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Under An Umbrella - Recognising Diversity In LGBT+ Mental Health

01/02/2017 08:44
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A range of studies have shown that LGBT+ people are more likely to experience mental health problems than the wider population.

Around 40% of LGBT+ people experience a mental health issue, compared to 25% of the wider population.

Put those worrying stats aside and LGBT History Month provides a welcome moment to reflect on the positive progress of the LGBT+ community in London.

Increasingly visible and integrated, this community has won a series of legal victories over the last quarter century - from lowering the age of consent, to the introduction of gay marriage and the increasing recognition of trans rights.

With greater equality and diversity in the capital, London can count its place among the most open and truly accepting of global cities.

But the fight shouldn't stop there.

This broad march of progress can act as a mask for the individual distress and turmoil that many LGBT+ Londoners currently face.

It is estimated that up to one in ten people in London identifies as lesbian, gay, bisexual, transgender and/or other definitions of sexual orientation or gender identity. This equates to over 800,000 Londoners.

LGBT+ people are at more risk of suicidal behaviour and self-harm than the rest of the population.

LGBT+ people are 50% more likely to develop depression and anxiety than the rest of the population.

Gay and bisexual men are four times more likely to commit suicide than the rest of the population.

These statistics highlight the profound inequalities out there.

I chair the London Assembly Health Committee, which has been examining mental health inequalities, and particularly access to mental health services among marginalised groups of people.

The investigation into LGBT+ mental health highlighted the fact that what is often badged as one community encompasses extraordinary diverse groups of people and this is often overlooked by policy makers and health care commissioners.

One size does not fit all

It seems obvious but we must recognise that lesbians may have different mental health needs than gay men, or that bisexual people may have needs different from either group. These basic distinctions are often absent in needs assessments, which funding decisions are largely based upon.

Transgender issues have historically been considered alongside LGB matters, in part due to shared experiences of discrimination and stigmatisation sadly common across all the groups under the LGBT+ umbrella. The elusive '+' - incorporating intersex, gender fluid, questioning, asexual, non-binary and a number of other identities - represents more layers of poorly understood personal complexity and therefore potentially unmet needs.

Lumping together sexual orientation and gender identity may be a convenient shorthand for the people who write policies, but if we lose sight of the people behind the label, then how can we know what their needs are, much less how to meet them?

Good news and bad news

The good news is that there are a wide range of third sector organisations - many of them small and local - which have worked across the LGBT+ spectrum to shine a spotlight on specific mental health needs. They are a goldmine of information and expertise on how to engage with their target populations, what works and what doesn't. We heard from many of them through the course of our investigation. They are experts by experience, an asset to anyone looking to develop more inclusive policy.

The bad news is that many of these organisations are chronically underfunded and massively overstretched. The closure of PACE in 2014, one of the leading advice and support services for LGBT+ mental health in London, and the imminent disappearance of others like it, will have a massive impact. It also deprives decision-makers of a valuable source of experience and expertise that could help to design truly inclusive mental health support services.

This loss will be hard felt as local commissioners come under budgetary pressures and a drive for efficiencies and seek to resolve these by moving towards more generic mental health services. But relying on generic services to provide the right support for specialist needs runs the risk of driving the people, who need the most help, away.

These issues will not fade away

Despite 25 years of increasing acceptance and visibility, too many young LGBT+ people are entering adulthood severely damaged by the internal and external homophobia, biphobia, or transphobia they face.

We need to ensure that mental health services are fit for the next generation of LGBT+ people - services need to meet their needs, help reduce levels of mental ill health and allow this generation to lead positive lives.

This massive challenge to mental health and social services needs to be tackled straight on. There should be no ifs and buts. We need the Mayor of London to look up and listen carefully to the rallying call.


Dr Onkar Sahota AM
is Chair of the London Assembly Health Committee. You can find the Health Committee LGBT+ Mental Health report here.

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