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Improving the mental health and wellbeing of lesbian, gay, bisexual and trans individuals

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This week we mark both Mental Health Awareness Week and the International Day Against Homophobia.

Evidence shows there are stark inequalities in mental health for gay, bisexual, lesbian and trans individuals.

The Stonewall lesbian and gay health surveys, which represent some of the largest targeted population surveys of gay, bisexual and lesbians in the world, powerfully demonstrates the level of inequalities around mental health:

  • 22% of gay men are experiencing mild to severe levels of depression, and the rate is even higher among bisexual men (26%).
  • In the last year, 79% lesbian and bisexual women say they have had a spell of sadness, felt miserable or felt depressed. This increases to 84% of bisexual women and 86% of black and minority ethnic women.
  • 46% of gay pupils who experience homophobic bullying have symptoms consistent with depression. 35% of gay young people who aren’t bullied are also likely to be depressed compared to just 5% of young people generally.
  • 23% lesbian, gay and bisexual young people have tried to take their own life at some point. Girls are more likely to attempt this than boys (29%:16%)
  • Rates of mental ill health are significantly higher amongst lesbian, gay and bisexual ethnic minorities than their white counterparts and are also much higher amongst disabled lesbian,gay and bisexual individuals.

Although there is less published evidence on trans mental health issues, the Scottish Trans Mental Health Study, which is one of the largest surveys of trans people in Europe, found that 88% of trans people reported that they have experienced a mental health issue,over 37% have experienced physical threats or intimidation for being trans and 19% had been hit or beaten up for being trans.

Shockingly, 25% had to move away from family or friends for being trans. One positive from the survey was that 74% said that their mental health had improved since transitioning gender, which is perhaps a strong indication that being true to your identity is good for your mental health and wellbeing.

PHE’s previous work on the health and wellbeing of gay and bisexual men and other men who have sex with men highlighted the key role that discrimination and homophobia can play in creating a background of negativity that undermines an individual’s self-worth and identity.

This can significantly impair a person’s ability to make healthy choices and can lead to sexual risk taking, poor mental health and substance misuse.

The importance of addressing discrimination and homophobia has been reiterated in PHE’s work on Black and Ethnic Minority Gay and Bisexual Men in partnership with NAZ, GMFA, Metro and The Quest. A systematic review and evaluation of the project by De Montford University highlighted the key importance of mental health and wellbeing and how social isolation, discrimination and marginalisation had a negative impact on both mental and physical health.

The evaluation of the projects highlighted their key positive impact on re-building social networks and connections for this group of men and enabling healthier relationships.

Sadly, much of the burden of mental ill health is a result of experiences of discrimination across the life course.

Rejection by people who we love and respect can be especially damaging and the rejection is compounded by the loss of a key relationship that would have otherwise offered support and stability. Conversely having parents, family, friends and communities who support lesbian, gay and bisexual identities can be protective.

A survey conducted by Stonewall, the LGB&T campaign charity, which looked at the attitudes of healthcare professionals to LGB&T patients, reported that the NHS still had a significant way to go to provide a safe and inclusive service.

Last year PHE worked with the RCN to produce a toolkit for school nurses on suicide prevention for lesbian, gay, bisexual youth and for trans youth, alongside a new e-learning resources with the RCGP on LGB issues in primary care. As well as within our own workplace looking at how we can be better employers of LGB&T staff, benchmarking through the Stonewall Workplace Equality Index.

So this week as we think about both mental health and sexual orientation and reflect on how marginalisation and discrimination can cause real harm.

This is an opportunity to look at  how we might do more to support lesbian, gay and bisexual people at home, work and across life.

This way we can help them to achieve their potential, celebrate their identity and remain mentally healthy.

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