Lesbian, gay, bisexual and transgender people (LGBT) experience mental health problems in a similar manner to the rest of the population. It should be emphasized that being lesbian, gay, bisexual or transgender in no way constitutes a mental health issue in itself. Furthermore, although LGBT people are often referred to as if they make up 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 lesbians, gays, bisexuals and transgender people are different and at the individual level they can experience varying mental health risks and concerns.

One of the major problems faced by people with a mental health concern is the issue of stigma. The situation for LGBT people can be further aggravated given the ‘minority stress’ they frequently encounter as members of a minority group in our society. The stigma and discrimination they confront in their daily lives can place them at an elevated risk of developing mental health concerns.

According to a national phone poll of 2,711 respondents, conducted by the HRB National Psychological Wellbeing and Distress Survey, approximately 14 per cent claim they had experienced some form of mental, nervous or emotional problem in the past year. Almost 10 per cent had consulted their GP over the previous 12 months on a mental health issue.

Harassment

The discrimination and abuse that LGBT people regularly face is frankly alarming. In the report ‘Supporting LGBT Lives’,  produced by GLEN¹ and BeLonG To² in partnership with the HSE’s National Office for Suicide Prevention (NOSP), the mental health risks facing LGBT people are well documented.

The report clearly highlights the stigmatisation, marginalisation and discrimination LGBT people encounter in their lives. Around 80 per cent of the survey’s respondents had experienced verbal abuse, 40 per cent had been physically threatened, 25 per cent physically assaulted and 8 per cent attacked with a weapon or other implement.

This abuse started early with close to 60 per cent reporting homophobic bullying at school, with 34 per cent even reporting homophobic comments by staff. This discrimination follows LGBT people into their workplaces with more than a quarter of those who had been employed having been subjected to abusive name calling from their work colleagues regarding their sexual orientation or gender identity.

Fifteen per cent had received verbal threats, 7 per cent 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 on-line respondents reported having felt depressed in the past year. Sixty per cent of those who participated in the in-depth interviews directly attributed their feelings of depression to social and/or personal challenges related to their LGBT identity.

The research revealed that LGBT people discovered their sexual identity or gender orientation around the age of 14 on average, but only felt prepared to come out at 21. These seven years between discovering their sexual orientation or gender identity and coming out coincided with the critical years of social and emotional development, including school-going and early adulthood.

On-line participants reported their initial suicide attempt had occurred when they were on average around seventeen-and-a-half. Over half of respondents aged 25 or under had seriously considered suicide, with almost 20 per cent having tried to do so. In the year prior to the survey, suicide had been seriously contemplated by more than one third, with nearly 5 per cent having attempted it.

Accessibility of services

One of the major risks factors for suicidal behaviour is a lack of engagement with the health services. A 2001 public health study revealed that the last time 51 per cent of the study population who had committed suicide had been in contact with the health services was either unknown or had been over a year previously.

The accessibility of the public mental health services is therefore of particular significance for LGBT people. Although two-thirds of survey participants had generally received useful and appropriate guidance from healthcare professionals, over 75 per cent believed they should display more awareness and sensitivity to LGBT issues. Nearly a quarter had concealed their LGBT identity lest they might evoke negative reactions.

Many found their interaction with GPs off-putting, citing concerns that their needs were not understood. Some 20 per cent actively sought out LGBT-friendly professionals following negative experiences.

These issues were particularly accentuated for transgender people, who often found it difficult to obtain the information they required, feared a lack of confidentiality and had encountered mixed responses from GPs.

Many were even obliged to travel abroad to access the services they required, further increasing their emotional and mental stress. Given these factors, it is imperative the public mental health services ensure they are accessible and welcoming to LGBT people. Odhrán Allen, Director of Mental Health Policy at GLEN, recommends that mental health personnel adhere to the following five principles:

1. Be aware of LGBT mental health issues and specific stressors (e.g. fear of coming out);

2. Don’t assume service users are heterosexual (or their parents in the case of children);

3. Respond supportively when service users disclose that they are LGBT;

4. Challenge anti-LGBT bias and take an LGBT-affirmative approach;

5. Demonstrate that your practice is LGBT-inclusive.

In order to ensure that LGBT individuals feel relaxed and secure when coming in contact with mental health professionals and GPs, a notice should be openly displayed informing that the clinic or practice 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.

At the broader level, it is essential the Department of Health and the Health Service Executive 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 HSE have made progress. The establishment of an LGBT Health subcommittee and launch of the new Patient Safety First Charter in September that commits to ensuring lesbian and gay people are treated with respect and dignity when accessing health and social services are important steps forward. The HSE’s NOSP also supports research into LGBT mental health issues and funds a number of 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 great majority of LGBT people in Ireland generally have good self-esteem, are comfortable with their identity and enjoy high levels of life satisfaction. However, it is crucial that we remember those who are finding it difficult to cope and ensure that our mental health services are appropriately designed to meet their needs. In this respect the establishment of the First National Helpline to help Relieve Stress for Lesbian, Gay, Bisexual and Transgender People which was inaugurated on November 22^nd is a significant step in the right direction. The telephone number is 1890 929 539 and further information on the service is available at  http://www.lgbt.ie/.

Notes:

1. GLEN works to achieve 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/.

2. BeLonG To is an organisation for Lesbian, Gay, Bisexual and Transgendered (LGBT) young people, aged between 14 and 23. For more information, visit http://www.belongto.org/

A version of this article, written by Justin Frewen & Dr. Anna Datta was published in the Irish Medical Times in November.