Mental distress in lesbian, gay and bisexual people

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					 Lesbian, Gay, Bisexual and Trans
communities and suicide prevention
                  Sara Roberts
       Associate Director of Public Health
                     Al Green
       Project lead, Healthy Gay Cornwall
 Autumn 2008 –
 growing interest/

• Media coverage of local suicides in the Helston
• Police diversity officer identified a number of gay
  suicides and called a meeting of partner
• Feedback to consultation on local suicide
  prevention strategy
• Publication of NIMHE systematic review
      Feedback to consultation on suicide
             prevention strategy
“The level of homophobic prejudice is believed to be
  higher in Cornwall – so more LGBT people are in the
  ‘closet’ down here.
Someone who is LGBT can become doubly isolated and
  see themselves as being totally alone.
There are only a couple of gay venues in
 Cornwall and LGBT people trying to
 book local halls have been turned away.
 The nature of rural bigotry makes it
 very difficult for someone to lead a
 different    lifestyle in Cornwall”
 Experiences in the South West
Mixed picture – some individuals widely ‘out’ and confident, many
others not.

• Isolation is widespread
• Rural residents are less likely to be
  widely ‘out’ in private lives or work
  places but more likely to be out to
  their GP
• <50% ‘out’ to their GP
• Don’t have confidence in local govt
  or NHS to deliver services without
• Despite homophobic or
  transphobic crime, reluctance to
  report crime – strong feeling that
  police not free from prejudice
                     The NIMHE study
 Systematic review of the world literature, published in 2008

• There is at least twice the risk of
  suicide attempts in lesbian, gay and
  bisexual people compared to
• This risk increased to four times in gay
  and bisexual men
• Depression, anxiety, alcohol and
  substance misuse were at least 1.5
  times more prevalent in LGB people
• Lesbian and bisexual women were
  particularly at risk of suicidal ideation
  and substance dependence.
  Why would mental health risks be
• Unsympathetic society:
  – Social hostility
  – Stigma
  – Discrimination
• Social exclusion encourages social
  contacts in gay venues
  – easy access to drugs and alcohol.
        What we still don’t know
What is the likelihood of completed suicides among
 LGB people? And how does that compare with
 the risk among heterosexuals?
• Sexual orientation is not recorded on the death certificate.
• Many LGB people who die by suicide may never have
  declared their sexual orientation to other people
• They may be particularly reluctant to reveal their sexuality
  to health professionals
• Families may be reluctant to
  discuss this subject at inquest
•    An awareness of the mental health needs
    of LGB people should become a standard
    part of training for health and social work
•   Routine inclusion of sexual orientation in
    data collection
•   Agencies and professionals who have
    particular expertise with gay and lesbian
    clients should be made known through
    appropriate publicity
•   Mental health services to develop LGB
    sensitive services
•   Further research into the reasons for
    increased risk and to assess appropriate
             Qualitative research
Suicidal thoughts bound up in a range
  of experiences associated with
  LGBT lives
Double stigma – alienated from LGBT
  community because of MH issues,
  isolated within MH services because
  of LGBT identification.
• Good practice guidelines for
• Interventions to improve identity
  formation for LGBT people
• Further research
Suicide prevention strategy for England
                Goal 2 (promote mental wellbeing
                  in the wider population):
                • Socially excluded, deprived and
                  other vulnerable groups.
                • People from black and ethnic
                  minority groups, including Asian
                • People who misuse drugs and/or
                • Victims and survivors of abuse,
                  including child sexual abuse.
                • Children and young people (aged
                  under 18 years).
                • Young women during and after
                • Older people.
                • LGB people
 Suicide prevention strategy for C&IoS

Recommendation 32:

• Work in partnership to reduce
 discrimination and isolation of people in
 the LGBT community, and provide
 sensitive support to those in need.
   Questions put to a multi-agency
                      • Do the findings of the
                        NIMHE report ring true in
                      • What are the challenges
                        faced by LGBT people in
                      • Are local services ‘LGBT
                      • What can be done to make
                        life easier?
                 Issues raised
•   Discriminatory practice by statutory services including
    the health services and police service
•   Mental health services - calls for improvement
•   Domestic violence, need to encourage people to talk
    and for service providers to know how to respond
•   Youth issues and provision of services – very
    important and not covered at the conference
•   Mental health promotion and suicide prevention
•   Need to work with the media, e.g. change language
•   Faith Community responses
•   Wider community responses – outreach, involvement,
• Mental Health Trust to host a conference to explore how
  to improve services for minority groups
• ASIST and SafeTALK training offered to people
  providing LGBT support services
• LGBT suicide risk highlighted in newsletter for primary
• Agreement by the Coroner to engage in research
• How to be LGBT friendly – resources and training
  provided within the NHS
• LGBT youth group formed
• Cornwall Pride event – mental health services stalls
• Cornwall & IOS PCT Healthy Lives - Stonewall
How to be LGBT friendly
        How to be LGBT friendly

•Healthy Gay Cornwall – health promotion
project, promoting good sexual, physical
and mental well-being for gay/bisexual
men & MSM
•Recognised awareness deficit of LGBT
issues in health and social care staff in
Cornwall (much of it latency, rather than
•(Free) one day training course for any
healthcare staff in Cornwall/IOS
•“How To Be LGBT Friendly” booklet
        How to be LGBT friendly
The days training explores:
•Common myths about LGBT people
•How law has changed, and impact to
society and individual
•Common barriers LGBT people report
when accessing health services
•Key aspects of health that significantly
affect LGBT people in higher numbers
than their heterosexual counterparts –
including mental health issues
•How workers and services can make
simple changes to improve the
experience of LGBT people accessing
“How to LGBT Friendly” Booklet
• “30 practical ways to create a
  welcoming environment for
  lesbian, gay, bisexual and
  trans people”
• Provides a very simple, easy to
  implement guide to making
  services LGBT friendly
• Broken down into sections:
  Language, Policies, Staff,
  Involvement, information and
  visibility, useful contacts
• Information about targeted
  LGBT services locally and
 Good practice in other areas

• Mind OUT! Brighton
• Terrence Higgins Trust - Online
  counselling – national
• PACE London based, but making
  links with services across the UK
• Yorkshire MESMAC

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