LGBT+ people across Scotland are continuing to face health inequalities across every measure of wellbeing, according to a major new report by NHS Greater Glasgow and Clyde, NHS Lothian and Public Health Scotland.
The findings of the Health Needs Assessment, commissioned by the Boards, found that the COVID pandemic has exacerbated issues, with significant numbers experiencing loneliness and isolation, while almost a half of LGBT+ people in the survey said they had experienced discrimination in the previous year – with trans and non-binary communities experiencing higher levels of abuse.
The assessment also revealed significantly high levels of mental ill-health, with more than half of all respondents reporting issues such as depression, anxiety and stress, with the highest rates experienced by trans and non-binary individuals.
The comprehensive assessment was undertaken to better address gaps in knowledge about the health and wellbeing of LGBT+ patient groups, to better inform approaches to public health for LGBT+ people, across seven groups: lesbian and gay women, gay men, bisexual women, bisexual men, trans women, trans men (trans masculine) and non-binary people across the Greater Glasgow & Clyde and Lothian areas.
Nicky Coia, Health Improvement Manager at NHSGGC said: “This report should serve as a wake-up call for everyone involved in the health and wellbeing of LGBT+ communities. Too many continue to suffer from discrimination and abuse, are experiencing social isolation and loneliness and suffering the impacts of poor mental health. This, combined with the poor socio-economic situations many find themselves in, contributes to a substantial health inequalities on every measure of wellbeing.
“While there are positives to be taken in terms of how LGBT+ experience healthcare, particularly from the GPs, there is still work to be done to improve access to, and experience of, person-centred healthcare, that treats the individual, no matter their gender identity or sexual orientation.”
Dona Milne, Director of Public Health and Health Policy at NHS Lothian said: “We interviewed more than 200 people and over 2,500 people took part in the online survey as part of this research. Their experience is in stark contrast to the progress that many of us may feel has been made in achieving equality in Scotland.
“I want to thank everyone who took part and express our shared desire to highlight this as a key public health issue and deliver real improvements in health and wellbeing for LGBT+ communities.”
Some of the key findings include:
· Nearly three in four (73%) survey respondents said they ever felt isolated from family and friends and nearly two in five (38%) had felt lonely all of the time or often in the previous two weeks. Trans and non-binary people showed the highest levels of isolation and loneliness.
· The survey showed that overall more than half (54%) of respondents said they had mental health problems e.g. depression/anxiety/stress, but this was higher for trans masculine (75%), non-binary people (72%) and bisexual women (61%). Only one in four (25%) survey respondents rated their general mental and emotional wellbeing positively – but this was lowest for non-binary (9%) and trans masculine (12%).
· Of those who answered the question in the survey, nearly one in three (31%) said that they had ever made an attempt to end their life. Although the prevalence of suicide attempts was high across all LGBT+ groups, it was highest among trans masculine and non-binary people, with nearly half of respondents in these groups saying they had made a suicide attempt.
· Overall, nearly half (44%) of LGBT+ people in the survey said they had been discriminated against in the last year, but this was highest for non-binary (65%), trans masculine (62%) and trans women (55%).
· The survey findings show that 37% of LGBT+ respondents had ever experienced an abusive relationship; identity groups with the highest proportion reporting abusive relationships were trans masculine (48%), non-binary (45%), bisexual women (43%) and trans women (38%).
· only 59% overall rated their general health positively. Gay men and gay/lesbian women were the most likely to rate their health positively, while trans masculine and non-binary people were the least likely. A third (33%) of LGBT+ people had a long-term condition or illness that substantially interferes with their day to day activities.
· Most (88%) survey respondent had financial worries at least some of the time. One in six (18%) had experienced food insecurity in the previous 12 months. One in eight (13%) had ever been homeless.
The report’s authors have made 41 recommendations, including an immediate request that all Scottish local authorities should provide or fund at least some, community-led groups or activities for LGBT+ people, with provision for cultural, sport and physical activity and social interest groups, as well as targeting specific identity groups. Other recommendations call for improvements in LGBT+ education in schools, improved LGBT+ training and awareness for health and other staff, improvements in mental health and gender identity clinics and more visibility of LGBT+ inclusive services.
Professor Nicola Steedman, Deputy Chief Medical Officer at the Scottish Government, said: “The assessment lays bare the fact that too many LGBT+ people are subject to significant inequalities which impact every aspect of their lives. I’m grateful to everyone who took part in the research and NHS Greater Glasgow and Clyde and NHS Lothian for carrying out this important work.
“The Scottish Government is committed to reducing inequality – in all its forms – and we welcome the report. We will continue to work with, and across our partners, to improve the health and wellbeing of our LGBT+ communities.”
Mark Kelvin, Chief Executive of LGBT Health and Wellbeing, said: “This report highlights what many of our community members experience in their daily lives.
“Whilst many people believe that LGBTQ+ people have achieved equality, this report reminds us that there is still a lot of work to do. Scotland is celebrated as being a welcoming and inclusive country and whilst that is true, almost half of LGBTQ+ respondents experienced discrimination in the past year. The report also highlights the health inequalities that still exist for many of us and provides very useful and realistic recommendations that will help LGBTQ+ people to live well.
Speaking specifically on how COVID-19 has impacted the LGBTQ+ community, Mark pointed out the dependency on LGBT nightlife for socialisation. He added: “Whilst the closure of pubs and clubs can be seen by many as an inconvenience, for LGBTQ+ people queer-friendly spaces provide an important place of safety and belonging. This meant that during the months of closures, people were shut-off from contact with others like them. I’m hopeful that this report can restart conversations with local authorities and other interested parties to open LGBTQ+ Community Centres, where people of all ages can access a place of safety, information, support, and importantly connection.”
Mhairi Crawford, from LGBT Youth Scotland, said: “LGBT Youth Scotland notes the publication of the health needs assessment of LGBT research findings report. We know from our own recently published research that health care remains a significant issue for LGBTI young people in Scotland. In particular, we welcome the recommendations for healthcare providers and other public bodies to undergo training, which is a key part of our LGBT Charter, in which we also support organisations to undertake reviews of policies and practice to ensure that they are as welcoming as possible for the LGBTI community, whether they are staff, clients, pupils or wider stakeholders.
“We know that alcohol free spaces are highly valued by young people we work with in our youth spaces – so we welcome the recommendation for more LGBT spaces that don’t have alcohol.”
“Finally, we also welcome the recommendation that schools should undertake the LGBT Charter as we know this can have a massive impact on daily lives of LGBTI young people.”