Mental health has become one of the most pressing concerns for the NHS in this generation. With one in four people experiencing a mental health problem at some point in their life and more young people reporting mental health problems, the NHS needs to expand services to adapt.
Different populations and communities will have specific needs and may have different mental health problems. This includes those in the lesbian, gay and bisexual (LGB) community who will experience and approach mental health problems differently. This could be because the root cause of their mental health problems stems from things such as bullying, stigma and prejudice based on their sexuality, which most heterosexual individuals will not have to face.
The LGB community has a particular set of mental and physical health needs in comparison to the general population. While transgender individuals are often included in discussions about this community, they will not be discussed in this article.
Research into the prevalence of mental health issues in the LGB community is still fairly thin. A survey by Stonewall conducted in 2013 found that 27% of gay and bisexual men had thought about suicide compared with 4% of heterosexual men. Over half (53%) of gay and bisexual men reported taking drugs in the last year.1
However, despite the fact that the little research available indicates that this particular group is more likely to experience mental health problems, few healthcare professionals feel confident in discussing this with them.
At this year’s RCN Congress Stewart Attridge, a HIV clinical nurse specialist at the Cardiff Royal Infirmary, began a debate on mental health services for the LGB community. A powerful debate full of facts and personal anecdotes around nurses’ experiences of working with this community followed. RCN members present voted that the RCN should lobby for improved mental health services for LGB patients. The motion was passed by 96.4%, showing the recognition that this community needs more targeted services.
Student nurse Grant Byrne, summed up the crux of the debate by saying: ‘No-one chooses to be gay, but they do choose to access our services. They must be designed to meet our patients’ needs.’
Recent research from Stonewall of more than 1800 healthcare professionals, including nurses, mental health workers and doctors, highlighted that there are still healthcare professionals that stigmatise patients who aren’t heterosexual.2 A quarter of patient-facing staff had heard their colleagues make negative remarks about LGB people or use discriminatory language in the past five years. Sixteen per cent of staff reported that they would not feel confident challenging colleagues who made negative remarks about LGB people.
Nurses have a professional responsibility to not let their own feelings and views hinder the care they provide to patients, says Mr Attridge. ‘It comes down to if the nurse felt uncomfortable with different sexualities then you would hope that they wouldn’t put the patient to any kind of harm but would refer them to someone who was able to give more appropriate care.’
He acknowledged that certain nurses such as those specialising in sexual health or mental health may be more likely to see cases where sexuality is a defining factor in a patient’s physical or mental health.
Alongside negative feelings towards the LGB community is the fact that many healthcare professionals do not appreciate the role that sexual orientation can have in a person’s mental health. Fifty-seven per cent of social care practitioners such as nurses, mental health workers, social care workers say that they don’t consider sexual orientation to be relevant to one’s health needs.2 One in 10 respondents to the Stonewall survey said they were not confident in their ability to understand and meet the needs of LGB patients.2
Although all Trusts and healthcare settings are required to provide diversity and equality training for staff, there is no mandatory training for working with members of the LGB community. ‘I think one of the key problems is that nurses get a lot of diversity awareness training but it needs to focus on different groups so nurses have the confidence to start the conversation and the awareness to ask the questions,’ says Jason Warriner, chair of the RCN’s public health forum.
Mr Warriner says that the local population’s health needs should be taken into account when providing training for nurses. They will then be able to provide the appropriate information and signpost patients to services.
Not only are patients feeling discriminated against, but NHS staff who are part of the LGB community also said they felt that colleagues let their personal feelings cloud their judgement.2
While there is not much current training for nurses around supporting LGB patients there are a number of resources across England, Wales and Scotland to help educate and support nurses.
The RCN developed a toolkit to help nurses support young LGB people having suicidal thoughts. The toolkit contains practical advice for all nurses working with young people, including school nurses and practice nurses. It provides information to raise awareness in all nurses of the specific needs of LGB young people when it comes to suicide prevention.
The toolkit was created in collaboration with Public Health England (PHE) after a motion was passed at the RCN Congress last year for the RCN to lobby for all student nurses to have suicide prevention training.
Justin Varney, national lead for adult health and wellbeing at PHE, explained that there are two toolkits: one for adults and one for children. ‘The toolkit talks about the things you can do as a practice and as an individual to indicate to LGB individuals that [general practice] is a safe place for them to be themselves. There are a series of resources in the toolkit, web links and phone numbers for national agencies to remind nurses that there is support for them too.’
Mr Varney also points towards existing and forthcoming e-learning modules hosted on the Royal College of General Practitioners’ (RCGP’s) website. ‘We know from evidence that LGB youth are at increased risk of self harm and suicide attempts and therefore there is a need that must be met. This is why we have developed the resource and we have other things in the pipeline.’
PHE will be launching two new e-learning modules on the RCGP platform and they will be free for anyone to access for the next two years. The first will be an introduction to LGB issues and the second is specifically around the needs of LGB individuals in certain faith groups, with disabilities and in other sub-communities.
In Scotland, the LGBT Mental Health Audit Tool, was launched in 2014 as a guide to show mental health services and organisations how they could become more inclusive. The tool was developed with input from the Scottish Recovery Network, the Scottish Government, NHS Health Scotland, Consultation and Promotion Service (CAPS) and NHS Lothian. The aim of the audit tool is to gain an overall snapshot of a mental health service so healthcare professionals can think about the ways they can develop their practice to support LGBT inclusion.
The Rainbow Project in Northern Ireland provides LGB counselling, support and signposting to services. The project provides sexual health advice, support and advocacy for patients.
A small pool of resources are available for nurses who wish to learn more about supporting LGB patients with mental health concerns but they require nurses to proactively seek them out. However, despite there being so much emphasis on mental health, the NHS needs to figure out how to tailor services for various different sections of the population and how better to train and support primary care nurses to be open with the LGB community. IN
1. The Rainbow Project.
2. LBGT Mental Health Tool.
3. Preventing suicide among lesbian, gay and bisexual young people.
1.Guasp A. Gay and Bisexual Men’s Health Survey. Stonewall. 2013. http://www.stonewall.org.uk/sites/default/files/Ga...
2. Unhealthy attitudes, the treatment of LGBT people within health and social care services. Stonewall. 2015.