Public Health Forum on LGBT Health Wednesday 15th February 2017

Programme 12:15pm Welcome and overview- Helene Denness, Public Health Consultant, Nottingham City Council 12:30pm Healthshop and Nottingham Recovery Network: Service inclusivity and service user issues- Louise Wilkins and Apollos Clifton- Brown 13:00pm Trans4Me: Benefits of community support and the effects of transition on Mental Health- Sharon O’Love, Sharp Manager, CAMHS 13:20pm Healthwatch: An overview- Richard Mayer, Healthwatch Nottingham 13:35pm Questions and close- Helene Denness

Population 6% of people in England and Wales identify as LGB, approximately 3.42 million (Stonewall) Little data recorded nationally and locally No census data Inconsistent recording in healthcare data No trans estimates nationally (that I have found), inability to assess health inequalities if we do not capture data on LGBT use and access to healthcare, inability to monitor progress without data capture

58% did not declare their sexual orientation Local data This means locally… 15,582 citizens over 16 identify as LGB 3% of citizens told us they identify as LGB 4% of the NCC workforce (who declared) identify as LGB, however…. 58% did not declare their sexual orientation 3% as per citizen’s survey, what does the lack of declaration tell us about how comfortable people feel in how this information will be received? We cannot be sure the workforce is representative or identfy if any barriers to progression as data capture not sufficient. 121 identified as LGB as of December 2016. Due to low numbers we do not captre trans figures in the council.

Multiple identities NOT a homogenous group LGBT- Lesbian, Gay, Bi-sexual, Transgender… NOT a homogenous group Other identities at play Ethnicity Disability Faith Family roles These all can affect health in different ways and can affect the individuals experience Minorities within a minority, within LGBT health issues are experienced differently, e.g. Trans people are more likely to experience exclusion from health screening based on their gender at birth Significantly higher rates of suicide, self harm and MH across minority LGBT than general LGBT population Smoking and drug use is higher amongst disabled gay and bi-sexual men than non-disabled gay and bi-sexual men Variation between LGBT groups and health risks and health behaviours Those who are disabled are less likely to tell their GP their sexual orientation than non-disabled LGBT citizens

Health issues Mental health and suicide Alcohol misuse Substance misuse Smoking Diet and eating disorders In many health measures around these topics LGBT are at increased risk than non-LGBT, as such it would be reasonable to expect a lower life expectancy amongst this group.

Mental health and suicide Increased prevalence of suicide- two-fold Self-harm Depression Loneliness Access to services Two fold increase in LGB suicide risk, LGB twice as likely to have suicidal thoughts than heterosexual people, 84% of trans people have considered suicide. Higher prevalence of self-harm amongst LGBT, particularly young people, 56% of LGBT yp have deliberately self-harmed. Self-harm is directly inked to experience of homophobic bullying. High levels of depression particularly amongst the trans community More likely to be alone in older age and less likely to have children We do not capture data so cannot be sure access to services is equitable

Smoking Higher prevalence Heavier smoking habits 1/4 of lesbian and bi-sexual women ¼ of gay and bi-sexual men 32% of trans More likely to be smokers than the general population Higher prevalence compared to hetero population Heavier smoking habits

Diet and eating disorders Poorer diet Higher rate of eating disorder in lesbian and bi-sexual women Almost 1 in 5 trans people state they have an undiagnosed eating disorder Lower rate of obesity amongst gay and bi men Higher rate of obesity amongst lesbian and bi women Again, not a homogenous group Less LGB get their 5 a day, 13% compared to around 25% of men and women generally 1 in 5 LB women have an eating disorder compared to 1 in 20 in general women population 45% of gay and bi mane worry about how they look and feel about their body 44% of GB men are overweight or obese compared to 70% in general male population

Local people said… Local health survey data identified…

What next?..... CCG research