‘What are the healthcare inequalities faced by the LGBTQ+ community and how can we help address these?’ by Eleanor Murray, Medical Student , University of Shefflield
“Equality means more than passing laws. The struggle is really won in the hearts and minds of the community, where it really counts.” – Barbara Gittings
The NHS principle that ‘Everyone Counts’ is written into the constitution to protect minority groups from discrimination during their interaction with the health service. Like anyone else who works or studies within the NHS, I have clicked through comprehensive e-learning exercises on equality and discrimination. I believe in the value of these online training packages. Even if it is just through the click of a button, there is significance in working somewhere where every member of your team has committed to tackling discrimination where they see it.
However, there is strong evidence that the LGBTQ+ community faces healthcare inequality [1-3]. This shows us that current efforts are not enough. I perceive the starkest inequalities to be in mental health and I will focus on these for this essay.
LGBTQ+ people are more likely to suffer from mental health conditions such as anxiety and depression [3-5]. Importantly, too, they are more likely to fear discrimination from healthcare professionals and to mistrust them . The increased incidence of mental health problems among lesbian, gay and bisexual (LGB) people was seen to be even greater in those between the ages of 15 and 18 . Tragically there were found to be twice as many suicide attempts among LGBTQ+ people . LGBTQ+ people were found to be more likely to struggle with substance misuse, particularly with reference to dependence on alcohol and smoking cigarettes[3, 5]. My intention is to explore reasons these inequalities may exist and put forward my perspective on how we can address them.
There are many reasons why LGBTQ+ people may suffer more with mental health problems. Important factors may play a role very early in life. The Stonewall school report showed that that 45-64% of LGBTQ+ school pupils are bullied for being LGBTQ+ at school. It shows that 10% of trans students have received death threats due to being trans. It shows that 7/10 lesbian, gay and bisexual pupils have thought about taking their own life. For trans pupils this is 9/10 . In addition to this, rejection by family or secrecy around sexuality or gender identity means that many LGBTQ+ young people may not be able to rely on the traditional support systems that others can. It has been found, however, that a large majority of LGBTQ+ people report the positive effects on their wellbeing of belonging to and receiving support from some type of LGBT+ community . It is hard, therefore, to overstate the importance of safe spaces, like gay bars and gay clubs, for LGBT+ people to meet and build these communities.
The emotional gravity that these safe spaces hold for members of the LGBTQ+ community and their association with alcohol and other substances is unfortunate. Firstly, it excludes them to people under the age of 18 who may be the ones that need a supportive community the most. Secondly, I suggest, they may play a role in the increased incidence of substance dependence among LGBTQ+ people. To me, this highlights a need for local, community led, youth groups that provide specialised support as well as social opportunities to empower LGBTQ+ youth and reduce feelings of loneliness and alienation.
I have been following the rainbow badge initiative that started at the Evelina Children’s Hospital in London. Small enamel pins with rainbow flags and the NHS logo were manufactured and given out to self-nominating patient-facing staff. The badge means that the wearer has educated themselves on the unique set of challenges faced by the LGBTQ+ community and that they are a safe person to discuss these issues with. They also signify that the wearer knows the local organisations they can refer LGBTQ+ people or their families to if they are in need of any extra support.
The rainbow badge initiative was started as a response to the stonewall unhealthy attitudes report , the findings of which were many but which included that the majority of healthcare staff didn’t consider sexual orientation to be relevant to one’s healthcare needs, and that three in four patient-facing staff had not received any training on the health needs of LGBTQ+ people. These findings are disappointing but explain in part why so many LGBTQ+ people feel mistrustful of healthcare staff  and why the relationship between the health service and LGBTQ+ people is damaged in places.
Rainbow badges can now be seen up and down the country in over 227 acute trusts. This is evidence of a solid commitment to address inequalities in this area. Of course they do not fix everything, not even close, but visual allyship is powerful and these small changes cost almost nothing.
1. Office, G.E., LGBT Action Plan, in IMPROVING THE LIVES OF LESBIAN, GAY,
BISEXUAL AND TRANSGENDER PEOPLE. 2018, Government Equalities Office.
2. Somerville, C., Unhealthy Attitudes, in The treatment of LGBT people within
health and social care services. 2016, Stonewall.
3. Metcalf, N.H.-S.a.H., Inequality among lesbian, gay bisexual and
transgender groups in the UK: a review of evidence 2016: National Institute of Economic and Social Research.
4. Chakraborty, A., et al., Mental health of the non-heterosexual population of England. Br J Psychiatry, 2011. 198(2): p. 143-8.
5. Mitchell, M. and C. Howarth, Trans Research Review. 2009, Equality and Human Rights Commission.
6. Pesola, F., K.H. Shelton, and M.B. van den Bree, Sexual orientation and alcohol problem use among U.K. adolescents: an indirect link through depressed mood. Addiction, 2014. 109(7): p. 1072-80.
7. Mitchell, M., et al., Sexual orientation research review, E.a.H.R. Commission, Editor. 2008.
8. Dr Jadva, V., et al., School Report, in The experiences of lesbian, gay, bi and trans young people in Britain’s schools in 2017. 2017, Stonewall.
9. Formby, E., Sex and relationships education, sexual health, and lesbian, gay and bisexual sexual cultures: views from young people. 2011: Sex Education Sexuality, Society and Learning. p. 255-266.