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How remote mental health services have improved access for the LGBTQ+ community

When the COVID-19 pandemic, hit many aspects of our lives, including the way we access healthcare, changed. For the LGBTQ+ community, the move to remote mental health services also resulted in greater uptake of those services.

LGBTQ+ mental health

It's hard to quantify the increase in the number of LGBTQ+ people accessing remote mental health services, as NHS Digital, the body responsible for collecting data on how NHS services are used, does not collect these data.

But Charlotte Cooke, organisational safeguarding lead for charity LGBT Foundation, and clinical psychologist Dr Brendan Dunlop, of Pennine Care NHS Foundation Trust, both agree the move to remote mental health services has improved uptake among the community.

Here they explain how remote mental health services have benefited LGBTQ+ people, and where people can access these services.

Overcoming barriers

The LGBT Foundation experienced a 46% increase in demand for its therapy service from 2019-20 to 2020-21, Cooke explained. There was also a change in the complexity of referrals received, with themes such as trauma, PTSD, self-harm, suicidal ideation, and co-existing issues such as substance misuse and domestic abuse.

The move to remote mental health services also removed a number of barriers for LGBTQ+ people, which goes some way in explaining the increase in access to services. Cooke says people tend to travel to access LGBTQ+ specific support, but for many, travel isn't an easy option.

"Not everyone within our community feels (or is) safe travelling via public transport. The offer of accessing online from home, either by telephone or via video call, has removed this barrier for many," she says.

"It also adds the additional convenience of not having to arrange appointments to fit into other responsibilities and around working commitments factoring in travel to a face-to-face location.

"The feeling of safety when you are accessing this support from home can be invaluable to the therapeutic process, as it removes the anxiety about seeing a practitioner face-to-face, sitting in a waiting area and so on."

But she adds that mental health service providers should not fall into the trap of thinking going digital works for everyone. She explains issues such as "digital poverty, digital literacy, and the lack of a confidential space at home" can prevent people from using remote services.

Dr Dunlop explains that engaging with mainstream mental health services can often be difficult for LGBTQ+ people, due to heteronormative stigma - the assumption of heterosexuality - and potential shame associated with being seen accessing some services, including HIV or sexual health clinics.

"We know that LGBTQ+ people experience disproportionate rates of mood difficulties, including anxiety, compared to heterosexual people. The experience of high levels of anxiety for some may prove to be a barrier to attending initial appointments," he says.

"Engaging in sessions in an environment that feels more comfortable can therefore be beneficial. Linked to this, I think, is the fact that people can feel more in control of their appointment when they are more easily able to end the session on their terms."

The need for better access to mental health services

Overall, the pandemic saw a huge shift towards remote healthcare, which has proved a positive experience for many. According to the Nuffield Trust, prior to the pandemic patients who had a general practice appointment via the phone were 4% less likely to feel their healthcare professional recognised and understood any mental health needs.

But for members of the LGBTQ+ community, accessing mental health services can have unnecessary barriers.

The 2018 report by Stonewall, titled LGBT in Britain - Health Report, found that one in seven LGBT people had avoided seeking treatment for fear of discrimination.

Add to that the discrimination they can face on the street, on public transport and in waiting rooms and it's not hard to see why access to health services becomes a problem.

However, it's important that access to mental health services is easily accessible for the LGBTQ+ community. According to the Mental Health Foundation, one in eight LGBTQ+ people aged 18-24 had attempted to end their own life, half had experienced depression and three in five had experienced anxiety.

The stark figures were only heightened by the pandemic, which saw a significant rise in the number of LGBTQ+ people seeking suicide-prevention support. Support group LGBT Hero reported 35% of respondents to its LGBTQ+ Lockdown Wellbeing Report 2021 said they felt suicidal. Trans and gender diverse people were three times more likely to attempt suicide in the last year than cis-gendered people, while 46% of LGBTQ+ people under 25 reported feeling suicidal in the last year.

While rates of depression, anxiety and loneliness showed 'marginal' decreases, some 49% of LGBTQ+ people who took part in the research said they found the most recent lockdown harder than the first.

Advice for LGBTQ+ people accessing services

While there has been an increase in the uptake of remote mental health services among the LGBTQ+ community, there remains a stigma around accessing mental health services that can leave some feeling uncomfortable about asking for help.

Dr Dunlop says one of the most important things to ask when accessing mental health services is whether they have appropriate knowledge of the specific challenges LGBTQ+ people face.

That way you can ensure the person or service you are accessing will be best equipped to deal with your needs.

"Ensure you feel comfortable with the individual or service you are seeking support from," he explains.

"It is difficult for LGBTQ+ people to attend services and then have to explain every nuance of the community to a practitioner who is just not tuned in to this part of our society.

"It might be helpful to read up about the professional or the service before you attend or ask the service directly. Feeling comfortable and safe is essential to getting the most out of your appointment.

"If someone feels uncomfortable and unsafe, then they are unlikely to be as open and honest, as they may need to be to get the support they need."

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