This year’s 2023 Health Report by LGBT Youth Scotland has revealed a worrying negative trend in the mental health of young, 13-25 year olds, LGBTQ+ people across the country. 77% reported anxiety and 54% depression, compared with around 31% for both conditions in the general population. Half had experienced suicidal thoughts and 43% had engaged in acts of self harm.
The study, which involved 1,200 participants from across the country, found that the mental health of young trans people was particularly poor, and that seeking help sometimes resulted in them feeling worse because they encountered mental health professionals who did not respect their identities. It also found those over 18 were more likely to be depressed but less likely to be suicidal, perhaps reflecting greater agency over their lives.
Some participants told researchers they felt that healthcare professionals did not adequately take into account the additional stress of living as an LGBTQ+ person experiencing prejudice and discrimination, whilst others felt their doctors were too willing to ascribe all their problems to issues connected with their sexuality or gender identity, rather than listening to them properly. One noted that it can be difficult to talk about sexuality or gender identity at all if only able to see a mental health professional when accompanied by a parent.
“My CAMHS [Children and Adult Mental Health Services) therapist told me on multiple occasions that bisexuality does not exist and that all of my mental health problems come from being confused and being unable to pick a side,” said one participant.
The downward trend in mental health, compared with previous years, is popularly ascribed within the LGBTQ+ community to the impact of negative media coverage and increasing experiences of hostility from other people. Other research has noted, however, that the mental health of young LGBTQ+ people was severely affected by pandemic lockdowns, which led to many being trapped in situations where they felt unsupported, unable to have honest conversations, or actively at risk from family members.
Low levels of trust in doctors
The survey also looked at wider aspects of health and found that a third of participants felt unsafe or unsupported by their GPs, with many cautious about coming out of the closet in a medical setting, which limited their ability to discuss important matters like sexual health.
LGBTQ+ cancer charity Live Through This recently noted trans men and non-binary people with cervixes are less likely to get smear tests because campaigning tends to be targeted at women and can make them feel unwelcome. Its Remove the Doubt campaign, which was unfortunately subject to attacks on social media, sought to educate healthcare staff on ways of making services more inclusive.
Lesbian women are less likely than straight women to see their GPs regularly. Historically, misunderstanding amongst male doctors as to the nature of sex between women has led to lesbians being incorrectly told that they don’t need smear tests.
“Nobody has ever asked me whether I’m a woman that has sex with women. I’ve been given healthcare as though I only have sex with men,” said one participant in the LGBT Youth Scotland survey, whilst others noted they found it exhausting to have to out themselves all the time, when each time felt like taking a risk.
“I feel that the odds of a healthcare professional being blatantly homophobic are fairly slim since they would get referred to the GMC, but I worry that they might privately become biased against me because of my sexuality, or that I might experience subtler forms of discrimination,” said one asexual and panromantic participant.
Waiting lists
Waiting lists were also a big concern, with mental health services and gender-related services notoriously slow. Moving between child and adult services can create further delays.
“I think the wait lists make people feel like they don’t matter. After I left CAMHS cause I turned 18 I have had a full year of waiting with no real help and only got worse,” said one survey participant.
“I tried to kill myself in August,” said another. “I was referred to a mental health team in May but they never got back to me. After my attempt I was referred, it’s October now and I’m meant to have my first phone consultation today but I don’t know if they’ll actually call. This didn’t make me feel very supported. (I’ve called them multiple times after my first and second referral and they always say they’ll phone back and they never do).”
Although trans men and non-binary people can theoretically get mastectomies at the age of 16, when they are considered old enough to consent, not being able to join the waiting lists until this point means that they are highly unlikely to be treated before they turn 18 and many not until they are in their twenties. This can have a serious impact on their ability to get on with their lives, pursuing higher education, living independently or developing relationships, something which many find ironic in light of misleading media claims about hasty surgery being carried out on children.
Time for change
Commenting on the findings, LGBT Youth Scotland’s CEO, Dr. Mhairi Crawford, said “It’s dismaying to see that, during a time when access to timely and appropriate healthcare has become particularly difficult in the UK, LGBTQ+ young people are experiencing multiple additional barriers to accessing the services they need. Long waiting lists, prejudice and discrimination, along with systems which don’t recognise the specific needs of LGBTQ+ young people, are all unnecessary barriers to accessing appropriate healthcare.
“It is vital that, as part of the ongoing work to redevelop NHS services, the Scottish Government and NHS Boards take action to ensure that healthcare services are fully inclusive, and that LGBTQ+ young people do not experience additional barriers to receiving appropriate care due to their identity.”
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