LGBTQIA+ & mental health

Mental health has long been a topic of discussion, especially in the past few years. But recent research has revealed how there is a disproportionate number of people within the LGBTQIA+ community struggling with their mental health and facing barriers in the healthcare sector.

Here, we discuss the importance of LGBTQIA+ mental health with Dr Andrew Motherwell. Plus, we share our top tips for nurturing your mental wellbeing and where you can find additional support.

What is LGBTQIA+?

LGBTQIA+ is an acronym for lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual, and more. These terms are used to describe a person's sexual orientation or gender identity. LGBTQIA+ is an umbrella term that encompasses all people within the diverse community, including those that aren’t listed in the abbreviation, such as non-binary and pansexual.

It’s important to note that gender identity and sexuality are not conscious choices that people make, in the same way that people do not choose to be heterosexual. These are simply innate characteristics of an individual.

What factors affect the mental health of the LGBTQIA+ community

Like anyone, LGBTQIA+ people may experience poor mental health or a mental illness at some point during their life. However, those who identify as LGBTQIA+ are two to three times more likely to report having a mental health problem.^ This includes the risk of developing issues like:

• Low self-esteem

• Depression

• Anxiety, including social anxiety

• Problems with eating

• Misusing drugs and alcohol

• Self-harm

• Suicidal feelings

In fact, a devastating 52% of LGBT people said they’ve experienced depression in the last year, while one in eight LGBT people aged 18-34 said they’ve attempted to take their own life in the last year.^^

It’s important to note that being LGBTQIA+ does not cause mental health problems. The reasons why there are higher rates of mental health issues among the LGBTQIA+ community are complex. There are many experiences LGBTQIA+ people will likely endure as a minority community which may contribute to poor mental health, such as:

• Homophobia, biphobia and transphobia

• Stigma, prejudice and discrimination

• Difficult experiences coming out to others

• Social isolation, exclusion, rejection and disadvantage

• Bullying and hate crimes

• Negativity in news and on social media

Intersectionality highlights how factors such as age, religion, ethnicity, disability, cultural, and socio-economic backgrounds can add another layer of complications for some LGBTQIA+ people.

But embracing your LGBTQIA+ identity should also be celebrated for the positive impact it can have, such as:

• Increased confidence

• The freedom of self-expression and self-acceptance

• Stronger relationships with friends and family

• Feelings of relief

• A sense of community and belonging

• Better resilience

The impact of discrimination & societal attitudes on the LGBTQIA+ community

Experiencing discrimination can negatively impact mental health, however, there are some types of discrimination that LGBTQIA+ people are more likely to experience at some point. This could happen in:

• Workplaces

• School, college or university

• The healthcare system

• Religious and faith groups

• Wider society

And while we can argue that societal attitudes towards the LGBTQIA+ community have changed dramatically over the past few decades, stigma and discrimination are still very much prevalent in daily life. Whether this is experiencing poor service in shops and restaurants, unfair treatment when buying a house, being refused use of a public bathroom or bordering on threats and physical attacks.

In fact, according to a report from Stonewall†, 21% of people have experienced a hate crime or incident due to their sexual orientation and/or gender identity in the last 12 months. And a further 81% of those who experienced a hate crime didn’t report it to the police out of fear of not being listened to.

It’s worth knowing that in some settings, discrimination is not lawful in the UK under the Equality Act 2010, so it’s important to know your rights and seek support if you feel you need it.

What barriers are faced by the LGBTQIA+ community to access mental health support?

One of the many things those in the LGBTQIA+ community may experience is difficulty accessing quality healthcare. While this isn’t the case for everyone, a Stonewall report† found that 25% of LGBTQIA+ people experienced a lack of understanding of specific LGBT health needs by healthcare staff.

This can stem from assuming pronouns to inappropriate curiosity, which may come down to limited education on the community and their specific health needs, as well as a fear of saying the wrong thing. This, combined with the under-representation of LGBTQIA+ people within healthcare and the long wait times for gender affirming care, can mean they’re less likely to reach out for help. Dr Andrew Motherwell, a Nurse Independent Prescriber at Boots Online Doctor, is a champion of inclusive healthcare for LGBTQIA+ people and sheds some light on these barriers.

“Research has shown that one in eight LGBTQIA+ people in the UK have experienced discriminatory treatment from healthcare providers, so there’s a precedent for individuals being wary of disclosing their sexual or gender identity,” says Andrew. “In some cases, this can result in people avoiding seeking treatment until they become very unwell.”

While questions about sexual practices or genitals may be relevant in some situations, such as in sexual and reproductive health, Andrew states how “It’s important for healthcare professionals to be sensitive and consider how this information would make a difference to the care they provide.

“As with other minority groups, discrimination and harassment has an impact on the health of LGBTQIA+ people, so knowing someone’s sexual or gender identity can help give clinicians context to health concerns,” says Andrew. "For example, transgender, non-binary and gender non-conforming people can be more likely to experience urinary infections as a result of finding it difficult to access public toilet facilities.”

Andrew explains how “Some people choose to avoid going too far from home, which can worsen feelings of isolation and loneliness, as well as reducing the amount of exercise they take.” He adds, “We can prescribe antibiotics to treat the infection, but this context allows us to tailor preventative advice.”

Some LGBTQIA+ people under the age of 18 may also find it difficult accessing healthcare, due to certain mental health services being unavailable to under 18s and coming with a fee. For under 16s who want a doctor’s appointment, it’s recommended that they’re accompanied by an adult which can be especially challenging if they’re yet to come out to friends and family.

“While we’re seeing greater acceptance of LGBTQIA+ people, this is not the case for everyone. School bullying is still more common for young LGBTQIA+ people compared to their peers and there may be a fear of perceived or actual rejection from their families if they were to come out,” says Andrew.

“For young people questioning their sexual or gender identity, being able to have that initial conversation with a healthcare professional, someone separate from their life at home and school, can be really valuable," he adds.

So how does Andrew tackle some of these concerns? “From my background in sexual health, we always try to ensure that young people have at least some opportunity to speak without a parent or guardian present. This is important for allowing the young person to be more open about their situation, as well as allowing the clinician to assess for any possible safeguarding concerns.”

In light of these barriers, both Sleek and the No7 Beauty Company have donated £50,000 to the charities Stonewall (1101255) and The Terrence Higgins Trust (288527). They’re teaming up to invest in training resources for pharmacists across a multitude of stores to help them sensitively interact with patients, helping to beat stigma and much more.

Never feel like you can’t reach out for help, especially if you’re struggling with your mental health.

The importance of self-care & mental wellbeing

It’s important for everyone to nurture their wellbeing. And if you're a member of the LGBTQIA+ community, you may have experiences that your friends and family simply can’t understand. It’s because of this that it’s vital to prioritise your self-care and mental wellbeing. 

Self-care looks different to everyone. For some people, self-care is all about writing down thoughts and feelings in a daily journal, while to others it looks like exercising or having dinner with friends. Wherever you are in your mental health journey, we’ve put together some useful tips that may be worth considering to help you along the way.

Practical tips

• Allow yourself to feel whatever you’re feeling

• Find solace in other members of the LGBTQIA+ community

• Speak to somebody you trust, whether it’s a close friend, family member or a colleague

• Join an LGBTQIA+ group, such as a football team or volunteer group

• Make an appointment with a therapist

Lifestyle tips

• Eat a healthy, balanced diet

• Get plenty of sleep (ideally between seven and nine hours)

• Try doing some physical activity

• Get outside and enjoy nature

• Make a conscious effort to limit negative screentime and ‘doom scrolling’

Mindfulness tips

• Write down five things you’re grateful for

• Take the time to do things you enjoy, such as reading a book or soaking in a bubble bath

• Practise mindfulness and journaling

• Practise reciting kind words to yourself

What mental health support is available for the LGBTQIA+ community?

It’s no secret that those with LGBTQIA+ identities may face extra challenges around getting the right support, but rest assured there’s plenty of help available. Remember, different approaches work for different people. Only try what you feel comfortable with and try not to put too much pressure on yourself – if one approach doesn’t suit you, it’s okay to keep searching until you find what’s right for you.

If you’re experiencing a mental health crisis or are at risk of harming yourself or others, please call NHS 111 now, speak to the Samaritans on 116 123, text Shout on 85258, or speak to your GP.

Consider Boots Online Doctor

If you’re struggling and want to reach out for help but don’t know where to start, the Boots Online Doctor Depression and Anxiety service* may be suitable for you. We know it can be difficult to open up to a healthcare professional who may not fully understand, which is why this particular service has doctors trained in LGBTQIA+ healthcare.

Ask your GP for help

Alternatively, you can make an appointment with your GP. Opening up to a doctor about your personal thoughts and feelings is challenging for everyone, especially for those in the LGBTQIA+ community. While you do not have to inform them of your identity, this may help them point you in the right direction for support. This could include:

• Making a diagnosis

• Offering support and treatments such as talking therapies and possibly medication

• Refer you to a specialist LGTBQIA+ mental health service

Reach out to LGBTQIA+ mental health services

These specialist services often employ staff or volunteers that identify as LGTBQIA+ and may provide the following:

• Advocacy

• Helpline and email advice

• Talking therapies and counselling

You can find these services in your area through Mind’s Infoline or The Consortium Organisation.

Try talking therapies

As mentioned above, talking therapies can be a beneficial way to support your mental health. They involve talking to a trained professional about your thoughts, feelings and behaviour to help you manage and cope with anything from difficult emotions and life events to upsetting experiences and mental health problems like depression and anxiety. You can find a therapist through:

• The NHS – you can do this by asking your doctor to refer you or self-referring if you’re registered with a GP and are over the age of 18

• The private sector

• Some charity organisations, such as Mind

If you’d prefer your therapist to be a member of the LGBTQIA+ community, you can mention this during your first call with your chosen service. However, bear in mind that it’s not always possible to be matched with an LGBTQIA+ therapist. If this is the case, rest assured that they may still have experience of helping people with similar problems. If it’s not for you, then you can keep trying until you find a therapist that works for you.

Seek support through your workplace

It can be worth reaching out to the appropriate mental health resources, if your workplace offers this kind of service. It can be really beneficial to speak to someone about how you’re feeling who sits outside of your usual circle and can offer a listening ear.

Where to seek help & resources

If you’re wanting some places to turn to in the meantime, you can always take a look at some of the below resources for additional support:

• Mind – this is a mental health charity that also has a full directory of useful contacts for LGBTQIA+ mental health

• LGBT Foundation – this offers information, advice and support services, including an LGBT talking therapy programme

• Pink Therapy – this has an online directory of therapists who work with LGBTQIA+ people

• Switchboard LGBT+ Helpline – this is a listening service for LGBT+ people, via the phone, email or online chat

• Consortium – a membership organisation that supports LGBTQIA+ organisations and projects across the country

• Albert Kennedy Trust – this supports young LGBTQIA+ people aged 16-25

• Gendered Intelligence – a trans-led charity that aims to better the quality of trans people’s lives, especially those under 25

• London Friend – this offers support groups and services, such as counselling, to LGBTQIA+ people in and around London

• MindOut – a community mental health charity run by LGBTQIA+ people

• The Trevor Project – a suicide prevention and crisis intervention organisation for LGBTQIA+ people

• Terrence Higgins Trust – offers support for HIV/AIDS, counselling and sexual health advice

• Stonewall – a charity movement that stands for LGBTQIA+ rights. They also have a full list of LGBTQIA+ terms as well as invaluable information on campaigns, inclusive schools and employer resources

There’s plenty of help out there, it’s just finding the right support for you. Just know that you’re never alone and that there is light at the end of the tunnel.