Mental health issues - 2

WHAT IS THE INCIDENCE OF MENTAL ILLNESS AMONGST GAY MEN, LESBIANS AND BISEXUALS?

  • 25-65% of gay people seek counselling at some stage of their lives (Man, Lyndsay (1994) Journal of the British Association for Counselling vol. 5 no.1)
  • Levels of alcoholism are over twice that in the general population. Reasons suggested include using alcohol and drugs as a means of coping with depression and the pivotal role of bars in gay social networks (Herbert, Hunt & Dell (1994) Journal of Rehabilitation)
  • Young gay men were 13.9 times more likely to attempt suicide than their heterosexual peers (Bagley and Tremblay (1997) Suicidal behaviour in Homosexual and Bisexual males)
  • 6 population based studies since 1997 showed rates of attempted suicide between 20 and 42% amongst gay men, lesbians and bisexuals (Remafedi (1999) Archives of General Psychiatry. American Medical Association 56)
  • 53% of those bullied at school because of their sexuality had contemplated self harm or suicide and 40% had attempted self harm or suicide (Rivers - the bullying of sexual minorities at school (2001) Education and Child Psychology Vol. 18 no. 1)
  • 18% of respondents had attempted suicide; 66% had experienced depression (Respondents to the Nottinghamshire "I Count" survey - 2003)
  • Young gay men are 5.6 times more likely to injure themselves without suicidal intent than young men in the general population (Hutchinson, Porter, Le Voil (2003) Findings from a study of suicidal thoughts amongst young gay men and bisexuals in Edinburgh)
  • 43% had mental disorder, 31% had attempted suicide (respondents to survey - Rates and predictors of mental illness in gay men, lesbians and bisexuals - Warner, McKeown, Griffin et al (2004) British Journal of Psychiatry)

EXPERIENCES OF GAY MEN, LESBIANS AND BISEXUALS AS USERS OF THE HEALTH SERVICES

  • Nursing staff share the homophobia prevalent in society and this is carried over into their practice (Royal College of Nursing working party 1990)
  • It was found that all the counsellors surveyed had worked with lesbian and gay clients, but none had received any specific training related to counselling these clients. 50% of lesbian and gay clients reported discontent with their experiences of counselling (Man, Lyndsay (1994) Journal of the British Association for Counselling vol. 5 no.1)
  • There is widespread evidence of homophobia amongst doctors (McColl Homosexuality and medical health services: Editorial BMJ Feb.1994)
  • 73% of lesbian, gay or bisexual mental health service users reported experiences of prejudice, discrimination, harassment and even physical and sexual violence (MIND: Without Prejudice 1997)
  • It is surmised that 77% of mental health nurses were either moderately or severely homophobic (Wells, Homophobia and Nursing Care, Nursing Standard 12, Oct 1997)
  • Lesbians feel unable to disclose their sexuality to health care professionals due to homophobia and heterosexism (Carr, Scoular et al British Journal of Family Planning 25 - 1999)
  • It is particularly difficult for school nurses to tackle homophobia where school policy is not supportive (Mahoney, A Law for bullies, Nursing Times 96, 2000) 99% of schools have anti-bullying policies, but only 6% refer to homophobic bullying (Stonewall)
  • There is considerable anxiety and fear of stigmatisation in relation to disclosing ones sexuality in the context of primary care services (Cant Primary Health Care Research and Development 3: 2002)

COMING OUT

Coming out is not a single-step process. Usually, it involves acknowledgement of one's sexual identity first to oneself and after that to other people. Usually, the involvement of "other people" is also a step-wise process: it often begins with acknowledgement to other people who are known to be gay or lesbian, then to a few friends who are assumed to be heterosexual and gradually to more and more people. For some people coming out goes through all these stages, for some it stops somewhere along the route.

Coming out is generally seen as a process by which lesbians, gay men and bisexuals challenge internalised homophobia and increase the self-esteem which will help develop healthier ways of dealing with oppression. It can be seen as an important political statement in the context of living in a heterosexual society. It has been suggested that it is important to understand the processes many people go through in moving from a negative to a positive identity both for the people who are oppressed and those trying to help.

LESBIANS, GAY MEN AND BISEXUALS FROM BLACK AND MINORITY ETHNIC COMMUNITIES.

This group of people will face multiple oppression. To all the factors listed previously we can add racism and cultural conflicts - with inevitable consequences on stresses which may affect mental health.

Quibilah Montsho believes that up to 60% of black lesbians will have had some experience of the mental health system during their lives. She describes psychiatry as both racist and homophobic and what is classed as mental illness is defined and controlled by straight white men. She talks of the difficulty for a black lesbian to complain of sexism, racism and/or homophobia in a psychiatric setting because complaining may be interpreted as displaying an aspect of paranoid psychosis. She makes the point that because of cultural and language differences, the service user can be misunderstood and labelled as defensive or uncommunicative. (Behind locked doors: Talking Black, Cassell, 1995)

It is important not to stereotype people from the same ethnic group. Although there are similarities, there will also be many differences. However, a substantial number of black and ethnic minority people are British-born and have grown up living in two cultures.

Many black and Asian LGB people identify strongly with their communities and this helps to deal with the racism of the dominant culture which they experience. The concept of coming out as an individual does not easily fit into the value systems of themselves, their families and their communities.

Coming out may result in an additional burden to the level of discrimination they already experience. Rita Brauner (Issues in Therapy with LGBT clients OUP, 2000) argues the following point. While coming out to one's family may be crucial to the psychological health of, say, a white gay man, it may be equally crucial to the psychological health of say, an Asian gay man, not to come out to his family. Coming out may mean being cut off from family and community support.

Earlier it has been mentioned that the second step of coming out is often that of being open about one's sexuality to other lesbians or gay men. Black and ethnic minority LGBs often face racism from LGB organisations that would be expected to support them, such as LGB social/support groups. The commercial gay scene is certainly not free from racism. Black and Asian lesbians and gay men often say that they are perceived as being lesbian and gay within their own communities, but as Black or Asian in the general gay scene.

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