the additional worry about whether that service will be inclusive of them as an LGBT person. 

We have found that people in crisis benefit most from a tailored rather than blanket approach, as the latter looks over the specifics of someone’s problems and tries to make them fit to criteria. A holistic way of looking at mental health acknowledges all the stressors and triggers and looks at people rather than conditions. 

Above all, it is important to build in protective strategies when working with people who are likely to have experienced discrimination and associated stressors. For LGBT people this means creating an environment where they are able to be completely open and honest about what’s going on in their lives, keeping it in mind that anyone can have any sexual orientation or gender identity and remembering to start that important conversation, every time.

Tell us what you think – have your say below or email [email protected]