Lesbian, Gay, Bisexual and Transgender LGBT+ (health and wellbeing needs in South Tyneside)
Introduction
Although good progress has been made in the field of equal rights for lesbian, gay, bisexual and transgender people in the UK, there are still people who experience discrimination across the life-course as a result of their sexual orientation or gender identity. LGBT+ people are also unequally affected by a number of health issues and wider determinants which may also impact on their future outcomes.
Policy and decision makers have a duty under the Public Sector Equality Duty under the Equality Act 2010 to take the health needs of LGBT+ communities in planning and delivering publicly funded services.
This health needs assessment contributes to both these duties by highlighting the needs of the lesbian, gay, bisexual and transgender population in South Tyneside. By building a better understanding of these needs as part of the JSNAA- public sector organisations can use this knowledge to further reduce the health inequalities experienced by sexual and gender minorities.
In law, the term "LGBT+" covers two protected characteristics under the Equality Act (2010): sexual orientation and gender identity. However, for the purposes of understanding different needs, the term LGBT+ is used here to cover four distinct groups with very different needs and expectations:
- Lesbian - a woman who is attracted to other women
- Gay - a man or woman who is attracted to people of the same gender
- Bisexual - a person attracted to the same gender and / or opposite gender
- Transgender - a person whose gender identity and / or gender expression differs from the sex they were assigned at birth.
There are two additional groups - men who have sex with men (MSM) and women who have sex with women (WSW). These people do not identify as gay or lesbian and would not consider themselves to be part of the LGBT+ community, but because of common behaviours may also share similar inequalities and health risk factors.
These terms are used interchangeably for the purpose of this report however. individuals may also use different terms to describe their sexuality which aren't covered here.
It is worth noting that LGBT+ people should not be defined by their sexuality alone. Within the LGBT+ population there are intersectionality's of race or disability which create greater health inequalities. These complexities or not covered by this chapter.
Key issues
The public health outcomes framework measurement of progress is through a set of public health indicators which cover a wide range of areas and are grouped under four 'domains':
Domain One: Improving the wider determinants of Health
LGBT+ individuals often experience discrimination and marginalisation that impacts on wider factors such as education, housing and perceptions and experiences of crime and violence, meaning that these groups experience specific health inequalities as a result.
Domain Two: Health Improvement
Local and national research and needs assessments of LGBT+ communities have repeatedly demonstrated higher levels of health risk behaviours, such as smoking and drug and alcohol use, as well as higher levels of self-harm. LGBT+ people are less likely to engage with health interventions and screening programmes, and gender-specific screening can present particular challenges for trans and non-gendered individuals. LGBT+ communities therefore have higher levels of need for intervention and targeted support related to these indicators.
Domain Three: Health Protection
These indicators focus on protecting the population's health from major incidents, and other threats, while reducing health inequalities there are some areas which particularly affect LGBT+ people. There is a lack of evidence on LGBT+ communities in relation to many of the indicators in this domain, yet the available evidence indicates that LGBT+ people may be experiencing health inequalities in relation to health protection.
Domain Four: Healthcare public health preventing premature mortality
Evidence indicates that LGBT+ communities are more likely to be experiencing health inequalities in relation to public health areas and preventing premature mortality. The higher prevalence of smoking, alcohol use and drug use, and lower uptake of screening programmes are likely to contribute to increased risk of preventable ill health. There is also a significant body of evidence demonstrating high rates of suicide attempts.
High level priorities
Recognition:
- Health and Wellbeing Board Chairs must ensure that Health and Wellbeing Strategy implementation plans and supporting strategies explicitly consider the actions to reduce inequalities affecting LGBT+ communities.
- All health and social care commissioners should continue to use equality impact assessment frameworks, which include sexual orientation and gender identity, for population strategy documents and action plans.
- All health and social care providers should implement the published guidance on becoming LGBT+ friendly providers.
Engagement:
- Healthwatch commissioning and contracting processes should monitor levels of engagement with LGBT+ populations.
- Clinical Commissioning Group public and patient involvement initiatives should ensure that LGBT+ communities are specifically included in CCG communication and engagement strategies.
Monitoring:
- Commissioners should include a requirement in contracts for service providers to monitor sexual orientation and gender identity in service users over 16 years, and consider monitoring younger age groups where appropriate.
Service Provision:
- Commissioners should use the data available to them to assess whether mainstream services they have commissioned are accessible to and appropriate for LGBT+ people.
Those at risk
The Public Health White Paper 'Healthy Lives, Healthy People' identified poor mental health, sexually transmitted infections, alcohol use and smoking as the top public health issues facing the UK. All of these disproportionately affect LGB&T populations.
- 1 in 10 men who have sex with men are living with HIV, and 1 in 3 HIV positive men (in major UK cities) have undiagnosed HIV infection
- Illicit drug use amongst LGB people is at least 8 times higher than in the general population
- Around 25% of LGB people indicate a level of alcohol dependency
- Nearly half of LGB&T individuals smoke, compared with a quarter of their heterosexual peers
- Lesbian, gay and bisexual people are at higher risk of mental disorder, suicidal ideation, substance misuse and deliberate self harm
- 41% of trans people reported attempting suicide compared to 1.6% of the general population
Gay and Bisexual Men's Health (2)
Smoking, alcohol and drugs
| A quarter of gay and bisexual men currently smoke compared to 22 per cent of men in general. More than two in five (42 per cent) gay and bisexual men drink alcohol on three or more days a week compared to 35 per cent of men in general. Half of gay and bisexual men have taken drugs in the last year compared to just one in eight men in general. |
General fitness and exercise | Over half of gay and bisexual men have a normal body mass index (BMI) compared to under a third of men in general. Despite being more likely to have a normal BMI, just a quarter (25 per cent) of gay and bisexual men meet recommendations for 30 minutes or more of exercise five times or more per week compared to 39 per cent of men in general. |
Mental health | In the last year, three per cent of gay men and five per cent of bisexual men have attempted to take their own life. Just 0.4 per cent of men in general attempted to take their own life in the same period. One in sixteen (six per cent) gay and bisexual men aged 16 to 24 have attempted to take their own life in the last year. Less than one per cent of men in general aged 16 to 24 have attempted to take their own life in the same period. One in fourteen gay and bisexual men deliberately harmed themselves in the last year compared to just 1 in 33 men in general who have ever harmed themselves. One in six (15 per cent) gay and bisexual men aged 16 to 24 have harmed themselves in the last year compared to seven per cent of men in general aged 16 to 24 who have ever deliberately harmed themselves. |
Eating disorders and body image | Thirteen per cent of gay and bisexual men have had a problem with their weight or eating in the last year compared to four per cent of men in general. Two thirds of gay and bisexual men who have had a problem with their weight or eating have never sought help from a healthcare professional. |
Sexual health and HIV
| One in four gay and bisexual men have never been tested for any sexually transmitted Infection. Three in ten gay and bisexual men have never had an HIV test in spite of early diagnosis now being a public health priority. |
Discrimination in healthcare
| A third of gay and bisexual men who have accessed healthcare services in the last year have had a negative experience related to their sexual orientation. A third of gay and bisexual men are not out to their GP or healthcare professionals. Gay and bisexual men are more likely to be out to their manager, work colleagues, family and friends than their GP. |
Domestic abuse
| Half of gay and bisexual men have experienced at least one incident of domestic abuse from a family member or partner since the age of 16 compared to 17 per cent of men in general. More than a third of gay and bisexual men have experienced at least one incident of domestic abuse in a relationship with a man. Almost one in four gay and bisexual men have experienced domestic abuse from a family member, for example mother or father, since the age of 16. Four in five gay and bisexual men who have experienced domestic abuse have never reported incidents to the police. |
Cancer and common male health problems
| Just a third of gay and bisexual men check their testicles monthly as recommended as a preventative measure against testicular cancer. Just one in ten gay and bisexual men have ever discussed prostate or bowel cancer with a healthcare professional and only three per cent have ever discussed lung cancer. Almost nine in ten gay and bisexual men have never discussed heart disease with a healthcare professional. Four in five have never discussed high blood pressure or high cholesterol with a healthcare professional. |
Lesbian and bisexual women's health (3)
Smoking, alcohol and drugs
| Two thirds of lesbian and bisexual women have smoked compared to half of women in general. Just over a quarter currently smoke. Nine in ten lesbian and bisexual women drink and 40 per cent drink three times a week compared to a quarter of women in general. Lesbian and bisexual women are five times more likely to have taken drugs. Over one in ten have taken cocaine, compared to three per cent of women in general. |
General fitness and exercise | The BMI for lesbian and bisexual women is the same as women in general. Half exercise three times a week. |
Mental health | One in five lesbian and bisexual women have deliberately harmed themselves in the last year, compared to 0.4 per cent of the general population. Half of women under the age of 20 have self-harmed compared to one in fifteen of teenagers generally. Five per cent have attempted to take their life in the last year and sixteen per cent of women under the age of 20 have attempted to take their life. ChildLine estimate that 0.12 per cent of people under 18 have attempted suicide. One in five say they have an eating disorder, compared to one in 20 of the general population. |
Sexual health and HIV | Less than half of lesbian and bisexual women have ever been screened for sexually transmitted infections. Half of those who have been screened had an STI and a quarter of those with STIs have only had sex with women in the last five years. |
Discrimination in healthcare
| Half have had negative experiences in the health sector in the last year, despite the fact that it is now unlawful to discriminate against lesbian and bisexual women. Half of lesbian and bisexual women are not out to their GP. One in ten say that a healthcare worker ignored them when they did come out. Just three in ten lesbian and bisexual women say that healthcare workers did not make inappropriate comments when they came out. Just one in ten felt that their partner was welcome during a consultation. |
Domestic abuse
| One in four lesbian and bisexual women have experienced domestic violence, the same as women in general. In two thirds of cases, the perpetrator was another woman. Four in five have not reported incidents of domestic violence to the police and of those that did, only half were happy with their response. |
Cancer screening | Fifteen per cent of lesbian and bisexual women over the age of 25 have never had a cervical smear test, compared to seven per cent of women in general. One in five who have not had a test have been told they are not at risk. One in fifty have been refused a test. One in twelve lesbian and bisexual women aged between 50 and 79 have been diagnosed with breast cancer, compared to one in twenty women in general. |
Transgender Health (4)
Mental health problems | 36% identified as having mental health issues. Almost 1/5 identified as having a learning disability or impairment. 66% had used mental health services for reasons other than access to gender reassignment. 31% were currently using anti-depressant medication. 53% had self-harmed at least once. 33% had attempted suicide more than once; 3% had attempted more than 10 times. |
|
Feelings relating to being trans | 23 years was the average age at which people started to live part time in their felt gender. 31 years was the average age at which people started to live full time in their felt gender. 13% did not want to undergo any form of transition. | |
Negative experiences | 19% had experienced sexually harassment for being trans within the last year. 6% had being raped for being trans within the last year. 17% had experienced domestic violence for being trans within the last year. 52% had experience problems with work due to being trans. 19% had been homeless at some point. | |
Lifestyle behaviours | 24% had used drugs in the last 12 months. 19% were current smokers. 62% responded to questions which suggested alcohol dependency. | |
Experience of services | 65% had experienced at least one negative experience of general physical health services. 63% had experienced at least one negative experience of mental health services. | |
Young LGBT+ People (5)
Mental health | 4 times more likely to suffer major depression. |
3 times more likely to be assessed with generalised anxiety disorder. | |
Males are seven times more likely to have attempted suicide and three times more likely to have suicidal intent. | |
Healthy lifestyles | Lesbian and bisexual girls are 10 times more likely to smoke than their heterosexual peers. |
Illicit drugs may be an increased risk for some young gay and bisexual young men. | |
Lesbian and bisexual girls are twice as likely to have consumed alcohol in the past month. | |
Lesbian and bisexual girls are one and a half times more likely to have engaged in binge drinking in the last year. | |
Lesbian and bisexual girls are nearly three times as likely to have consumed a first alcoholic drink before age 12. | |
Young LGBT+ people are three times more likely to use MDMA / ecstasy. | |
Young LGBT+ people are eight times more likely to use ketamine. | |
Young LGBT+ people are 26 times more likely to use crystal methamphetamine. | |
Victimisation | 78% of LGBT+ people under the age of 18 had experienced verbal abuse. |
23% of LGBT+ people under the age of 18 had been attacked by another pupil. | |
Young LGBT+ people are more likely to suffer from bullying at school than their peers although rates have fall over the past 15 years with the number of schools explicitly saying that homophobic bullying is wrong doubling. However, the use of homophobic language remains endemic (Stonewall, 2015a). | |
Sexual health | Young gay men are becoming sexually active from the age of 14 and may not be aware of the risks from unprotected sex. |
Level of need
There is a lack of information about how many people identify as LGBT+ in South Tyneside. Nationally, identifying how many people identify as LGBT+ is incredibly difficult. There is not one reliable source of data which can identify level of need.
Available data comes from the Office for National Statistics (ONS) Integrated Household Survey, (IHS), 2014 - national survey containing information from over 420,000 respondents estimates 5-7% of people are LGB.
In terms of numbers for transgender people, an estimated 1% of the population identifies as transgender and 0.2% may seek gender reassignment intervention with the median age for presentation for reassignment being 42 years of age. There are now an increasing number of people presenting in adolescence (Varney, 2013).
Estimated LGBT+ Population in South Tyneside
| Population Estimate (ONS Mid-Year Estimates 2015) | LGB Population Estimate (ONS 7%) | T Estimate (ONS 1%) |
0-16 | 27,491 | 1924 | 275 |
16-24 | 15,793 | 1105 | 158 |
25-34 | 18,482 | 1293 | 184 |
35-49 | 27,964 | 1957 | 279 |
50-64 | 31,463 | 2202 | 314 |
65+ | 29,150 | 2040 | 291 |
Total | 148,671 | 10406 | 1486 |
Unmet needs
- In South Tyneside there are currently no services which work exclusively with members of the LGBT+ community. Individuals need to travel to Sunderland, Gateshead or Newcastle to attend a LGBT+ specialist service.
- There is no current set of standards or benchmark for services to meet to ensure they are LGBT+ friendly.
- There is a lack of clarity about numbers of LGBT+ people who access health services to determine whether or not this is reflective of the estimated numbers in South Tyneside.
Projected Need and Demand
None available.
Community assets and services
MESMAC North East undertakes a regular mapping of LGBT+ assets. Their directory can be found MESMAC: North East.
Current Public Health sexual health contract outlines LGBT+ communities as a target group for greater outreach support. South Tyneside's integrated sexual health service has a key priority of proving support, advice and outreach services for locally identified at risk populations, including LBGT+ communities. The service works in collaboration with key stakeholders locally in order to engage with vulnerable groups and understand their particular needs in line with the evidence base.
Recommendations and Evidence for interventions
- Local authority commissioners should make data collection around sexuality & gender identify compulsory part of contracts and quality assurance should be monitor this data to ensure LGBT+ people are accessing services. ( See clinical and non- clinical guidance at LGBT Foundation)
- Public health communications should consider prevention messages targeted at LGB& T populations- Shown to be cost saving - Department of Health (2005) Health Economics of Sexual Health A guide for Commissioning and Planning'.
- Universal services need support to ensure they are equipped to meet the needs of LGBT+ people. The local authority should take the lead on creating and implementing an evidence based framework that services should follow to show they are LGBT+ friendly and able to meet their needs. Good practice examples can be taken from 'Pride in Practice', LGBT Foundation: Pride in Practice.
- Local authority should take the lead on ensuring that LGBT+ communities are considered as part of wider work. LGBT+ sections should be cross-referenced in other JSNAA topics such as tobacco.
Views
In the process of writing this chapter, an online survey was undertaken to collect the views of professionals working with LGBT+ people in South Tyneside. The survey was sent electronically to a wide network of statutory and third sector services. The survey generated responses from eighteen different services. The results are outlined below.
How best would you describe your service?
Local authority | 1 |
Health | 3 |
Third sector / charity / voluntary | 13 |
other | 1 |
How would you know that LGBT+ access your service?
Fourteen out of the 18 respondents explained that they collect sexual orientation and gender identity monitoring routinely as people enter their service.
What are the top 3 health priorities for LGBT+ people in South Tyneside ?
Mental health | 94% |
Sexual health | 67% |
Domestic abuse | 50% |
Substance Misuse | 33% |
What needs do you feel are not being met currently by services in South Tyneside?
- Housing, especially for those with mental health issues
- LGBT+ people who have a learning disability
- General awareness for services so they know how to meet their needs
- Older LGBT+ people's needs
- No group support for young LGBT+ people
- G.Ps not knowing how to support people
- Services being inclusive
Any other comments?
There is a need to look at housing for older LGBT+ people who do not want to go back in the closet when accessing supported or care home.
Additional Needs Assessments Required
A 'deeper dive' into health needs for each of the distinct groups rather than grouping them together as 'LGBT+'.
Key contacts and references
Key contact | Christina Hardy |
Job Title | Public Health Practitioner |
Phone Number | 0191 4546794 |
1. Guidance on Sexual Orientation Monitoring
2. 'Lesbian and Bisexual Women's Health Survey: Prescription for Change' (2008) Stonewall UK
Stonewall: Prescription for Change
3. 'Gay & Bisexual Men's Health Survey' (2013) Stonewall UK.
Stonewall: Gay and Bisexual Men Health Survey
4. Trans Mental Health Study (2012) Scottish Transgender Alliance in partnership with TransBareAll, the Trans Resource and Empowerment Centre, Traverse Research and Sheffield Hallam University
5. Gender and children and young people's emotional and mental health: manifestations and responses A rapid review of the evidence (2016) national Childrens Bureau
National Children's Bureau: Review Gender and Mental Health
6. Integrated Household Survey, Office for National Statistics
Data.gov.uk: Integrated household survey
7. Healthy Lives, Healthy People: Our strategy for Public Health in England (2010)
Last updated: January 2017