London Is In The Grip Of An LGBT Mental Health Epidemic

Illustration by Paola Delucca
Last year, a gay journalist and playwright called Matthew Todd published a book entitled Straight Jacket: How To Be Gay and Happy. As you can probably guess from the title, the book was about mental health issues particular to the LGBT community, leading into a sort of autobiographical self-help guide on how to overcome them. “More and more statistics reveal that LGBT people have higher levels of depression, anxiety, addiction and suicidal thoughts,” he wrote. “Though increasing numbers of young people spring out of the closet with confidence, many of us still live with the emotional scars of growing up hated.”

Straight Jacket was a poignant reminder that, no matter how far LGBT rights have come in the 50 years since homosexuality was first decriminalised in the UK, when it comes to the inner wellbeing of LGBT people, there’s still a lot of catching up to do.

Yesterday morning, a new report released by the London Assembly confirmed as much, its research finding that 40% of LGBT people in the capital experience mental health problems, compared to 25% of the wider population. LGBT people have specific mental health needs that are not being met by their GPs and other doctors, it said, while leaders of the report called on London Mayor Sadiq Khan for better provision of services to the community, as well as specialist training for healthcare professionals.

In a statement, London Assembly health committee chairman Dr. Onkar Sahota told the press: “At the start of LGBT History Month we want this call heard loud and clear by the mayor. Action is needed now to tackle the urgent mental health needs of LGBT+ people.”

For some, the notion that LGBT are suffering these issues disproportionately might come as a surprise. In a time when LGBT people have the right to marry, adopt and join the military, and are better represented across the media, it can feel like equality has been won, and that gay people are no longer just tolerated but accepted. While this might be true for certain gay people – particularly those who are white, moneyed and born male, or who live in cities – for a lot of LGBT people, it’s sadly not a reality. According to the LGBT rights organisation Stonewall, for example, 48% of trans people under 26 say they have attempted suicide.

Sami Cee, a trans woman living in London, is one of these people. The first time she experienced severe mental health issues, she was 17 and living in Bournemouth. “In hindsight, I should have accessed counselling because I was thinking about killing myself, but at my worst I never accessed services because I didn’t see what was going on as something I could seek help for – I didn’t have the language for that. In the end, I got myself through it with self–help books, Buddhism and thinking about how suicide would affect other people around me – I was lucky.”

Sami puts her mental health issues back then down to the shame of living as a gay man, explaining that she thinks a lot of LGBT mental health issues are related to stigma: “Even when you’re brought up in a nice, accepting home, you can feel like a second-class citizen – you subordinate yourself.”

Shame can persist as an inferiority complex and is often dealt with through substance abuse and promiscuity

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According to the psychologist Alan Downs PhD, author of The Velvet Rage, a book about gay men and mental health, shame manifests from an early age; LGBT people often spend their childhoods “acting as if” they are straight, effectively splitting their lives into two parts. Later, even after coming out, shame can persist as an inferiority complex, and is often dealt with – particularly by gay men – through substance abuse as a form of escape, and through promiscuity as a form of self-validation. Some statistics do indicate that gay men are more inclined towards these behaviours than straight men. Likewise, in one comprehensive US study, lesbians and bisexual women were found to be twice as likely as straight women to drink heavily.

“Those sorts of behaviours dictated my life for a long time,” comments Sami, for whom The Velvet Rage was a kind of bible, growing up. “But I would say it’s not always about sleeping with the right people to validate that you’re worthy, sometimes it can be about sleeping with the wrong people to validate the idea that you’re not worthy, which can be more destructive.”

Last year, Sami began transitioning, a process which has thrown up entirely new challenges for her mental health. “I was suffering bad social anxiety and couldn’t leave the house as I was becoming aware something was different and that, actually, I’m transgender,” she explains. “I was putting a lot of pressure on myself and felt really conscious of myself in public.”

This time – 26, living in London and training to be a mental health nurse – Sami accessed her wellbeing team at university but felt put off because, rather than receiving support for her mental illness, she was assessed by occupational specialists as to whether she was fit to continue studying. “Employers should look at how they’re supporting people and create an environment where it's OK to talk about these things,” she reflects. Eventually they offered her six sessions of counselling, which she’s finding helpful.

And as for support over the transition itself? “I’ve gone to my GP, and they were understanding, but I’ve decided to go private because the NHS waiting list is 52 weeks for an initial assessment.”

There’s currently a deficit of mental health services for anybody, gay or straight

Until last year, there was a London-based charity called PACE that worked specifically to deal with LGBT people’s mental health issues, but unfortunately, due to financial issues, they were forced to shut up shop. Now, services are few and far between.

“There’s currently a deficit of mental health services for anybody, gay or straight, so anything specialist is a push,” says Sami. “There’s stuff out there, but you have to be in the know. I access a sexual health service called CliniQ at Dean St. for trans, non–binary people and people living with HIV. They offer mental health counselling and relationship counselling. It’s a community – they have cakes and tea – people go as a space to connect. The staff aren’t judgemental, which is important, because I’ve come across a lot of healthcare staff – both personally and professionally – who are.”

Aside from the sparse services that are out there, Sami says she thinks a lot of the responsibility for care in the LGBT community falls on the community itself – “taking in friends who have been made homeless, dealing with mental health problems, fundraisers for trans healthcare” – although that’s not a practical solution for people who are more isolated – in rural areas, or because they’re new to a city, for example.

“I’d like to see more funding for services, but if I’m thinking about what’s realistic, I’d like to see more LGBT community spaces that are accessible, where people can meet and support one another. The GLC used to run a support centre in London, but that closed in the '90s.”

Sami has trained as a mental health nurse because she wants specifically to help other people who experience stigmatisation, either for who they are or the behaviours they engage in, and challenge the idea of what a nurse is – “because we know the people who can best help us have lived experience”. But while LGBT people continue to help one another out by writing support books, getting jobs in the mental health sector and counselling one another ad hoc, what we really need to see is change that comes from the top down as well as the bottom up.

Statistics like those released yesterday ought to demonstrate the urgency of the situation, and the desperate need for funding to the sector. As Dr. Sahota summed it up: “Time has run out for some and the mayor needs to take firm and decisive action on his mental health promises to LGBT+ Londoners.”
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