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‘I felt like a project, not a person.’ This quote comes from a gay man’s description of his experience of accessing counselling service while he was at university. He went on to describe how he got the impression from his counsellor that he wasn’t really allowed to be depressed about anything else, other than his sexuality.
The lack of understanding of LGBTQ+ issues from this one particular health professional could be indicative of the profession as a whole, according to a number of LGBTQ+ people who were part of a recent panel discussion on Scotland’s mental health services.
The discussion was led by the charity LGBT Health and Wellbeing, Scotland’s only charity dedicated to providing specialist services to LGBTQ+ adults. In a bid to improve the well-being of LGBTQ+ people in Scotland, the charity has launched a National Conversation on Mental Health.
Throughout the course of one afternoon, community members were brought together with those representing services and supporting organisations, to thrash out the issues. We heard from a number of different panel members, with real life experience of accessing health services, for better and for worse.
The LGBTQ+ community’s relationship with the psychiatric profession has historically been dire – think electroshock and conversion therapy – you would assume and hope that we have moved on from this. But recent research has shown that there continues to be higher levels of mental health problems within the LGBTQ+ community. The rates of depression are high (49%), and anxiety (60%), resulting in self-harm (16%) and thoughts of suicide (32%) according to official stats from Stonewall Scotland.
Despite the need for LGBTQ+ people to access mental health services, the provision of services isn’t always available and when services are used, the experiences are far from ideal.
We heard from one woman on the panel, who suffered from poor mental health. She was seen by a consultant psychologist and comments that their view was: ‘Me being gay was the cause of my mental ill health.’
While the link between the LGBTQ+ community and poorer mental health are clear, the viewpoint of this health professional was clearly unhelpful and showed a lack of willingness to see the ‘whole-person’ within a counselling context. The woman was in her 30s at the time she accessed services, and her experience of coming out was in her view, a positive one. She saw her consultant’s attitude as out of touch with what she had experienced. Her referral to mental health services was for issues beyond her sexuality.
She went on to explain about how there are presumptions made by mental health professionals ‘that you are straight’ which doesn’t allow for the client to be fully themselves within counselling sessions. Her view is that the community is denied help, ignored and mistreated when it comes to mental health support. If you consider the potential trauma that has been experienced by some (not all) LGBTQ+ people in their lives – rejected because of their identity, subjected to hate crime – having such presumptions made by professionals is far from ideal.
On gender identity, the panel member suggested that counsellors should ask for the clients preferred pronouns (he/she, he/him) on meeting them for the first time and not to guess the person’s identity based on how they appear.
I touch on the complexities and challenges of dealing with gender variation in my review of Madison Amy-Webb’s rather brilliant book: ‘A Reflective Guide to Gender Identity Counselling’.
No two experiences of gender and sexuality are the same, and it’s important that the mental health profession recognises this rather than treating clients from within the LGBTQ+ community as a ‘project’, as was experienced by the man accessing his student counselling services. During his session with his counsellor he was handed a leaflet about being gay and suicidal, which once again shows a lack of understanding of why he was in need of support.
Are gay people not allowed to be depressed about anything other than their sexual orientation? The silver lining came for him during his second spell of counselling which he described as ‘night and day’ compared to the previous one as he felt listened to and not judged.
We also heard from a trans woman who gave an honest and frank account of her gender dysphoria reaching crisis point and attempts to get support when feeling suicidal – there was a waiting list of up to 18-months. She was able to access support privately which was a life saver and very fortunate as not everyone in a similar situation could afford to do this.
The final panellist was a gay woman who has living with a physical disability. She talked about assumptions of LGBTQ+, disability and poor mental health. She touched on the positive work of Flourish House, a mental health recovery charity based in Glasgow, who can support people through challenging times. She says: ‘No one is just one identity and we all come with a full deck of cards.’
Adapt, learn and listen
Although many of the experiences told here reveal the gaps in mental health services for LGBTQ+ people and what the real-life impact of this is, it’s not all bad. There are numerous organisations and professional groups in Scotland who are getting it right and providing a lifeline for many. We need services to adapt, learn and to listen those they are supporting, and also to consider when a person’s identity is relevant and when it isn’t. Only then will we have any chance of improving Scotland’s LGBTQ+ mental health and well-being.
Mike Findlay is a Glasgow-based writer and communications professional. His interests include equality, mental health and social justice.