LGBT Minds: Lesbian Gay Bisexual
and Transgender People’s
Experiences of Mental Health
Services
Eddie McCann PhD RN RPN FHEA
Trinity College Dublin
Overview
 Stigma and discrimination
 Social exclusion (Vision for Change 2006)
 Psychological distress (King et al. 2008)
 Internalised self-hatred and shame (Cochran 2004)
 Mental health risk (Kuyper & Fokkema 2011)
Study aim and objectives
Aim:
 Explore LGBT people’s experiences of mental health
service provision in the Republic of Ireland
Objectives:
 Experiences of access
 Identify barriers and opportunities
 Identify good practices and service gaps
 Develop practice framework
Study design
 Exploratory mixed methods
 Survey which could be completed electronically, by
telephone or by post
 In-depth interviews with a sample of participants whom
had completed the survey
Inclusion criteria
 Over 18
 LGBT
 Service use last 5 years
Survey
Advisory group input
Existing tools e.g. Visible Lives
35 questions
Demographics
Sexual orientation and gender identity
Mental health status
Mental health service use
Service Experiences
2 open ended questions (suggestions for improving services and further
comments)
Recruitment and data collection
 Survey pilot (n=5)
 Invisibility and hard to reach
 On-line, post, telephone
 Website: www.lgbtminds.ie
 LGBT and mental health ) organisations
(n=170)(information and posters), press
Ethics and protection
 TCD approval granted
 LGBT guidelines (Kandirikirira 2004)
 Anonymity
 Signed consent
 Support
 Data storage
Profiles
N (%)
Age range
18-64
125 (100)
Cultural background
White Irish
White Non-Irish
Asian
Other
104 (84)
16 (12)
2 (2)
2 (2)
Area living
Urban
Rural
89 (72)
34 (28)
Gender identity
Male
Female
Transgender
Other
46 (37)
68 (55)
3 (2)
7 (6)
Sexual orientation
Gay
Lesbian
Bisexual
Heterosexual
Other
52 (42)
41 (33)
19 (15)
1 (1)
12 (10)
Diagnosis (n=97)
%
Depression
74
Anxiety
51
Sleep disorder
22
Eating disorder
18
Gender identity disorder
10
Post traumatic stress disorder
9
Bipolar disorder
8
Obsessive compulsive disorder
8
Personality disorder
8
Substance-related issues
5
Schizophrenia
3
Other
8
Services used
 Out patient clinic (n=83)
 Psychiatric Hospital (n=27)
 Day hospital (n=18)
 Day centres (n=16)
Survey-service experiences 1
 Could not discuss LGBT identity (33%)
 Professionals should know identity (65%)
 Feared negative reaction (16%)
 Feel professionals lack LGBT knowledge (64%)
 Not sensitive to LGBT issues (37%)
 Seek out LGBT friendly services (42%)
 Partners not acknowledged (40%)
Survey-service experiences 2
 Non-inclusive language use by staff (40%)
 Disclosure and negative reaction (30%)
 Helped improve mental health (80%)
Engagement and staff attitudes
 Ensure an atmosphere of comfort and acceptance to
encourage LGBT people to be completely honest and
treat people with dignity and respect.
 Having been in an abusive lesbian relationship I
received very little sympathy from some psychiatrists I
have seen and it has even been suggested to me that
my life will stabilize when I find a man.
LGBT identities
 I've noticed the term 'Borderline Personality Disorder'
being applied far to readily to anyone who identifies as
LGBT, thus dismissing the validity of the person’s sexual
orientation
 While mental health professionals were usually willing
to read up on issues related to trans* people, and many
were willing to learn, there was little understanding
of: -The way many different aspects of one's identity
can overlap to cause stress related to social oppression.
Partner and carer supports
 My partner is trans. I feel this is an incredibly
underserved group, both trans people and their
partners, and I find it difficult to have my experiences
understood by mental health practitioners across the
board when it comes to this issue specifically.
Treatment options
 I wasn't comfortable coming out to my mental health
provider (psychiatrist) and did not feel they would be
sensitive or even try to help me with any LGBT issues. They
were not willing to help (apart from medications) with any
other mental health issues I was experiencing. This is very
different to some to my experiences I had in the UK, where I
did get access to CBT, counselling, psychotherapy,
mindfulness etc. and was able to feel comfortable addressing
LGBT issues - and all free of charge.

+ve service experiences
 I am currently an outpatient attending a day hospital
for 14 months. As an LGBT person I felt respected and
at ease with the staff I encountered. When I mentioned
in passing that I was a lesbian I was asked to share my
coming out experiences etc and received good feedback
from my counsellors and psychiatrist and was offered
leaflets/advice etc. I must admit I was kind of amazed
but pleasantly surprised.
-ve experiences
 Area psychiatrists are paid by the HSE. Some refuse to deal with
transgender patients. These people should either be trained in trans
issues or stop ignoring those who need their help.
 Health system in Ireland is archaic and severely under-funded. I cannot
get access to a qualified therapist to support me with ongoing issues as
a result of a history of child sexual abuse.
 Mental health services in Ireland are awful in general not just with
LGBT. I was put on anti-depressants at the age of 15 by my G.P when I
told her I was feeling down due to my parents splitting up. I didn't see
any mental health professional until the age of 18. And then only saw
her twice. Very little came of 20 minutes talking.
Increasing awareness of LGBT issues
 Continue to destigmatise mental health; educate our
society (at secondary level, 3rd level and society in
general) more on mental health; get people talking
about it. More programmes on TV
 Educate staff and providers on Trans issues and the
diversity of transgender experience in particular.
Main concerns 1
 Mental health professionals not adequately trained or
educated in LGBT issues – gender sensitivity
 LGBT identity an important part of who the person is,
not considered relevant or important
 Fear of coming out to mental health professionals
 Lack of trust in health professionals
 Assumptions made by health professionals re sexuality
 Intense fear of institutionalisation – equated with total
loss of control
Main Concerns 2
 Trans community in need of support
 No integration of services
 Accessing services
 Overreliance on pharmaceuticals
 Isolation, stigma
Advisory group:
Danika Sharek
Odhran Allen
Patrick Callaghan
Agnes Higgins
Thank you
mccanned@tcd.ie