LGBTQIA+ people’s mental health

How members of LGBTQIA+ communities are treated and written about in the medical field has drastically changed over time, and is still changing today. Different communities have different views on what terminology should be used to describe themselves in medicine. The history of how LGBTQIA+ people were treated in medicine can still impact mental health of communities today and may influence how people trust, and access medical facilities. It’s important that LGBTQIA+ people should be able to refer to themselves medicinally in a way that they feel comfortable with.

• Some early medical professionals thought being lesbian, gay or bisexual was a mental illness and only in 1990 did  the World Health Organisation remove homosexuality from their list of mental illness.
• Up until recently the International Classification of Disease listed gender identity disorders, such as people who have had gender confirmation surgery, as being a mental health disorder. The term ‘gender identity disorders’ has been removed from being within the mental health category, a positive step for the trans community as being trans is no longer medically categorised as a ‘mental illness’.
• Gender dysphoria today is listed in the Diagnostic and Statistical Manual. Gender dysphoria refers to the distress people feel when their sex doesn’t match their gender identity. When this causes a lot of distress, it can be defined as a mental disorder . There is controversy over whether gender dysphoria should be classed as a mental health disorder.
• Conversion therapy refers to therapy practice that aims to stop or suppress someone from being gay, or from living as a different gender to their sex recorded at birth. The government has now banned conversion therapy aimed at changing a person’s sexual orientation – but not their gender identity.

Workplace discrimination and bullying can take place in many forms including direct discrimination, indirect discrimination, harassment and victimisation. Experiencing any form of bullying, discrimination or harassment at work can make you less likely to want to go to work and more likely to experience poor mental health.

• LGBTQIA+ employees are more likely to experience conflict and harassment at work compared to their heterosexual and cisgender colleague.
• A study of more than 15,000 workers found that 40% LGBTQIA+ employees and more than 55% of trans workers experienced conflict in the workplace over the last 12 months. This is compared to 29% of heterosexual and cisgender employees.
• The same study also found that 16% of LGBTQIA+ workers and 18% of trans employees felt mentally unsafe in the workplace. This is compared to 10% of heterosexual workers.
• 19% of LGBTQIA+ employees have experienced verbal bullying from colleagues, customers or service users because of their sexual orientation in the last 5 years.
• 5% of trans employees are made to use an inappropriate toilet in the workplace, or provided with none at all, during the early stages of transition.

More than half of younger LGBTQIA+ people experience homophobic, biphobic or transphobic bullying in Britain’s schools. Although many schools now teach pupils about different sexualities, lack of LGBTQIA+ education on a whole, means young people within these communities often feel isolated, fearful and targeted in school settings.

• Verbal, physical and sexual abuse is more commonly reported in transgender youth compared to cisgendered youth.
• One third of LGTBTQIA+ pupils drop out of education after 16 years of age. The impact of bullying is thought to be one of the reasons discouraging LGBTQIA+ young people from continuing their education.
• Nearly half of pupils who experience bullying have symptoms of depression.

Navigating teenage years and young adulthood can impact the mental health of anybody, but young people who identify as part of LGBTQIA+ communities are more likely to face challenges and discrimination which can further impact their mental wellbeing.

• Young LGBTQIA+ adults are more likely to self-harm.
• 13% of those who identify as LGBTQIA+ who are aged 18-24 have attempted to take their own life in the last year.
•  Symptoms of depression are more common and severe in young people who identify as LGBTQIA+.
• Young LGBTQIA+ adults are more likely to show symptoms of eating disorders

A hate crime is a criminal offense against a person or property motivated in whole or in part by an offender’s bias against a race, religion, disability, sexual orientation, ethnicity, gender or gender identity. Being a victim of any form of  hate crime can increase chances of experiencing poor mental health and can lead to mental health problems such as anxiety disorders, panic disorder and post traumatic stress disorder. The most common type of hate crime incident reported by LGBTQIA+ communities is verbal abuse.

• 91% of LGBTQIA+ people either didn’t report an incident of hate crime at all, or didn’t report it themselves.
• People said that they didn’t report the incident because they felt that nothing would happen or change, it isn’t serious enough, or it happens all the time.
• Transgender people are around twice as likely to experience threats of physical or sexual harassment or violence compared with the other LGBTQIA+ communities.
• It was found that 69% of LGBTQIA+ people who had been the victim of a hate crime experienced depression and 76% reported episodes of anxiety or panic.

If you aren’t happy with your treatment, you can talk to your doctor and see if you can resolve the situation with them. The National Institute for Health and Care Excellence (NICE) produces guidelines for the treatment of different mental health conditions. You can refer to these guidelines if you feel your doctor isn’t offering you the right treatment. You may feel that your treatment needs to be changed. If your doctor doesn’t agree, you could ask for a second opinion. You aren’t legally entitled to a second opinion, but your doctor might agree to it if it would help with treatment options.

An advocate is someone who in independent of the NHS but understands the system and your rights. They can come to a meeting with you and your doctor and make sure you get what you are entitled to. Advocates help you make sure your voice is being heard. Some organisations may have specialist LGBT+ advocacy services. You can search online to see if there are any local advocacy services in your area.

The Patient Advice and Liaison Service (PALS) at your NHS trust can try to help you with any problems or issues you have with an NHS service.

You can complain using the NHS complaints procedure. The GP practice or mental health trust should be able to give you a leaflet about their complaint procedure. You can then find more information about second opinions, advocacy and complaining about the NHS or social services at Rethink or call their General Enquiries team on 0121 522 7007 and ask them to send you a copy of the factsheet.