Here's what change we need to improve LGBT+ mental health

LGBT+ people are more likely to experience poor mental health*, yet mental health services don’t always understand their needs, and some even discriminate against them. With stigma and discrimination persisting in society, and hate crimes on the rise, this blog from our Chief Executive Mark Winstanley looks at the challenges LGBT+ people in England face when it comes to their mental health and what change is needed to improve their wellbeing.

We LGBT+ people live in a strange, fragmented time. On one hand, I have observed transformative progress in my lifetime. We now have access to hard-won rights such as gay marriage, and more people than ever identify as LGBT+. But stigma and discrimination persist, and with our rights once again being treated as a matter for public debate, there is the creeping worry that progress is fragile and easily-shattered. 

As a charity working to improve the lives of everyone severely affected by mental illness, we recognise that poor mental health is more prevalent within the LGBT+ community, with significant academic research revealing they experience higher rates of depression, anxiety, self-harm, substance abuse and suicide. This is hardly surprising when you consider that LGBT+ people continue to face misunderstanding and prejudice throughout their lives, whether at home, on the street, in the workplace, or even when accessing public services such as the NHS.

Hate crime

Hate crime has soared in recent years. In 2022, police data revealed that homophobic hate crime reports in the UK have doubled and transphobic hate crime reports have tripled over the last five years, and that represents only the crimes that were reported. Hate crime can leave physical and mental scars, with LGBT+ people who are the victims of a hate crime more likely to report depression and anxiety. Many want help to recover from such an incident, but only one in five who do are able to access professional support. It’s clear that LGBT+ victims of hate crime need greater access to suitable mental health support to help them recover and move on with their lives.

The current ‘debate’ around LGBT+ people

Rising hate crime is happening at the same time as a harmful backlash against the rights and visibility of LGBT+ people, and transgender people in particular. The way that transgender people are currently being discussed reminds many of us of the days of Section 28. Last year, professional bodies and support groups warned this debate is leading to a crisis in the mental health of transgender people. I am proud to lead an organisation that believes wholeheartedly that the identities of LGBT+ people should not be treated as a debate.

Conversion therapy

Too many people in the community have been subject to deliberate attempts to supress their sexuality or gender identity in an archaic practice known as ‘conversion therapy’. Attempting to change such a fundamental part of someone’s identity is deeply unethical and can cause long-lasting harm to mental health. Despite evidence that transgender people might be more likely to be subjected to conversion therapy, a long-awaited ban on the practice from the government proposed not to include this group.

We supported the British Association of Counselling and Psychotherapy’s call for the government to introduce a full ban on conversion therapy that includes transgender people, and are pleased that the government has since announced this will happen. However, we recognise concerns about loopholes in the proposed legislation. After years of delay, we need the government to introduce a full and inclusive ban on conversion therapy as soon as possible to protect LGBT+ people from further harm. 

Stigma and discrimination in mental health services

Despite a higher prevalence of poor mental health, LGBT+ people sometimes find little solace when they turn to mental health services for help. A national survey by Stonewall highlighted the types of discrimination LGBT+ people face across healthcare settings, such as being outed without their consent and witnessing discriminatory or negative remarks from staff. Meanwhile, an evidence review of the inequality faced by LGBT people found that ‘mental health services are the most often perceived to be discriminatory’.

This has worrying implications for LGBT+ people’s mental and physical health, with one in seven in the Stonewall survey saying they have avoided seeking healthcare because they fear discrimination. Staff in mental health services must have the skills and knowledge to appropriately support LGBT+ people. The changes that the government committed to in its LGBT+ Action Plan were a step in the right direction, but this was scrapped last year. We’d like to see this action plan reinstated and progressed.

Lengthy waits for gender-affirming care

Some transgender people may wish to medically transition to help relieve the profound distress caused by their gender dysphoria, but they face years of waiting for this gender-affirming care on the NHS. The recent inquest into the death of Sophie Williams, a 28-year-old transgender woman who had been waiting five years for treatment, found that the lengthy waits had contributed to her death. In no other area of medicine would this be acceptable. These waiting times must be reduced, and that those waiting for treatment should receive informed support for the distress they are experiencing.

Access to housing, secure employment and other factors vital to good mental health

When it comes to achieving good mental health, we all need a place to call a home, stable finances, access to meaningful employment or volunteering opportunities, and connection with others. We already know that people living with a mental illness face barriers in these areas, and the discrimination baked deep into society can compound these challenges for LGBT+ people. For example, LGBT+ young people are at high risk of homelessness due to family rejection, but often face issues in finding appropriate housing. Meanwhile, research by the Chartered Institute of Personnel and Development has found that LGBT+ people are more likely to have faced conflict and harassment in the workplace.

The Equality Act states that people should not be discriminated against because of their sexuality or gender reassignment. While we know discrimination can still happen in practice, this legislation is vital for discouraging discrimination and ensuring those that engage in it can be held to account.  We are concerned that changes to this legislation currently being considered by the government would undermine hard-won rights and create distressing barriers to the full and authentic participation of LGBT+ individuals in society. It is vital that protections for LGBT+ people remain in their current form.

Moments of joy

It's important to note that LGBT+ people experience many moments of joy too, as we find pride in being who we truly are and build community. Public attitudes are slowly changing over time, and it is unlikely we will return to the darkest days when LGBT+ people in the UK were forced from public view. But now more than fifty years on since the Stonewall Riots and the first pride marches, it is clear that there is still much work to do in tackling stigma and discrimination within mental health services and wider society.

Until this happens, the mental health of LGBT+ will remain under threat. We are committed to calling out discrimination against LGBT+ people where we see it and are planning further work to improve the lives of LGBT+ people severely affected by mental illness.

*We have used the term ‘LGBT+’ throughout because the research we have drawn on mostly focuses on lesbian, gay, bisexual and transgender people. However, we recognise that ‘LGBTQIA+’ is a more inclusive term, and that members of the community who identify as queer, intersex, asexual or any other minority sexuality or gender may experience similar issues discussed in this blog.