Being lesbian, gay or bisexual (LGB) is not in itself
a mental health problem; ‘homosexuality' was once regarded as a mental illness
but it was finally removed from the World Health Organisation International
Classification of Diseases in 1990. However, coping with the effects of discrimination,
isolation and homophobia can be highly detrimental to the mental health of a
lesbian, gay or bisexual person.
Like everyone, lesbian, gay and bisexual people can
experience mental distress for reasons unconnected to their sexual orientation.
However, it is widely accepted that a range of social factors can affect the
lives of LGB people and are likely to have an impact on mental health. LGB
people often have to live with the risk of rejection by their families and
communities; they deal with the continual stress of assessing when and where
it's safe to ‘come out'. Young LGB people can be at risk of homophobic bullying
in school. Such experiences can impact on identity and esteem as well as mental
health.
Recent research findings on the mental health of
LGB people show they are at significantly higher risk than heterosexual people
of suicidal feelings, self-harm, drug or alcohol misuse and mental health
problems such as anxiety and depression. These findings were generally similar
for men and women; however, lesbian and bisexual women were at particular risk
of suicidal feelings and drug or alcohol dependence, while gay and bisexual men
were over four times more likely than heterosexual men to attempt suicide.
Over the past ten years, studies have suggested
that ‘internalised homophobia' (that is low self esteem, negative feelings and
shame relating to sexual orientation) is a risk factor for alcohol and drug
dependency among LGB people. Anxiety, depression, self-harm, suicide and
attempted suicide have also been linked with the combination of social prejudice,
experience or fear of discrimination and internalised negative feelings.
A study by Imperial College London in 2004
demonstrated a possible link between levels of homophobic discrimination and
mental ill-health among LGB people. Researchers found that the incidence of
mental distress, including anxiety, depression and self-harm, was higher than
average among the LGB participants.
Research from Stonewall focusing specifically on
the health of lesbians and bisexual women has found rates of self-harm, suicide
attempts and eating disorders are significantly higher than those found among
heterosexual women. The same report drew attention to widespread discrimination
and negative attitudes towards lesbians and bisexual women within health services.
There is a strong evidence base to show that mental
health services need to be more accessible to and safer for LGB people.
Research has shown that negative staff attitudes and responses exist which can
impact further on the mental health of LGB people and influence how they engage
with statutory services.
In response to this situation it has been
recommended that ‘an awareness of the mental health needs of LGB people should
become a standard part of training for health and social work professionals'
(NIMHE 2007 p3).
Some key
findings on the mental health of LGB people
- ‘Our findings show that LGB people are at significantly higher risk of mental disorder, suicidal ideation, substance misuse and deliberate self-harm than heterosexual people' (NIMHE 2007)
- ‘LGB people have been shown to be at greater risk of deliberate self harm' (Department of Health 2007)
- ‘There is at least twice the risk of suicide attempts in LGB people compared to heterosexuals' (NIMHE 2007)
- ‘Discrimination has been shown to be linked to an increase in deliberate self-harm in LGB people' (Department of Health 2007)
The following figures give an idea of the prevalence of different mental health problems for LGB people compared with the general population. It is based on a review of UK research studies.
From: Meads C, Pennant M, McManus J, Bayliss S
(2009) A systematic review of UK research on lesbian, gay,
bisexual and transgender health Unit of Public Health,
Epidemiology & Biostatistics, West Midlands Health Technology Assessment
Group
http://www.wmhtac.bham.ac.uk/postersx/LGBTHealth.pdf
LGB experience
of mental health and social care services - a snapshot
- ‘In mental health provision, lesbians and gay men have reported insensitive and sometimes hostile treatment by professionals despite being proportionally greater users of services' (Fish 2009)
- 1/3 of gay men, 1/4 of bisexual men and over 40% of lesbians reported negative or mixed reactions from mental health professionals when they disclosed their sexual orientation (DH 2007)
- 20% lesbians and gay men and 1/3 of bisexual men stated that a mental health professional made a causal link between their sexual orientation and their mental health problem (DH 2007)
- 45% of LGBT respondents reported discrimination in social care services but only 9% of services were specifically addressing this discrimination (CSCI 2007)
What needs
to improve?
In 2007 NIMHE said:
- ‘There is an urgent need for mental health services to develop LGB sensitive services and an obvious initial step would be the incorporation of LGB issues into diversity training for staff'
- ‘An awareness of the mental health needs of LGB people and their increased risk of mental disorders should become a standard part of training for health and social work professionals'
- ‘Links with agencies and professionals who have particular expertise with gay and lesbian clients should be made and referrals to such agencies should be encouraged where appropriate' (NIMHE 2007)
A systematic review of UK research on improving health and social care services for LGB people showed the need for:
- specific training for healthcare professionals in relation to LGB patients and their health
- information for healthcare professionals about relevant social groups and health establishments for referrals
- LGB- or non-sexuality-specific literature to be made available in healthcare establishments
- protocols that make no assumptions about sexual orientation
- strict measures to ensure confidentiality for LGB patients
- better continuity of care for LGB patients (Pennant, Bayliss & Meads 2009)
Finally the NHS Core Training Standards for Sexual Orientation make it clear
that: "Inclusive services require
health and social care staff, (....) whether concerned with the delivery of
frontline services or strategic and policy development, to be aware of the
current discrimination experienced by lesbian, gay and bisexual people, to
understand the impact of prejudice and discrimination on lesbian, gay and
bisexual communities and to develop well informed attitudes and approaches to
LGB people in all aspects of service delivery." (Cree & O'Corra 2006 p11)
References
CSCI (2008) Putting People First: equality and diversity
matters 1 - Providing appropriate services for lesbian, gay and bisexual and
transgender people. London: CSCI http://www.cqc.org.uk/_db/_documents/putting_people_first_equality_and_diversity_matters_1.pdf
Cree W & O'Corra S (2006) Core
Training Standards for Sexual Orientation: Making National Health Services
inclusive for LGBT people London: Department of Health
Department of Health (2007) Briefing 9: Mental health issues within
lesbian, gay and bisexual (LGB) communities London: Department of Health
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_078346.pdf
Fish J (2009) Invisible no more? Including
lesbian, gay and bisexual people in social work and social care Practice 21 (1) pp 47-64
Meads C, Pennant M, McManus
J, Bayliss S (2009) A systematic review of UK
research on lesbian, gay, bisexual and transgender health Unit
of Public Health, Epidemiology & Biostatistics, West Midlands Health
Technology Assessment Group http://www.wmhtac.bham.ac.uk/postersx/LGBTHealth.pdf
NIMHE (2007) Mental disorders, suicide and deliberate self-harm in lesbian, gay and bisexual
people London: NIMHE
http://www.nmhdu.org.uk/silo/files/mental-disorders-suicide-and-deliberate-selfharm-in-lesbian-gay-and-bisexual-people.pdf
Pennant M, Bayliss S & Meads C (2009)
Improving lesbian, gay and bisexual healthcare: a systematic review of
qualitative literature from the UK Diversity
in Health and Care 6 pp.193-203
For further online resources and perspectives
on LGB experiences of mental health and social care services go to: Social Care TV (2010) Working with lesbian, gay,
bisexual and transgendered people - People
with mental health needs: Alison's story http://www.scie.org.uk/socialcaretv/video-player.asp?guid=4a79aa7d-12da-4f10-b770-ea5c02ee41c3
Useful Resources (suggested by Stonewall):
The Coalition Government have published their commitment to Lesbian,Gay,Bisexual and transgender equality outlining the actions the government plans to take to tackle homophobic bullying and transphobic discrimination.
Stonewall have produced a short booklet on monitoring sexual orientation, entitled ‘Whats it got to do with you?' , to help people understand why they should complete monitoring forms.
Stonewall's ‘Prescription for Change' research of lesbian and bisexual women found high rates of mental health problems compared to the general female population.
The ‘Count me in too' census in Brighton and Hove of LGB (T) people's health found high levels of anxiety, suicidal thoughts and discrimination within the NHS.
Nottinghamshire Healthcare NHS Trust's ‘How to be LGBT friendly' sets out 30 ways the NHS can become more welcoming for LGBT people.
‘Sexual Orientation: A practical guide for the NHS' provides advice and guidance to enable NHS organisations to meet their responsibilities relating to sexual orientation service delivery and employment practice.
Leeds Partnership NHS Foundation Trust's ‘Closing the Gap', an NHS Pacesetters programme, is the result of a year long study into the challenges of mental health service access among the LGB community. The report sets out specific recommendations for mental health services on improving access for LGB people focussing on suicidal ideation, self-harm and attempted suicide.
