Legal equalities notwithstanding, being LGBT in a Straight world can still lead to mental health issues—and existing support services are just not fit for purpose, says Paul F Cockburn.
Half a century on from the partial decriminalisation of male homosexual sex in England and Wales, it’s easy to believe that we live in a wonderfully accepting world, with equality enshrined in law and a shrinking minority of the UK population admitting any hostility to LGBT people.
However, research published by Stonewall in September 2017 remains sobering reading. It found that, during the last year, one in five LGBT people experienced a hate crime or incident because of their sexual orientation and/or gender identity. Overall, the number of reported cases had risen by 78% during the last five years.
“While we have come a long way in the past 25 years, it is clear there is still a huge amount of work we need to do before all LGBT people can feel safe, included and free to be themselves in Britain today,” said Ruth Hunt, Stonewall’s Chief Executive.
“This report warns against complacency, and stands as a call to action for everyone who supports equality. We now need to work together, to bring forward the day when no individual faces hatred or discrimination simply because of their sexual orientation or gender identity.”
Until that happy utopia, though, growing up LGBT in a potentially hostile straight world can—and does—have a significant affect on our mental health. The clearest evidence for this is that LGBT people experience very significantly higher rates of poor mental health, depression, psychological distress, suicidal behaviour and self-harm when compared with the general population.
This is especially so among young LGBT people, aged between 13 and 25. Recent research by LGBT Youth Scotland found that two in five (40%) young LGBT people and two thirds (67%) of transgender young people considered themselves to have a mental health problem. Hardly surprising, given that two-in-three (69%) of all LGBT respondents said they had experienced homophobic or biphobic bullying in school, while three-in-four transgender contributors had faced homophobic, biphobic or transphobic bullying behind the school gates.
According to the Mental Health Foundation, there are numerous factors which contribute to having good mental health: these range from feeling loved, understood and valued to having a sense of belonging within our family and wider community. Sadly, significant numbers of LGBT people of all ages lack those emotional foundations: discrimination; a fear of discrimination; and stresses arising from conforming to societal gender expectations—all can have a very negative impact on mental, and indeed physical, health.
Which is why, of course, we should be able to turn, when required, to our doctors for support and information. Yet, while LGBT Youth Scotland found that just over half (56.5%) of those surveyed felt “safe and supported by the NHS” when it came to their sexual orientation and/or gender identity, the obvious conclusion is that a significant minority—more than two in five (43.5%)—do not. Indeed, less than half (48.1%) of transgender young people admitted to “feeling safe and supported” by current NHS staff and facilities.
When asked to rate their experiences of the support available—specifically, the NHS’s Child and Adolescent Mental Health Services—the majority of respondents opted for “Not OK” (41%) and “Terrible” (35%); barely one in four (24.5%) felt it had been “OK”. Most focused on the disappointment, isolation, and frustration experienced during their treatment but some transgender people’s concerns went beyond being just misunderstood. All too often they found that staff would assume that their mental health issues were part of their LGBT identity, and so were not treated separately.
Yet, the 2015 Unhealthy Attitudes research also found that just over half (51%) of mental health workers, counsellors, psychologists and psychotherapists do not consider sexual orientation to be relevant to people’s health needs at all—meaning that homophobic, biphobic and transphobic bullying is unlikely to be viewed as a factor.
Admittedly, it doesn’t help that many LGBT people are reluctant to disclose their LGBT status to healthcare professionals, because of past discrimination, stigma and a perceived invisibility within a heteronormative health service. Not being open about their identities means that additional challenges arising from their LGBT identity, especially in regards to potential support networks, are unlikely to be discussed, with all-too-real consequences on their future recovery.
Both factors mean that our mainstream health services providers are likely incapable of responding proactively and in a culturally sensitive manner to the needs of LGBT people. Or, indeed, correctly anticipating the levels of need they genuinely face.
It could be so different, however. Much of LGBT Health and Wellbeing’s own work is based around prevention, the promotion of self-management and enhancing individuals’ resilience. As a result they know that timely support, which both affirms LGBT identities and supports people to connect with their community, can be highly effective—and cost-effective too!
First published in Pride Life, Summer 2018.