Ireland's mental health services need to be more inclusive of LGBTQ+ community, report finds

This comes from a study on experiences with national mental health services, paying special attention to those of LGBTQ+ respondents.

A hand writing on a clipboard, indicating the provision of mental health services and the need for better inclusivity of the LGBTQ+ community
Image: Alex Green via Pexels

A study examining the experiences of people using HSE mental health services, with emphasis on the experiences of LGBTQ+ people, has released its report. The research revealed disparities in levels of satisfaction with the services between LGBTQ+ mental health service users and non-LGBTQ+ mental health service users.

The study used survey questions to compare general measures of satisfaction between those belonging and not belonging to the LGBTQ+ community. Focus groups of LGBTQ+ respondents were also conducted to better understand how the queer community feels about the services.

A joint venture between LGBT Ireland and Mental Health Reform, the report’s introduction describes the study as “an effort to provide insight into how mental health services and supports can better meet [LGBTQ+ mental health service users’] needs.”

As the report notes, mental health difficulties affect LGBTQ+ people at higher rates than heterosexual cisgender people, making this research especially important. Though there is little past research on the subject, what research does exists reveals that LGBTQ+ people are also more likely than non-LGBTQ+ people to have dissatisfactory experiences in both general health care and in mental health services specifically. 

A question about being treated with dignity and respect by community mental health services revealed a significant difference between LGBTQ+ and non-LGBTQ+ respondents in experiences with mental health services. The study found a 13 point difference between LGBTQ+ and non-LGBTQ+ mental health service users who said they were always treated in this manner (31% and 44%, respectively).

Over a quarter of LGBTQ+ respondents said they were never treated with respect and dignity by community mental health services, as compared to 18% of non-LGBTQ+ respondents.

The survey also found significant differences between the two groups in level of satisfaction with mental health treatment from GPs, and feelings of having been given enough time to speak about mental health issues with GPs and having been listened to in such conversations.

One positive finding was that the majority (58%) of LGBTQ+ respondents did say they felt supported by their key worker, only 1% lower than the percentage of non-LGBTQ+ respondents who said the same.

The study additionally involved discussions with three focus groups of LGBTQ+ respondents, from which researchers identified certain themes. These were broadly categorized as LGBTI+ Competence and Sensitivity, Access, Treatment and Care, Transition/Gender Affirmation and the Mental Health Services, and Service Improvements. 

Negative experiences shared by participants were characterised by a lack of LGBTI+ competence and sensitivity among mental health professionals,” a release from Mental Health Reform said. “This manifested as inappropriate questions and comments by some mental health professionals, as well as apprehension and even fear among LGBTI+ service users.” 

Focus group participants noted having to explain or teach about their identities and issues they navigate or censor themselves as some of the challenges they faced when accessing mental health services.

In a focus group specifically for transgender respondents, participants raised objections to Ireland’s requirement that transgender people access mental health services and be diagnosed with gender dysphoria or referred in order to access gender affirmation services. 

The diagnostic approach to transition care was described as problematic by participants and perceived by some to be an infringement on their personal autonomy,” Mental Health Reform’s release said. 

Overall, the study demonstrated a clear disparity between the experiences of LGBTQ+ respondents and non-LGBTQ+ respondents. The report notes the “considerable scope for improvement” within Ireland’s mental health services, and makes some recommendations as to how such improvement can be achieved. 

“The research found that the knowledge, competence and sensitivity of mental health professionals was a significant moderating factor in the quality of the LGBTI+ people’s experiences of mental health services,” said Paula Fagan, LGBT Ireland’s CEO.

“Where this was positive it was a lifeline – where this was negative it caused additional strain and led some participants to self-censor what they shared with their mental health professional.”

Róisín Clarke, Interim CEO of Mental Health Reform, touched on the same issues. “It is… crucial that individuals in the LGBTI+ community have access to inclusive and appropriate mental health supports that respect their rights and needs,” she said at the report’s launch.

“Findings demonstrate a clear need for LGBTI+ training and education for mental health service providers. Increased investment in our mental health services must also be prioritised to improve the quality of treatment and care for people in the LGBTI+ community.”

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