LGBTQ+ community helps improve health and social care in North Yorkshire during Pride Month
More than 200 people worked with the charity, which is the independent champion for people using health and social care services in the county, to highlight the issues they can face when accessing care.
Now those responsible for commissioning and delivering services are working to make things better – with staff training a key area highlighted by those who took part in Healthwatch North Yorkshire’s research.
In the new report LGBTQ+ People’s Experience of Using Health and Social Care Services in North Yorkshire – released during Pride Month – the number of personal stories shared demonstrate that barriers to access and instances of discrimination throughout the patient journey are representative of a wider problem. However, it was also highlighted that professionals using inclusive language, showing empathy and having knowledge of LGBTQ+-specific mental health issues can result in positive experiences for people accessing services.
Inequalities
Research has shown that significant health disparities exist for those identifying as LGBTQ+, an umbrella term used to encompass people from any minority sexual orientation (such as asexual or pansexual) or gender identity (such as non-binary, questioning or genderqueer). They are statistically more likely to experience health inequalities, more likely to smoke and to use drugs, to have poorer mental health and a higher risk of attempted suicides.
Healthwatch North Yorkshire’s research was aimed at finding out what these inequalities look like for the county’s LGBTQ+ community, with a particular focus on mental health care.
Many people who shared their experiences felt respected and comfortable using services after disclosing their LGBTQ+ identity, but most did not feel services and staff were able to support LGBTQ+-specific or gender-identity needs. Many had met with an assumption from health and care professionals that they were heterosexual, and some had experienced negative or hurtful comments. Feedback included:
“My wife was forced to have a pregnancy test when she presented with stomach pains, despite the fact she has never had intercourse with a man in her life. It’s often presumed by medical professionals I’m heterosexual. There should be no presumptions.”
“As far as my sexual identity is concerned, positive experience is limited to simply acceptance or indifference.”
“I reveal it when necessary, as being trans can change how certain issues need to be approached. However, I have had invasive and inappropriate questions from GPs as a result of disclosing my trans status.”
“Staff need much more education on how to deal with LGBTQ issues. I’ve been advised against coming out, told “you could just try being ‘normal'” (ie not trans), told to “deal with your real problems” when I’ve asked to be recognised as non-binary in a hospital setting.”
Isolation
A key factor for those identifying as LGBTQ+ in North Yorkshire, England’s largest county – where there are just 76 people per square mile compared with the English average of 430 – is the impact of rurality and a lack of transport to access services, especially those which are already difficult to access or scarcely available. The perceived lack of access to both mental health support and to a local LGBTQ+ community were highlighted at length. Comments and suggestions included:
“I’ve been looking for a mental health support group, with a safe space for LGBT stuff too. But I haven’t found one yet. I’m willing to travel to the next town along, but Leeds or York is too far.”
“The clinics are so spread out. I live in quite a rural area … I can’t afford to be travelling to Leeds.”
“Perhaps trying to create social groups that are easily accessible for like-minded people to get together in their local communities rather than sending them straight to professionals to talk about; sometimes people that have only just come out or identified themselves as LGBTQ+ don’t know anyone else in their immediate friendship group who identify as this, so meeting people like this in a friendly place could help!”
“You feel alone because there is no local community. They say representation matters, there is no representation around here, I’m completely alone and it’s isolating. So you end up not wanting to go to the GP or the doctors and saying ‘I’m struggling’.”
Language
Healthwatch North Yorkshire was approached by North Yorkshire County Council to carry out research to increase understanding of the experiences and needs of the LGBTQ+ community when accessing mental health support, to inform the implementation of ‘Hope, Control and Choice’, the North Yorkshire Mental Health Strategy and the mental health section of the Joint Strategic Needs Assessment.
As well as asking people to take part in the survey, the charity carried out phone interviews and spoke to people at Pride events in North Yorkshire in summer 2019.
The report shows that LGBTQ+ people experience treatment and care that is not uniform when accessing help in North Yorkshire. The examples given included positive and negative experiences at mental health services, sexual health clinics and GPs. Factors included use of appropriate language and pronouns, educated understanding of LGBTQ+ issues and general level of care available.
Trans people also told how assessment can be repetitive, difficult and can take a long time before getting treatment, and explained how delays in processes and poor admin can affect waiting times for Gender Identity Clinics.
Where people enjoyed positive experiences, some highlighted the benefits of professionals and services being particularly supportive and understanding of LGBTQ+ issues, and taking care to use the correct pronouns in written correspondence. Comments included:
“My therapist is happy with my identity and I am comfortable talking about it. She uses the right name and pronouns.”
“When going for my Smear Test, the nurse was very understanding about the difference in LGBT sex and how that could affect the success of my smear.”
“It’s that sort of blasé, but cheery, ‘I’ve seen this a million times and it doesn’t faze me at all’ attitude, and it’s all nice and normal. Then you can talk about… general life and things and that’s lovely and beautiful because it’s like they see me as a human person. Not as a thing, or some weird oddity that walked in. They actually just see you as a person and that’s what makes you feel nice and human when someone actually sees who you really are.”
Training
However, some LGBTQ+ people in North Yorkshire felt services were not knowledgeable about their specific health needs or lacked understanding. They also highlighted a lack of awareness from professionals of other sources of support. There were suggestions that more or better training would increase awareness and understanding of LGBTQ+ identities and care needs as well as improving the language used by professionals, and would help to provide better information and accessibility.
“There needs to be more people who work in mental health services who are knowledgeable about LGBTQ+ issues or are part of the LGBTQ+ community itself as some support I would require mental health wise it would be very beneficial to have that. Also for people who are less knowledgeable to get training and not to air unhelpful views like ‘gender being a phase’ in therapy settings. To also accept people’s identities and not make them feel bad for being themselves.”
“Educating staff, if they feel comfortable about discussing it then service users will overall feel more comfortable. Normalisation of sexual orientations and taking that into account where relevant just like with anything else a service user discloses. Never making assumptions and just listen, you don’t need to know the answer but if you are open to hearing what service users have to say and where possible providing support then that makes so much of an impact.”
“It needs to be accessible and understood that the needs of LGBT+ people are varied and different. Most doctors have no understanding of our needs. Trans healthcare needs a complete overhaul and expansion. We are left basically adrift if we do not constantly fight and in rural communities our needs are basically ignored.”
Making things better
Recommendations made by Healthwatch North Yorkshire in the report include services ensuring they collect LGBTQ+ demographic data – and better explaining how disclosing their LGBTQ+ identity can improve patients’ experience. Services are also urged to improve the availability of support groups and signposting resources in health and social care settings.
Professionals should avoid misgendering and making heteronormative assumptions, and providers should improve their administration systems to include inclusive gender identity and sexual orientation options as well as preferred pronouns and preferred contact person rather than “next of kin”.
As a sideline to the research, Healthwatch North Yorkshire spoke to North Yorkshire equality trainer Jake Furby to discuss the challenges members of the community can face when accessing care – and how things could be improved.
I think one of the biggest fears health professionals have is ‘I don’t know how to ask the question’; ‘do I have to ask this question?’; ‘why do I need to ask this question?’ In the community, we talk a lot about why it’s important to be out to your GP, to healthcare professionals. One, it’s representation but two it enables them to build a wider picture of what your healthcare needs may be.
“The main thing is to try, and services are trying. There are lots of good things happening.”
One of the key actions arising from the report is to improve staff training on LGBTQ+ issues to increase awareness and inclusivity, and the preliminary responses from health and social care providers show work is already under way.
Richard Webb, Corporate Director Health and Adult Services, North Yorkshire County Council, said: “The report gives a valuable insight into the experience of LGBTQ+ people when accessing health and social care, and will prove an extremely useful source of evidence when considering the needs of the LGBTQ+ community.
“Equality and diversity is already a core element of staff training for social care and health providers; this report will provide a good foundation for NYCC Health and Adult Services to review and strengthen that training to ensure it meets the needs of LGBTQ+ people and no doubt will be useful for system partners.
“We would ask all health and social care organisations to share this report and ask themselves are they responding positively and what more could they do?”
“In our new Equality, Diversity and Human Rights strategy we have an objective to train staff so that they are more confident and able to work with service users and staff who identify as trans. This will include information on admission to hospital and on record keeping. This will include some information on LGB and avoiding heteronormative assumptions.”Tees, Esk and Wear Valleys NHS Foundation Trust, the main provider of mental health services in North Yorkshire, said: “The trust recognises that it needs to improve collection of data around service users’ sexual orientation and there is an objective in the new Equality strategy around improving data completeness in this area.
Healthwatch North Yorkshire will continue to work with local health and social care commissioners and providers to ensure people’s views and experiences are used to improve care for members of the LGBTQ+ community.
