Discrimination (including biphobia, homophobia and transphobia) and verbal and physical abuse can have acute impacts on individuals’ mental health and wellbeing. Impacts can include an increased risk of mental health problems such as depression, anxiety, substance abuse, suicidal behaviour/ideation and self-harm. Mental health service providers need to consider the significance of discrimination and abuse in the assessment, treatment and support of people who are LGBTI.
People who are LGBTI have significantly higher levels of depression and anxiety than the general population for a variety of reasons. They can face social pressures in relation to ‘coming out’, and uncertainty about disclosing sexual orientation, gender identity or intersex status in new environments. For example, some people with intersex variations have experienced inappropriate medical treatment as children, which can result in mental health issues and a reluctance to engage with the medical community or disclose their intersex status.
Older and younger generations of people who are LGBTI face different but significant pressures. Issues for Same Sex Attracted, Gender Diverse and Intersex (SSAGDI)young people may include pressure when interacting with family, schools and peers. SSAGDI young people are vulnerable to bullying, lack of acceptance, social exclusion, depression, homelessness and drug use. Older people who are LGBTI may encounter ‘invisibility’ (particularly those who have been in a heterosexual relationship/marriage), internalised homophobia, biphobia or transphobia, and for some, issues with ‘coming out’.
For people who are LGBTI experiencing intersections of discrimination on the basis of Aboriginality, their cultural and linguistic background, disability or other factors the risk of mental health problems can be compounded.
Mental health issues for specific groups
Some services may not be aware of specific mental health issues within the LGBTI population, such as:
- bisexual women are more likely to have experienced emotional, sexual and physical abuse than lesbians
- bisexual people are at greater risk of developing physical and mental illness (including suicide) than those who are gay or lesbian, who in turn are at greater risk than people who are heterosexual
- same sex attracted people are more likely to experience depression than heterosexual people
- younger men who have sex with men (MSM) are at higher risk for depression than older MSM
- higher rates of depression have been found in Australian trans, gender diverse and some intersex populations than amongst lesbians, gay men and bisexual people; this depression can lead to increased risk of self-harm and suicide
- high rates of mental health issues, isolation and reluctance to seek medical treatment are anecdotally reported by some intersex support groups.
Responding to the needs of people who are LGBTI
Strategies to better respond to the mental health needs of people who are LGBTI include:
- ensure practitioners develop and/or access specialist knowledge and skills, including:
- knowledge of the effects of discrimination and marginalisation
- knowledge of phobia related violence and domestic violence issues
- cultural competencies in working with people who are LGBTI with mental health issues
- relevant referral networks (including peer support, advocacy, online resources)
- understanding the difference between intersex variations and the issues experienced by intersex people
- clinical practice guidelines.
- guidelines for organisations include:
- in settings such as inpatient units and residential settings, ensure accommodation offered is based on the person's identified gender
- create an organisational culture that promotes respect and understanding about the needs of LGBTI people
- provide guidance to address potential risks at the time of disclusure and at transition points (such as discharge from service)
- ensure intake and assessment forms have the capacity to reflect gender and sexual diversity.
Australian Psychological , 2000, Guidelines for psychological practice with lesbian, gay and bisexual clients.
Grant, J. E., Odlaug, B. L., Derbyshire, K., Schreiber, L. R. N., Lust, K., and Christenson, G., 2014, Mental Health and Clinical Correlates in Lesbian, Gay, Bisexual, and Queer Young Adults, Journal of American College 62(1):75-78.
Royal Australian and New Zealand College of Psychiatrists (2016) “Recognising and addressing the mental health needs of the LGBTI population”.
Leonard, W., A., Lyons, A., and Bariola, E. (2015) A Closer Look at Private Lives 2: Addressing the mental health and wellbeing of gay, lesbian, bisexual and transgender (GLBT) Australians. Monograph Series Number 103. Melbourne: The Australian Research Centre in Sex, Health & Society, La Trobe University.
Leonard, W. and Metcalf, A. (2014) Going upstream: A framework for promoting the mental health of lesbian, gay, bisexual, transgender and intersex (LGBTI) people. Produced on behalf of the MindOUT! LGBTI Mental Health and Suicide Prevention Project, National LGBTI Health Alliance.