Response 49771375

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Stonewall Scotland

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1. Our framework sets out 8 priorities for a new Mental Health Strategy that we think will transform mental health in Scotland over 10 years. Are these the most important priorities?

If no, what priorities do you think will deliver this transformation?
Stonewall Scotland welcomes the importance placed on reducing inequalities under the “live well” priority; however, we believe this to be relevant across all stages of life and experiences of mental health (see below). We additionally support the use of a PANEL approach to considering the human rights impact of actions to improve mental health services and ensure that the strategy meets the diverse needs of Scotland’s communities, though further detail on how this will be delivered and achieved would be valuable. The priorities outlined in the consultation cover a number of important issues which impact on the lives of LGBT people. In particular, the priorities rightly place emphasis on prevention and early intervention in improving the mental health of children and young people, and prioritise improving access to mental health services. Experiences of young LGBT people Stonewall Scotland welcomes the emphasis placed on prevention and early intervention for infants, children and young people. A preventative approach to improving mental health in Scotland must take into consideration the impact of young people’s experiences at school. Stonewall Scotland’s work with teachers, schools and young LGBT people consistently highlights that teachers are ill equipped to tackle homophobic, biphobic and transphobic (HBT) bullying and lack confidence to talk about LGBT issues in school. 75 per cent of primary, and 44 per cent of secondary teachers say they either aren’t allowed to, or aren’t sure if they’re allowed to talk about LGBT issues with their pupils (Teachers Report 2014). By failing to address LGBT issues within the school environment, LGBT young people often report feeling isolated and disconnected from their school community (School Report 2012). A quarter of LGB people also report facing HBT bullying during school sport (School Report 2012). This can often lead to them to be put off participating in physical activity and therefore gaining the physical, social and mental benefits of being involved in sport from a young age. Given the links made between physical and mental health, it is crucial that efforts are made to ensure LGBT people feel safe and included in school and community sport. Stonewall Scotland therefore would support a focus on reducing inequality as part of a prevention strategy, as well as work to ensure that Child and Adolescent Mental Health Service practitioners understand LGBT young people’s experiences of inequality and are equipped to address these experiences where relevant in treatment. This should be developed in consultation with LGBT young people. Improve access to mental health services Stonewall Scotland supports the Scottish Government’s view that improving access to mental health services is a key part of early intervention. Your Services Your Say (Stonewall Scotland 2014) highlighted that LGBT people were almost four times more likely than the general population to access mental health services (11 per cent of LGBT people, compared to 3 per cent of the population in general had accessed these services in the last year), yet almost one in five (18 per cent) LGBT people, including almost half (46 per cent) of trans people, would expect to face discrimination when using these services. Stonewall Scotland’s Unhealthy Attitudes (2015) research into the treatment of LGBT people within health and social care services highlights that almost 3 in 5 health and social care staff with direct responsibilities for patient care say that they don’t consider sexual orientation to be relevant to one’s health needs, including half of mental health workers, counsellors, psychologists and psychotherapists. There was a greater awareness of the relevance of someone’s trans status, but this understanding was often related to the medical procedures that a trans person may undergo, rather than the impact of discrimination on a person’s physical and mental health. One in ten health and social care staff with direct responsibility for patient care say they are not confident in their ability to understand the specific needs of lesbian, gay and bisexual people. A quarter are not confident in their ability to respond to the specific care needs of trans people. Improving access to mental health services therefore relies on improving staff knowledge and understanding of LGBT health needs and the impact of inequality and discrimination on someone’s mental health. The impact of discrimination and inequality Stonewall Scotland believes that there is a strong case for including an additional priority which specifically address the negative impact of experiences of discrimination, bullying and isolation on an individual’s mental health, and recognises that those with protected characteristics may be more vulnerable to certain mental health conditions. Studies including Stonewall’s Prescription for Change: Lesbian and Bisexual Women’s Experiences of Healthcare (2008), Gay and Bisexual Men’s Survey (2012) and the Scottish Transgender Alliance’s Trans Mental Health Study 2012) have consistently highlighted a disproportionately high level of mental health conditions experienced by LGBT people in Scotland. Stonewall Scotland is clear that this is due to the impact of often life-long experiences of discrimination, bullying and hate crime. • More than half of LGB young people face bullying at school and 99 per cent hear derogatory language such as “that’s so gay” or “you’re so gay”. 97 per cent hear language such as “poof” or “dyke” being used on a daily basis (School Report 2012) • One in six LGB people have been the victim of a hate crime or incident in the last three years (Hate Crime 2013) • 62 per cent of trans people have experienced transphobic harassment from strangers in public (STA, Transgender Experiences in Scotland, 2008) • One in six LGBT people have faced discrimination from a public service provider in the last three years (Your Service Your Say 2014) Stonewall Scotland’s research highlights the devastating impact that discrimination and bullying can have on LGBT people mental health. • More than half of LGB young people have self-harmed, and one in four have attempted to take their own life (School Report 2012) • Stonewall Scotland’s 2012 research into gay and bisexual men’s health suggested that 3 per cent of gay men and seven per cent of bisexual men had attempted to take their own life in the last year, and 30 per cent had thought about it. One in sixteen had deliberately harmed themselves in the last year (Gay and Bisexual Men’s Health Survey 2012) • Research from 2008 suggests a similarly worrying picture for lesbian and bisexual women. 5 per cent of lesbian and bisexual women had attempted suicide in the last year, and one in five said they had deliberately harmed themselves (Prescription for Change 2008) • Over a third of trans people had attempted suicide at least once (Trans Mental Health Study 2012) It would therefore be valuable to include a priority aimed at reducing discrimination and inequality, and improving practitioners’ awareness of their impact. There should be specific reference to continuous engagement with communities across protected characteristics to ensure that their experiences are consistently informing how priorities are set, achieved and measured.

2. The table in Annex A sets out a number of early actions that we think will support improvements for mental health.

Are there any other actions that you think we need to take to improve mental health in Scotland?
Stonewall Scotland believes that the activities suggested in this strategy could be built on to better reflect the experiences and health needs of LGBT people. Some key areas are detailed under the relevant priorities below, and we also support the amendments suggested by LGBT Youth Scotland in their response to this consultation. Focus on prevention and early year intervention for infants, children and young people The mental health strategy should clearly define the term “vulnerable groups”, including clear information about how this relates to different protected characteristics. Specifically, it should be clear that sharing a protected characteristic does not itself make someone vulnerable, rather experiences of discrimination, poor treatment and isolation which are more common for these protected groups may have an impact on their mental health. The recommendation to develop a series of evidence-based programmes targeted to promote good mental health, and support key vulnerable populations is one that Stonewall Scotland would support. However, this should be done in consultation with the relevant communities, and should build on existing work and good practice to support LGBT communities. For example, LGBT Youth Scotland’s youth groups and online support service is a life-line to young people from across Scotland. Introduce new models of supporting mental health in primary care Primary care is an important route into our healthcare system, and would be valuable for primary care providers to be better equipped to support people suffering from mental health conditions. However, it is vital that any work to introduce new models of supporting mental health in primary care includes specific actions to better equip GPs to support LGBT people. One in ten LGBT people would expect to be treated worse by their GP because of their sexual orientation or gender identity, and of those who had been to their GP in the last year, almost one in ten rated their experience as “poor” or “very poor” (Your Services Your Say, 2014). Stonewall Scotland’s research also suggests that LGBT people are less likely to access their GP, whilst more likely to use mental health services and phone/ online services. It is also important that primary care providers are able to understand and support LGBT people’s mental health as part of a holistic approach to healthcare provision. In particular, primary care providers are worryingly ill-equipped to support trans people’s mental health needs in conjunction with support for their transition. Studies on the experiences of trans people and mental health suggest extremely worrying levels of depression, anxiety, self-harm and suicide. Studies also suggest that the mental health outcomes of trans people often improve after they have transitioned, and an approach to improving trans mental health must therefore be considered holistically and reflect the need for improved health provision for trans people generally. Stonewall’s 2015 Unhealthy Attitudes research suggested that a quarter of health and social care staff with direct responsibilities for patient care said that they were not confident in their ability to respond to the specific care needs of trans patients and service users. Whilst data on the experiences of trans people’s mental health is relatively limited, Scottish Transgender Alliance’s 2012 study showed that 88 per cent of trans people felt they either currently or previously suffered from depression (Trans Mental Health Study 2012). Activity to improve access to mental health services through primary care should therefore be informed by consultation with LGBT people to ensure that the barriers to accessing those services are understood and considered. Improve access to mental health services and make them more efficient, effective and safe Stonewall Scotland’s research reveals that health and social care staff have a lack of confidence in their ability to support LGBT patients, and lack an understanding of the relevance of sexual orientation to someone’s health needs. A quarter of health and social care staff have never received any equality training, and those who have often report that the training did not include important issues in caring for LGBT patients and service users (Unhealthy Attitudes 2015). Almost three in four patient-facing staff have not received any training on the health needs of LGBT people, the rights of same-sex partners or parents, or the use of language and practices that are inclusive of the LGBT community. Only a quarter of those trained reported that the training covered the legal rights of trans staff and service users. In improving access to, and quality of mental health services, it is therefore vital that this type of training is delivered as a priority. This lack of knowledge and confidence has serious implications for the efficiency, effectiveness and safety of services. Ensuring that staff have had appropriate training and have access to guidance and resources to support patients is vital. Access to CAMHS services presents particular challenges to LGBT young people, and particularly trans young people. Consideration of activity to achieve this outcome should therefore be done in consultation with LGBT young people using those services, as well as LGBT Youth Scotland as a service provider. Improve the physical health of people with severe and enduring mental health problems to address premature mortality In working to better include people with mental health conditions within health prevention programmes it is important that the needs of different protected characteristics are also considered. Research into LGBT people’s health suggests that they are more likely to exhibit risk taking behaviours including smoking, high alcohol consumption and drugs. Stonewall Scotland’s research into LGBT people’s health experiences suggest that they are also disproportionately affected by eating disorders. 2008 research suggests that one in four lesbian and bisexual women say they have had, or been told they had, eating problems (Prescription for Change 2008). One in five gay and bisexual men say they have had, or been told they had, problems with their weight or eating at some point (Gay and Bisexual Men’s Health Survey 2012). Work to improve the accessibility of health prevention programmes for people with mental health conditions must therefore also consider the experiences of people with intersectional identities.

3. The table in Annex A sets out some of the results we expect to see.

What do you want mental health services in Scotland to look like in 10 years' time?
The new Mental Health Strategy for Scotland gives us the opportunity to make sure that the many factors which may impact on an individual’s mental health are considered, and clear plans are put in place to make sure that no-one is left behind. In our response to questions 1 and 2, we have illustrated the devastating impact that discrimination, bullying and isolation can have on LGBT people’s mental health. We have also outlined some of the specific experiences of trans people in this area. It is vital that mental health staff under understand the impact of these experiences, and are equipped to respond to the specific health needs of LGBT people. It is also important that mental health provision is considered holistically, and in particular, services targeting young people must be responsive to the experiences they have at school or college. It is therefore important that programmes developed to support young people’s mental health work in partnership with local schools to ensure that LGBT equality is embedded within the curriculum and that HBT bullying is effectively tackled. The evidence detailed above, also outlines the positive mental health impact medical transition often has for many trans people. It is important to note, however, that Gender Identity Clinics in Scotland are vastly under-resourced and waiting lists for an initial appointment are often as long as 9 months. Work to improve mental health provision should therefore involve analysis of the impact of other health services on mental health, and a clear strategy for how these services could be improved.