This guidance has been produced to provide assistance to staff working in mental health services in their daily interactions with lesbian, gay, bisexual, transgender and queer (LGBTQ) people availing of services.
The guidance has been structured under the themes of the MHC Quality Framework for mental health services. It outlines the steps that those working in and providing mental health services can take to ensure that services are provided in an inclusive way to LGBTQ service users, as well as their partners and families/chosen advocates.
Theme 1: Provision of a holistic seamless service and the full continuum of care provided by a multidisciplinary team
- LGBTQ service users: all mental health services are likely to have LGBTQ service users and/or family members or parents of services users who are LGBTQ. In a recent national study, approximately 8% of people identified as lesbian, gay or bisexual. It will, therefore, follow that a similar percentage of mental health service users are LGBTQ.
- Identify specific needs: a person’s LGBTQ identity may be unrelated to their need for the service. For some, their experiences as an LGBTQ person will be closely related to their presentation. Therefore, in addition to routine assessment and treatment, where appropriate, consider the role of LGBTQ-specific stresses in the person’s presentation to services, including questioning their own sexual orientation/gender identity, fear of coming out, lack of support after coming out or, for those who are already out, experiences such as homophobic or transphobic bullying. There is a section on key LGBTQ mental health issues on page six of the document below for more information.
- Training: training on LGBTQ issues is available from a range of groups (see list of LGBTQ organisations and services in the resources section of the document below). An empowering approach to the care and treatment of LGBTQ service users will be based on mental health staff being aware of their specific needs and the range of LGBTQ community resources and organisations that can be used in recovery programmes.
Theme 2: Respectful, empathic relationships are required between people using the mental health service and those providing them
- Provide an LGBTQ-inclusive service: this is a service that is respectful of and values both its LGBTQ service users and service providers. Respond supportively when service users disclose they are LGBTQ: where appropriate ask the person about their experience of coming out and if there are any issues related to being LGBTQ that they would like to discuss or need help with.
- Familiarise yourself with LGBTQ issues: LGBTQ specific stressors that can impact on mental health include difficulties before or after coming out, isolation, homophobic or transphobic bullying and lack of family support.
- Recognise: when working with young people that issues related to sexual orientation or gender identity can play a role in young people’s presentation with emotional and behavioural difficulties. This is particularly important for those working in Child and Adolescent Mental Health Services (See MHC resources for further guidance on working with young people). When working with older people that older LGBTQ people may have fears and anxieties related to historical approaches to LGBTQ people and their relationships.
Theme 3: An empowering approach to service delivery is beneficial to both people using the service and those providing it
- Respect the rights of LGBTQ service users: do not discriminate on the basis of sexual orientation or gender identity. This is an important component in providing an inclusive mental health service that respects the rights of LGBTQ service users.
- Use language and questions that reflect openness: it is important not to assume heterosexuality and recognise that gender identity may differ from presentation.
- Person-centred: offer person-centred care that focuses on self determination and empowering relationships based on trust, understanding, respect and meaningful roles in society.
Theme 4: A quality physical environment that promotes good health and upholds the security and safety of service users
- Display LGBTQ information: displaying an LGBTQ poster or including LGBTQ people’s views and experiences in service literature can help create a friendly welcoming environment for LGBTQ service users.
- Create a safe environment: staff in inpatient and residential mental health services should be mindful of the safety and security of LGBTQ individuals who may be subjected to negative comments or behaviour related to their LGBTQ identity from other service users.
Theme 5: Access to services
- Equal access: mental health services must ensure equality in access to their service regardless of the service user’s gender, sexual orientation, civil status, family status, age, disability, ethnicity, social class, religion or membership of the traveller community.
- Include LGBTQ people in the service ethos statement or equality policy: this demonstrates equality of access for all service users including LGBTQ people.
Theme 6: Family/chosen advocate involvement and support
- Support: provide information, advice and support to the partners of LGBTQ service users in the same way as you would to the spouses/partners of heterosexual people.
- Equality: treat same-sex married, civil partnered or co-habiting couples in the same way as you would married or co-habiting heterosexual couples in the context of their legal rights and entitlements (e.g. next of kin). This is required in line with Equal Status legislation.
- Involve advocates where acceptable to the person: for some LGBTQ people, particularly those who have no contact with their family of origin, their advocates may include friends or staff from LGBTQ services.
Theme 7: Staff skills, expertise and morale are key influencers in the delivery of a quality mental health service
- Recognise: a similar percentage of staff working in mental health services are likely to be LGBTQ in the same way that approximately 8% of service users are LGBTQ.
- Training: provide LGBTQ awareness training for staff as this can build their capacity to best meet the needs of LGBTQ service users.
- Make available existing guidance: Guidance for mental health professionals has been developed by a number of professional bodies including the College of Psychiatry of Ireland, the Irish Institute of Mental Health Nursing and the Irish Association of Social Workers.
Theme 8: Systematic evaluation and review of mental health services underpinned by best practice will enable providers to deliver quality services
- Involvement: LGBTQ issues should be considered by the mental health service when developing policy and services and LGBTQ service users should be consulted in service evaluation.
- Engagement: engagement with LGBTQ community groups may facilitate LGBTQ service user involvement.