A look into the treatment and experiences of the LGBTQ+ community within the Mental Health Services by a mental health professional and ally.
Hello. I am a psychological therapist in the field of Cognitive Behaviour Therapy. My individualities are that I am female, BME, and have dyspraxia. I understand what it is to be sometimes seen as ‘different’ in society. I identify as heterosexual but although I have not given myself a label as such, I am allied to the LGBTQIA+ community. Of course, like everyone else, I am still learning with respect to this area. However, I consider myself an understanding and inclusive person and hope that this qualifies me sufficiently to be writing this article.
‘LGBTQQIAA’ access to services in the community
There are many ways to refer to sexuality, gender orientation, and gender identity. The most encompassing acronym that I have come across is LGBTQQIAA (The LGBTQ+ Experiment 2018), which stands for ‘lesbian, gay, bisexual, transgender, queer, questioning, intersex, asexual and ally’. There are other similar terms that are more abbreviated versions, such as LGBTQIA+ (where the ‘Q’ stands for ‘queer’ and the ‘+’ stands for ‘other’), LGBTQ+, LGBTQ, LGBT+ or LGBT. There is much debate about which of those terms is the most appropriate, and I’m sure that this debate will go on for some time. I have settled somewhere in the middle by using LGBTQIA+ to hopefully include the majority of identifiers, while not excluding too many others. I appreciate that there will be some people who agree with this, and others that may be offended (I am going to have to be comfortable with being Marmite for a short duration!).
In the UK, there are laws to protect people from discrimination. An example is the Equality Act (2010) which protects people with regards to employment and the use of private and public services. Amongst the protected characteristics that are covered by the Equality Act (2010) are sexual orientation and gender reassignment. There have been positive advances in the last few years such as same-sex marriage becoming legal (The Marriage (Same Sex Couples) Act 2013). However, as we know, fair treatment is not always upheld. To this day, people who identify as LGBTQIA+ are faced with misunderstanding and mistreatment. In 2017, the government launched a national survey of LGBT*1 people, results of which are published in the LGBT Action Plan (2018). Please note, the published results do not overtly indicate whether or not identities other than lesbian, gay, bisexual and transgender have been included (they have identified intersex responders, therefore I can only hope and assume that they have been). The largest LGBT national survey at the time, it showed that sixteen percent of respondents trying to access healthcare in the preceding twelve months had a negative experience due to their sexual orientation and 38 percent had a negative experience due to their gender identity. Further, eleven percent of intersex people asked reported difficulties in accessing mental health services compared to five percent of responders who were not intersex. Bullying still happens in education. Twenty-one percent of survey respondents experienced someone disclosing their LGBT identity without their consent while nineteen percent were subjected to some form of verbal harassment. Furthermore, 23 percent had experienced a negative or mixed reaction in the workplace due to being or being perceived as LGBT.
"Sixteen percent of respondents trying to access healthcare...had a negative experience due to their sexual orientation and 38 percent had a negative experience due to their gender identity"
LGBTQIA+ mental health
Mental health is part of our overall health and an area that I am very passionate about. This writing will therefore focus on the mental health of the LGBTQIA+ population. As we have seen, people have a hard time accessing mental health care. There are two sides to this issue: the fact that inequalities can lead to poorer mental health, and the fact that people aren’t receiving the support they require for their health on the basis of their identity. This of course leads to a vicious cycle in which the mental health of vulnerable people just gets worse and worse. It also highlights the irony that the very same institution that has a role in the deterioration of their health is the one that fails to adequately treat them. I do not disregard the fact that one of the main reasons for LGBTQIA+ individuals experiencing mental health problems is the discrimination that they face socially; however, that may be the scope of another discussion.
"Two sides to this issue:...that inequalities can lead to poorer mental health, and...that people aren’t receiving the support they require for their health on the basis of their identity"
The LGBTQIA+ population experiences higher levels of moderate to severe mental health problems compared to the general population (MIND 2016); 40 percent of LGBT*1 people were reported to experience significant mental health problems as opposed to 25 percent of the whole population. It was also reported that there are increased suicide rates for the LGBT population; they are twice as likely to commit suicide compared to the rest of the population.
According to MIND Islington, many feel misunderstood and that mainstream services don’t cater to their particular vulnerabilities. The services may be set up in such a way that they do not actively recognise diversity in sexuality. An individual who identifies as LGBTQIA+ and as having a mental health problem may be offered a service that addresses their mental health but fails to consider how their sexuality or gender impacts on their state of mind. One of the problems with this would be that the clinician may miss the opportunity to signpost the client to an appropriate LGBTQIA+ service in the community. Or they may overlook the other struggles that are present in their life. It can be important for individuals to feel a shared experience with fellow service-users or empathy from professionals who identify similarly. Nevertheless, it appears that we aren’t seeing enough environments that are aimed at enabling LGBTQIA+ patients to interact and share their experiences from both angles. Neither does it seem to be the case that the workforce is so diverse as to represent the community.
"The clinician may miss the opportunity to signpost the client to an appropriate LGBTQIA+ service in the community"
Another shortcoming could be that the LGBTQIA+ identity of those seeking a psychological service is not always understood by the organisation/clinician or the other clients, thus leading to perceived or actual negative reactions towards them. One may, for example, offend them by using inappropriate terminology or by making certain assumptions. I have heard of such an incident in one of the Primary Mental Health Services in London, where a clinician gathering demographic information used the word ‘abnormal’ to refer to a client’s sexual orientation.
What are we doing to address this?
It is a bit difficult at present to assess the true progress of mental health services in addressing LGBTQIA+ needs due to the current pandemic. According to the Guardian newspaper, quarantine has in fact led to an increase in mental health difficulties in those that identify as LGBT*1, for such reasons as having to be confined with homophobic/biphobic/transphobic relatives or housemates and not being able to reach the support of LGBTQIA+ organisations at this time.
Nevertheless, since the LGBT Action Plan was published in 2018, the following changes have so far been made:
In March 2019, a National Advisor for LGBT*1 Health was appointed for the first time, and five organisations including London Friend were awarded funding to continue improving LGBT health and social care, amongst other steps that were taken.
The Government Equalities Office released an updated plan in 2019 stating that it commits to ‘supporting the national LGBT health adviser to provide leadership on reducing the health inequalities that LGBT people face’ and ‘working with the DHSC [Department for Health and Social Care] to jointly develop a plan focused on reducing suicides amongst the LGBT population’, which suggests to me that they are still working towards progress in this area.
"In March 2019, a National Advisor for LGBT+ Health was appointed for the first time"
The MIND Lesbian, Gay, Bisexual, Trans and Queer Guide Practice Guide (2016) seems a very helpful document that sets out ways to be more inclusive and is accessible to everyone.
In effect, MIND Islington runs a pan-London LGBTQ+*1 service that has been supporting individuals with a range of mental health problems for over eight years. They recognise the importance of addressing all aspects of a person’s presentation; they work with people who have co-occurring mental health with LGBTQ+ identity, BME, Asylum Seekers and Refugees, Autism and survivors of domestic abuse.
"MIND Islington runs a pan-London LGBTQ+ service that has been supporting individuals with a range of mental health problems for over eight years"
Professional development within organisations
I can attest to the fact that for mental health clinicians, training does occur in a variety of areas, namely on LGBTQIA+ identity. Within the last twelve months a colleague in the IAPT service that I work for delivered compulsory training with the aim of promoting a non-judgmental approach when working with our clients, as well as an awareness of issues facing this group of people. This has made us more aware of such things as appropriate terminology to use when working with them. It has also helped in reminding us of the local LGBTQIA+ community organisations that exist that can offer further support, so that we can signpost clients as appropriate.
Equal Opportunities recruitment is an issue that has been spoken about for many years. Demographic information is withheld from employers to promote fairness in the recruitment process and employers are increasingly being asked to have a diverse interview panel. This is a great step towards promoting inclusivity as, in theory, it leads to a more diverse workforce, increased understanding of diversity issues within the task force, and ultimately an improved service to those populations that have felt marginalised.
What more could we do?
Further progress needs to be made for LGBTQIA+ individuals to feel more included in healthcare settings. Below are some suggestions of things that could be done. This is not an exhaustive list but rather just fuel for discussion.
Demographic data within mental health services:
Service-users are asked to supply this information upon registration and/or upon completing service feed-back forms. I personally find myself in the position of having to select my client’s gender and sexuality on tick-box forms when referring them onto other organisations. I have rarely, if not never, seen the option of a gender other than ‘male’ or ‘female’. The categories of ‘heterosexual’, ‘gay/lesbian’, ‘bisexual’, ‘other’, ‘unknown’ and ‘prefer not to say’ are a common feature, but those identifying as ‘queer’, ‘asexual’ and ‘pansexual’ are limited to placing themselves in a box that does not acknowledge their identity. The gathering of demographic data should be improved to reflect all genders and sexual orientations. This could start at a local level such as within one mental health service altering their forms to reflect the above, or it could come from a national level where the government issues guidance on such a change.
This could be a starting point.
"The gathering of demographic data should be improved to reflect all genders and sexual orientations."
Challenge discrimination when we see it in the workplace (or other setting).
I recently attended a training (online, of course) on Building Inclusive Cultures. The facilitator helpfully highlighted that discrimination can take many forms which may on the surface seem harmless but actually play a part in maintaining the problems at hand. For instance, if you were to witness a Manager giving one of your colleagues a disproportionate amount of work, this would count as harassment and you may not be wrong to assume that could have been done on the basis that said colleague was part of the LGBTQIA+ community (or BME, or had a disability or any other individual difference). If you were to challenge that behaviour rather than turning a blind eye, it would be a dent in chipping away at discriminatory behaviours. I must admit that I do remember, many years ago, listening to a colleague making fun of the Mandarin/Cantonese language. At that stage, I did not have the knowledge or the courage to challenge this and so I stayed silent. This is the type of small gesture that I am referring to. This could well have been a comment about the LGBTQIA+ community and I would like to know that should I be faced with a similar situation in the future, I would vocalise my opinion to the offending person.
"If you were to challenge that behaviour rather than turning a blind eye, it would be a dent in chipping away at discriminatory behaviours."
Events to promote awareness in society such as informational talks, discussions or celebrations could help. These would target all walks of life so that health professionals would become further informed and apply this to their practice. Petitions to put pressure on the government to push the agenda even further forward. These can be set up on legitimate websites such as Change.org. I would like to see further LGBTQIA+ specific workplace training and therapeutic groups being offered within mental health services. Joint working between mental health services and LGBTQIA+ organisations is a feasible and necessary idea. This could make it easier for individuals to access the different services that they need without feeling that they are having to repeat their story or are being passed from pillar to post.
Dialogue is powerful. Let’s keep the dialogue going to combat stigma and drive change. Ventures such as Queermunity are powerful contributors to this cause. Attending the Queermunity Housewarming Party a few months ago was definitely informative for me and allowed me to witness a variety of experiences in a short timeframe.
May Queermunity long continue and instigate further such initiatives!
"Dialogue is powerful."
Conclusion
The UK has clearly taken many steps to achieve equality over the years such as enforcing the Equality Act, conducting a large survey of the LGBT(QIA+) community’s experiences, appointing an LGBT Health Advisor, and pledging to continue investing in achieving equality. Mental Health charities such as MIND in Islington have created services specifically designed to support LGBTQIA+ individuals who have complex needs. There is still a way to go but hopefully things are moving in the right direction.
*1 - use of the old term ‘LGBT’ in keeping with the terminology used in the source reference
Article Written By Judithea Tchikaya
(She/Her)
Works Cited
GEO (Government Equalities Office) (2018a) LGBT Action Plan: Improving the Lives of Lesbian, Gay, Bisexual and Transgender People. [https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/721367/GEO-LGBT-Action-Plan.pdf], accessed 8 October 2020
GEO (Government Equalities Office) (2019). GEO Strategic Plan 2019/20.
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/814357/GEO_Strategic_Plan_080519_.pdf, accessed 31 October 2020
GEO (Government Equalities Office) (2019) LGBT Action Plan: Annual Progress Report https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/814579/20190702__LGBT_Action_Plan__Annual_Report__WESC.pdf, accessed 31 October 2020
MIND Lesbian, Gay, Bisexual, Trans and Queer Good Practice Guide (2016). https://www.mind.org.uk/media-a/4687/mind-lgbtqplusguide-2016-webres.pdf, accessed 31 October 2020
The Guardian (2020). Lockdown having 'pernicious impact' on LGBT community's mental health. https://www.theguardian.com/society/2020/aug/05/lockdown-having-pernicious-impact-on-lgbt-communitys-mental-health, accessed 31 October 2020
The LGBTQ Experiment (2018). Should I use LGBT, LGBTQ, LGBTQ+, LGBTQQIA, or something else? https://lgbtqexperiment.com/2018/10/28/should-i-use-lgbt-lgbtq-lgbtq-lgbtqqia-or-something-else/, accessed 4th November 2011
UK Public General Acts (2013). Marriage (Same Sex Couples) Act (2013). https://www.legislation.gov.uk/ukpga/2013/30/contents/enacted, accessed 8 October 2020