Addressing LGBT Health Inequalities Lesbian, Gay, Bisexual and Transgender (LGBT) people, Health Inequalities & Barriers to Equality of Access Introduction The overall theme is Equality and Diversity This session is about: LGBT people Stigma, prejudice and discrimination Access to the NHS Addressing LGBT Health Inequalities Addressing LGBT Health Inequalities

Addressing LGBT Health Inequalities Why this session? Low levels of knowledge and understanding of the health needs and concerns of LGBT people Issues for LGBT people in openly, confidently accessing services and receiving appropriate care and treatment NHS Scotland commitments to Equality, Diversity and LGBT inclusion The Law… Context The NHS in Scotland is committed to promoting Equality and valuing Diversity Little is known about the health concerns relating to LGBT people There is a history of homophobia and transphobia within the NHS, and History influences the present ‘Homosexual acts’ were ‘illegal’ until 1967 in England and Wales, and 1980 in Scotland For LGBT people, there can be issues about being open with NHS staff *historically, being gay was seen as a psychiatric disorder; aversion therapies to ‘convert’ gay people or help them to suppress ‘homosexual urges’ were provided, and Electro-Convulsive Therapy was used to attempt to ‘cure’ gay people - in the NHS. Homosexuality was removed as a psychiatric condition in 1975 in the US The World Health Organisation in 1993 Japan in 1995 China will remove it as a psychiatric disorder this year A young gay couple were beheaded in Iran in 2005 for being ‘caught’ Continuing prejudice, along with this history still has an impact on the lives, experiences and confidence of LGBT people to be out Addressing LGBT Health Inequalities Addressing LGBT Health Inequalities Addressing LGBT Health Inequalities

‘LGBT’ stands for… Lesbian Gay Bisexual Transgender LGBT is only an acronym - covering a wide and diverse community…Men and women, young and old, Living in cities, rural & remote areas; Mums & Dads, sisters and brothers, cousins, nieces and nephews; pupils, students, manual and professional workers, managers, students, lecturers… And in the NHS…Patients, partners, carers; Nurses, doctors, porters, domestics… Emphasise that ‘LGBT’ is an alliance of interest: Common factors are experiences of stigma, prejudice and discrimination and that LGBT people challenge traditional gender roles and gender constructs Addressing LGBT Health Inequalities Addressing LGBT Health Inequalities Addressing LGBT Health Inequalities

Addressing LGBT Health Inequalities The Law… Sex Discrimination Act Amendment 1999 Employment (Equality) Regulations 2003 Gender Recognition Act 2004 Civil Partnerships Act 2005 Equality Act 2006 Equality Act (Sexual Orientation Regulations) 2007 Discrimination at work or vocational training It is now illegal to discriminate in the workplace or vocational training - on the basis of a person’s sexual orientation (2003 regulations) or transgender identity (Sex Discrimination Act Amendment 1999) Gender Recognition Act Transsexual people can have their Birth Certificate altered to match their chosen gender. It is illegal for staff to breach the privacy or confidentiality of transgender people who will, are or have transitioned, without their prior consent. Civil Partnerships Full legal rights are now accorded to same-sex couples (equivalent to those covered by marriage) Equality Act As of April 2007, LGB people have protection in the provision of Goods and Services. Protection will be in place by the end of 2007 for transsexual people Addressing LGBT Health Inequalities Addressing LGBT Health Inequalities Addressing LGBT Health Inequalities

Addressing LGBT Health Inequalities A lesbian is… A woman who is sexually and emotionally attracted primarily to other women Addressing LGBT Health Inequalities Addressing LGBT Health Inequalities

Addressing LGBT Health Inequalities A gay man is… sexually and emotionally attracted primarily to other men. Addressing LGBT Health Inequalities Addressing LGBT Health Inequalities

Addressing LGBT Health Inequalities A bisexual is… A man or woman who is sexually and emotionally attracted to people of both sexes Addressing LGBT Health Inequalities Addressing LGBT Health Inequalities Addressing LGBT Health Inequalities

Addressing LGBT Health Inequalities Transgender people … Do not conform to common ideas of gender roles and expression. Transgender is an ‘umbrella’ term used to describe a diversity of gender identities. Transgender is an inclusive term The ‘communities’ that fall within it are: Transsexuals Transvestites (or ‘cross-dressers’) Drag Queens (entertainment and caricature) Intersex conditions (e.g. Klinefelters Syndrome or Androgyne Insensitivity Syndrome) *See Introducing Transgender Issues PowerPoint/Gender Identity Booklet for more… Addressing LGBT Health Inequalities Addressing LGBT Health Inequalities Addressing LGBT Health Inequalities

Part 2 Barriers to Equality of Access Addressing LGBT Health Inequalities Addressing LGBT Health Inequalities

Addressing LGBT Health Inequalities Heterosexism is… The assumption that we are all, or should be, heterosexual The belief that heterosexuality is the normal, natural way to be, and That heterosexual relationships are inherently of greater value and morally superior to same-sex relationships e.g. The Granny/Auntie who takes you aside as a teenager…have you got a boyfriend/girlfriend yet then (a ‘natural’ assumption of heterosexuality) The story of the 11 year old sitting with his dad on the Sunday afternoon watching a film where the young man is preparing to go and meet another young man for a ‘liaison’. His father sitting beside him comments ‘that’s disgusting…’ (again the ‘natural’ assumption that his son would be heterosexual) It hadn’t even occurred to him that his son might be…and it takes another 10 years for him to come out to his father… Addressing LGBT Health Inequalities Addressing LGBT Health Inequalities Addressing LGBT Health Inequalities

Addressing LGBT Health Inequalities Homophobia is… the irrational fear of, aversion to, or discrimination against lesbian, gay and bisexual people. Addressing LGBT Health Inequalities Addressing LGBT Health Inequalities Addressing LGBT Health Inequalities

Addressing LGBT Health Inequalities Transphobia is… the irrational fear of, aversion to, or discrimination against transgender people. For some transgender people, this can be a daily reality… Addressing LGBT Health Inequalities Addressing LGBT Health Inequalities Addressing LGBT Health Inequalities

Addressing LGBT Health Inequalities Homophobia - alive and kicking? Around 1 in 3 gay & bisexual men & 1 in 4 lesbian and bisexual women had been assaulted because of their sexual orientation (or assumptions about SO)… 75% have been called names because of their sexual orientation (or assumptions about their SO)… …within the previous 5 years Taken from the First Out report (2002) the biggest survey of LGBT people in Scotland with 924 respondents from across the LGBT community and the Country… Addressing LGBT Health Inequalities Addressing LGBT Health Inequalities Addressing LGBT Health Inequalities

Addressing LGBT Health Inequalities Homophobia - in the NHS? ‘My senior partner in the practice was very homophobic. Made jokes about ‘homosexuals’ in front of me, and made disparaging comments about gay patients’ Gay GP (2004) Taken from ‘Sexual Orientation in the Workplace’ British Medical Association Equal Opportunities Committee report 2005 Addressing LGBT Health Inequalities Addressing LGBT Health Inequalities Addressing LGBT Health Inequalities

Addressing LGBT Health Inequalities Homophobia - in the NHS? 1 in 4 LGBT people have experienced homophobia from NHS staff. “health professionals automatically make prejudicial links between your sexuality and your health care…” From First Out report 2002 Reality is difficult enough, but when there is also a ‘perception’ that we will not be treated favourably, it is much harder to address… Addressing LGBT Health Inequalities Addressing LGBT Health Inequalities Addressing LGBT Health Inequalities

Addressing LGBT Health Inequalities Coming out is… The experience of disclosing sexual orientation, and the process through which transgender people come to recognise and acknowledge their gender identity. ‘Coming out’ is an ongoing, sometimes daily, process of decision-making that can and does cause significant stress for some LGBT people Who do LGBT people come out to first? (answer is to themselves – and this can take months, years and even decades) Coming out to other people – what might the issues be? Stress: not a one-off process, but can be a regular/daily challenge and stress – e.g. a new job, new social situations, new neighbours, colleagues… Addressing LGBT Health Inequalities Addressing LGBT Health Inequalities Addressing LGBT Health Inequalities

Addressing LGBT Health Inequalities Coming out – what’s the issue? More than 1 in 3 LGBT people have not disclosed sexual orientation or gender identity to their health care professionals. “Not the nicest time to have to come out to people, but they (Doctors in hospitals) always assume you’re straight. Just adds to the trauma to be honest.” Important to stress: sexual orientation is only one aspect of people’s lives, but the relationships we have can be very important to us, particularly when we are unwell or ill… Being ‘out’ can be important for several reasons: Next of Kin – what happens if it is not a known ‘partner’ or family member? In order to get the best health care, it can be really important to know patients social circumstances and significant relationships…particularly where mental distress or illness is a feature For staff; example of staff nurse in mental health services with nearly 40 years of service who has only been confident to come out at work in current post. She was ‘kicked out’ of the nursing home for being ‘odd’ in the 1970’s… Addressing LGBT Health Inequalities Addressing LGBT Health Inequalities Addressing LGBT Health Inequalities

Addressing LGBT Health Inequalities Internalised Homophobia and Transphobia… Describes the impact of negative messages and portrayals on LGBT people, leading to negative feelings about self. These can cause significant emotional distress and affect the way LGBT people see themselves, and lead to denial of sexual orientation or transgender identity in situations that are threatening or require the individual to “come out”. For example… Attempts to pass as heterosexual, sometimes marrying someone of the other sex to gain social approval or in hope of 'being cured' Attempts to alter or change your sexual orientation. Withdrawal from friend and relatives, particularly when sexual orientation or gender identity is concealed Shame and guilt related to being LGB or T Low self-esteem, self-worth and self-value Poor self/body image Expressions of contempt for more open LGBT people Dismissive of the needs of those at earlier stages of the coming out process Contempt or disgust for those that are different, or who seem similar Reluctance to be around or have concern for children for fear of being seen as a paedophile Clowning or ‘camping up’ as a way of acting out society's negative stereotypes Addressing LGBT Health Inequalities Addressing LGBT Health Inequalities Addressing LGBT Health Inequalities

Addressing LGBT Health Inequalities What could the impact of: Heterosexism, homophobia/transphobia issues around coming out and, internalising of negative feelings… have on the health and wellbeing of LGBT people? Lead discussion. See Towards a Healthier LGBT Scotland for a summary of health issues Addressing LGBT Health Inequalities Addressing LGBT Health Inequalities Addressing LGBT Health Inequalities

Addressing LGBT Health Inequalities What does the NHS say? The NHS in Scotland is working towards establishing a service where people are: treated as individuals treated with respect enabled and involved in their own care From NHS Scotland Equality and Diversity e-learning module: Equality and Diversity – Lesbian, Gay, Bisexual and Transgender people Addressing LGBT Health Inequalities Addressing LGBT Health Inequalities Addressing LGBT Health Inequalities

Addressing LGBT Health Inequalities What can we do? Observe the Law, and NHS Scotland’s commitment to Equality, Diversity and LGBT inclusion Contribute to creating an environment in which all patients and staff are affirmed and valued… Challenge Homophobia or Transphobia There is no place for homophobia or transphobia in NHS Scotland Addressing LGBT Health Inequalities Addressing LGBT Health Inequalities Addressing LGBT Health Inequalities

Addressing LGBT Health Inequalities