Lesbian, Gay, Bisexual, & Transgender People and Mental Health in Ireland
The mental health concerns of lesbian, gay, bisexual and transgender people (LGBT) are similar to those of the rest of the population. Of course, being lesbian, gay, bisexual or transgender in no way constitutes a mental health issue in itself. Furthermore, although LGBT people are frequently referred to as a single category, due to the similarity of stigma and discrimination they face as a minority group, they are not an homogenous entity. The sexual orientation and gender identities of LGBT people are different and at the individual level they can experience varying mental health problems. By Justin Frewen & Dr Anna Datta
Perhaps the major difficulty faced by people with a mental health concern is that of stigma. The level of stigma experienced by LGBT people can be further aggravated by the 'minority stress' they frequently encounter as members of a minority group. The stigma and discrimination LGBT people confront in their daily lives can place them at an elevated risk of developing mental health concerns.
A national phone poll of 2,711 respondents found approximately 14% of those contacted had experienced a mental, nervous or emotional problem in the past year while almost 10% had consulted their GP about a mental health issue.
The discrimination and abuse LGBT people regularly face is frankly alarming. The Gay and Lesbian Equality Network (GLEN*) and BeLonG To** joint report, entitled 'Supporting LGBT Lives', clearly documents the mental health risks faced by LGBT people and highlights the stigmatisation and marginalisation LGBT people encounter in their daily lives.
Around 80% of the survey's respondents had experienced verbal abuse, 40% had been physically threatened, 25% physically assaulted and 8% attacked with a weapon or other implement. Nearly 60% reported homophobic bullying at school with 34% reporting homophobic comments by staff. This discrimination follows LGBT people into their workplaces with over a quarter having been subjected to abusive name calling by work colleagues regarding their sexual orientation or gender identity.
15% had received verbal threats, 7% had been physically threatened and nearly one in ten admitted missing work as they were afraid of being injured or felt threatened as a result of their LGBT identity.
Depression and Suicidal Behaviour
Such abuse can take a toll on even the most resilient. A significant number of online respondents reported having felt depressed in the past year. 60% directly attributed their feelings of depression to social and/or personal challenges related to their identity.
Research revealed that LGBT people discovered their sexual identity or gender orientation on average at around 14, but only felt prepared to come out at 21. The seven intervening years coincided with the critical years of social and emotional development, including school-going and early adulthood.
Over half of respondents aged 25 or under had seriously considered suicide, with almost 20% having attempted to do so. In the previous year, suicide had been seriously contemplated by more than one third with nearly 5% having made an attempt.
Accessibility of services
A major risk factors is a lack of engagement with the health services. A 2001 public health study revealed that the last contact with the health services of 51% of those who had committed suicide was either unknown or had been over a year previously.
The accessibility of public mental health services is therefore particularly significant. Although two-thirds of survey participants had generally received appropriate guidance from healthcare professionals, over 75% believed there should be more awareness and sensitivity to LGBT issues. Nearly a quarter had concealed their LGBT identity to avoid negative reactions. Many found their interaction with GPs off-putting, citing concerns their needs were not understood. 20% actively sought out LGBT-friendly professionals following negative experiences.
These issues were particularly accentuated for transgender people. They often encountered mixed responses from GPs, found it difficult to obtain the information they required and feared a lack of confidentiality. Many were obliged to travel abroad to access the services they required, further increasing their mental stress.
It is imperative the public mental health services ensure they are accessible and welcoming to LGBT people. Odhrán Allen, Mental Health Policy Director at GLEN, recommends that mental health personnel adhere to the following five principles:
- Be aware of LGBT mental health issues and specific stressors (for example, fear of coming out)
- Don't assume service users are heterosexual (or parents in the case of children)
- Respond supportively when service users disclose they are LGBT
- Challenge bias and take an LGBT-affirmative approach
- Demonstrate your practice is LGBT-inclusive
To ensure LGBT individuals feel relaxed and secure when dealing with mental health professionals and GPs, a notice should be openly displayed informing the clinic or practice's policy to treats all patients equally, irrespective of sexual orientation and gender identity. These could be included in a list outlining the nine grounds where discrimination is explicitly outlawed by the Equal Status Acts 2000-2004.
The Department of Health and the HSE should fully integrate the needs of LGBT people into all health policies and strategies. All relevant mental health professionals should be made fully aware of how LGBT identity might become a risk factor for suicidal behaviour, self-harm and depression. LGBT individuals should play a central role and be fully consulted in these processes.
The Department of Health and the HSE have made progress. The establishment of an LGBT Health subcommittee and the launch of the new Patient Safety First Charter in September commits to ensuring lesbian and gay people are treated with respect and dignity when accessing health and social services. The HSE's National Office for Suicide Prevention (NOSP) supports research into LGBT mental health issues and funds programmes addressing LGBT mental health promotion and suicide prevention.
Despite the increased risk of mental health problems faced by LGBT people, respondents to the research conducted for 'Supporting LGBT Lives' demonstrate high levels of resilience.
In spite of encountering negative social situations, discrimination and even physical violence, the vast majority of LGBT people in Ireland enjoy good self-esteem, are comfortable with their identity and have high levels of life satisfaction. However, it is crucial we remember those who find it difficult to cope and ensure our mental health services are appropriately designed to meet their needs.
The establishment of the First National Helpline to help Relieve Stress for Lesbian, Gay, Bisexual and Transgender People, inaugurated November 22nd, is a significant step in the right direction. The number is 1890 929539 and further information is available at http://www.lgbt.ie/.
*GLEN works towards full equality and inclusion for lesbian, gay and bisexual (LGB) people in Ireland, and protection from all forms of discrimination. For further information, visit http://www.glen.ie/.
**BeLonG To caters for Lesbian, Gay, Bisexual and Transgendered (LGBT) young people, between 14 and 23. For further information, visit http://www.belongto.org/