Being Ourselves as We Age

1
Being Ourselves as We Age

• Older lesbian, gay, bisexual and trans older
  people and mental health
• Lindsay River
• Director
• Sam Wintrip
• Mental Health Research and Development Worker

2
Sources

• Our thoughts today are based on six main sources
• Polaris Mental Health Project 2007-8 a research
  project which looked at the experience of mental
  health service users over 50 who are lesbian, gay
  and bisexual
• (These are not our photos - they are of older
  LGBs - from books)

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Sources

• Polaris work 2002-2005 Polari in Partnership
  - a participative project involving LGB people
  over 55 and service planners and providers
• Ongoing work with older LGB and T people via our
  information service, support to groups and
  networking

4
Sources

• Informal consultation with older trans people
  through contacts with organisations, networking
  and guest participation on 2 older trans
  messageboards
• Reference to published research and our own
  2006a, 2006b and 1995
• Polaris work training care staff and social
  workers

5
Ageing impacts (on all users - not mental health
services specifically)

• Only a proportion of older people need to access
  care. Most dont.
• For those LGBT people that do need to because of
  changed health status or the death of a carer,
  the implications can be dramatic.
• Complex familiar negotiations with the homophobia
  and transphobia of society disrupted by new
  needs

6
Mental health needs

• There is a demonstrated need for mental health
  services. But older people are less likely to
  access them because of their greater perception
  of stigma and also the relative lack of
  availability - especially to those over 65.

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Sexual orientation and mental health

• Homophobia from staff and users has a
• major impact on mental health
• Anecdotal evidence suggests the need to conceal
  sexual orientation may have profound mental
  health effectsdepression, anxiety, withdrawal
• Id rather die in a ditch - many older LGBs
• feel they would never fit in to older services

8
Gender identity and mental health

• Consultation with older TS and TG people flagged
  up
• concern about lack of awareness in care workers
  of trans existence and issues
• concern about personal dignity lack of help with
  gender presentation, being treated as if in ones
  previously assigned gender
• issues related to personal care particularly for
  those whose bodies do not meet care staffs
  expectations for their gender

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Other issues

• Gender presentation is not only an issue for
  trans older people. Also for older lesbians who
  I.D as butch (we found evidence of prejudice),
  and those older gay men who are seen as
  effeminate by staff and other users
• No generalisations can be made about LGBT culture
  - older LGBTs are all diverse and need
  person-centred care which respects their
  individual culture

10
State of the OLGBT Nation

• Sexuality is ignored or addressed as a problem
• Few specific LGBT alternatives to mainstream care
  and support exist
• Homophobia of some care staff and other users can
  be a major issue. (Not yet enough evidence
  accumulated about transphobia)
• Anxiety about their possible futures continues
  high amongst older LGBTs

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Not just to do with partnership

• It is often assumed that CP and the recognition
  of partner carers will solve all problems for
  older LGBs
• But many of us are single
• For some our friends are our significant others
• Need recognition of the importance of sexual
  orientation and gender identity for mental health
• Need new qualitative research on value of
  sexuality and gender I.D. in older age - and
  mental health implications

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Polaris scoping study of older LGB mental health
service users

• Targeted to LGB mental health service users and
  ex users (with some who needed but did not use a
  service) who are 50 and over. It was hard to
  recruit over 70s, BME participants and bisexuals
• A questionnaire (hard copy, administered on
  phone, and online) - 49 responses
• 11 interviews
• A small focus group

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Some findings of the questionnaire

• Large majority were able to be out to services
• 41 said a greater visibility of LGBs in service
  literature would make them more comfortable being
  out

• One third thought they would have had a better
  service if heterosexual
• One third thought behaviour of mental health
  professionals in relation to their sexual
  orientation had made their problem worse

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• 41 reported being subjected to homophobic
  remarks from professionals and discriminatory
  behaviour
• 30 claimed they were physically attacked by
  staff within the last five years on account of
  their sexual orientation
• About half of respondents report having had
  inappropriate questions or comments asked about
  their sexual orientation and/or behaviour.
• Just under half report hearing staff speak in a
  negative way about LGB people in general.

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We also spoke to services

• Weve found that, when we have put up LGB
  materials, about Pride or other events or
  services, there has been less in the way of
  homophobic comments or behaviour in the centre.
  Just doing that has helped.

• We would be unable to display any materials
  relating to gay or lesbian services because the
  venues that host our service are Christian
  venues, and they wouldnt like us to display that
  kind of thing there.

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Qualitative from interviews

• Some early experiences of mistreatment within
  statutory services gt attempting to cope on their
  own
• Feeling of stigmatization/exclusion by LGB
  communities
• Users sense that contemporary services are
  inadequate gt fear, anger, anxiety
• Experience of homophobia and inappropriate
  treatment, especially from religious staff
• NHS needs to actively demonstrate that it
  recognises LGB existence and needs by taking a
  hard and visible stance on homophobia

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Overall we found

• Insufficient training
• Recognition that some staff are overtly
  homophobic and management often does nothing to
  address this
• There is often a general acceptance that
  homophobia exists, even if it is deplored, and
  there was sometimes an apparent feeling of
  helplessness to prevent it

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Top 7 Innovations participants wanted

• 1. All mental health professionals to be trained
  in awareness of older LGB issues
• 2. More information about LGB voluntary mental
  health services in GP surgeries, day centres and
  hospitals
• 3. More information and more support in making
  complaints about unfair treatment
• 4. LGB mental health advice service
• 5. LGB-specialist counsellors and therapists
• 6. LGB-specialist case workers (CPNs or support
  workers)
• 7. A regular LGB mental health service users
  forum

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Polaris immediate priorities

• Urgent introduction of S.O. and G.I. training in
  all older services and mental health services
• New systems of (peer?) support of older LGB and T
  mental health service users
• Management New systems of intervention to
  prevent homophobic or transphobic behaviour of
  staff and users
• Better recognition of the value of sexuality and
  gender i.d. in the mental health and quality of
  life of ALL older people

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• To order our new older LGB mental health report
  (ready within weeks) write to
• policy_at_polari.org