LGBT Mental Health

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LGBT Mental Health

• Odhrán AllenDirector of Mental Health
• GLEN

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Sexuality

• Four components
• Biological sex
• Social gender role
• Sexual orientation
• Gender identity
• (American Psychological Association, 2008)

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Sexual Orientation

• Sexual orientation is distinguished by an
  emotional, romantic, sexual or affectionate
  attraction to individuals of a particular sex.
  (APA, 2008)

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Sexual Orientation

• Three sexual orientations
• Heterosexual attraction to individuals of the
  opposite sex
• Homosexual attraction to individuals of ones
  own sex
• Bisexual attraction to members of both sexes

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LGB Lesbian, Gay Bisexual

• Lesbian woman a woman who is romantically,
  sexually and emotionally attracted to women
• Gay man a man who is romantically, sexually and
  emotionally attracted to men
• Bisexual a man or woman who is romantically,
  sexually and emotionally attracted to someone of
  either sex
• Avoid using homosexual to refer to someone
• 8 LGB in My World Survey (2012)

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Gender Identity

• Gender identity refers to whether one feels male
  or female regardless of sex assigned at birth.
• Gender expression refers to outwardly expressing
  ones gender identity through mannerisms,
  grooming, physical characteristics, social
  interactions and speech
• (American Psychological Association)

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Transgender

• Transgender is a term used to describe people
  whose gender identity or gender expression,
  differ from the sex assigned to them at birth
• Not everyone whose feelings, appearance or
  behaviour is gender-atypical will identify as a
  transgender person
• Gender dysphoria gender identity opposite to
  sex assigned at birth (Transsexual, GID)

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Gender Dysphoria

• Transgender Girl/Woman
• Designated male sex
• Male appearance
• Raised as a boy
• Identifies as a girl/woman
• Trans girl/woman or woman with trans history
• (GIRES, 2013)

• Transgender Boy/Man
• Designated female sex
• Female appearance
• Raised as a girl
• Identifies as a boy/man
• Trans boy/man or man with a trans history

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Transitioning

• Process of changing the way someones gender is
  lived publicly. People who wish to transition
  often start by expressing their gender identity
  in situations where they feel safe.
• Typically work up to living full-time in their
  preferred gender by making gradual changes to
  their gender expression.
• Transitioning typically involves changes in
  clothing and grooming, a name change, change of
  gender on identity documents, hormonal treatment
  and surgery.
• (American Psychological Association)

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Transitioning

• Psychosocial support during process
• Connecting with other transgender people through
  peer support groups and transgender community
  organisations is also very helpful for people
  when they are going through the transition
  process.
• Professional guidelines www.wpath.org
• Information support
• TENI Transgender Equality Network Ireland
  www.teni.ie
• TransParentCI Trans Parent Connect Ireland via
  TENI
• LOOK (Parent Support) www.lovingouroutkids.org
• BeLonG To Youth Service www.belongto.org

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Demographics

• First major Irish study on LGBT mental health
• Commissioned GLEN BeLonG To Youth Service
• Funded HSE National Office for Suicide
  Prevention
• Research Team TCD UCD - Paula Mayock, Audrey
  Bryan , Nicola Carr, Karl Kitching
• 1,110 survey participants and 40 interviewees
• Age range 14 73
• LGB 96, T 4

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Mental health Key Findings

• 46 had hazardous drinking (AUDIT-C)
• 27 had self-harmed at least once
• 85 more than once
• 16 years average start age
• 40 female and 20 male
• 17.7 had attempted suicide at least once
• 60 more than once
• 17.5 average start age
• 24 female and 15 male
• ? of under 25s had seriously contemplated suicide
  in past year (50 ever)
• These findings strongly linked with LGBT-specific
  stresses. i.e. minority stress

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Minority Stress 3 Characteristics

• Unique additional to general stressors that are
  experienced by all people. Members of minority
  groups require a stress adaptation effort above
  that required of non-minorities
• Chronic related to enduring underlying social
  and cultural structures
• Socially Based stems from social processes,
  institutions and structures beyond the individual
• (Meyer, 2003)

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COMING OUT

• Realising LGBT identity
• 12 years of age most common age
• Disclosing LGBT identity
• 17 years of age most common age
• 5 year period between people knowing they were
  LGBT and disclosing this to others.
• This period of time coincided with participants
  school-going years a time of critical social
  and emotional development
• Emerged as a time of particular vulnerability

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• Coming out is probably one of the most extreme
  and difficult things you can do. Before you come
  out you have to deal with it all yourself and it
  took me six years to. And I couldnt be myself
  for those six years and it is, again, its called
  in the closet because you are in the closet. No
  one can see you they see this door because no
  ones ever opened up the closet to look inside

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COMING OUT

• Coming out was more positive than anticipated for
  majority of respondents
• Majority came out to a friend or other trusted
  individual prior to coming out to their family.
• Feelings of relief were commonly felt after
  coming out, particularly when respondents
  received a positive response from others.
• Regardless of outcome of coming out, the period
  prior to coming out was consistently reported as
  a stressful one questioning identity, afraid to
  tell parents/friends, secret crush on best
  friend, being seen as different, worries about
  future life
• For some their distress wasnt eased by coming
  out

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HARASSMENT

• HARASSMENT in daily life
• 80 had been verbally abused because of their
  LGBT identity
• 40 were threatened with physical violence
• 25 had been punched, kicked or beaten

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• Im sure people knew I was gay you know, Id
  walk up through the village and people would be
  calling faggot and stuff like that. It did kill
  me a lot hearing the words and stuff and I was
  afraid as well. I felt very alone inside and the
  drink was my best friend

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HOMOPHOBIA IN SCHOOLS

• 58 reported homophobic bullying in their school
• 40 verbally threatened by fellow students
• 25 physically threatened by fellow students
• 20 missed or skipped school because they felt
  threatened or were afraid of getting hurt at
  school
• 34 reported homophobic comments by teachers
• 8 were called homophobic names by teachers
• 5 left school early because of homophobic
  bullying

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• I left school because of the hurt and suffering
  I got in school, and the teachers didnt care, as
  I think it was a case of "well they call him gay
  and he probably is gay, so why should we step in,
  cos they arent saying anything wrong" attitude
  towards gay people... even though I wasnt out at
  school. I was forced to leave at my junior cert,
  due to the abuse I got jumped on, called puff,
  queer etc

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SUICIDALITY/SELF-HARM linked to

• Younger age
• Victimisation experiences
• Fear of rejection or actual rejection by family
  friends
• Homophobic bullying in school
• Higher alcohol consumption

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Key Findings Comparison LGB T

• Lesbian, Gay, Bisexual
• Now comfortable 81
• Physically attacked 24.4
• Contemplated suicide 26
• Self-harm 27
• Attempted suicide 17.7

• Transgender
• Now comfortable 61
• Physically attacked 39.1
• Contemplated suicide 80
• Self-harm 43.5
• Attempted suicide 26.1

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• My mother doesnt get my body yet and she was
  very shocked at first. She tried to convince
  herself that it was just a phase and then she was
  trying to tell me that there are some women who
  are feeling masculine but they are fine with it.
  When I told her I was actually going through
  hormone therapy, she was like, if youre doing
  that then youre not living here anymore
  (Female-to-Male Trans, 20).

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SOCIAL SOURCES OF RESILIENCE

1. Supportive friends
2. Accepting family
3. Belonging to LGBT community group or organisation
4. Positive school or work experiences

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PERSONAL SOURCES OF RESILIENCE

1. Forming a positive LGBT identity
2. Developing good self-esteem
3. Positive turning points
4. Developing positive coping strategies

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• I am happy to conclude by saying that I am now
  a very content, confident, well-adjusted gay man,
  fully out and very happy to be gay. I have grown
  and thrived with the love and support of my
  friends and two of my sisters being gay was
  never my problem but how people reacted to me
  being gay was certainly part of what made life
  very hard in the past

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• Available at http//www.glen.ie/news-post.aspx?co
  ntentid15493namenew_lgbt_guide_for_mental_healt
  h_services

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• Thank you
• odhran_at_glen.ie
• _at_odhranallen
• www.glen.ie

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• Other Information
• Resources

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INCLUSIVE PRACTICE

• Inclusive practice means
• Expecting diversity among your clients,
  colleagues, service users, etc. and respecting
  this diversity.
• Understanding the issues facing diverse groups
  (such as LGBT people) and being able to respond
  to their specific needs.
• Providing an accessible and appropriate service
  within your area of competence.
• (Psychological Society of Ireland, 2008)

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UNHELPFUL SERVICES

• Unhelpful services had 5 characteristics
• Presumption of heterosexuality
• Lack of understanding of LGBT issues
• A lack of meaningful connection between the
  person and the practitioner
• A lack of willingness or ability on the part of
  the practitioner to engage with or respond to
  LGBT peoples specific concerns or needs
• Anti-LGBT bias among professionals
• (Mayock et al 2009)

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HELPFUL SERVICES

• Helpful Services had 4 characteristics
• Acceptance and open-mindedness of practitioners
  towards the LGBT people
• Unbiased, sensitive practice
• The provision of constructive and meaningful
  support
• Confidence of the LGBT person that they were
  understood by the professional
• (Mayock et al 2009)

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General Guidelines

• Adapted from Lesbian, Gay and Bisexual Patients
  The Issues for Mental Health Practice (2010)
• Be aware of LGBT mental health issues/LGBT-specifi
  c stressors and assess for/respond to same
• Dont assume everyone is heterosexual/not
  transgender
• Respond supportively when service users disclose
  they are LGBT
• Challenge anti-LGBT bias if it exists and take a
  gay-affirmative approach (see CPsychI Guide
  APA)
• Demonstrate that your practice is inclusive of
  LGBT people
• (see guide for more detail on these)

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Professional Anti-Gay Bias

• Professional anti-gay bias results in lesbian,
  gay and bisexual people receiving sub-optimal
  care and experiencing direct or indirect
  discrimination or exclusion when they use health
  services. The characteristics of professional
  anti-gay bias are
• Presuming service users are heterosexual
• Pathologising, stereotyping and stigmatising LGB
  service users
• Failing to empathise with or recognise LGB
  service users? health concerns
• Denigrating any non-heterosexual form of
  behaviour, identity, relationship, family or
  community
• Attempts to change a persons sexual orientation
• (Irish Institute of Mental Health Nursing,
  2010)

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Reparative Therapy

• As the name suggests, reparative (or conversion)
  therapy is based on the belief that homosexuality
  is an illness and aims to cure LGB people by
  converting them to heterosexuality.
• Extensive empirical research has been carried out
  on the use of reparative therapy with LGB people
  and this research has demonstrated that
  reparative therapy does not work and can be
  damaging to the mental health of LGB people who
  undergo it.
• The CPsychI, ICGP, IASW and IIMHN do not support
  referral to or the practice of reparative therapy
  or any approach aiming to change a persons
  sexual orientation and instead promote inclusive
  practice that is gay-affirmative.

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Gay-affirmative approach

• A gay-affirmative approach is based on the
  following key principles derived from research
• Same-sex sexual attractions, behaviour, and
  orientations per se are normal and positive
  variants of human sexuality and are not
  indicators of either mental or developmental
  disorders
• Lesbians, gay men, and bisexual people can live
  satisfying lives and form stable, committed
  relationships and families that are equivalent to
  heterosexuals relationships and families in
  essential respects
• Same-sex sexual orientation is not linked to
  family background, problems or trauma

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• Sexual orientation cannot be changed and attempts
  to change a persons sexual orientation do not
  work and can be damaging to the mental health of
  those who undergo it
• The historical stigmatisation of lesbian, gay and
  bisexual people can have a variety of negative
  consequences throughout the life span for LGB
  people and social workers need to be proactive in
  challenging this stigmatisation among
  professional peers, society and service users.
• (Irish Association of Social Workers, 2011)

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Resources for Professionals Sexual Orientation

• Lesbian, Gay Bisexual Patients The Issues for
  Mental Health Practice
• College of Psychiatry of Ireland,
  2011. Available at
• www.glen.ie/attachments/CPsychI_LGB_Mental_Health_
  Guide.PDF
• Gay, Lesbian Bisexual People Guide to Good
  Practice for Mental Health Nurses
• Irish Institute of Mental Health Nursing, 2010.
  Available at
• www.glen.ie/attachments/IIMHN_LGB_Mental_Health_Gu
  ide.PDF
• Lesbian, Gay Bisexual People A Guide to Good
  Practice for Social Workers
• Irish Association of Social Workers,
  2011. Available at
• www.glen.ie/attachments/IASW_LGB_Mental_Health_Gui
  de.PDF
• Appropriate Therapeutic Responses to Sexual
  Orientation
• American Psychological Association,
  2009. Available at
• www.glen.ie/attachments/APA_Therapeutic_Responses.
  PDF

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Resources for Professionals Gender Identity

• Standards of Care for the Health of Transsexual,
  Transgender and Gender Nonconforming People
• The World Professional Association for
  Transgender Health, 2012. Available at
• www.glen.ie/attachments/WPATHstandards.PDF
• Guidance for GPs, Other Clinicians and Health
  Professionals on the Care of Gender Variant
  People Transgender Wellbeing and Healthcare
• National Health Service, 2008. Available at
• www.gires.org.uk/assets/DOH-Assets/pdf/doh-guideli
  nes-for-clinicians.pdf
• GIRES Gender Identity Research and Education
  Society
• www.gires.org.uk/index.php

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Irish LGBT Reports

• LGBT Health Towards Meeting the Healthcare Needs
  of Lesbian, Gay, Bisexual and Transgender People
• Health Service Executive, 2009. Available at
• www.glen.ie/attachments/HSE_LGBT_Health_Report.PDF
  
• Supporting LGBT Lives A Study of the Mental
  Health and Wellbeing of Lesbian, Gay, Bisexual
  and Transgender People
• Mayock, Bryan, Carr Kitching, 2009. Available
  at
• www.glen.ie/attachments/Supporting_LGBT_Lives_Repo
  rt.PDF
• Visible Lives Identifying the Experiences and
  Needs of Older Lesbian, Gay, Bisexual and
  Transgender people in Ireland
• Higgins, Sharek, McCann, Sheerin, Glacken, Breen
  McCarron, 2011. Available at
• www.glen.ie/attachments/Visible_Lives_Report.PDF