NHS Long Term Plan does not provide enough for LGBTQ young people

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Rainbow flag known for LGBTQ rights flying

By Dr Jason Schaub, Lecturer in Social Work
Department of Social Work and Social Care, University of Birmingham

The 7th January saw the launch of the new NHS Long Term Plan (NHS, 2018). It was surprising that this Plan included only a single mention of LGBTQ people. It correctly identifies that there are particular concerns about LGBTQ young people’s mental health (Point 3.28). The plan suggests that healthcare teams will be trained to better help young people at risk of mental health issues, particularly outside of education. This brief consideration, however, does not do justice to the range and complexity of psycho-social issues experienced by LGBTQ young people, and the oversight of other LGBT people is problematic. In particular, transgender people have worse experiences of health services, and LGB people have more significant mental health issues across their lives.

One consideration is whether LGBTQ people have particular needs which require addressing. A recent review of evidence found that LGBTQ people have worse general health outcomes when compared to cisgender and heterosexual people, including higher rates of mental health problems, attempted suicide, self-harm, anxiety, and depression. This is a particularly pressing issue for transgender people and young people, with long waiting times seen to adversely affect mental health. LGBT people are also more dissatisfied with health services in comparison to their peers. In addition, we know that healthcare and social work practitioners are often uncertain about how to respond and support LGBT people.

It is important to note that LGBTQ young people have significantly worse psychosocial outcomes than their heterosexual/cisgender peers. These include higher substance misuse; mental health issues; suicidality; homelessness; more issues with family and community; and sexual health issues. The adolescence/young adult phase is particularly problematic for LGBTQ people, with significant external impacts and greater deficits. Young LGB adults are more likely to lose important social relationships, including those with parents, when their sexual orientation is disclosed. The most recent study of British LGBTQ young people and bullying found that almost half of LGB and 2/3rds transgender young people experience bullying at school, with 1 in 10 transgender young people receiving death threats. We know that these experiences can cause mental health problems later in life.

The National LGBT Survey, the largest survey of its kind, found that almost 70% of respondents were concerned about negative reactions in public in response to visible signs of their sexual/gender identity (such as holding hands with a same-sex partner).  Furthermore,  over ¼ of respondents had received verbal harassment for being LGBTQ in the last 12 months, with 95% of the most serious incidents not reported because of the concern that ‘it happens all the time’. Discrimination and a lack of response have both been linked to later mental health issues.

Because of these noted and persistent issues, LGBTQ young people need greater attention from healthcare. Given the seriousness of the issue, the plan should have included a more detailed consideration for LGBTQ people, and young people specifically, and linked to other healthcare policy documents that have highlighted these issues, both mental health and public health.

It is disappointing that the new NHS Long Term Plan does not go far enough to address these issues that will affect young people throughout their entire life or to identify how to better support LGBT generally. Without a clear plan to engage with these issues, it is likely that services will struggle to respond to their pressing and ongoing needs.

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