Eddie McCann PhD RN RPN FHEA

Trinity College Dublin

LGBT Minds: Lesbian Gay Bisexual and Transgender People’s Experiences of Mental Health Services

Overview

Stigma and discrimination

Social exclusion (Vision for Change 2006)

Psychological distress (King et al. 2008)

Internalised self-hatred and shame (Cochran 2004)

Mental health risk (Kuyper & Fokkema 2011)

Study aim and objectives

Aim:

Explore LGBT people’s experiences of mental health service provision in the Republic of Ireland

Objectives:

Experiences of access

Identify barriers and opportunities

Identify good practices and service gaps

Develop practice framework

Study design

Exploratory mixed methods

Survey which could be completed electronically, by telephone or by post 

In-depth interviews with a sample of participants whom had completed the survey

Inclusion criteria

Over 18

LGBT

Service use last 5 years

Survey

Advisory group input

Existing tools e.g. Visible Lives

35 questions

Demographics

Sexual orientation and gender identity

Mental health status

Mental health service use

Service Experiences

2 open ended questions (suggestions for improving services and further comments)

Recruitment and data collection

Survey pilot (n=5)

Invisibility and hard to reach

On-line, post, telephone

Website: www.lgbtminds.ie

LGBT and mental health ) organisations (n=170)(information and posters), press

Ethics and protection

TCD approval granted

LGBT guidelines (Kandirikirira 2004)

Anonymity

Signed consent

Support

Data storage

ProfilesN (%)

Age range 18-64 125 (100)

Cultural background White IrishWhite Non-IrishAsianOther

104 (84) 16 (12) 2 (2) 2 (2)

Area living UrbanRural

89 (72) 34 (28)

Gender identity MaleFemaleTransgenderOther

46 (37) 68 (55) 3 (2) 7 (6)

Sexual orientation Gay

LesbianBisexual Heterosexual Other

52 (42) 41 (33) 19 (15)

1 (1) 12 (10)

Diagnosis (n=97) %

Depression 74

Anxiety 51

Sleep disorder 22

Eating disorder 18

Gender identity disorder 10

Post traumatic stress disorder 9

Bipolar disorder 8

Obsessive compulsive disorder 8

Personality disorder 8

Substance-related issues 5

Schizophrenia 3

Other 8

Services used

Out patient clinic (n=83)

Psychiatric Hospital (n=27)

Day hospital (n=18)

Day centres (n=16)

Survey-service experiences 1Could not discuss LGBT identity (33%)

Professionals should know identity (65%)

Feared negative reaction (16%)

Feel professionals lack LGBT knowledge (64%)

Not sensitive to LGBT issues (37%)

Seek out LGBT friendly services (42%)

Partners not acknowledged (40%)

Survey-service experiences 2

Non-inclusive language use by staff (40%)

Disclosure and negative reaction (30%)

Helped improve mental health (80%)

Engagement and staff attitudes

Ensure an atmosphere of comfort and acceptance to encourage LGBT people to be completely honest and treat people with dignity and respect.

Having been in an abusive lesbian relationship I received very little sympathy from some psychiatrists I have seen and it has even been suggested to me that my life will stabilize when I find a man.

LGBT identities

I've noticed the term 'Borderline Personality Disorder' being applied far to readily to anyone who identifies as LGBT, thus dismissing the validity of the person’s sexual orientation

While mental health professionals were usually willing to read up on issues related to trans* people, and many were willing to learn, there was little understanding of: -The way many different aspects of one's identity can overlap to cause stress related to social oppression.

Partner and carer supports

My partner is trans. I feel this is an incredibly underserved group, both trans people and their partners, and I find it difficult to have my experiences understood by mental health practitioners across the board when it comes to this issue specifically.

Treatment options

I wasn't comfortable coming out to my mental health provider (psychiatrist) and did not feel they would be sensitive or even try to help me with any LGBT issues. They were not willing to help (apart from medications) with any other mental health issues I was experiencing. This is very different to some to my experiences I had in the UK, where I did get access to CBT, counselling, psychotherapy, mindfulness etc. and was able to feel comfortable addressing LGBT issues - and all free of charge.

+ve service experiences

I am currently an outpatient attending a day hospital for 14 months. As an LGBT person I felt respected and at ease with the staff I encountered. When I mentioned in passing that I was a lesbian I was asked to share my coming out experiences etc and received good feedback from my counsellors and psychiatrist and was offered leaflets/advice etc. I must admit I was kind of amazed but pleasantly surprised.

-ve experiences

Area psychiatrists are paid by the HSE. Some refuse to deal with transgender patients. These people should either be trained in trans issues or stop ignoring those who need their help.

Health system in Ireland is archaic and severely under-funded. I cannot get access to a qualified therapist to support me with ongoing issues as a result of a history of child sexual abuse.

Mental health services in Ireland are awful in general not just with LGBT. I was put on anti-depressants at the age of 15 by my G.P when I told her I was feeling down due to my parents splitting up. I didn't see any mental health professional until the age of 18. And then only saw her twice. Very little came of 20 minutes talking.

 Increasing awareness of LGBT issues

Continue to destigmatise mental health; educate our society (at secondary level, 3rd level and society in general) more on mental health; get people talking about it. More programmes on TV

Educate staff and providers on Trans issues and the diversity of transgender experience in particular.

Main concerns 1

Mental health professionals not adequately trained or educated in LGBT issues – gender sensitivity

LGBT identity an important part of who the person is, not considered relevant or important

Fear of coming out to mental health professionals

Lack of trust in health professionals

Assumptions made by health professionals re sexuality

Intense fear of institutionalisation – equated with total loss of control

Main Concerns 2

Trans community in need of support

No integration of services

Accessing services

Overreliance on pharmaceuticals

Isolation, stigma

Advisory group:

Danika SharekOdhran AllenPatrick CallaghanAgnes Higgins

Thank you

mccanned@tcd.ie