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Eddie McCann PhD RN RPN FHEA
Trinity College Dublin
LGBT Minds: Lesbian Gay Bisexual and Transgender People’s Experiences of Mental Health Services
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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)
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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
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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
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Inclusion criteria
Over 18
LGBT
Service use last 5 years
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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)
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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
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Ethics and protection
TCD approval granted
LGBT guidelines (Kandirikirira 2004)
Anonymity
Signed consent
Support
Data storage
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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)
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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
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Services used
Out patient clinic (n=83)
Psychiatric Hospital (n=27)
Day hospital (n=18)
Day centres (n=16)
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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%)
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Survey-service experiences 2
Non-inclusive language use by staff (40%)
Disclosure and negative reaction (30%)
Helped improve mental health (80%)
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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.
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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.
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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.
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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.
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+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.
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-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.
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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.
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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
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Main Concerns 2
Trans community in need of support
No integration of services
Accessing services
Overreliance on pharmaceuticals
Isolation, stigma
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Advisory group:
Danika SharekOdhran AllenPatrick CallaghanAgnes Higgins
Thank you