Evidence to Inform the Development of Guidance for Mental Health Service Providers on the Care and Treatment of LGBTQIA+ Service Users.

Abstract

A significant body of research has consistently demonstrated that LGBTQIA+ people experience a disproportionate burden of mental health difficulties compared to the general population. In Ireland, the largest study of the mental health of LGBTQI+ people to date, the Being LGBTQI+ In Ireland study (Higgins et al., 2024) reported poorer mental health outcomes compared to its prequel study the LGBTIreland study (Higgins et al., 2016). These differences were particularly marked in young people under the age of 25 years and in transgender people. While there were a number of positive findings about participants’ general healthcare experiences, there were reported gaps in healthcare provider knowledge of LGBTQIA+ identities, and barriers to accessing mental healthcare specifically including resource barriers, stigma, and the fear of pathologisation. Negative encounters centred on engaging with mental health practitioners who were unsure how to react to the person’s gender identity or sexual orientation, or were disinterested and not supportive, with participants detailing incidents when they were disregarded, not taken seriously or misgendered. Positive experiences centred on engaging with respectful, sensitive and knowledgeable practitioners. A 2022 study by Mental Health Reform, the My LGBTI+ Voice Matters study focused specifically on the views of LGBTI+ mental health service users who used community mental health services, inpatient mental health services, and/or a psychiatrist in the two years prior to taking part in the study. Compared to non-LGBTI+ participants, a greater proportion of LGBTI+ service users reported ‘never’ feeling well-supported by their current psychiatrist and fewer LGBTI+ participants reported ‘always’ being treated with respect and dignity by community mental health services. Participants reported a lack of LGBTI+ competence amongst mental health professionals, needing to self-censor their LGBTI+ identity, getting inappropriate questions and comments, and having their LGBTI+ identity pathologized by attributing their mental health difficulties to their identity. It is evident that there are a sizeable proportion of people, particularly young people and transgender people who report a significant level of mental distress and unmet mental health needs, and mental health services in Ireland need to be responsive to these needs. The dominant culture in mental health settings and among mental health professionals is generally heteronormative and cis-normative (Rees et al., 2021). This needs to be challenged by practices that are inclusive, respect equality and are LGBTQIA+ affirming. In recent years, LGBTI+ specific policy documents such as The LGBTI National Youth Strategy 2018-2020 (DCYA, 2018) and the National LGBTI+ Inclusion Strategy 2019-2021 11 (DCEDIY, 2019) have referred to the importance of LGBTI+ inclusive healthcare and LGBTI+ knowledgeable and affirming healthcare staff. In addition to these LGBTI+ specific policies, mainstream mental health policies including Connecting for Life Ireland’s National Strategy to Reduce Suicide 2015- 2024 (DoH, 2015), and the national mental health policy Sharing the Vision 2020-2030 (DoH, 2020) identify the LGBTQI+ group as a priority group requiring targeted mental health actions. Recommendation 61 of Sharing the Vision explicitly states that ‘The HSE should maximise the delivery of diverse and culturally competent mental health supports’ (DoH, 2020:63). This is supported by the Quality Framework of the Mental Health Commission (Farrelly et al., 2023) which promotes ensuring quality through the provision of equal, socially inclusive, and diverse mental healthcare services. The reviews to follow in this report contribute to the evidence base to inform the development of guidance for mental health service providers on the care and treatment of LGBTQIA+ service users.