Sexuality and identity

People who are lesbian, gay, bisexual, transgender or intersex (LGBTI) have an increased risk of mental illness or suicidal feelings because they suffer discrimination and exclusion.

In NSW, most people who identify as LGBTI use mainstream mental health services so it's vital these services meet their needs.

Lesbian, gay, bisexual, transgender and intersex
Cultural awareness and inclusion
Accessible and appropriate services
Prevention and early intervention
Tackling stigma and discrimination
Special considerations

Lesbian, gay, bisexual, transgender and intersex

Being lesbian, gay, bisexual, transgender or intersex doesn’t mean you have an intrinsically higher risk of mental illness or suicidal feelings. But there is an increased risk for those of us who belong to LGBTI communities and it’s the result of being subjected to discrimination and exclusion.

Most international and Australian studies have found LGBTI people experience mental health issues at a significantly higher rate than heterosexual people.

  • They are more than twice as likely to have anxiety disorders (in particular lesbian and bisexual women).
  • They report higher rates of depression and mood disorders.
  • They have significantly higher prevalence of past suicide attempts.
  • Same-sex attracted youth in particular have significantly higher risks of self-harm and suicidal behaviours.
  • Australian data on suicidality confirms that LGBTI groups have elevated rates of suicidal thoughts, plans and attempts.
  • Gay men with HIV have higher rates of depression associated with factors such as socio-economic deprivation, isolation and withdrawal.
  • Nearly three-quarters of LGBTI people report some experience of depression

The highest rates of almost all forms of violence are perpetrated against transgender people. Little data is available on the experiences of intersex Australians.

  • In Australia, 2.7% of men and 2.3% of women identify as homosexual, bisexual or undecided/other sexual identify.
  • 6% of men and 8.5% of women report some same-sex sexual experience.
  • Transgender (which includes transsexual) people have an internal sense of gender that differs from their birth sex.
  • Intersex people are born with a physical variation that differs from expectations of male or female sex.

Towards change

  • Mainstream mental health services and initiatives must be inclusive of LGBTI people and their diverse issues. True inclusion means they and their issues must be visible, particularly in programs, services and resources; policy frameworks and guidelines; and research, monitoring and reporting.
  • LGBTI community and mainstream services must work in partnership to build the capacity of both. But we also need to invest in enabling the LGBTI community sector to engage with the mental health sector as partners. Leadership, participation and ownership by the community must be a focus of all services.

Infographic of statistics for LGBTI people relating to mental health

  • Up to 80% of same-sex attracted and gender-questioning young Australians experience public insult
  • 20% explicit threats, 18% physical abuse, 26% 'other' forms of homophobia
  • 80% of this abuse occurs at school
  • Homophobic abuse and rejecting reactions are associated with feelings of shame, isolation and low self esteem, and may contribute to higher rates of self-harm, depressed mood and suicidal behaviour.

Cultural awareness and inclusion

A lack of LGBTI knowledge and cultural competency leads to poor-quality service.

Towards change

  • Health professionals and other organisations can respond appropriately only if they develop greater knowledge and understanding. Training for the broader health workforce, community organisations and human service professionals – along with education within the community – are important ways to improve services.

Accessible and appropriate services

Issues including economic, geographic, timeliness, care co-ordination and continuing care for people undergoing gender transition – as well as the perception of a lack of LGBTI sensitivity and responsiveness – challenge accessibility for LGBTI people.

Towards change

  • In NSW, most people who identify as LGBTI use mainstream mental health services so it’s vital these services meet their needs. Good-quality research and rigorous evaluation will improve our understanding and responses.

Prevention and early intervention

The current focus is on crisis intervention and predominantly medical models of mental health.

Towards change

  • Prevention of mental illness should also be a priority within LGBTI communities. Mental health issues are preventable, and interventions such as supportive counselling during adolescence can reduce the risk of later mental health problems or drug and alcohol misuse. We need a comprehensive approach that builds protective factors into people’s lives but also addresses social factors that contribute to people developing mental illness or suicidal behaviour.

Tackling stigma and discrimination

Discrimination and stigma are problems not only in the general community. Historically, the relationship between LGBTI communities and psychiatry has been very sensitive. This is because being LGBTI has itself been seen as a mental illness rather than the mental illness being acknowledged as a likely consequence of the discrimination, violence or exclusion they experience.

Towards change

  • We need training for service staff in LGBTI mental health and wellbeing and must support an increase in the LGBTI mental health consumer workforce. We also need community responses to combat stigma and discrimination.

Special considerations

LGBTI people from culturally and linguistically diverse backgrounds face additional barriers, such as discrimination within their own community.

It’s a challenge to find an LGBTI responsive and inclusive service in rural and remote areas of NSW, where access to mental health services in general is already limited.

Mental health and alcohol and other drug services must be integrated because of a higher rate of coexisting mental illness and alcohol or other drug dependency among LGBTI people.

Towards change

  • We need communication among government, services and LGBTI communities to harness the expertise of LGBTI communities in the development, delivery and evaluation of initiatives, with targeted inclusion of particularly marginalised groups.
  • We must support collaboration among government agencies, mainstream mental health services and LGBTI organisations. We need targeted, tailored initiatives to complement inclusive mainstream initiatives.
  • We need specific training and support for government agencies, mainstream services, mental health services and community-managed organisations on LGBTI issues.

Related links

Strategic Plan and Report

References

Source material for content on this page is from the Living Well Report

Last updated: 5 April 2017

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