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Calling for whole-of-government approaches to improve health and wellbeing of LGBTIQ+ people

Addressing the burnout, discrimination, distress and harms experienced by LGBTIQ+ people requires whole-of-government action and investment, according to Nicky Bath, CEO of LGBTIQ+ Health Australia.


Nicky Bath writes:

Back in 2021, LGBTIQ+ Health Australia (LHA) released Beyond Urgent, its Second National LGBTIQ+Mental Health and Suicide Prevention Plan 2021-2026. As I reflected at that time, in the foreword, we were at a critical juncture for LGBTIQ+ people in Australia.

We were coming out of the COVID-19 pandemic that brought a broader focus on the mental health of the nation, which exposed the inadequacy of mental health care for LGBTIQ+ people. The Productivity Commission inquiry on mental health had been released in November 2020, and the National Suicide Prevention Adviser provided her final advice to the then Prime Minister Scott Morrison. In response, the Australian Government released its National Mental Health and Suicide Prevention Plan in May 2021, committing to reform the system and continue work toward zero suicides.

At this time, the Australian Bureau of Statistics was gathering data for its 2020–2022 National Study of Mental Health and Wellbeing data. This iteration of the study for the first time included the Australian Bureau of Statistics Standard for Sex, Gender, Variation of Sex Characteristics and Sexual Orientation Variables, 2020 (‘2020 Standard’).

The findings of the targeted surveying of LGBTIQ+ communities, through convenience sampling, confirm what we already know about the burden of poor mental health and wellbeing.

What is critical in this survey is that it enables us to see how LGBTQ+* people are faring compared to the broader population; and it is not good.

The findings tell us that over half of the people (58.7%) who described their sexual orientation as gay or lesbian, bisexual or who used a different term (LGBQ+) had a 12-month mental health disorder (people who met the diagnostic criteria for having a mental disorder at some time in their life and had sufficient symptoms of that disorder in the 12 months prior to when they completed the survey), compared with just 15.9% of people who identified as heterosexual.

One in two LGBQ+ people (50.3%) had a 12-month anxiety disorder (typically involving feelings of tension, distress or nervousness, which causes a person to avoid situations they believe cause these feelings, potentially limiting their interactions with the wider world and impacting the way they live).

The study also found that one in three transgender people (33.1%) had a 12-month mental disorder, compared with one in five cisgender people (21.3%). It is important to note here that these figures are incongruent with other data findings that indicate a much greater burden of poor mental health amongst trans and gender diverse people in comparison to LGBQ+ people. LHA is in the process of working with the ABS to understand these findings. Nevertheless, one in three transgender people living with a mental disorder is in and of itself an appalling finding.

Collection of accurate, inclusive data has been a focus of my time at LHA. It is front of mind for me every day, and that is no exaggeration. I am a huge advocate for the inclusion of the 2020 Standard in all research, service utilisation data, the census, and the minimum data sets used by governments.

The inclusion of the 2020 Standard for the first time in the 2020–2022 National Study of Mental Health and Wellbeing proves how important it is that we can collect and disaggregate the data in this way.

The question for me is: when will this data translate into meaningful actions and change?

Unacceptable

We are living in challenging times. Societal stigma and discrimination towards LGBTQ+ people continues to be alive and well.

What I see happening to trans and gender diverse people here in Australia and across the globe, resonates with what I lived through as a young lesbian under the Margaret Thatcher and John Major governments in London in the 1980s and 90s.

Being spat on in the street regularly, losing a job, being told I was dirty, disgusting, and looked like a man. Having human excrement put through my council flat letter box on more than one occasion, noting that I had government housing as private landlords were not too keen on having any of ‘that’ going on in their property — I could go on.

It is incomprehensible to me that within a society of great differences, individuals still purposely seek to demonise and harm others.

My own mental health, and the challenges it has posed, is not because of my sexual orientation. It is and was because of the actions of others.

Now, at nearly 56-years-old, I am outraged that people from the communities of which I am a part of continue to suffer.

While it is too late for the likes of me, we must make the trajectory for our young people different. The level of health and wellbeing disparities that we see today cannot be the case into the future.

In many ways, I am tired of the adage that we are resilient and live through adversity. At the end of the day, we are all just people. The burnout I see amongst my colleagues and the harm I witness towards our communities, particularly trans and gender diverse people, is just unacceptable. What we need to occur, to improve the health and wellbeing of LGBTIQ+ people, will not happen by our actions alone.

Invest well

Across Australia, LGBTIQ+ community-controlled health and wellbeing organisations are severely underfunded and overwhelmed with the demand of their services. Jurisdictions are slowly developing LGBTIQ+ specific Strategies and Plans, some more effective than others. None are resourced properly.

I have great hope for the inaugural 10 Year National LGBTIQ+ Health and Wellbeing Action Plan that is currently in train. I hope that this Plan will bring a much-needed whole-of-government lens to the health and wellbeing of LGBTIQ+ people, acknowledging that it will fail if the social determinants of health are not front and centre.

We need a concerted effort to look at procurement processes and ensure that money is invested most effectively for LGBTIQ+ people and communities. Discrimination from services that are set up for cisgender, heterosexual people significantly impact health-seeking behaviours and decisions of LGBTQ+ individuals.

Studies have shown that almost half of LGBTQ+ people would prefer to attend a healthcare provider that is known to be LGBTQ+ friendly. One in five prefer to attend an LGBTQ+ specific service.

As we head towards Trans Awareness Week (13–19 November) and Transgender Day of Remembrance (Monday 20 November), I invite you to strengthen your allyship and get involved.

Join us in standing strong and challenging hate and misinformation so that we can all live and thrive.

*The 2020–2022 National Study of Mental Health and Wellbeing was unable to report on data relating to people with variations of sex characteristics as the numbers were too small. LHA is working with the ABS to understand what can be learned from the responses they did receive.


See Croakey’s archive of articles on LGBTQI+ health and wellbeing