CREATING A SAFE SPACE FOR LGBT+ PATIENTS

Between May 1988 and February 2003, Section 28 silenced and suppressed the LGBT+ community by making it illegal for schools and councils to promote “the teaching of the acceptability of homosexuality as a pretended family relationship”. In February 2003 the United Kingdom abolished this law, allowing for the conversation about rights, equality, and acceptance of LGBT+ people to begin. Now, we have the privilege and the duty to continue this conversation, Bringing awareness and acceptance into our workplace.

LGBT+ Mental Health

People who identify as LGBT+ are at a higher risk of having mental health problems1 and are more likely to experience a range of problems such as depression, self-harm, suicidal thoughts and alcohol and substance misuse. This increased risk is not associated with being LGBT+ but with a range of factors such as homophobia, discrimination and isolation. LGBT+ people are also at an increased risk of experiencing hate crime compared to heterosexual people, with gay men, young people and those identifying as LGBT from black and ethnic minority groups being the most at risk. On the whole people from LGBT+ communities rate their quality of life lower than that of heterosexual people.

This has only been made worse by the current pandemic2 where many LGBT+ people cannot access supportive community groups due to the lockdown and many of whom have had to spend the lockdown periods with family who are discriminatory or whom they are not yet ‘out’ to. LGBT+ people are also at an increased risk of experiencing domestic violence, including family and partner violence, with the LGBT Foundation reporting a 30% increase in calls to their helpline about domestic abuse and violence from LGBT+ people during the lockdown periods. 

Both LGBT+ colleagues and patients struggle due to their sexuality or gender identity. Many LGBT+ colleagues have faced homophobia in the workplace3, and many members of the LGBT+ community feel dissatisfied with mental health services4 and often perceive them to be discriminatory. 

Within our work as researchers/mental health professionals and within the workplace, there is a lot we can do to ensure the health and safety of LGBT+ people. So, what can we do?

Main Challenges

Heteronormativity and Assumptions

First of all, be aware of your assumptions. When a woman says she is married – do you automatically assume it’s to a man? Do you assume that people are automatically straight and cis-gender unless they tell you otherwise? Do you assume that if people are either gay or straight and forget that some people identify as bisexual or asexual? Assuming the norm like that can lead us to not adequately address the needs of patients and/or make co-workers uncomfortable. This may not be an easy task, as assumptions, biases and other mental schemas are ingrained in our way of thinking. For this reason, keeping an open mind and avoiding assumptions requires an active role. 

Particularly when it comes to patient work, we are aware of how diversity can affect our experience of the world. Gender, race, sexuality, beliefs and more affect the perceived power we have over ourselves and our societal role. This experience is even more complex for LGBT+ people. They may be the only one in their community who knows they are LBGT+. They may ‘pass’ for the norm and never be directly targeted for their identity – yet this doesn’t mean that their experience of the world has not been shaped by it. By not making space for conversations about LGBT+ experiences within our practice, we may never know that a patient identifies as such. This will limit our understanding of their experiences and the adequacy of the treatment. In the trust, we could start including our pronouns in our email signatures which may reduce the likelihood of individuals being misgendered, opens the door to LGBT+ themed conversations, and makes it a normalised, community show of support.

Coming Out, Being ‘Outed’

Another issue, which stems from assuming that people are automatically straight and cis-gender, is ‘coming out’. LGBT+ individuals have to make the decision to ‘come out’ with every new interaction, a situation that is stressful and draining every time. The fear and anxiety that comes with telling someone that you are LGBT+ never fades, whether that’s with your manager, a colleague, your named worker or doctor. This fear is valid as 39% of LGBT+ people who are ‘out’ have been harassed or discriminated against3 by a colleague at work. It can also have consequences for patients, as they may fear being targeted, victimised or stigmatised. To overcome this, we can make a safe and accepting environment where we do not assume sexuality and gender and hence it is more comfortable for people to express themselves. 

Appropriate Language

The use of language is another way that we can create a safe environment- Conversations about other ‘equality and diversity’ issues such as race are facilitated by having a clear understanding of what is the appropriate language. It also makes it easier for staff to challenge when inappropriate language is used. This is very important to make LGBT+ patients feel safe by using the correct language and teaching and challenging non-LGBT+ people to use the correct language too. Here is a glossary of LGBT+ terms5. Becoming familiar with these terms, and using them appropriately, can help us create a safe space for all LGBT+ individuals, even if we are not aware of them being LGBT+.

Starting the Conversation

Every LGBT+ person is different, there is no protocol to interact with LGBT+ people. Some will want to talk about being LGBT+, others won’t. Some will be out to their family, some won’t. If you’re uncertain the best thing to do is ask! As long as you ask in a kind and compassionate way and are open to listening and learning, asking an LGBT+ individual is ok. However, don’t put all the responsibility of education on them. Read articles and websites, watch informative videos, or TV and film, and look on forums written by LGBT+ people to build your knowledge. Here’s a few good places to start. 

https://www.stonewall.org.uk                https://lgbtplushistorymonth.co.uk                    https://lgbt.foundation

                                  https://www.derbyshirelgbt.org.uk                       http://www.nottslgbt.com

Thank you for being part of the conversation! Feel free to share these resources to keep it going.

1https://www.mentalhealth.org.uk/statistics/mental-health-statistics-lgbt-people

2https://lgbt.foundation/coronavirus/impact

3https://www.tuc.org.uk/research-analysis/reports/cost-being-out-work

4160719_REPORT_LGBT_evidence_review_NIESR_FINALPDF.pdf (publishing.service.gov.uk)

5https://www.stonewall.org.uk/help-advice/faqs-and-glossary/glossary-terms

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