LGBT+ Mental Health: Understanding disparities and meeting mental health needs

Abstract

LGBT+ Mental Health: Understanding disparities and meeting mental health needs

Full text

LGBT+ Mental Health:
Understanding disparities and
meeting mental health needs
Dr Joanna Semlyen PhD, CPsychol, AFBPsS, SFHEA
HCPC Registered Health Psychologist
Senior Lecturer in Psychology and Medical Education, University of East Anglia

Lead on analysis of UK LGBT+
population health outcomes
Cigarette smoking and hazardous alcohol use in LGB
Common mental disorder in LGB
Obesity/overweight - body mass index (BMI) in LGB
*Population data available only on sexual identity as no
national survey data available for gender identity
Joanna Semlyen July 23 2019, Westminster Forum

Numbers of LGBT+
Estimates
Modelled estimate by Public Health England 2017. Based on all
recorded responses to UK surveys - a range of between 0.9%-
5.52% LGBO, present weighted estimate of 2.5%
In representative national health surveys where sexual orientation is
measured, around 3% select a sexual orientation identity other than
heterosexual (Semlyen et al 2016)
Depends on
how asked (ftf, online, written)
anonymous online survey 5.7% (Ellison and Gunstone, 2009)
how worded (attraction, behaviour, identity)
Higher when behaviour/attraction
Joanna Semlyen July 23 2019, Westminster Forum

Research evidence: UK
Majority UK LGBT+ mental health research - lower quality ‘convenience samples’
Studies that compare LGBT+ to heterosexuals from a representative population sample
offer significantly increased evidence quality
Recent improved evidence base - few longitudinal cohort studies and population health
cross sectional surveys include the Office for National Statistics question on sexual
orientation.
‘Which of the following options best describes how you think of yourself?’
Response options were ‘Heterosexual or Straight’, ‘Gay or Lesbian’, ‘Bisexual’,
‘Other’, or refusal
Small # of respondents
Data pooling
No Gender Identity question so no population data on health inequalities for
trans/nonbinary people.
Joanna Semlyen July 23 2019, Westminster Forum

Poorer mental health in LGBT+
Recent secondary analysis showed
increased common mental disorder in UK
LGB population Semlyen et al 2016
Lesbian/Gay > mental health disorder than
Heterosexual
under 35 (OR = 2.06, 95 % CI 1.60, 2.66),
non significant at age 35–54.9 (OR = 1.03,
95 % CI 0.71, 1.48), but
strongest at age 55+ (OR = 2.11, 95 % CI
1.16, 3.83).
Bisexual > mental health disorder than
Heterosexuals (and LG).
under 35 age group (OR = 2.31, 95 % CI
1.83, 2.90),
age 35 to 54.9 (OR = 1.80, 95 % CI 1.29,
2.50)
strongest at age 55+ (2.45, 95 % CI 1.58,
3.79)
Joanna Semlyen July 23 2019, Westminster Forum

Poorer mental health in LGBT+
Recent meta analysis showed increased
prevalence of mental health in LGB
compared to heterosexual King, Semlyen
et al., 2008
Suicide attempts lifetime OR x 2 (x 5 men)
Suicide attempts last 12 month OR x 2-3
Suicidal ideation lifetime OR x 2
Suicidal ideation last 12 months OR x 2 (x
2-3 women)
Depression last 12 months OR x 2-3
Anxiety last 12 months OR x 1.7
Alcohol dependence last 12 months OR x
1.5 (x 4 women)
Drug dependence last 12 months OR x 3
Joanna Semlyen July 23 2019, Westminster Forum

Poorer mental health in LGBT+
Higher rates of low well being
Higher rates of substance misuse
Higher rates of suicide and self
harm
Higher rates of eating disorders
Higher rates of depression and
anxiety
Higher rates of self reported long
standing psychological problems
Poorer mental health in trans and
nonbinary (TGNB)
Higher rates of suicide and self
harm
Higher rates of depression and
anxiety
Higher rates of eating disorders
Long waiting times adversely
effect mental health in TGNB
E.g. 4 times higher in waiting
lists sample
Joanna Semlyen July 23 2019, Westminster Forum

Mental health service use
LGB people seek to and/or access mental health services
more frequently than heterosexuals
Mental health services were accessed by 24% of the 108,000
respondents to the UK Government’s LGBT survey
Joanna Semlyen July 23 2019, Westminster Forum

Mental health service use in LGBT +
Recent systematic review provides
understanding of mental health service use
in LGBT King, Semlyen et al., 2007
Therapy/ists make heterosexual
(heteronormative) assumptions
LGB have more episodes of therapy and
greater number of sessions than non-LGB
LGB seek counselling/therapy more than
non-LGB
LGBT concerns about safety
Preferences for LGBT therapist
LGBT therapist knowledge
Misattribution of problem to LGBT identity
Joanna Semlyen July 23 2019, Westminster Forum

Risk and protective factors for
mental health in LGBT
Causal pathways not demonstrated but likely minority stress
Linked to discrimination and homophobia
Exacerbated by structural inequalities experienced across a wide range of
contexts including education, home and family, and health services (primary
and secondary care)
Fear of disclosure
Hiding parts of their lives from staff
Lacking a sense of belonging
Need to feel safe and to trust service providers
Negative staff attitudes and behaviours are main barrier for accessing
services
Joanna Semlyen July 23 2019, Westminster Forum

Recommendations – training
and practice
Interventions to address discrimination, increase resilience
and reduce impact on LGBT+
Draw on LGBT+ people’s own expertise
Adopt LGBT+ community led services – more trusted
Training for heath care professionals and teaching for
students
should not be optional or tokenistic but be embedded and
integrated
No one off ‘diversity’ session as a tick box.
Joanna Semlyen July 23 2019, Westminster Forum

Recommendations - services
An understanding of the prevalence of mental health issues, as well as
the importance of making sensitive enquiry, avoiding assumptions, and
using inclusive language.
Always consider sexual orientation and gender identity as part of the
diverse population of service users
Avoid language that excludes or makes assumptions. And if you don’t
know – ask!
Promoting mental health for LGBT people in publicity and positive
imagery
Counselling and psychotherapy treatments should not use ‘anti-LGBT
reparative’ therapies. Guidelines for LGBT affirmative therapy
Joanna Semlyen July 23 2019, Westminster Forum

Recommendations – size of
population
Make every attempt to capture accurate LGBT+ population
size by including SO and GI questions in the 2021 Census.
Suggest campaign to encourage LGBT people to feel safe
and comfortable to disclose identity in Census 2021.
Suggest options for collecting Census 2021 data including
internet access.
Joanna Semlyen July 23 2019, Westminster Forum

Recommendations - evidence
Increase LGBT+ health evidence base - quality (datasets
that are representative), research on trans and non binary
populations, greater research on intersectionality in LGBT+
Include SOGI in all health population studies including
longitudinal data to allow causal pathways to be explored
Mandatory monitoring of sexual orientation and gender
identity data across health and social care settings.
Recording of sexual orientation identity is necessary to
comply with Equalities Act, 2010
Joanna Semlyen July 23 2019, Westminster Forum

References
King, M., Semlyen, J., Tai, S. S., Killaspy, H., Osborn, D., Popelyuk, D., & Nazareth, I. (2008). A systematic review of mental disorder, suicide,
and deliberate self harm in lesbian, gay and bisexual people. BMC psychiatry, 8(1), 70.
Hagger-Johnson G, Taibjee R, Semlyen J, Fitchie I, Fish J, Meads C, et al. (2013) Sexual orientation identity in relation to smoking history and
alcohol use at age 18/19: cross-sectional associations from the Longitudinal Study of Young People in England (LSYPE). BMJ Open.
Ellis, S. J., Bailey, L., & McNeil, J. (2015). Trans people's experiences of mental health and gender identity services: A UK study. Journal of Gay
& Lesbian Mental Health, 19(1), 4-20.
Semlyen, J. (2015). Health psychology. In The Palgrave Handbook of the Psychology of Sexuality and Gender (pp. 300-315). Palgrave
Macmillan, London.
Semlyen J, King M, Varney J, Hagger-Johnson G. Sexual Orientation and Symptoms of Common Mental Disorder or Low Wellbeing: Combined
Meta-Analysis of 12 UK Population Health Surveys. BMC Psychiatry. 2016; 16:67.
Hulbert‐Williams, N. J., Plumpton, C. O., Flowers, P., McHugh, R., Neal, R. D., Semlyen, J., & Storey, L. (2017). The cancer care experiences of
gay, lesbian and bisexual patients: A secondary analysis of data from the UK Cancer Patient Experience Survey. European journal of cancer
care, 26(4), e12670.
Semlyen J. Recording Sexual Orientation in the UK: Pooling Data for Statistical Power. American Journal of Public Health. 2017; 107:1215-7.
Semlyen, J., Ali, A., & Flowers, P. (2017). Intersectional identities and dilemmas in interactions with healthcare professionals: an interpretative
phenomenological analysis of British Muslim gay men. Culture, health & sexuality, 1-13.
Semlyen (2018) LGBT health inequalities. Select committee written evidence
http://data.parliament.uk/writtenevidence/committeeevidence.svc/evidencedocument/women-and-equalities-committee/health-and-social-care-
and-lgbt-communities/written/90982.html
Semlyen J. et al (2019) Sexual orientation identity in relation to unhealthy Body Mass Index (BMI): Individual Participant Meta-Analysis of 93,429
individuals from 12 UK health surveys
Semlyen (2019) LGBT health inequalities. Select committee oral evidence https://www.parliament.uk/business/committees/committees-a-
z/commons-select/women-and-equalities-committee/news-parliament-2017/health-social-care-lgbt-1-evidence-17-19/
Joanna Semlyen July 23 2019, Westminster Forum

Thank you
Email: j.Semlyen@uea.ac.uk
Twitter: @Dr_Jo_S
Web: www.joannasemlyen.com/
Joanna Semlyen July 23 2019, Westminster Forum