The messages we need to hear about LGBTI mental health

Jennifer Power is a Senior Research Fellow at the Australian Research Centre in Sex, Health and Society and Co-director of Rainbow Health Victoria (formerly Gay and Lesbian Health Victoria).

Jennifer Power takes a fresh view of how to support wellbeing among LGBTI people.

Lesbian, gay, bisexual, transgender or intersex (LGBTI) people are at higher risk of poor mental health, suicidal thoughts, self-harm and drug and alcohol problems. These are the findings from multiple large-scale studies in Australia and internationally. All the studies show a link between experiences of homophobic discrimination, alienation, rejection, social isolation and bullying – or fear of these things happening – and significantly greater emotional and mental vulnerability.

We need to be careful, however, in our interpretation and translation of this evidence. These statistics show only one side of the story.

Most LGBTI people live contented and productive lives – even those who do experience mental health problems. For many people, coming out as same-sex attracted or gender diverse is an incredible journey of self-discovery and happiness, while LGBTI communities are networks in which people find friends, lovers, and like-minded collaborators in fun and politics.

Health-related research tends to be designed (and funded) to identify and measure the extent of a health problem in order to produce evidence that can drive change to improve lives. Findings from health research often translate into advocacy messages about health risks and vulnerabilities in order to create an argument for social, legislative or programmatic  change.

For LGBTI communities, this research has been invaluable. Clear articulation of the mental health effects of inequality and discrimination has galvanised support for policy and legislative change (including marriage equality) and brought much-needed funding for dedicated LGBTI support programs.

However, we rarely see advocacy campaigns that are not focused on health risks or vulnerabilities. Where is the advertising telling us that it’s great to be gay? Or presenting being LGBTI as inherently positive and desirable?

There are multiple reasons why such a campaign is unlikely. Despit significant shifts in public attitudes toward homosexuality and gender

diversity, underlying discomfort about LGBTI people remains evident in certain circles. For instance, conservative media outlets or advocacy groups still often give publicity to arguments that homosexuality should not be discussed in schools or that

children with same-sex parents are disadvantaged (despite ample evidence that this is not the case). Focusing advocacy on health disparities can be a way of circumventing conservative

backlash. It’s hard to argue against initiatives that clearly save lives.

Designing advocacy messages around poorer health outcomes also highlights the continued need for dedicated funding for LGBTI mental health services and programs – and ultimately that need is still very real.

However, it is important for LGBTI young people, or those who have recently come out (and their families), to know that the lives of LGBTI people are not always marked by poor mental health, vulnerability or discrimination. The message that ‘LGBTI = happiness’ is also true

and valid, and important to support good mental health.

Others things that support wellbeing among LGBTI people are:

  • Being around family and friends who are supportive and who are supportive and who understand that being LGBTI often brings benefits to a person’s life;
  • Having access to a strong peer network – other LGBTI people – whether through a social network or formal peer support group;
  • Access to space in which it is possible to speak openly and comfortably about LGBTI identity, relationships or desires;
  • Being part of collective advocacy or activist initiatives that challenge LGBTI stigma and allow people to externalise stigma by reframing it as a social issue rather than a personal failing.

Social and mental health services that are inclusive of LGBTI people make a significant difference to people’s lives. Mental health professionals may not always be aware how powerful it can be simply to acknowledge a person’s sexuality, gender identity or relationships in a way that is normalising and affirming. For some LGBTI people, this will make the difference between asking for help and walking away.

For others, it may be their first experience of someone acknowledging their identity or ‘seeing’ them the way they want to be seen.

At a service level, LGBTI inclusivity means being on the front foot and assuming all clients may be LGBTI, rather than expecting people to disclose, which can be very frightening for some people. Inclusive practice begins with comprehensive intake forms, staff training and a critical review of all policy and procedures to identify subtle practices that may exclude LGBTI people. For instance, the perspective that ‘we treat all people the same’ is not an inclusive policy because ‘the same’ tends to assume heterosexuality unless someone actively comes out.

The subtleties of inclusive practice may also relate to the difference between acceptance and celebration of LGBTI people. Acceptance is easy. Most people today accept and tolerate LGBTI people. However, the perspective that LGBTI people and communities make a valuable contribution to society – a necessary contribution – is less common. Cultivating, at a service level, the attitude that being LGBTI is a strength will create a form of inclusive practice that will provide support for LGBTI people’s mental health.