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Oodles of evidence to lead change

Jon Sutton reports from a conference on ‘Mental health in Lesbian, Gay, Bisexual, Trans and Queer Communities: Building resilience’, part of De Montfort University Pride month.

02 March 2017

The first principle of the NHS constitution promises a comprehensive service to all. In practice, said Baroness Liz Barker (founder of all-party parliamentary group on global LGBT rights), ‘if you’re LGBT it doesn’t happen. That’s the lived experience for many.’ 

According to the Baroness, ‘there is oodles of evidence that shows the state of health across our community and what the problems are, for example, the Stonewall health briefing. The NHS knows what to do. It has an absolutely wonderful guide it has produced for its staff on sexual orientation, produced in 2009.’ Yet the ‘Five Year Forward View for Mental Health’ contains just two mentions of ‘lesbian’. ‘We are faced with a bunch of staff who are not trained and have no idea what to do with us,’ Baroness Barker concluded. ‘If we wait for the NHS to solve our problems, we will wait forever… We’ve got a little bit of “walking wounded” about us… We need to start building some resilience within our communities and go to the source of our problems.’

There was much agreement amongst speakers that school and family education is the place to start. ‘What’s the difference between being gay and black?’, Baroness Barker asked. ‘If you’re black you don’t have to tell your mum you’re black.’ The next speaker, Dr Ruth McNair (University of Melbourne), noted that in the US, LGBTQ people account for 20-40 per cent of homeless youth. The evidence suggests this problem is largely driven by parental rejection, abuse, aggression and violence in the family. ‘Parents or carers are often not terribly supportive when young people have come out… I would say that is probably at the heart of most of those who are LGBTI who are at risk of homelessness,’ McNair said. The other route to homelessness is a more complex interaction, a ‘cascade of negative events’, including outright discrimination from letting agents: ‘they want nice, double income, heterosexual couples… I think that’s what they’ve got at the top of their list’, reported one transwoman. ‘There’s a lack of guidelines for the sector on LGBTI best practice,’ McNair concluded, with limited training options and referral networks. On top of this, current Commonwealth policy lists a number of priority subgroups but not LGBT. These policies drive funding, services, education.

Next up, Dr Zowie Davy (De Montfort University) discussed discourses from the trans movement contesting the pathologisation of trans people. Some trans advocates’ claims now evoke a cerebral intersex condition – an innate, biological variation, a mismatch between brain sex and genital sex. Comments on online forums suggest that some want further studies like this, to ‘prove beyond a shadow of doubt that the phenomenon is a natural occurrence, leading to social acceptance of transgender people.’

Delving into data, Dr Elizabeth McDermott (Lancaster University) is investigating why, ‘crudely, you are around twice as likely to develop a mental health problem if you’re LGBT compared to heterosexual’. Young people are around 4-7 times more likely. Dr McDermott’s Queer Futures study on preventing LGBTQ youth suicide and self-harm, funded by the Department of Health – ‘I was as shocked as anyone else when we got the money’ – looked at five interconnecting factors: Homophobia, biphobia and transphobia; Sexual and gender norms; Managing sexual and gendered identities across multiple life domains; Being unable to talk; and Other life crises. Those who reported they were affected by abuse had double the odds of planning or attempting suicide, and there was a ‘general ether’ that made people think there was something wrong with them, even if they were not directly abused. Farouk, a 24-year-old, gay, cis male, British Asian, said: ‘I used to feel that… what I am is wrong and what I am doing in life.’ Managing sexual and gender identity across multiple life domains was particularly stressful for people like Farouk. Over a fifth hadn’t asked for help at all – when they did, more likely to be online or from friends rather than seeking out services, and more likely to be at crisis point. When asked ‘How much did not being able to talk about your emotions affect your self-harm and suicidal feelings?’, 74 per cent reported ‘completely’ or ‘very much’. ‘We need to provide safe and non-judgemental environments for young people to talk about their sexualities, and mental health services outside the clinical environment’, McDermott concluded. There are pockets of fantastic work going on in the NHS, she said, but we need national mandatory LGBT awareness training for all mental health service staff.

The lack of a ‘safe space’ for talking about LGBTQ issues was also highlighted in a personal account from Adrian Hyyrylaininen-Trett, the first openly HIV+ candidate to stand at a UK General Election. ‘We’re hiding who we are, why we are who we are’, he said. Realising he was attracted to boys at the age of 7, ‘who could I ask about it, who could I talk to?’ Three decades on, Hyyrylaininen-Trett feels there is no difference in terms of compulsory education for young people which could prevent the catalogue of complications to come. A keen sports fan, Hyyrylaininen-Trett says sport has ‘so much to answer for’. On the one hand he dreaded it, always the last to be picked; on the other hand, it was a place to see men in a different light and he was drawn to it. Openly gay men in, for example, football, could make all the difference. As his life spiralled out of control during numerous transitions, Hyyrylaininen-Trett looked for barriers and controls to his drug and sex addictions. He tried CBT but felt it ‘only cared for the here and now, not the build up of issues’.

That build up of issues was tackled evocatively through the screening of a Kings College London film on identity, stigma and micro-aggressions – those everyday challenges faced by the LGBTQ communities. It ‘chips away, pricks away’, admitted one interviewee.

In the panel Q+A, one audience member wondered if the speakers had been ‘preaching to the choir – this conference was badged as building resilience, and I would really like to hear examples of how we do that.’ The speakers took the point on board, but said there is still value in ‘producing evidence that we know, that might still be a leader of change.’ All came back to the value of education in schools and families, but as is so often the case these days it comes back to that financial crunch – where is the Department of Health going to start putting the money?

To end on a positive, consider the 2007 National Survey of Mental Health. This revealed twice the rates of many disorders amongst the LGBTQ communities, but 58 per cent reported no mental disorder in past year. Discovering the secret to their resilience may help all those in the communities feel more open, confident and comfortable.

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Picture: Dr Ruth McNair, Baroness Liz Barker and DMU's Professor Julie Fish (who introduced the day)