June 14, 2003 - Source: The Point magazine of the Scottish Association

A survey carried out this year in Glasgow revealed the number of people who would be 'very concerned' if someone who was lesbian or gay moved in next door was almost as great as those who would feel the same if people with a criminal record became their neighbours.

It is against this background that the Scottish Executive Health Department has funded a two-year initiative to better understand the health needs and experiences of Scotland's Lesbian, Gay, Bisexual & Transgender (LGBT) population.

Initial findings highlight the impact of homophobia, social exclusion and heterosexism on the health, in particular mental health, of Scotland's LGBT community.

INCLUSION project manager, Alastair Pringle, explains more in The Point, the magazine of the Scottish Association for Mental Health

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From an early age LGBT people face a huge number of barriers, challenges and discrimination because of their sexual orientation or gender identity. Hiding such a significant part of their identity is one of the first things many young LGBT people learn to do, which naturally impacts on self-identity and self-esteem. A lack of role models to identify with and the denial of 'rites of passage' classroom romances, first dates etc., unique to adolescence, further compound the early experiences of young LGBT people.

Family disruption and rejection from the family home is a common experience for young LGBT people who reveal their identity in an unsupported environment. Isolation from their peer group and significant levels of homophobic bullying, both verbal and physical, are also particular to the early experiences of young LGBT people. 'Gay' is now the most commonly used term of abuse in the schoolyard. Young LGBT people often leave school early and fail to meet their academic potential due to such negative experiences in the school setting.

Unfortunately, accessible and appropriate support for young LGBT people in Scotland has been severely affected by the now repealed Section 28 (2A), which effectively legitimised homophobia by banning the 'promotion' of homosexuality in schools. The vague wording in Section 28, which left teachers and educators unsure and unsafe in dealing with the issue, has not been in any way remedied with appropriate guidance or support for teachers in dealing with the issues in its aftermath. While most schools have developed comprehensive bullying policies, only a handful explicitly targeted homophobia.

Ian Rivers at The University of Luton has conducted various pieces of research into bullying and its impact on the mental health of gay and lesbian youth. Findings reveal that the bullying which lesbians and gay men experienced in school was more severe in nature than general bullying. 53 per cent of participants said that they had contemplated self-harm as a result of being bullied. 40 per cent indicated that they had attempted self-harm or suicide on at least one occasion. Of these, three quarters had attempted on more than one occasion. In later life some of those bullied said that they experienced nightmares or flashbacks related to the bullying. Others said that they tended to avoid social situations or large gatherings for fear of experiencing a panic attack.

So where does this leave young LGBT people? Understandably, the outcomes can be costly both in terms of the physical and emotional well being of individuals and it is hardly surprising to discover that research demonstrates that low self-esteem, anxiety and depression are common experiences for many young LGBT people. These in turn can be linked to other health and social concerns including the relatively high incidence of HIV infection among young gay men, increasing incidence of sexually transmitted infections in young lesbian and bisexual women, higher than average rates of suicide and self harm, homelessness (often associated with prostitution) and academic underachievement.

Problems associated with homophobia in early life, such as bullying and low self-esteem, can continue into adulthood and have serious, long-term negative health and social consequences for individuals who are affected.

Verbal and physical abuse is a key issue for both young and adult LGBT people living in Scotland. The 'Something to Tell You' survey, carried out by NHS Greater Glasgow in 2002 showed that up to 80% of young LGB people living in and around Glasgow had experienced discrimination, most more than one type. The most common was name calling, experienced mainly at school or in the street. Most LGBT literature features similar unacceptable levels of harassment, violence and bullying.

One UK survey of 4000 LGB people found that 34% of men and 24% of women had experienced violence because of their sexuality. 32% had been harassed in the last five years, and 73% had been called names because of their sexuality. Anxiety, depression, self-harm, suicide and attempted suicide have all been linked with the combined effects of the experience of prejudice and discrimination and internalised negative feelings. Studies suggest anywhere between 20 - 50% of LGBT people attempt suicide. Higher levels of substance abuse and eating disorders have also been attributed to societal discrimination, but again, limitations in research make it difficult to get a clear picture.

What is most remarkable, however, is the extent to which these issues have, to date, been effectively ignored or neglected by public sector policy, planning and provision of services. Institutional homophobia and heterosexism is largely blamed for this important omission.

The Scottish Executive are now trying to redress this issue and are working closely with a wide range of organisations throughout Scotland to address the health needs and experiences of LGBT people. The INCLUSION project, housed within voluntary sector body Stonewall Scotland, follows on from the Executive's work on black and ethnic minority communities' health. The Health Minister, Malcolm Chisholm, recently committed to extending the principles of Fair for All to all excluded groups in the new white paper on health, 'Partnership for Care'.

The INCLUSION project, the first of its kind in Europe, has already reviewed a wide range of available literature on LGBT health and is in the process of carrying out a 'stocktake' of current NHS activity in relation to NHS employees who are LGBT; where health policy and activity target the needs of these groups; and how NHS Boards can be supported to take this agenda forward. New research is also underway, looking at rural issues, general LGBT health issues and the first national health needs assessment of transgender people.

Demonstration activity to look at how we can improve service provision, accessibility and staff knowledge and awareness will commence in five different Health Board areas from June this year, which will be written into guidance and recommendations for the NHS in Scotland by October 2004. However, only so much can be achieved by developing an LGBT-friendly and accessible health service. We need to work across all public sectors, primarily within the Education system, to deal with the root causes of the problem.

While it is important to remember that not all LGBT people suffer poor mental health, attempt suicide, or turn to alcohol or drugs to escape the discrimination they face, it will not be until homophobia and LGBT discrimination are made unacceptable in all areas of public life, from the schoolyard to the workplace, that we will begin to properly address their impact on mental health.

For more details contact INCLUSION on 0141 204 0746 or info@lgbthealthscotland.org.uk

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