A yes vote is vi­tal for the men­tal health of LGBTI Aus­tralians. That's a fact

The Guardian Australia - - News - Kam­ran Ahmed

With the au­tho­ri­sa­tion of an un­nec­es­sary postal vote on mar­riage equal­ity, the public de­bate has pre­dictably turned into a cir­cus. So it should per­haps come as no sur­prise that the in­tel­lec­tual equiv­a­lent of cus­tard pies are be­ing thrown. False claims by the no cam­paign that mar­riage equal­ity would some­how con­sti­tute an at­tack on free­dom of speech and set in mo­tion a chain of events cul­mi­nat­ing in young boys hav­ing to wear dresses in schools are as imag­i­na­tive as they are in­ac­cu­rate.

The ques­tion would per­haps bet­ter be phrased as fol­lows: does Aus­tralia wish to stop sense­lessly dis­crim­i­nat­ing against a mi­nor­ity group, or not? De­spite the prime min­is­ter declar­ing that he has more im­por­tant things to fo­cus on than this is­sue, a yes vote is vi­tally im­por­tant for the sake of equal rights as well as the mes­sage of ac­cep­tance it would send to LGBTI peo­ple in Aus­tralia.

Aus­tralia, like ev­ery other coun­try in the world, has a long tra­di­tion of dis­crim­i­na­tion against peo­ple based on their sex­ual ori­en­ta­tion, the men­tal health ef­fects of which are strik­ing. Gay men and women have higher rates of a range of men­tal health prob­lems in­clud­ing de­pres­sion, anx­i­ety dis­or­ders, sub­stance abuse prob­lems and sui­ci­dal thoughts and be­hav­iour. Th­ese rates ap­ply to young LGBTI peo­ple too – who are more than three times as likely to have at­tempted sui­cide than their hetero­sex­ual peers.

Th­ese higher rates of psy­cho­log­i­cal dis­tress and men­tal ill­ness have been well ex­plained by “mi­nor­ity stress” the­ory. Ini­tially de­scribed in re­la­tion to the gay com­mu­nity, it could rea­son­ably be ap­plied to any mi­nor­ity group fac­ing dis­crim­i­na­tion. The the­ory pro­poses that LGBTI in­di­vid­u­als are a dis­ad­van­taged mi­nor­ity group and face three ad­di­tional types of stress not ex­pe­ri­enced by the ma­jor­ity: the ob­jec­tive ex­pe­ri­ence of ho­mo­pho­bic abuse, both phys­i­cal and ver­bal; “per­ceived stigma” or the ex­pec­ta­tion of dis­crim­i­na­tion, which leaves peo­ple in a state of high alert and slowly chips away at their psy­cho­log­i­cal de­fences; and the in­ter­nal­i­sa­tion of neg­a­tive at­ti­tudes or “in­ter­nalised ho­mo­pho­bia”, re­fer­ring to LGBTI peo­ple ab­sorb­ing the neg­a­tive at­ti­tudes around them which trag­i­cally fos­ters a mis­guided self-per­cep­tion of in­fe­ri­or­ity.

Sub­se­quent re­search has bol­stered sup­port for the mi­nor­ity stress the­ory, link­ing the three in­gre­di­ents of this toxic cock­tail to high lev­els of dis­tress and sui­ci­dal thoughts and be­hav­iour. So it is clear as day that stigma and prej­u­dice are com­pro­mis­ing the men­tal health of LGBTI Aus­tralians.

It is fair to then ask whether or not mar­riage equal­ity is the an­ti­dote to this prob­lem, since it would not nec­es­sar­ily erad­i­cate stigma and prej­u­dice against LGBTI peo­ple. We can, in fact, con­fi­dently say it would have a pos­i­tive ef­fect on their men­tal health – an Amer­i­can study found a sig­nif­i­cant re­duc­tion in men­tal health care vis­its and costs for gay men in the year af­ter le­gal­i­sa­tion of same-sex mar­riage when com­pared with the 12 months prior. This was true for sin­gle men as well as those in a re­la­tion­ship, sug­gest­ing it may be the prin­ci­ple of ac­cep­tance rather than the ac­tual abil­ity to marry that makes a dif­fer­ence.

Con­versely, an­other study found that US states ban­ning same-sex mar­riage saw a rise in the num­ber of var­i­ous psy­chi­atric con­di­tions, with nearly 3.5 times the preva­lence of gen­er­alised anx­i­ety dis­or­der. So the con­nec­tion be­tween mar­riage equal­ity and bet­ter men­tal health in the LGBTI com­mu­nity is also clear.

As well as be­ing an equal rights is­sue, this is a public health is­sue, as mat­ters of equal­ity of­ten are. One of the pri­mary func­tions of any na­tion is to pro­tect and en­hance the well­be­ing of its cit­i­zens. Since the in­sti­tu­tion of mar­riage is seen by many as a recog­ni­tion by the state of the love and com­mit­ment be­tween two peo­ple, ex­clud­ing LGBTI in­di­vid­u­als from such an im­por­tant rite of pas­sage is dis­crim­i­na­tory and per­haps even abu­sive. The clear ev­i­dence of the men­tal health ill-ef­fects of dis­crim­i­na­tion against LGBTI peo­ple should firmly ban­ish out­dated poli­cies to the past where they be­long.

Gov­ern­ments are not the only in­sti­tu­tion guilty of stig­ma­tis­ing LGBTI peo­ple, of course – my own pro­fes­sion of psy­chi­a­try also has a shame­ful his­tory of sys­tem­atic dis­crim­i­na­tion against them, with ho­mo­sex­u­al­ity classed as a psy­chi­atric dis­or­der un­til as late as 1973. Psy­chi­a­try was crim­i­nally slow in real­is­ing the dis­tress associated with be­ing gay was caused by so­ci­etal at­ti­tudes. Now that we have this un­der­stand­ing it would be crim­i­nal to dis­re­gard it and to con­tinue ex­pos­ing LGBTI peo­ple to dam­ag­ing prej­u­dice when mar­riage equal­ity pro­vides a clear path to chang­ing at­ti­tudes and im­prov­ing LGBTI men­tal health.

Kam­ran Ahmed is a psy­chi­a­trist and film-maker, writ­ing on men­tal health, cul­ture, pol­i­tics and health­care

Cri­sis sup­port ser­vices can be reached 24 hours a day: Life­line 13 11 14; Sui­cide Call Back Ser­vice 1300 659 467; Kids Helpline 1800 55 1800; Men­sLine Aus­tralia 1300 78 99 78; Be­yond Blue 1300 22 4636. QLife is an Aus­tralian coun­selling ser­vice for LGBTQI+ peo­ple that op­er­ates ev­ery day be­tween 3pm and mid­night AEST. Call 1800 184 527, or visit the web­site to ini­ti­ate a text-based chat

In the UK the Sa­mar­i­tans can be con­tacted on 116 123. In the US, the Na­tional Sui­cide Preven­tion Life­line is 1-800-273-8255. Other in­ter­na­tional sui­cide helplines can be found at www.be­frien­ders.org

‘As well as be­ing an equal rights is­sue, this is a public health is­sue, as mat­ters of equal­ity of­ten are.’ Pho­to­graph: Lisa Ma­ree Wil­liams/Getty Images

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