This year National coming out day comes a day after World Mental Health Day focussing on ‘Mental Health in an Unequal World’. The sharing of a week with both days brings an importance to highlight focus to the unequal access and support members of the LGBTQ+ community face around their mental well-being. In this article I want to focus on the intersection of the two days - what we know about inequalities for the LGBTQ community - and what we can do to support in a wider way. I also signpost to another article I have written for the day on helping support around a coming out conversation specifically.
I write this article with professional and personal focus to the topic. For the other half of my week to my mental health education role I work as a Doctor in a Psychosexual service - I have had the privilege to support patients in their struggles with their LGBTQ+ identity as part of wider difficulties with their sex lives and mental well-being. Personally, I have had friends and family members come out to me about their sexuality and gender orientation. I take every opening of identity as an humbling experience and take today as my own place to come forward and name my allyship to the community.
Starting - How are things unequal?
The LGBTQ+ community has higher rates of mental illness reporting concerns around mental health 2-3 more times than heteronormative peers, yet barriers to healthcare access and support are much greater.
Well-being is impacted by marginalisation stress, discrimination and a feared / real lack of understanding. In a report by Stonewall on LGBT Health in Britain some significant statistics include:
- 52% of LGBT people noted they had experienced depression in the previous year
- 41% of non-binary people, 20% LGBT women and 12% GBT men said they had harmed themselves in the last year
- 46% trans people and 31% LGB people had thoughts of taking their own life in the previous 12 months.
- 13% of the LGBT community had attempted to take their own life in the last year
In a recent NHS pride event discussions highlighted the real time concerns re a lack of understanding from healthcare providers and waiting times for certain services that are further impacting well-being. it was stated some waiting list times for trans services are so long that they have gone over a decade. While for some private support is an option this only highlights further inequality for those without funding.
The NHS England website notes some key statistics from the 2017 National LGBTQ+ survey, focussing specifically on mental health inequalities and access to care:
- 16% who completed the survey noted a GP was unsupportive,
- 27% in this survey felt worried, anxious or embarrassed about going to an appointment,
- 51 % of those that responded noted waiting too long to access mental health services
Experience in services and a Data Gap
Not all service experience is equal and the noted fear of a lack of understanding from healthcare professionals acknowledges the disparities between services. 1 in 8 people were also noted in the stonewall report as experiencing unequal care from healthcare staff and one in four had witnessed discriminatory or negative remarks . Of added concern is a lack of feedback to understand what experiences individuals with a LGBTQ+ identity may be having. As there have been longstanding known gaps in collecting a baseline feedback of women’s health experience to men’s, the collection of data for wider subsets of identity is also missing. Many NHS organisations have not included data collection for LGBTQ+ identities and this means that we cannot know how these identities feed into experiences around healthcare. Equally secondary to concerns around the sharing of a protected characteristic many in the LGBTQ+ community feel a concern to note their identity and generally the box that most often gets selected when boxes exist is ‘prefer not to say’.
Other intersections of healthcare
Those in the LGBTQ+ community also have higher rates of alcohol and smoking use and experience of disability- with a third of the LGBTQ+ community reporting that they have at least one form.
These factors can understandably also have a knock-on effect to experience of mental well-being, access and support.
So, what can we do to help?
Aiming for an inclusive and supportive service starts at every level of healthcare. For the individual a start may be the inclusion of pronouns in an email signature, or wearing of a rainbow badge to marker an allyship for LGBTQ+ needs. A service environment can be altered in ways to enable better access, having policies that note an awareness of LGBTQ+ identity and toilets that are non-gendered. Having training around LGBTQ+ identity needs to be carried forward across all healthcare spaces, be carefully informed and regularly updated. Patients from the LGBTQ+ community need to have their opinions and feedback collected through careful data entry that also considers the appropriate and sensitive recording of such information.
Specific services may also need considered tenants for recording data- for example a transman may have a cervix- and need cervical screening as a result- in this example a record of ‘person with cervix’ for cervical screening would be more appropriate.
As with all conversations an awareness in consultations that mistakes can happen helps one learn from this space. A caution exists also to not make everything about LGBTQ+ identity, ask questions appropriate to clinical needs and never to assume understanding by terminology- but rather to check with individuals what meanings are held for them.
The below article considers a link to a blog also posted today on how to support a coming out conversation, but the tips are transferrable to discussing generally around LGBTQ+needs.
ML Blog ‘Coming Out’
Other supports, references and articles that may be of interest include:
ML Podcast ‘LGBT Beyond the Rainbow’ LGBT+, beyond the rainbow (maudsleylearning.com)
Stonewall report on LGBT health in Britain: LGBT in Britain - Health (stonewall.org.uk)
NHS England page on LGBT Health NHS England » LGBT health
National LGBT Survey Summary Report National LGBT Survey: Summary report - GOV.UK (www.gov.uk)
Article author: Dr Camilla Tooley