After reading an admirable blog by Robbie Turner, Director for England at the RPS, I felt compelled to write about my own experiences as a young gay man. I’d also like to reflect on what is required from pharmacists current and future to support LGBT people, whether they are patients or colleagues.
Despite being among the most tolerant societies in the world, the long road to self-acceptance as a young gay man in 21st century Britain has still been troublesome and fraught with risk of psychological harm for myself and others. In my own experience, much of this comes from internalised homophobia rather than any overt prejudice from others, although negative remarks are far from uncommon. From the ages of 17 to 19 I went through a period of enormous emotional turmoil while I struggled to acknowledge my sexuality even to my closest friends. This led me down the path of drinking, using alcohol as a way to relax my inhibitions so I could tell them about it, but often as a coping mechanism. Far from coping, it actually made life a lot more difficult as my grip on self-control loosened and I couldn’t moderate how much I drank. To arrest the problem, I went teetotal in 2014, and luckily never reached a point where I became dependent on alcohol or began using any illicit substances. For every person like me who manages to bring it under control, many others continue to suffer. I wasn't the first and I won't be the last to battle with those issues. Last October I read an article by Owen Jones which really resonated with my experiences, and I highly recommend reading for a greater insight to the issue. He refers to it as a silent health crisis.
As we aspire to become healthcare professionals, we must subscribe to the principle of parity of esteem, where mental health is recognised and prioritised on par with physical health. I believe it’s important to recognise the mental health issues that are an all-too-common feature of LGBT life. According to the LGBT Foundation, drug misuse is seven times higher among LGB people than in the general population. The Youth Chances report by the charity METRO shows 42% of young LGBT people have sought medical help for anxiety or depression, and I’m among them. I found my teenage years incredibly isolating, as a deep-rooted anxiety set in which still pervades other aspects of my life. The pressure an LGBT person faces is unimaginable, and their character is forged from it – for good or for bad. The fact Galop, an LGBT anti-violence charity, report homophobic hate crimes rose 147% in the wake of the EU referendum shows a real threat which can ebb and flow. Quite frankly, all these statistics and personal stories are a shameful reflection on British society despite those from other countries facing even worse discrimination. In spite of the progress made in my own lifetime to bring about ‘equality’, I fear it’ll be many years, probably decades, before these damning statistics tell a more equal story.
Overall, 1.7% of the UK population identified themselves as LGB in 2015, although the figure was 3.3% for people aged 16-24 and the true figure is likely higher, as 4.4% refused or didn't know how to identify themselves. As a pharmacist, you’re guaranteed to come across LGBT people in your practice. The first step to meeting their needs is to acknowledge what those needs are. I hope this article has helped raise your awareness of the challenges LGBT people disproportionately face. You could be the one to spot signs of drug abuse. Working in community pharmacy or primary care, you might be the healthcare provider an LGBT person comes to seeking help for their mental health. In hospital or a specialist mental health setting, you may come across LGBT people in crisis. But don't forget that LGBT people are individuals, and their health needs are individual too. As well as the mental health considerations outlined, they suffer physical ill-health as anyone else might. Treat them with care and compassion, be sensitive to how their sexuality influences their needs, but avoid lumping them all into the same category or making assumptions.
Healthcare professionals need to create a safe environment and build rapport so that LGBT individuals feel able to share sensitive information, for example their sexual behaviours. This can lead onto conversations about higher rates of sexually transmitted infections, hazardous drinking, and smoking. Men who have sex with men are at higher risk of anal cancer due to increased risk of human papillomavirus infection, but a lack of culturally sensitive care means screening opportunities are drastically limited. Health issues in the LGBT population can only be addressed by making prevention and treatment programmes open and accessible.
HIV is closely associated with the gay community, with 54% of new diagnoses in the UK being in men who have sex with men. However there have been some notable successes in recent years, with increased HIV testing meaning 88% of eligible MSM received a test in 2015. This is translating to fewer late diagnoses. There are still an estimated 5800 MSM living with undiagnosed HIV, around 12% of the total. HIV is one of the most sensitive conditions to poor compliance, so once diagnosed pharmacists can play a crucial role in the long-term management of medicines and lifestyle.
A 2015 report by Stonewall, rather ominously titled Unhealthy Attitudes, showed that attitudes among health and social care workers leave much to be desired when it comes to the treatment of LGBT people. Particularly revealing was the finding that 57% of professionals directly responsible for patient care do not consider sexual orientation to be relevant to a person’s health needs. This was 51% among mental health workers, counsellors, psychologists and psychotherapists despite the clear evidence of disproportionately higher levels of depression, anxiety, self-harm and suicide attempts in LGBT people. Although well-intended, patients shouldn't be treated exactly the same regardless of their sexual orientation. LGBT patients have specific needs and their sexuality is just as relevant a factor in their care as their social circumstances, smoking status, physical activity levels, or individual priorities. Consider the individual as a whole.
The workplace can be surprisingly hostile for LGBT colleagues too, 24% of patient-facing staff have heard negative remarks or discriminatory language from their colleagues, and 26% of LGB staff have personally experienced bullying or discrimination. Only 59% of LGB staff in the healthcare sector are prepared to be open about their sexual orientation with all colleagues, managers and senior colleagues. Working with major employers across the UK, Stonewall have found LGBT staff perform better when they can be themselves at work and that this also improves the ability of organisations to understand the diverse communities they serve. Leadership is needed at all levels of pharmacy to make this an accepting profession which doesn't tolerate discrimination of colleagues or patients based on their sexuality. From a personal perspective, role models such as Robbie Turner are an enormous boost to my self-belief that I can excel in my chosen field.