LGBT+ and Mental Health

As with any minority community, there are certain health inequalities and particular health needs for LGBT+ people, and this has been demonstrated internationally. The most prominent health disparities seen between LGBT individuals and heterosexual people are mental health, in particular depression, anxiety, self harm and suicide. In terms of physical health, a recent UK study demonstrated higher rates of particular cancers in the LGBT community, mixed rates of diabetes, and higher rates of drug abuse, binge drinking and smoking.

We’re talking huge numbers of people affected. Statistics are sketchy, but national estimates of the UK’s LGBT+ population vary from 1 in 50, to 1 in 10 individuals. That equates to up to 6.5 million people.

As a clinician, I tend to find myself on the care-giving side of the equation, and care for LGBT patients on a regular basis. However, speaking as a gay man, I am also part of the above statistics, and have been on the receiving end of care for more than one of the above mentioned conditions. In that respect, I feel I have a good insight into the health needs of a proportion of the LGBT+ community.

As an unwell patient last year, I began to look into some of these health disparities, in particular the higher rates of mental illness in gay men. I asked myself, “why?”.

I knew why I was unwell, but what was causing such high rates of mental illness in others? Was there something in the rainbow-coloured water?

A recent survey of over 108,000 LGBT+ people showed that 1 in 4 had accessed mental health services in the last 12 months. Many more had accessed any health services in the preceeding year, and unfortunately a significant proportion did not have a positive experience, which they have put down to being LGBT+. Thankfully I was one of the fortunate ones who did have a good experience when accessing healthcare, although part of me suspects that is because I’m a clinician myself.

Minority stress is the leading theory behind these vast numbers, and it means an accumulation of all of the small but harmful events that have occurred over the years. Both from internal and external sources. Essentially, as a minority community, growing up in a largely heterosexual world, we have been exposed to insults, put downs, abuse, stigma; both perceived and real. These have all chipped away at our inner resilience, or our armour which eventually leads to illness, or in the most extreme cases, death.
Another theory is that those advantaged groups in society (i.e. non-LGBT+) have the resources necessary to reduce the risk of disease, and have better access to healthcare to reduce the impact of disease. A clear example of this can be seen when looking at the health of those who live in inner-city deprivation, and compared to more affluent areas. Those in deprived areas generally have poorer general health, and shorter life-spans.

I know what you’re thinking now. Given the above two theories, poorer health is inevitable in LGBT+ populations. It’s a given.

It’s an unfortunate reality that LGBT+ (in particular the trans community) have to face on a daily basis. But how can we overcome this? How can we address this inequality, and reduce those rates of mental illness towards that of the general population? The answer…education.

“There is no knowledge that is not power”

Ralph Waldo Emerson

By educating the general population, making LGBT+ and diverse relationships normalised in schools, on the television, in books and the media without stigma, we will eventually eradicate the minority stress that young LGBT+ children will be faced with. This is one of the reasons why Pride Month and Pride events around the country are so important. Simply having a presence in society will help. It will abolish the internal shame that we carry around, and consequently aid recovery for those in difficulty.

As a clinician, we’re very good at identifying those at risk of developing diabetes or heart disease and act accordingly by informing these patients and encourage changes to help prevent these diseases. When it comes to mental health however, we’re not as good at identifying at risk individuals, and we’re certainly not very good at intervening. This is even more true when it comes to the LGBT+ population.
At present, we don’t ask patients to disclose their sexual orientation or gender identity unless it is clearly relevant. Even then it isn’t always documented very well, so how are we to know who is at risk of both thge mental and physical health problems listed at the top of the blog?
I feel these important questions should be asked of all patients, but most importantly, it should be in a warm and comforting environment where patients feel accepted and supported to disclose these details.

How do we achieve this comforting and supportive environment? Again, it comes down to education. Doctors need better education at medical school surrounding LGBT+ health problems and how to promote openness. Also, the current NHS England Rainbow Badge campaign helps to signify to patients that this is a safe place to disclose these details.

If you were to ask older gay men what the biggest health problem affecting gay men in, they would likely answer HIV/AIDS. If you were to put the same question to a younger gay man, it is likely they would answer mental health problems.
Thankfully HIV/AIDS is no longer the death sentence it was thought to be back in the 1980s and 90s. With more efficient detection techniques, more accessible testing and more advanced medication, it can safely be put in the category of chronic disease, next to diabetes and kidney disease. Those with HIV are living fruitful and long lives thanks to daily anti-viral medication. There is even some early research that suggests a possible cure to HIV, which is astonishing considering the virus has only been known about for less than 40 years.
It is unfortunate that the condition still carries such significant stigma in society, and I suspect that it will continue to do so for many years to come.

LGBT+ people experience the same health problems that the rest of society suffers, just in different proportions. By normalising LGBT people in the community, that can help peoples’ perceptions and stigmas to change, and when this happens, everyone wins.

Pride Month – ”why do we still need it?”

A question I’ve been asked countless times. Followed by “there should be a straight pride”. Honey, every day is straight pride.

There are still countries in the world where it is punishable by death to be gay, and up until 1967, it was illegal for men to be homosexual in England and Wales. Pride month, and the various nationwide Pride parades help us to remember that and campaign for total equality whilst also celebrating diversity.

LGBTQIA+. That’s a lot of letters, and represents diversity. To those who do not know, this stands for lesbian, gay, bisexual, trans, queer, intersex, asexual, and the ‘+‘ represents all of those who do not identify as straight, nor as any of the preceding letters. A proportion of these people may identify as non-binary, where their gender does not fit into the the binary male or female genders. These terms are not exclusive, so one person can identify as more than one of these terms. If any of these terms or identities is new to you, then that proves there is a need for Pride month.

There has been a lot of progress in the UK with regards to legal entitlements for LGBTQIA+ people in the UK, including bringing in the Marriage (Same-Sex Couples) Act 2013 which permitted same-sex couples to marry. The UK government also introduced ‘Turing’s Law’ in the Policing and Crime Act 2017, which posthumously pardons men who were convicted of homosexuality prior to 1967.
This is all amazing, and certainly something to be proud of, but it is essentially legal entitlements and little else. Despite these advances, there is plenty of research and evidence to suggest that this group of people still face regular discrimination, bullying and harassment in education, the workplace, in the streets and in health and social care to name a few. There are higher rates of addiction and mental illness, lower rates of life satisfaction, and shorter healthy life expectancy. The statistics are even worse for BAME individuals in the LGBTQIA+ community.

It’s not all doom and gloom. Things ARE getting better for us, but we are far from achieving total equality yet.
I went to school during the ‘Section 28 years’. This was a clause in the Local Government Act 1988, passed under Mrs Thatcher’s Conservative government in May 1988. It stipulated that a local authority “shall not intentionally promote homosexuality or publish material with the intention of promoting homosexuality” or “promote the teaching in any maintained school of the acceptability of homosexuality as a pretended family relationship”. Just reading those words makes me feel sick to my stomach. Mrs Thatcher banned teachers from telling students that gay people exist, that it’s okay to be gay, and that it is not something to be ashamed of.
This has resulted in millions of us growing up, and feeling like we were doing something wrong, like we didn’t exist, and that it was not okay to be ourselves.

There is an amazing new NHS initiative called the Rainbow Badge Project, developed by consultant paediatrician Dr Mike Farquhar. Piloted at the Evelina London Children’s Hospital, the project is now available to all staff working in NHS trusts, clinical commissioning groups and GP surgeries in England. They are to symbolise that the wearer is a safe person for patients to talk to about gender and sexuality. As a result, the multi-coloured pins are not just freely distributed. Potential wearers are expected to read through several articles and resources, including Stonewall’s coming-out guidance, and to sign up to key principles. So be sure to look out for these next time you visit a healthcare professional.

A recent example of why Pride month and further diversity education is required can be seen at the protests outside of Anderton Park Primary school in Birmingham. Groups of parents were rallying against the school’s new implementation of LGBT awareness teaching. These protests have been so extreme and disruptive that the High Court has had to file an injunction to prevent further protests and demonstrations. The awareness education was simply for children to acknowledge that different types of families exist, and that these are all normal and okay. It is simply a reflection of the diversity of the UK, and something that I wish I had at school.

Pride month and LGBT education is not there to turn people gay. By that logic I would be as straight as a ruler, as I was only exposed to heteronomitivity whilst growing up, and was never taught about diversity in relationships at school. It is simply there to promote inclusivity, to demonstrate that different
 types of relationships exist, and that it’s okay to be yourself. In turn, this will hopfully address the shocking health and social inequalities faced by the LGBT communities, namely the high rates of mental illness and addiction

So that is why Pride month is still needed, and that is why I am a firm believer and supporter of its cause.

I’m going to put together a piece about LGBT and health, from the perspectives of both the clinician and as the patient, so be sure to subscribe and to not miss it!