Bad. Fab­u­lous. Tough.

Gay Times Magazine - - ESSAYS - Words Jaymie Huck­ridge

For many LGBTQ peo­ple, liv­ing with dif­fer­ence is tough. There are well doc­u­mented chal­lenges across the life­span, in­clud­ing bul­ly­ing, hate crime, aban­don­ment, and self-ac­cep­tance, all of which have huge im­pli­ca­tions for men­tal health. His­tor­i­cally, our needs have been sup­ported by the com­mu­ni­ties that we iden­tify with, through peer sup­port, un­der­stand­ing, and a shared sense of pride. But the re­la­tion­ship be­tween LGBTQ peo­ple and men­tal health ser­vices has been a dif­fi­cult one. Ser­vices and the wider sys­tem of re­searchers and pol­i­cy­mak­ers that in­form them have at best failed to un­der­stand the needs of LGBTQ peo­ple, and at worst have col­luded with dam­ag­ing ideas about dif­fer­ence, with ef­fects that can still be felt to this day.

In the early 19th cen­tury, sex­u­al­ity be­gan be­ing stud­ied sci­en­tif­i­cally, mostly from the po­si­tion that dif­fer­ence was an ab­nor­mal­ity, a disease to be cured. This sta­tus not only le­git­imized dis­crim­i­na­tion, and the per­cep­tion of LGBTQ peo­ple as “less than”, it also led to some ab­hor­rent prac­tices in the name of med­i­cal treat­ment. As the fields of psy­chol­ogy and psy­chi­a­try de­vel­oped through­out the 20th cen­tury, a num­ber of treat­ments to “cure” non-het­ero­sex­ual peo­ple were in­vented around the world, their de­scrip­tions read­ing like the acts of hor­ror movie ghouls: ice pick lobotomies, elec­troshock, chem­i­cal cas­tra­tion, and aver­sion therapy. The last known lo­bot­omy to treat ho­mo­sex­u­al­ity was in 1951 in the USA, but the other treat­ments, many in­clud­ing hos­pi­tal­i­sa­tion, are well doc­u­mented through­out the 1960s in the UK.

While the work of re­searchers in­clud­ing Kin­sey and Hooker in the 1950s made some steps to recog­nise LGBTQ peo­ple as nor­mally func­tion­ing hu­man be­ings, it would be a long time for the re­la­tion­ship with the men­tal health sys­tem to be im­proved. Ho­mo­sex­u­al­ity was in­cluded as a men­tal dis­or­der in the in­flu­en­tial Di­ag­nos­tic Sta­tis­ti­cal Man­ual (DSM), and wouldn’t be dropped com­pletely un­til the re­vised third edi­tion in 1987. The World Health Or­gan­i­sa­tion (WHO) only re­moved ho­mo­sex­u­al­ity from the In­ter­na­tional Clas­si­fi­ca­tion of Dis­eases (ICD) in 1992, 25 years after the Sex­ual Of­fences Act par­tially de­crim­i­nalised ho­mo­sex­u­al­ity in the UK. For trans peo­ple, the most re­cent ICD in­cludes ‘gen­der in­con­gru­ence’ in a new chap­ter on sex­ual health, fi­nally re­mov­ing it from the cat­e­gory of men­tal health, and mak­ing steps to­ward end­ing pathol­o­gisi­a­tion that has led to some trans peo­ple feel­ing alien­ated by men­tal health ser­vices.

Since the 1970s, the LGBTQ com­mu­nity it­self has at­tempted to re­spond to this lack of un­der­stand­ing, through set­ting up sup­port groups, pro­duc­ing in­for­ma­tion, cam­paign­ing and es­tab­lish­ing or­gan­i­sa­tions like Switch­board, the LGBTQ helpline. For many, these ini­tia­tives have been lifesaving. But the com­mu­nity now faces great chal­lenges, with the clo­sure of LGBTQ spa­ces which may be re­duc­ing the op­por­tu­ni­ties for peo­ple to ac­cess vi­tal so­cial sup­port. Fund­ing cuts are also caus­ing the clo­sure of LGBTQ-spe­cific sup­port ser­vices, which have ex­per­tise in is­sues fac­ing the com­mu­nity. This lim­its the choice peo­ple have in where they ac­cess sup­port, as well as im­pact­ing on the men­tal health of vul­ner­a­ble peo­ple, es­pe­cially those on a low in­come.

Mir­ror­ing the shift in so­ci­ety’s at­ti­tudes in re­cent years, the men­tal health sys­tem has

made strides to­wards chang­ing its ap­proach so that it is bet­ter equipped to sup­port the range of in­di­vid­u­als who need it. The field of psy­chol­ogy con­tin­ues to de­velop the­o­ries, but cru­cially with the aim of un­der­stand­ing the LGBTQ ex­pe­ri­ence. This has in­cluded the­o­ries around iden­tity and the process of com­ing out for prac­ti­tion­ers to use with LGBTQ clients. Work­ing with dif­fer­ence is in­cluded in pro­fes­sional train­ing pro­grammes, and pub­li­ca­tions have ex­plored adapt­ing ev­i­dence-based in­ter­ven­tions such as Cog­ni­tive Be­havioural Therapy (CBT) to LGBTQ spe­cific is­sues. Sur­viv­ing fund­ing cuts, or­gan­i­sa­tions like Switch­board, Pink Therapy, and Metro Cen­tre con­tinue to help LGBTQ peo­ple to find the right sup­port for them. The in­crease in openly LGBTQ men­tal health prac­ti­tion­ers and de­ci­sion mak­ers like MPs and com­mis­sion­ers has also al­lowed for in­creased dis­cus­sions around how ser­vices can best sup­port peo­ple, of­ten with lim­ited re­sources, as well as in­flu­enc­ing na­tional pol­icy. These shifts have meant that the NHS has cre­ated some ser­vices to bet­ter meet the spe­cific needs of LGBTQ peo­ple, with world class ser­vices es­tab­lished in­clud­ing the Tav­i­s­tock’s gen­der iden­tity de­vel­op­ment ser­vice and Dean Street’s chem­sex sup­port ser­vice, both in Lon­don.

But there is still a great deal of work to be done to build ap­pro­pri­ate men­tal health ser­vices for LGBTQ peo­ple that are ac­ces­si­ble, rel­e­vant, and trust­wor­thy – par­tic­u­larly if you don’t live in a ma­jor city. Re­cent data suˆests that LGBTQ peo­ple in the UK are 40% more likely to ex­pe­ri­ence de­pres­sion than the gen­eral pop­u­la­tion, twice as likely to end their lives by sui­cide, and seven times as likely to take drugs. A third of gay men, a quar­ter of bi­sex­ual men, and over 40% of les­bians have ex­pe­ri­enced neg­a­tive or mixed re­ac­tions from men­tal health prac­ti­tion­ers when they dis­closed their sex­ual ori­en­ta­tion. Many ap­proach ser­vices cau­tiously, know­ing that they may not be un­der­stood, be pathol­o­gised, or have lit­tle say over who they see and the val­ues they may hold. For some young peo­ple, get­ting a re­fer­ral to ac­cess sup­port may re­quire their fam­ily GP or school to be in­volved, while many older peo­ple with ex­pe­ri­ence of the past abuse of the health­care and jus­tice sys­tems have lit­tle faith in them. There is of­ten a fur­ther bar­rier to ac­cess­ing men­tal health ser­vices for peo­ple from Black, Asian and other mi­nor­ity back­grounds, who re­port in­creased stigma within their com­mu­ni­ties around dis­cussing their men­tal health.

Con­ver­sion in­ter­ven­tions are of course still prac­ticed, and while they may sound far more sub­tle, they are no less dam­ag­ing than their pre­de­ces­sors and are based on the same as­ser­tion that ho­mo­sex­u­al­ity can be ”cured”. Un­der the guise of coun­sel­ing, sup­port groups, and “spir­i­tual in­ter­ven­tions”, they claim to change the sex­u­al­ity of in­di­vid­u­als de­spite no valid sci­en­tific ev­i­dence of ef­fi­cacy; there are many sur­vivors who at­test to the harm the ex­pe­ri­ence of con­ver­sion has caused. The UK govern­ment’s re­cent re­search into the ex­pe­ri­ences of LGBTQ peo­ple found that 5% had been of­fered such in­ter­ven­tions, of­ten by faith or­gan­i­sa­tions. As a re­sult of this re­search the govern­ment pub­lished a 75 point plan to im­prove the lives of LGBTQ peo­ple, with ac­tion to pre­vent the use of con­ver­sion in­ter­ven­tions in the UK be­ing a key pri­or­ity.

His­tor­i­cally, the men­tal health sys­tem has un­der­stood LGBTQ peo­ple as both bad and mad, and has been in­stru­men­tal in main­tain­ing dis­crim­i­na­tion. The govern­ment’s re­cent LGBT Ac­tion Plan, an­nounced in July, makes a com­mit­ment to ap­point­ing a na­tional LGBT health ad­viser fo­cus­ing on re­duc­ing the heath in­equal­i­ties for LGBTQ peo­ple, and to ex­plore ways to

im­prove the care they re­ceive from ser­vices. The chal­lenge for this ad­vi­sor will be mean­ing­fully en­gag­ing with LGBTQ peo­ple and pro­vid­ing space for them to openly dis­cuss their men­tal health, their sex­u­al­ity and the chal­lenges cur­rently fac­ing the com­mu­nity. It will also be im­por­tant for them to re­flect on the past, and the rip­ple ef­fect that has lim­ited the scope of avail­able sup­port and caused hes­i­tancy to ac­cess it. For the LGBTQ com­mu­nity, his­tory has taught us about the im­por­tance of sup­port­ing each other, claim­ing the spa­ces where we can be open, and cam­paign­ing for our right to be treated with dig­nity and re­spect. We all have a role to play, whether sign­ing a pe­ti­tion, tak­ing part in con­sul­ta­tions, or sim­ply check­ing in with a friend who is hav­ing a hard time.

Pho­tog­ra­phy Won­der­hatch

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