1. Sexual Orientation issues in healthcare in Wales Ele Hicks Projects and Policy Officer

2. What is Stonewall Cymru? Aims to achieve legal equality and social justice for all lesbian, gay and bisexual people across Wales. Current areas of work: Policy development, Health, Education, Employment, Community Safety, Consultation, Housing. Community engagement, outreach and volunteering. www.stonewallcymru.org.uk

3. What is Sexual Orientation? A sexual orientation towards persons of the same sex, persons of the opposite sex, or persons of the same sex and of the opposite sex. Approximately 6% of the population is lesbian, gay or bisexual. They can be from any ethnicity, gender, age group, or religion. They can be disabled and can live anywhere, including rural areas

4. What is homophobia? A fear or dislike of lesbian, gay or bisexual (LGB) people, or people who are thought to be LGB. Homophobia exists at all levels of society: in employment, service delivery, culture, society, politics, tackling crime…and schools. Homophobia is often unintentional and part of organisational culture.

5. Counted In! The third all Wales survey of lesbian, gay and bisexual people (2007) 403 respondents across Wales Only just over half the sample was out to their GP. 21% reported feeling dissatisfied/very dissatisfied.

6. Counted In! Not overt discrimination in general. 34 people cited discrimination by a GP 32 cited inappropriate treatment. 18 were made to feel uncomfortable when visiting a partner in hospital. The respondents particularly saw the value of sexual orientation monitoring in health.

7. Inside Out project findings: Experience of receiving care or treatment 67% reported a positive experience 15% reported a negative experience 10% thought they had received inappropriate advice for their sexual orientation Over half reported receiving care or treatment as a positive experience but the examples given, ranging from simply being treated for the illness, a lack of negative reaction to coming out, to partners being treated equally to heterosexual couples, demonstrate a low expectation of positive experiences

8. Inside Out project findings: Issues around disclosure of Sexual Orientation 62% had either come out or been outed of these 26% felt that this changed the response or attitude of the health care provider Experiences ranged from a less friendly atmosphere to staff being embarrassed or judgemental.

9. Inside Out project findings: Issues around disclosure Nurse called a chaperone in whilst seeing to me, only person available she said was the female cleaner Contraception was offered quite forcibly and it became quite awkward once I came out and no alternative advice was given I look forward to the day when I dont have to come out as not being heterosexual. Its about time we all got individual tailored services for who we are not who we are not.

10. Inside Out Project findings: Experience of receiving care or treatment 81% if asked, would register their same-sex partner as next of kin Many people said they would feel more confident if the health care professionals gave equal status to same-sex relationships in their literature and culture.

11. Prescription for Change: Lesbian and bisexual womens health check 2008 (UK) 2/3 have smoked compared to ½ of women in general. 40% drink 3 times a week compared to a ¼ of women in general Lesbian and Bisexual women are 5 time more likely to have taken drugs. Less than half have ever been screened for STIs. Over half of those have had an infection. Some have been refused screening.

12. Prescription for Change: Lesbian and bisexual womens health check 2008 (UK) 15% over the age of 25 have never had a cervical smear test, compared to 7% in general. Of those who have not been tested 1 in 5 have been told by a health worker they are not at risk. Nearly ½ are scared to have a test. One in fifty had been refused a test. 1 in 5 who have not attended a smear test do not think they are at risk Health practitioners ask inappropriate questions, do not provide relevant information. Lesbian and bisexual women have to make a decision whether to come out, but for some being open can help..

13. Prescription for Change: Lesbian and bisexual womens health check 2008 (UK) Over 1 in 12 L+B women aged 50-79 have been diagnosed with breast cancer compared to 1 in 20 in general. 1 in 5 say they have deliberately harmed themselves in the last year compared to 0.4% of the general population. 1 in 5 say they have, or have been told they have had, eating problems compared to 1 in 20 of the general population (Mind estimate) Mental health services failed to recognise their needs or provide inclusive services

14. Prescription for Change: Lesbian and bisexual womens health check 2008 (UK) 1 in 4 L+B women have experienced domestic abuse. 2/3 say the perpetrator was a woman. Over ½ had experienced some form of physical violence from a female partner and 1 in 14 say they have been forced to have unwanted sex. 9% of women who report violence from a male partner say their sexuality was used against them 8 in 10 have never reported incidents to the police. Of those who did report only ½ were happy with how the police dealt with the situation.

15. Prescription for Change – The impact of discrimination Equal access – ½ reported a negative experience of healthcare Coming out – Practitioners should know yet ½ are not out to their GP, more are out to their manager and work colleagues. Assumptions of heterosexuality – 2 in 5 said a practitioner assumed they were heterosexual and they did not receive appropriate advice. 1 in 5 felt no opportunity to disclose and sometimes had to stop mid-procedure to correct. Confidentiality policies - 1 in 8 are not sure of GP confidentiality policies and are concerned about disclosure. Inappropriate questions – 1 in 10 report sexual orientation ignored or continued assumptions and exclusion. 6% report inappropriate comments.

16. Double Stigma: Being out in mental health services Just over two thirds of our survey respondents told us they were out, with 61% believing this had no relevance to the way that theyre treated. 21% even reported that being out enabled a more positive and inclusive experience of mental health services. However only 20% of participants in focus groups explicitly highlighted good experiences of accessing mental health services.

17. Double Stigma: Being out in mental health services Those who are out and experienced dissatisfaction with their treatment in mental health services attributed this to concerns relating to individual practitioners values, attitudes, knowledge and skills. A number of respondents reported feeling discriminated against by individual practitioners. The underlying basis of this was perceived to be homophobia and / or heterosexism which was reflected in attitudes and practices: I think my private counsellor has a conservative attitude to homosexuality which makes me feel uncomfortable disclosing information about myself. After coming out to her there has been an issue of confidentiality and she believes my private life to be a cause of my health issues

18. Double Stigma: Knowledge & skills: Respondents talked of a lack of awareness and knowledge around LGBT. Particularly in relation to respondents personal relationships. Respondents described incidents in which their partners were either trivialised or in some cases viewed with suspicion. When I was with a female partner her position in my life wasn't taken as seriously as my male partner is taken now. We often felt tolerated by medical staff, where as my partner now is invited to be with me. Gemma

19. Inside Out Project Recommendations 1.Awareness, training and education for all health staff on sexual orientation issues. 2.Literature on same-sex relationships. 3.Recognition, acknowledgement and treatment of same-sex sexual orientation as an identity. 4.Access to specific sexual health services for LGB people. 5.The right of a patient to nominate their same-sex partner/ family of choice member and have them treated equally. 6.Support and work with LGB community researchers/ interacters to consult with LGB people on your service provision

20. Counted In! Healthcare Recommendations Ensure that equality and diversity training and guidance for ALL NHS Wales staff includes LGB healthcare needs and concerns. Guidance in relation to the inclusion of partners and friends as next of kin should be issued. (Subsequent WAG health circular on LGB issues in healthcare.) Unregistered partners should be able to claim their deceased partners body for burial if this was their partners wish. Further advice and access to adoption services to be made available.

21. Counted In! Recommendations in relation to healthcare Ensure all public services in Wales are available to LGB people and that they take account of their needs. Statutory obligation to mainstream sexual orientation equality in all policy, service design and delivery. Service design which exceeds the scope of anti- discrimination legislation by addressing the reasons why LGB people can be reluctant to present to health providers. Service user monitoring for public services to capture both specific needs and to ensure equality is mainstreamed into provision.

22. Prescription for Change: Lesbian and bisexual womens health check 2008 (UK) - Recommendations 1.Understand Lesbian and Bisexual womens health needs 2.Train staff 3.Dont make assumptions 4.Explicit policies 5.Tell Lesbians and Bisexual women what they need to know 6.Improve monitoring 7.Increase visibility 8.Make confidentiality policies clear 9.Make complaints procedures clear 10.Develop tailored services

23. Double Stigma: Ways to improve We recommend that monitoring mechanisms should be in place to evaluate the extent of inclusion of LGB people within services in line and above anti-discrimination law requirements. There should be LGB and mental health specific training and awareness raising that forms a compulsory element of key relevant professional qualifications. This applies to all mental health professionals.

24. Any questions or comments? www.stonewallcymru.org.uk 02920 237744 Ele Hicks – Projects and Policy Officer Eleanor.hicks@stonewallcymru.org.uk