LGBT inclusive mental health services: a guide for service providers

In 2018, half of LGBT people in Scotland experienced poor mental health. However 37% report they struggle to find mainstream health information that is relevant to them. It’s time to talk about the mental health of LGBT communities and how to deliver LGBT inclusive mental health services.

At LGBT Health and Wellbeing, we all too often hear from our counselling clients that they have struggled to get mental health support elsewhere which affirms and gives the right weighing to their sexual orientation or gender identity. With high demand for our services, we want to do more to raise awareness about the needs of LGBT adults in accessing mental health services. Specifically, we want to help build the capacity of mainstream services to respond to some of the specific experiences and needs of our community.

LGBT experiences of mainstream mental health services

We started a national conversation on LGBT mental health on 22^nd September 2019. We ran a day of engagement exploring the experiences of LGBT people accessing mainstream mental health services. We held a total of three events engaging 105 participants in person and 7,264 online followers:

Our Community Brunch brought LGBT people together to share their experiences of using mental health services in Scotland, talk about the barriers and discuss potential solutions.

Our Community Discussion brought together LGBT people and a range of organisations who promote mental health to discuss what services could do to be more inclusive. We were grateful to have a panel of four speakers share their own stories of using mental health services and what they could improve. They generously allowed us to record their stories so that they could be shared more widely after the event. We hope you find their stories helpful, whether you’re looking for ways for your mental health organisation to become more inclusive, you want to be an ally to LGBT communities or you just want to know you’re not alone.

A Spoken Word Event provided a welcoming and creative space for LGBT people to share their mental health journey and take ownership of their story.

Key findings for LGBT inclusive mental health services: download the full report of the event

Waiting times

Participants revealed waiting lists can be “the cruellest thing about any form of healthcare”.

A ‘whole person’ approach

“I felt like a project… not like [my therapist] was looking at me as a person, just as an identity”

Participants demonstrated the need for non-judgemental practitioners who see “a person, not an identity” and who strive to understand, and believe, what a person says about the roots of their distress.

Awareness of structural inequality

Participants also demonstrated the need for mental health professionals to be aware of the content within which people’s identities exist and how this impacts their wellbeing. Society is organised around homophobic, ableist and patriarchal structures which means LGBT people have likely experienced prejudice and discrimination throughout their lives. This can translate into the expectation of rejection or the anticipation of less good treatment, all barriers to people coming forward for help.

Highlighting inclusivity

“If there had been even the slightest hint that someone in the building knew about LGBT issues I would have come out years before instead of waiting until … I reached crisis point”

However, participants made it clear to only use visual indicators if staff have been trained and are genuinely able to offer an LGBT inclusive service.

Recommendations for LGBT inclusive mental health services

Ask service users how they would like to be referred to and what pronouns they use
Lead by example and state your pronouns (she/her, he/him, they/them) in email footer or when meeting new people
Accept that non-binary people exist and respect they/them pronouns for people who do not feel exclusively male or female
Don’t assume the gender of someone’s partner(s) and enquire about someone’s relationships using neutral terms
Believe the person you are treating is expert in their own situation and work with them on their care
Be aware of the minority stress someone may experience as a member of a protected group(s)
Ensure you and your staff are aware of issues affecting LGBT people
Use cues to indicate you are aware and accepting of the diversity of sexual orientations and gender
Look at the diversity of your team and include LGBT people in the design and delivery of mental health services

Commitments from participant organisations

After our community discussion, representatives of organisations committed to a range of actions achievable in their day-to-day work, including:

Be active in seeking out LGBT voices to influence and inform projects
Create or seek inclusion training for staff at all levels
Pilot community networking events and promote Pride in Practice packs
Share explicit communications about being available for the LGBT community
Use more visual indications of LGBT ally-ship
Acknowledge visible and invisible barriers to people coming forward, and ask for feedback
Avoid making assumptions and use neutral language
Link with organisations who support LGBT mental health and wellbeing to collaborate on activities

Download the full report of the event

What’s next?

We will be using our event findings and resources to shape our wider engagement work with mental health professionals and their organisations, as well as with other LGBT and equality organisations. Our aim is to promote understanding of the lived experiences of LGBT people and to improve access to mental health services for our community in really tangible ways.

How can you get involved?

This is a conversation we hope will continue. We encourage you to increase your knowledge about the issues discussed at our events and welcome you to engage with us to work in partnership for more inclusive mental health services.

Listen to and share the podcast we recorded with our friends at Health and Social Care Alliance Scotland to turn our community discussion into a shareable audio recourse
Join the conversation on social media and use the hashtag #WellHealthy to let us know what would make mental health services more inclusive or what you are doing in practice to improve inclusion.
Get in touch with us at admin@lgbthealth.org.uk or call 0131 523 1100