1. EFECTS ON SERVICES: Mental Health Services (3 surveys several years ago) 1. Actual homophobia 2. Lack of knowledge 3. Inappropriate treatment 4. Inaccessible services

2. Actual Homophobia  Refusal of treatment  Homophobic acts  Physical abuse  Verbal abuse  Sexual abuse  Harassment  Violence  Rape

3. Lack of Knowledge  Ignorance of effects of homophobia  Ignorance of effects of minority stress  Misdiagnosis  Insufficient training  As I go through, please make a note if you think the point is relevant to your service

4. Inappropriate Treatment  Negative responses to coming out  Attempts to cure  Attitudes of staff  Lack of privacy  Sexuality seen purely as sexual  Inappropriate questioning  Insensitive interviewing  Inappropriate use of language

5. Inappropriate Treatment… Pathologising sexual orientation Psychiatric referrals Refusing to refer to LGB services Ignoring partners Enforced HIV test Complaints not investigated

6. Inaccessible Services  Fear of disclosing sexuality  Feeling vulnerable, ignored, disbelieved  Fear of discrimination and prejudiced treatment  Fear of disclosure to other users  Fear of physical and verbal abuse  Fear of rejection  Dependent on therapeutic communities, residences and families who are homophobic and unaware of needs

7. Progress? PACE Where to turn? 2010  23% LGBT users experienced negative response to them being LGBT  40% of LGBT youth services currently supporting suicidal young person described relationship with CAMHS as poor or very poor  22% of LGBT community services described relationship with AMHS as poor or very poor  34% of mainstream services aware of having done specific training on LGBT awareness  31% of mainstream mental health services monitoring sexual orientation, 21% trans  Of 121 strategic leads for suicide prevention only 28 responded to survey. Of these, 7 able to cite a specific activity targeting LGBTs as priority

8. Feedback  Were any points relevant to your service?  Write on flip chart  Who will take responsibility for feeding back to your management? (both good and bad)

9. Preventing suicide in England 2012  LGBTs one of groups identified for whom a tailored approach to their mental health is necessary if suicide risk is to be reduced  Staff in health and care services, education and voluntary sector need to be aware of higher rates of mental distress, substance misuse, suicidal behaviour and ideation and self harm amongst LGBTs

10. NHS Training video  What do you want from the NHS?