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Lesbians, gay men and bisexuals and mental health |
Introduction
Definitions
Mental health of LGB people
Effects of homophobia and heterosexism on
mental health
Introduction
Internalised homophobia
Interpersonal factors
Cultural factors
Institutional homophobia
Legislative change
The impact of homophobia
LGB experiences of mental health services
Homosexuality as a 'mental illness'
Discrimination in mental health services
LGB-friendly services
Other diverse groups
Introduction
Young people
Older people
Black and minority ethnic people
People with disabilities
People with HIV/AIDS
Taking action
Introduction
‘Coming out’
Information and support services
Social opportunities
Further reading
Useful organisations
References
Introduction
This factsheet is for lesbians, gay men and bisexuals (often referred to using
the collective initials LGB; see below), especially those with experience of
mental distress. It may also be of interest to the friends and family of LGB
people, to students and to people who work in public, voluntary and community
services.
This factsheet provides information on the types of mental distress experienced
by LGB people, the social factors that affect their mental health, and the
experiences of LGB people in mental health services. The final section describes
ways that LGB people can develop and maintain good mental health in the context
of a positive sexual identity.
This factsheet does not cover transgender or gender identity issues. Mind
produces a separate online booklet, Understanding
gender dysphoria,
which includes a list of useful organisations.
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Definitions
'Sexuality' or 'sexual orientation' describes the combination of emotional,
romantic, affectionate and sexual attraction towards another person. Lesbians
and gay men experience this attraction towards members of their own sex;
bisexuals experience this attraction towards members of both sexes. It is
estimated that 5–7 per cent of people in the UK are lesbian, gay or bisexual.
[1]
Although the initials 'LGB' are used by service providers and government policy
makers to refer collectively to people who are lesbian, gay or bisexual, people
whose sexuality is defined under this term are not a homogeneous group. The
attitudes, values and degree of shared identity within and between lesbians, gay
men and bisexuals varies widely.
Many people who experience same-sex attraction reject the terms 'lesbian' or
'gay' and chose to define their sexuality by other terms. Some people chose not
to define their sexuality at all and identify as 'label free'. More information
about these issues can be obtained from the LGB campaigning organisation
Stonewall (see ‘Useful organisations’).
Mental health of LGB people
Little is known about the mental health of LGB people in the UK. Information is
not collected at national level, and health authorities are not required to
monitor the sexuality of service users. However, several studies have been
carried out in recent years by statutory mental health services, as well as by
voluntary and community organisations such as Mind.
[2]
The available evidence suggests that anxiety, depression, self-harm and suicidal
feelings are more common among LGB people than among heterosexual people. Rates
of drug and alcohol misuse are also higher among LGB people. In all studies,
bisexual men and women were usually found to have the highest levels of mental
distress.
[3] [4]
These findings reflect those of a recent review of international literature on
the mental health of LGB people.
[5] This
review showed that LGB people are at significantly higher risk than heterosexual
people of suicidal feelings, self-harm, drug or alcohol misuse and having a
mental health problem. The findings were generally similar for men and women;
however, lesbian and bisexual women were at particular risk of suicidal feelings
and drug or alcohol dependence, while gay and bisexual men were over four times
more likely than heterosexual men to attempt suicide.
The reasons for these findings are complex and not yet fully understood.
However, poor mental health in LGB people has often been linked to experiences
of homophobic discrimination and bullying;
[6] this
is explored later in this factsheet.
LGB people, like heterosexual people, can experience mental distress for reasons
unconnected with their sexuality. However, it is widely accepted that a range of
social factors can affect the lives of LGB people and are likely to have an
impact on mental health. For some, other personal and social characteristics
such as age or ethnicity can further complicate an experience of mental
distress. These issues are discussed later in this factsheet.
Effects of homophobia and heterosexism on mental health
Introduction
Social factors that adversely affect the mental health of LGB people have their
roots in homophobia or heterosexism.
-
Homophobia has been defined as 'the irrational hatred,
intolerance and fear of LGB people.'
[7]
-
Heterosexism is 'bias shown by a society or community
where cultural institutions and individuals are conditioned to expect everyone
to live and behave as heterosexuals.'
[8]
While homophobia can cause the most obvious harm to LGB people, such as bullying
and violent attacks, heterosexism can cause more subtle damage to self-image and
self-esteem. Most societies, including those in the UK, are homophobic and
heterosexist to varying degrees, although there is evidence that this situation
has been improving in the UK in recent years, and continues to do so.
Internalised homophobia
LGB people who are brought up in a homophobic society can
come to believe these homophobic ideas, and develop negative feelings towards
their own sexuality. This is known as 'internalised homophobia' and can result
in low self-esteem and feelings of self-hatred.
[9] Internalised
homophobia is likely to have serious adverse effects on mental health.
Interpersonal factors
'Interpersonal homophobia’ refers to behaviour between individuals. Homophobia
may be expressed through jokes, verbal bullying or even physical violence.
Examples of interpersonal homophobia include negative attitudes from staff in
customer service environments, homophobic bullying in schools and homophobic
'hate crime'.
Cultural factors
'Cultural homophobia’ refers to the ways in which homosexuality is either
ignored or presented negatively throughout a culture. Homophobic beliefs and
values are transmitted through traditional rules and rituals (such as the
marriage ceremony in its religious context), through literature and the arts,
and through the mass media, including television and film. Mainstream culture
has been predominantly homophobic and heterosexist. Research by Stonewall in
2005 revealed that LGB people were under-represented on the BBC and were most
likely to be used as the subject of a joke or portrayed in a negative way.
[10] However,
in recent years LGB people have gained more positive visibility in the
mainstream media through films such as Brokeback Mountain and several
prime-time television programmes.
Institutional homophobia
Many of our social and economic institutions have a history of promoting
heterosexuality as the norm, running services and developing policies that do
not take account of the needs of LGB people. Where LGB people have been
recognised, their sexuality has often been seen as inferior or morally wrong.
The legal system, the armed forces, public services, including health and
education, and many religions have histories of institutionalised homophobia.
Legislative change
Organisations in the LGB sector have been campaigning against institutional
homophobia for many years. More recently, the issue has been recognised by many
institutions themselves, and action has been taken to improve the situation. The
following key pieces of legislation have been developed.
Repeal of Section 28 (2003)
Section 28 of the Local Government Act (1988) made it illegal for teachers to
'promote' homosexuality in schools, and labelled gay family relationships as
'pretend'. The repeal of Section 28 gives scope for LGB issues to be accorded
the same status as other personal and social issues within the education system.
Employment Equality (Sexual Orientation) Regulations (2003)
This Act protects people in the workplace from discrimination relating to their
sexual orientation. It covers the full range of workplace issues, from terms and
conditions and pay to recruitment and dismissal.
Civil Partnership Act (2004)
Since this Act came into force in 2005, same-sex couples have been able to
register as civil partners and gain the same legal rights and responsibilities
as married couples. This includes pensions and inheritance rights, and 'next of
kin' status under the Mental Health Act. Further information about the Mental
Health Act is provided in the Mind booklet The Mental Health Act 1983 – an
outline guide.
Sexual Orientation Regulations (2007)
This Act protects people from discrimination relating to sexual orientation by
any provider of goods or services. The regulations cover all sectors (public,
private and voluntary) and include services as diverse as healthcare, housing,
finance and leisure.
More information on anti-discrimination legislation and how it is being applied
can be obtained from Stonewall (see ‘Useful organisations’).
The impact of homophobia
Being lesbian, gay or bisexual is not in itself a mental health problem;
however, coping with the effects of homophobia can be highly detrimental to the
mental health of a lesbian, gay or bisexual person.
Over the past ten years, studies have suggested that internalised homophobia
(defined above) is a risk factor for alcohol and drug dependency among LGB
people. Anxiety, depression, self-harm, suicide and attempted suicide have also
been linked with the combination of prejudice or discrimination and internalised
negative feelings.
[11]
A study by Imperial College London in 2004 demonstrated a possible link between
levels of homophobic discrimination and mental ill-health among LGB people.
Researchers found that the incidence of mental distress, including anxiety,
depression and self-harm, was higher than average among the LGB participants.
The majority of this sample (83 per cent) had experienced damage to property,
physical attacks or verbal bullying.
[12]
Research by Stonewall has highlighted the association between homophobic
bullying and mental ill-health, including low self-esteem, fear, stress and
self-harm, [13] and
the organisation is currently campaigning to address the problems of homophobic
bullying and discrimination in schools.
Research from Stonewall focusing specifically on the health of lesbians and
bisexual women has found rates of self-harm, suicide attempts and eating
disorders are significantly higher than those found among heterosexual women.
The same report drew attention to widespread discrimination and negative
attitudes towards lesbians and bisexual women within health services. Examples
included inappropriate comments from healthcare professionals and unwelcoming
attitudes to same-sex partners.
[14]
LGB experiences of mental health services
Homosexuality as a 'mental illness'
[15]
For most of the twentieth century, LGB people who were open about their
sexuality experienced oppression and abuse within mental health services. This
occurred partly because mental health services reflected the homophobia of the
wider society, but also because such homophobia was given legitimacy within
psychiatry and psychology by theories of mental illness that ‘pathologised’
homosexuality. Homosexuality could be seen as the cause or effect of a mental
illness, or even as a mental illness in itself. LGB people were subjected to
damaging attempts to 'cure' them of their sexuality, including hospitalisation
and aversion therapy. Such treatments remained common throughout the 1960s and
1970s. The Government did not officially strike 'homosexuality' off its list of
psychiatric disorders until 1993.
Discrimination in mental health services
Fortunately, such pathologising of homosexuality and overt discrimination
against LGB people is rare nowadays. However, some problems remain. LGB people
who have used statutory mental health services and counselling or psychotherapy
services outside the NHS continue to experience discrimination relating to their
sexuality. Such discrimination is likely to be the result of a lack of awareness
among practitioners and service providers rather than an intention to
discriminate.
[16]
A study by Mind and University College London
[17] found
that the main issues for LGB people in mental health services are:
-
encountering mixed or negative reactions when being open about their sexuality
with health professionals
-
a lack of empathy around sexuality issues on the part of health professionals
-
visible discomfort on the part of health professionals, and deliberate
attempts to avoid discussing sexuality
-
the assumption that all service users are heterosexual
-
the assumption that being gay, lesbian or bisexual must be a problem for LGB
service users
-
a minority of health professionals still make a causal link between
homosexuality and mental ill health
-
a minority of health professionals still display overt homophobia.
The British Association for Counselling and Psychotherapy (BACP) has conducted a
literature review of the experiences of lesbian, gay, bisexual and transgender
people who have received counselling or psychotherapy services. The review
identified gaps in knowledge and negative attitudes among some therapists, and
BACP recommends that these problems should be addressed and part of therapists'
training.
[18]
Research from Stonewall focusing specifically on the health of lesbians and
bisexual women found discrimination and negative attitudes towards lesbians and
bisexual women within health services. Examples included inappropriate comments
form healthcare professionals and unwelcoming attitudes to same-sex partners.
[19]
In 2006, the annual census of inpatient mental health facilities in England and
Wales
[20] included
a question on sexuality for the first time. However, it is believed that the
results of this census under-represent the actual number of LGB people on
inpatient wards – reflecting the reluctance of some LGB patients to disclose
their sexuality, and discomfort among ward staff in asking the question.
[21]
As described in the section ‘Sexual Orientation Regulations’, LGB people are now
legally protected from discrimination relating to their sexual orientation from
providers of goods and services; this includes providers of mental health
services. However, evidence suggests that legislation has not yet led to the
cultural change that would bring about full equality for LGB people in mental
health services.
LGB-friendly services
Some LGB people who seek counselling or psychotherapy services wish to choose a
practitioner who identifies themselves as lesbian, gay or bisexual, or who has
stated that they have a positive attitude towards LGB issues.
[22]
Local LGB-friendly counsellors or therapists can be found in local directories
if there is an LGB information and support service (often called a
'switchboard') in the area. Alternatively, national services, such as MindinfoLine
or the London Lesbian and Gay Switchboard (LLGS; see ‘Useful organisations’)
can help. In addition, the organisation Pink Therapy provides a list of
counsellors and therapists who either identify as lesbian, gay or bisexual, or
who have adopted a positive approach to working with sexual or gender minority
clients; see 'Useful organisations' for contact details.
Local LGB groups or services may be able to recommend individual counsellors and
therapists based on their members' personal experiences.
It has also been noted that counsellors and therapists who specialise in
sexuality or sexual identity are likely to be positive towards LGB issues.
As when choosing any counsellor or therapist, it is important to check that the
practitioner is registered with a relevant professional association such as the
British Association of Counselling and Psychotherapy (BACP). General information
on choosing a counsellor or therapist can be found in the Mind booklet
Understanding talking treatments.
Other diverse groups
Introduction
Everyone has personal and social characteristics that can affect their private
lives and their treatment in society. Some of these characteristics are
temporary (such as age), while others (such as ethnicity) stay with us for life.
Our awareness and experiences of being part of any social group is likely to
change over time.
In addition to being lesbian, gay or bisexual, LGB people may find that other
characteristics such as age, ethnicity or other health issues can affect their
mental health or complicate an experience of mental distress.
Like LGB people, people from other diverse groups are now protected by law
against discrimination on the basis of age, disability, gender, race/ethnicity,
religion and sexual orientation. Currently, different groups experience
different levels of protection under law, though there are currently moves to
rationalise the law and give all groups equal protection. More information on
equality and diversity issues can be obtained from the Equality and Human Rights
Commission (see ‘Useful organisations’).
Young people
Young LGB people may face particular problems.
-
They may not have access to information about their sexuality.
-
At an age where conformity and acceptance is important, they may try to
conceal their sexuality from their family and friends to avoid rejection.
-
They may already experience 'internalised homophobia' and find it hard to
accept their sexuality.
Young people who identify themselves as lesbian, gay or bisexual have been found
to face a higher risk of being bullied at school. Recent research by the
campaigning organisation Stonewall found that almost two-thirds (65 per cent) of
lesbian, gay or bisexual pupils had experienced homophobic bullying in school;
this figure was 75 per cent for faith schools. Such bullying has a powerful
negative effects on pupils' health and wellbeing. Among LGB adults who had been
bullied at school, 50 per cent had contemplated suicide or self-harm.
[23]
More positively, the combination of legislative change, the increased visibility
of LGB people in the mainstream media and the availability of new communication
technologies has given young LGB people unprecedented opportunities for social
contact and support. Age-appropriate services now exist across England and Wales
for LGB people seeking information, advice, support and the opportunity to meet
other LGB people.
Local directories will list any local LGB information and support service (often
called a 'Switchboard') operating. Alternatively, you can contact a service with
national coverage, such as MindinfoLine or the LLGS (see ‘Useful
organisations’).
Older people
The term 'older' embraces several different generations. Some people like to
identify themselves as 'older' and others do not. The issues facing a
50-year-old lesbian or gay man are likely to be different from those relevant to
a person of 80 years. Rigid categorisation can be disempowering and unhelpful.
Some older lesbians and gay men may have been subjected to psychiatric treatment
in the past in an attempt to 'cure' them, which may have left a legacy of guilt
and emotional damage. Many others will have stayed 'closeted' throughout their
lives. Others were active with the gay liberation movement and the women's
movement.
Ageism within society has meant that older people are often depicted as
unattractive and socially boring. The 'gay scene' is no exception and is mostly
geared towards younger people.
Despite the lack of social opportunities generally, some older lesbians and gay
men have long-established support networks. In addition, a number of
organisations at both local and national level provide social opportunities,
information, advice and support specifically for older LGB people. Moreover, the
new communication technologies such as social networking sites can be just as
useful to older as to younger LGB people.
Some organisations that work with older people fail to take into account the
fact that a service user may not be heterosexual. Sheltered housing and
residential care are usually mixed sex and are geared towards heterosexuals.
However, some of the main national organisations that work for older people have
now publicly recognised their LGB members and service users. Two examples are
The Alzheimer's Society, which now runs a telephone support service for lesbian,
gay, bisexual and transgender carers,
[24] and
Age Concern's 'Opening Doors' programme, which has developed a programme of
publications and other resources for and about older LGB people.
[25]
Black and minority ethnic people
Black and Asian LGB people may face double discrimination, being at risk of
negative perceptions and treatment on the basis of both their sexuality and
their visible ethnicity. LGB people whose minority ethnicity is less visible
(for example, Eastern European people) are less likely to experience some forms
of racial discrimination. However, they may face language barriers and other
cultural problems when trying to access LGB services and social opportunities.
As discussed in the section ‘Effect of homophobia and heterosexism on mental
health’, most ethnic groups, both majority and minority, have a history of
homophobia. This means that LGB people from black and minority ethnic groups may
feel that they have to choose between their sexuality and their cultural
identity; they may fear exclusion from the support networks of friends, family
and culturally specific organisations if they 'come out' (i.e. tell other people
about their sexuality).
Black and minority ethnic people now have increased visibility and face less
discrimination within the LGB sector than was formerly the case.
[26] The
main LGB organisations such as Stonewall and the LLGS provide resources on
issues relating to black and minority ethnic groups, reflected in their media
publicity.
Several organisations work to promote and support LGB people from particular
ethnic groups. Contact details and descriptions of these services can be found
under ‘Useful organisations’.
People with disabilities
People with disabilities are frequently assumed not to have any sexuality at
all, and this applies equally well to disabled LGB people. Disabled people have
generally been pressurised to play down their sexuality, both in wider society
and in residential settings. Where the issue of sexuality is raised, most people
with disabilities – like most non-disabled people – are assumed to be
heterosexual.
LGB people are affected by the discrimination against disabled people that still
exists in society generally, including the perception that people with
disabilities lack sexuality. This discrimination can result in practical
barriers for people with disabilities who wish to participate in LGB events and
services: many LGB venues are not fully accessible for people with disabilities.
Some disabled people may require the input of unpaid carers (such as family
members) or paid personal assistants to carry out the tasks of everyday life.
Some disabled people draw on the support provided by networks or communities who
define themselves by health status, disability or experiences of social
exclusion. A suspicion of homophobia in such valued sources of support can make
the process of 'coming out' extremely risky for a disabled person.
Fortunately, in addition to improving awareness of disability issues within the
LGB community, several organisations work to promote the needs of and support
LGB people with specific disabilities. Contact details and descriptions of these
services are given under ‘Useful organisations’.
People with HIV/AIDS
Some gay men encounter fear, harassment and/or discrimination on the grounds
that they could be HIV-positive or have AIDS. In reality, HIV/AIDS predominantly
affects heterosexual people worldwide, even though gay men were the first to
develop HIV-related illnesses in significant numbers in the West.
Since the early 1980s, HIV/AIDS organisations have paid particular attention to
the emotional needs of people with HIV/AIDS. For example, the Terrence Higgins
Trust has a helpline and offers counselling for anyone with or concerned about
HIV/AIDS. Some mental health professionals have specialised in the mental health
needs of people with HIV/AIDS. Such services have generally had a strong input
from gay men and are less likely to be discriminatory than mainstream mental
health services.
[27] The
impact of HIV/AIDS has also raised awareness of the need for bereavement support
that acknowledges the grief of gay partners and friends.
[28]
Advances in the treatment of HIV infection in recent years have led HIV/AIDS
organisations to focus on eradicating stigma and discrimination, as well as
promoting safer sex practices and HIV testing.
[29]
All people living with HIV/AIDS now have the same legal rights as other disabled
people under the Disability Discrimination Act (2005).
Taking action
Introduction
Whether or not we have experienced mental distress or used mental health
services, it is likely that the way we experience our sexuality will affect our
health and wellbeing. LGB people can take action to develop good mental health
in the context of a positive sexual identity in many ways.
‘Coming out’
[30]
'Coming out' is the process of telling others about our sexuality. This is not
usually a one-off event: LGB people may come out to different people in
different ways over the course of their lives. Deciding whether or not to come
out, and the process of doing so, can have a powerful impact on health and
wellbeing.
Whether or not coming out improves health and wellbeing will depend on the
person's individual circumstances and needs. Some people decide that coming out
as gay, lesbian or bisexual would cause problems in their family (e.g. if they
are married) or in other areas of their social or personal life (e.g. if they
believe that a social group they are part of holds homophobic views). Coming out
may be particularly difficult if a person has not yet 'come out to themselves'
(i.e. recognised and accepted their own sexuality) or if they are experiencing
'internalised homophobia'.
While there is no one prescribed way to come out, many people have found the
following tips useful.
-
Don't feel under pressure to come out – take your time. Only you will know
when you feel comfortable and ready to do it.
-
If you decide to come out but are unsure how others might react, consider
making contact with a support group first. (The following section explains how
to find a support group.)
-
People who feel safe being visible and honest about being LGB can challenge
the stereotypes and prejudice others may have about being LGB.
-
If you do come out but get a negative reaction, don't despair. You might find
it helpful to speak to one of the information and support services listed in
the ‘Useful organisations’ section.
Most people who do come out find the process to be more positive than they had
expected, even if is it difficult at times. Long-term benefits can include
release from the strain of hiding sexuality, and having access to information
and support on emotional, sexual and social issues.
Information and support services
Information and support on LGB issues are available from various sources across
England and Wales. Most local areas are served by an LGB information and support
service known as a switchboard, which is usually listed in local telephone
directories. LLGS has national coverage, and other switchboards may have access
to information resources covering other parts of the country. Switchboards
answer enquiries and provide support on topics as diverse as social events,
coming out, sexual health, relationships and emotional issues.
Switchboards can also provide information on 'face to face' support that is
available in the community. These will differ between local areas but can
include support groups, counselling and befriending services.
Social opportunities
Social contact has well known benefits for our mental health.
[31] For
people in minority social groups, meeting others who identify in similar ways
can be empowering as well as enjoyable. Consequently, all switchboards provide
information on social opportunities for LGB people. Stonewall also provides the
resource, 'What's in my area?'
[32] which
covers arts and leisure activities as well as health and support services.
Social opportunities vary between local areas. Events and services may include:
-
discussion groups
-
sports clubs
-
arts groups (e.g. reading groups, art groups, film clubs)
-
bars, pubs or nightclubs that are either aimed at LGB people or have a mixed
clientele and a positive attitude to LGB customers
-
‘pride’ events, which celebrate the political empowering of LGB people and
present-day LGB life in all its diversity. (More information on prides and
mardi gras can be obtained from the Stonewall Info Bank.)
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