Mental health

Although attitudes towards gay people are improving, most lesbian, gay, bisexual and transgender people have experienced difficulties in their lives. Being lesbian, gay, bisexual or transgender does not, in and of itself, cause mental health problems. Instead, homophobic bullying, rejection from family, harassment at work and poor responses from healthcare professionals are still commonplace for many lesbian, gay, bisexual and transgender people.

For young lesbian, gay and bisexual people who have experienced homophobic bullying, levels of suicidal thoughts and depression are far higher than amongst those who have not been bullied.

Mental health services need to change their approach if they are to understand and meet the needs of lesbian, gay and bisexual people. Assumptions of heterosexuality, a lack of visibility and patchy equality monitoring need to be overcome to improve the mental health of lesbian, gay, bisexual and transgender people throughout Scotland.

Gay and Bisexual Men

Depression and anxiety

Stonewall’s Gay and Bisexual Men's Health survey (2011) asked respondents a set of questions widely used by health professionals that help determine whether someone is experiencing depression or anxiety at that time and found that:

One in seven (14 per cent) gay and bisexual men in Scotland are currently experiencing moderate to severe levels of mixed depression and anxiety compared to seven per cent of men in general.

A further eight per cent of gay and bisexual men are experiencing moderate to severe levels of depression with mild or no anxiety compared to two per cent of men in general.

Thus overall, 22 per cent of gay and bisexual men are experiencing moderate to severe levels of depression.

‘I’ve been suffering from depression due to bullying since I was 15. I’ve been on prescribed medication since then and still feel that there is little help out there.’ Charlie, 22, London

Suicide

In the last year, three per cent of gay men and seven per cent of bisexual men in Scotland have attempted to take their own life. UK wide figures show that this increases to five per cent of black and minority ethnic men, five per cent of bisexual men and seven per cent of gay and bisexual men with a disability. In the same period, 0.4 per cent of all men attempted to take their own life.

In the last year, 30 per cent of gay men and 37 per cent of bisexual men in Scotland thought about taking their own life even if they would not do it. UK wide figures show that this rises to 35 per cent of black and minority ethnic men, 38 per cent of bisexual men and 47 per cent of gay and bisexual men with a disability. Just four per cent of men in general thought about taking their own life in the last year.

Half (51 per cent) of gay and bisexual men in Scotland said they have felt life was not worth living compared to 17 per cent of men in general. Two in five (41 per cent) of gay and bisexual men who have felt this way did so in the last year.

‘I have tried to hang myself. I have also swallowed cleaning fluid.’ Gary, 25, South West

Self-harm

One in sixteen (six per cent) gay and bisexual men in Scotland deliberately harmed themselves in the last year, which including cutting themselves or swallowing pills or objects. UK wide figures show this increases to 11 per cent of bisexual men and 15 per cent of gay and bisexual men with a disability. Just 1 in 33 men in general have ever deliberately harmed themselves.

Three in five gay and bisexual men who have self-harmed in the last year have cut themselves and almost three in ten (29 per cent) have swallowed pills or objects. One in seven (13 per cent) have burned themselves.

‘I’ve punched, bit, pinched myself and pulled my hair out.’ Ed, 16, South West

Lesbian and Bisexual Women

Depression and Anxiety

Stonewall’s Prescription for Change (2008) asked respondents across the UK to report on feelings of depression and anxiety over the last year and found that:

In the last year, four in five (79 per cent) lesbian and bisexual women say they have had a spell of sadness, felt miserable or felt depressed. This increases to 84 per cent of bisexual women and 86 per cent of black and minority ethnic women.

In the last year, three quarters (74 per cent) of lesbian and bisexual women say they felt anxious or nervous. This increases to 78 per cent of bisexual women and 81 per cent of black and minority ethnic lesbian and bisexual women.

Suicide

Prescription for Change (2008) also asked respondents about suicide and suicidal thoughts and found that:

In the last year, five per cent of lesbians and bisexual women in Scotland say they have attempted to take their own life. UK wide figures show that this increases to seven per cent of bisexual women, seven per cent of black and minority ethnic women and ten per cent of lesbians and bisexual women with a disability.

Across the UK in the last year, 33 per cent of lesbians and bisexual women thought about taking their own life even if they would not do it. This increases to 39 per cent of bisexual women, 41 per cent of black and minority ethnic women and 52 per cent of disabled women.

Self-harm

Prescription for Change (2008) asked respondents about self-harm and found that:

In the last year, one in five lesbian and bisexual women in Scotland have deliberately harmed themselves in some way. UK wide figures show that this increases to 26 per cent of black and minority ethnic women, 29 per cent of bisexual women and 31 per cent of lesbians and bisexual women with a disability compared to just 0.4 per cent of the general population.

Eighty four per cent of those who have self-harmed in Scotland in the last year have cut themselves, and one in five have swallowed pills or objects.

LGB Young People

Effects of homophobic bullying

Stonewall’s The School Report (2012) asked young people about their experiences at school and their current mental health. It found that:

More than half (52 per cent) of lesbian, gay and bisexual young people experience homophobic bullying in Scotland’s schools.

UK wide figures showed that almost half (46 per cent) of LGB pupils who experience homophobic bullying have symptoms consistent with depression. Thirty five per cent of LGB young people who aren’t bullied are also likely to be depressed compared to just five per cent of young people generally.

Half (49 per cent) of lesbians and bisexual girls have symptoms consistent with depression compared to three in ten (29 per cent) gay and bisexual boys.

Almost half (46 per cent) of those who experience bullying report having low self-esteem compared to 35 per cent of gay young people who aren’t bullied.

LGB pupils who don’t feel they have an adult to talk to are much more likely to have symptoms of depression than gay pupils who do have an adult to talk to (54 per cent compared to 37 per cent).

‘I believed everything they were saying to me.’ Adam, 16, secondary academy (West Midlands)

Suicide

The School Report (2012) also showed that one in four (26 per cent) lesbian, gay and bisexual young people in Scotland have tried to take their own life at some point.

UK wide figures show that girls are more likely to attempt this than boys (29 per cent compared to 16 per cent). Gay young people who experience homophobic bullying are much more likely to attempt to take their own life than gay young people who aren’t bullied; 28 per cent have attempted to take their own life compared to 17 per cent.

Seven in ten (71 per cent) lesbian and bisexual girls and almost six in ten (57 per cent) gay and bisexual boys have thought about taking their own life, with boys who are black or minority ethnic at particular risk of suicidal thoughts at 76 per cent. Gay young people who experience homophobic bullying are much more likely to think about taking their own life (72 per cent compared to 56 per cent). In comparison, Samaritans says seven per cent of all young people in general have ever attempted to take their own life and 20 to 45 per cent have thought about it.

Two in five (41 per cent) lesbian, gay and bisexual pupils who experience homophobic bullying attempt or think about taking their own life directly because of the bullying.

‘The bullying went on for the whole five years of secondary school. From when I started to when I finished. I tried to fight back. I was depressed, I cut, and I was on the verge of suicide. For one year, I came home everyday crying into my mum’s arms, saying I wanted to leave the school.’ Rabi, 15, sixth form college (Greater London)

Self-harm

The School Report 2012 asked young people if they have ever self-harmed and the link to bullying and found that:

More than half (54 per cent) of LGB young people in Scotland deliberately harm themselves, which can include cutting or burning themselves.

UK wide figures show that lesbians and bisexual girls are twice as likely as gay and bisexual boys to self-harm (72 per cent compared to 36 per cent), with girls who are black or minority ethnic at greatest risk at 83 per cent. LGB young people who experience homophobic bullying are more likely to harm themselves than those who aren’t bullied (61 per cent compared to 50 per cent). In comparison, NSPCC estimates that between 1 in 15 and 1 in 10 young people in general deliberately harm themselves.

Two in five (41 per cent) lesbian, gay and bisexual pupils who experience homophobic bullying say they deliberately harm themselves directly because of the bullying, which is consistent with other research that links experience of bullying with increased risk of self-harm.

‘I have recently started to cut myself. I have had enough of being hated by so many people for just being who I am.’ Rufus, 15, secondary academy (East Midlands)

Transgender People

The Scottish Transgender Alliance has recently published a report into transgender people’s experiences of mental health in Scotland.

The full report can be found here 

Depression and Anxiety

The report suggests worrying levels of depression, stress and anxiety amongst transgender people in Scotland:

  • 88 per cent  of transgender Scots surveyed felt they either currently or previously suffered from depression
  • 80 per cent suffered from stress and 75 per cent  suffered from anxiety
  • Over half of respondents (58 per cent) felt they had been so distressed at some point that they had needed to seek help or support urgently. Of those 35 per cent  avoided seeking urgent help because they were transgender or had a trans history
  • When participants did need urgent support they were more likely to contact friends, helplines or online groups, than NHS support
  • Almost a fifth (18 per cent) also stated that they did nothing when in need of support
  • Significantly, 70 per cent of participants were more satisfied with their lives since transitioning and only 2 per cent were less satisfied. Those who were less satisfied cited poor surgical outcomes, loss of family, friends and employment, everyday experiences of transphobia and reasons unrelated to being transgender

Suicide

  • More than eight in ten (84 per cent) respondents had thought about ending their lives at some point
  • Over a third (35 per cent) had attempted suicide at least once, and one in four (25 per cent) had attempted suicide more than once
  • Of those who had at some point thought about ending their lives, more than one in four (27 per cent) had thought about attempting suicide within the last week, and 4 per cent  thought about it every day
  • Almost two thirds (63 per cent) had thought about attempting suicide within the last year
  • Notably, suicidal thoughts and attempts reduced after transition, with 63 per cent of respondents thinking about or attempting suicide less after transitioning

Self-harm

Over half (53 per cent) of participants had self-harmed at some point, with 11 per cent currently self-harming. 20 per cent of respondents had wanted to harm themselves in relation to, or because of involvement with a Gender Identity Clinic or health service. Reasons included long waiting times, delays to treatment, appointment cancellations, inaccurate assessments, being denied hormones, being denied surgery, being denied access to a Gender Identity Clinic, being given the wrong information or advice, receiving negative or inappropriate treatment, and being discharged from a Gender Identity Clinic.

Who to contact

For information about support and advice available in your area visit our What's in my area? database.

What the health service can do

A lack of visibility of lesbian, gay, bisexual and transgender people in mental health services and poor measurement of access and outcomes for LGB&T people has an impact on their mental health. The high incidence of attempted suicide, self-harm and homophobic bullying in LGB&T young people means mental health services must actively work to improve the health of lesbian, gay, bisexual and transgender people.

There are a number of steps health services can take to improve the mental health of lesbian, gay and bisexual people:

  • Identify patients who are lesbian, gay or bisexual and take proactive steps to enable them to receive the best possible care
  • Work alongside schools and other education organisations to focus on early intervention and tackle homophobic bullying
  • Train staff on the specific mental health needs of lesbian, gay and bisexual people

Stonewall Scotland’s Online Learning Resource www.lgbtgoodpractice.org.uk can be freely accessed by all public bodies in Scotland as an effective means of rolling out LGB&T equality training to frontline staff.

The Studies

The findings in this briefing are taken from a number of Stonewall publications:

Gay and Bisexual Men’s Health Survey

In 2011 Stonewall and Sigma Research asked gay and bisexual men from across Britain to complete a survey about their health. 6,861 men responded making it the largest survey of its kind in the world.

Prescription for Change: Lesbian and bisexual women’s health check 2008

In 2007 Stonewall and De Montfort University asked lesbians and bisexual women from Britain to complete a survey about their health. 6,178 women responded making it the largest survey of its kind in Europe.

The School Report

Between November 2011 and February 2012, Stonewall and the Centre for Family Research, University of Cambridge asked 1,614 lesbian, gay and bisexual young people aged between 11 and 19 to complete a survey about their experiences in school or college.


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