Updated: 6 days ago
This is a guest blog written by Laura Clarke (she/her) from National LGBT Partnership
Accessing healthcare services can be unnerving for many people — whether navigating the societal stigma that comes with visiting a sexual health clinic, preparing to open up to a mental health professional for the first time, or visiting the GP with concern over a lump or bump. But for LGBTQ+ people specifically, there exists a whole other web of complexities within the world of health services.
Lesbian and bisexual women are up to ten times less likely to have a cervical smear, compared to heterosexual women (House of Commons Women and Equalities Committee, 2019). This is, in part, due to years of misinformation from medical professionals who have incorrectly advised that someone with a cervix can only get Human Papillomavirus (HPV) from engaging with sex with a penis. This is dangerous and irresponsible.
Bisexual people, who are up to four times as likely to experience mental health issues than their straight peers (House of Commons Women and Equalities Committee, 2019), repeatedly report their bisexual identity being used as further proof that they have unstable mental health by therapists. This is stigmatising and ignorant.
Trans men and non-binary people who experience pregnancy and birth find themselves with no directions to a male toilet when accessing pregnancy services, while the female toilets are signposted clearly. Trans people also experience frequent misgendering within healthcare settings, even when seeing doctors they’ve known for years. Both of these examples are cis-normative and erasing.
So, what impact does this have on the health of LGBTQ+ people?
“One in seven LGBT people (14 per cent) say they’ve avoided treatment for fear of discrimination because they’re LGBT. Almost two in five trans people (37 per cent) and a third of non-binary people (33 per cent) have avoided treatment for fear of discrimination” (Stonewall, 2018).
Needless to say that failure to access care for health concerns will, in many cases, lead to the worsening of ailments and, in worst-case scenarios, result in a — possibly otherwise preventable — death from a physical or mental health condition. LGBTQ+ people are at higher risk of developing certain cancers, diabetes and cardiovascular diseases than heterosexual, cisgender people (Williams et al., 2015) — this could, in part, be due to various lifestyle choices that disproportionately affect LGBTQ+ people.
For example, LGBTQ+ people are more likely to drink, smoke and use recreational drugs, and less likely to be physically active or have a good diet (LGBT Foundation, 2020).
There are multiple factors that may contribute to this including minority stress, lack of alcohol-free LGBTQ+ venues, poverty and mental health.
It is vital to note that the physical health of LGBTQ+ people may be worse than that of the general population as this may mean more access is needed to healthcare and that a lack of inclusive and appropriate care is even more hazardous to LGBTQ+ health outcomes.
But what about mental health?
LGBTQ+ people are also more likely to experience worse mental health in comparison to the general population (Stonewall, 2018). As with physical health, this is likely due to minority stress — experiencing prejudice and discrimination, lack of LGBTQ+ support, long waiting times to receive gender-affirming care, etc. It takes enormous strength and bravery to reach out for mental health support in a society that consistently stigmatises those who suffer. To build up such strength only to be met with microaggressions, or even overt discrimination, when accessing support can only worsen the mental health of LGBTQ+ people, and even lead to tragedy:
“One in eight LGBT people aged 18–24 (13 per cent) said they’ve attempted to take their own life in the last year. Almost half of trans people (46 per cent) have thought about taking their own life in the last year, 31 per cent of LGB people who aren’t trans said the same” (Stonewall, 2018).
Changes desperately need to be made to our health systems. We need inclusive and well-informed care for LGBTQ+ people as a matter of urgency.
It only takes one bad experience, even hearing about one through a friend, to delay or completely avoid accessing vital care.
So where can we start?
If you have the power to do so, organise LGBTQ+ training for your service staff. [See here for Chloe's LGBTQ training] And if you don’t have this power then request training from someone who does. Start talking to your colleagues and challenging incidents of LGBTQ+ prejudice when you hear it. Ask yourself, “Does my service only represent cisgender, heterosexual people?” Look at the posters, the leaflets, the toilets ... everything.
If you’re thinking “I really don’t have the power to change my service” then start with yourself. Rainbow lanyards, pronoun badges, a Pride flag in your office — small visual cues that may help LGBTQ+ people feel seen and validated. Notice your language, your actions — do you assume pronouns? Picture a male when a young woman mentions a partner? Provide more sexual health tests purely on the basis of your patient being bisexual?
We absolutely have the power to make change — to provide safer services for LGBTQ+ people. The best time to do this was well before 2021, the second best time is now.
Laura Clarke (she/her)
National LGBT Partnership
Partnership Twitter: @lgbtpartnership
Partnership Instagram: @lgbtpartnership
Laura Twitter: @thelauraclarke Laura
House of Commons Women and Equalities Committee, 2019. Health and Social Care and LGBT Communities. London: House of Commons.