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Mental Health : Archives Of Suicide Research

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Mental Health : Archives Of Suicide Research

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Mental Health : Archives Of Suicide Research

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The sexual minorities in the society represented by the lesbian, gay, bisexual, transgender or intersexual people are plagued with several problems. They are often discriminated against, face abuse, encounter social stigma, and even pay disparities at work. Poor acceptance of their sexual preferences at home, at work and in the community makes them more likely to suffer from mental health problems, such as, depression, anxiety, suicidal thoughts and self harm. When coupled with problems of poverty, young age, belonging to an ethnic minority, lack of education, an unstable job their insecurities are likely to be more severe, leading to mental health problems that drive them towards committing suicides.
Alarming statistics come to light  when the LGBTI are surveyed for attempts or thoughts of suicide. Thoughts of suicide have been reported by 15.7% of bisexual, lesbian and gay Australians while 20% of trans have had episodes of suicidal ideation. Almost 50% of the trans population has attempted suicide at some point in their lives (Facts and stats about suicide in Australia, 2014). Australians those who report same sex attraction may have 14 times higher rates of suicide attempts as compared to the heterosexual majority (Rosenstreich, 2013). In Australia, most research papers point at the high rate of suicidal behaviour among the sexual minorities but there are no population studies specifically for the LGBTI (Skerrett, Kõlves, & De Leo, 2015). The likelihood of LGBTI person of attempting suicide is five times more than heterosexual people. They are twice as likely to cause self-harm than their heterosexual peers (Morris, 2016).
The LGBTI are healthy and capable of living fulfilling lives on the personal and professional front. But the discrimination and attitudes of homophobia against their sexual orientation makes them prone to several mental health disorders. People with sexual orientation other than heterosexual encounter social stigma at home, at school, at work and in the community. They are discriminated against and often people are prejudiced against them.
One of the first and most shocking rejection is encountered at home when individuals from sexual minorities face rejection from parents and family. They grow up in a hostile environment and are subjected to bullying and harassment at school. Institutional and personal discrimination occur repeatedly and are commonly referred to as gay-related stress and minority stress. Rejection by parents and family can increase the risk of suicide by up to eight times compared to individuals who have a more accepting family or parents. Lack of support from the family, parents discouraging atypical-gender behaviour and abuse at the hands of family are known to induce suicidal ideation among adolescents. The discrimination and hate crimes that target people on the basis of sexual orientation cause a higher incidence of mood disorders, anxiety and even substance abuse. Legislations in favour of gay marriages are quite recent and have caused considerable depression, anxiety and alcohol abuse among the LGBTI populations. It is understood that social recognition of same sex relationships and a legal stamp on marriages between individuals of the same sex is likely to reduce discrimination against them. Acceptance by the family and society can lead to better health outcomes for lesbians and gays. Stable family life in a legally approved marriage improves the prospects of a healthier life, better psychological health and better acceptance in the family and society (Buffie, 2011).
Negative attitudes towards people with HIV/AIDS are not uncommon. When the patient is gay the problems of social stigma and discrimination are even greater. The patient has to deal with health issues due to the disease and face societal stressors. They face isolation not only from the larger society but also from HIV negative gay men. Coupled with the need to adhere to a long term regimen of treatment leaves this group t a higher risk of suicide (Haas, et al., 2011; Smit, et al., 2012).
Before the gay movement began, mental health issues were so common among the LGBTI community that the common perception was to view their sexuality itself as a form of mental illness. A large contribution of the acceptance of the gay movement was to dismantle this belief. Homophobic abuse is more likely to be targeted at younger men and they are more likely to be assaulted. The impact of homophobia is likely to impact those men more who have little support from their families, have received lesser education. Factors such as poverty and racism are also likely to impact the mental health of some gay men more than the others (Hickson, /mental-health-inequalities-gay-bisexual-men/, 2016 ; Hickson, Davey, Reid, Weatherburn, & Bourne, 2016).
Mental health disorders are associated with  high risk for suicidal behaviour. There is a higher risk of suicides among the LGBTI than the general population because they are more likely to suffer from major depression, alcohol or substance abuse, and generalized anxiety disorder. The risk is higher among m. than in women (Haas, et al., 2011). Remaining connected with the family after disclosure, adult caring and school safety are important factors in preventing suicide among adolescent LGB.
The health disparities for the people from sexual minorities do not end with social stressors from the family and community that cause them considerable mental agony to be suffering from a variety of mental health issues. The access to healthcare and treatment of the mental afflictions caused due to society’s misunderstanding of their sexual orientation as unnatural is also compromised. Primary health care and end of life care for the LGBTI may often marginalise them further. In a study on the deficiencies in care a number of obstacles were observed. Social isolation and discrimination against gay, lesbian, bisexual and transgender people by health and aged care providers stemmed from the latter’s lack of knowledge about legal provisions that protect people from the sexual minorities (Cartwright, Hughes, & Lienert, 2012). Oppression on a day-to-day basis can lead to severe mental and physical health problems. The overall sense of well-being is also compromised. Some of these are caused due to a lifetime of encountering abuse, several times from strangers (National Survey of Mental Health and Well-being, 2007).
Although the awareness and understanding of the LGBT has undergone a sea-change in the last two decades, largely due to the sociocultural shift brought about by the gay revolution and the advent of the HIV/AIDS. But problems of mental health persist. Public and social recognition of the community has not succeeded in removing prejudices completely.
There are three processes that cause stress. The first is the objective stressor that occurs due to direct victimistion or prejudice, when the victim anticipates rejection and remains vigilant about expectations of adverse behaviour and the process of internalisation of negative experiences. Whether a person will be able to balance risk and resilience depends on how  interpersonal interactions and intrapersonal resources balance each other (Hatzenbuehler M. , 2009).
Persons belonging to the sexual minorities may often face barriers in getting access to health insurance coverage and may be deterred from seeking medical help.The fear of stigmatistion prevents them from sharing their health care needs from the physicians. The fear of negative attitude towards the LGBTI is not without reason. There are health professionals who fail to develop a relationship of trust because they do noy understand people from this community. Substandard care provision and the fear of confidentiality may often become roadblocks, particularly if the patient is seeking treatment for mental health issues (Quinn, et al., 2015).
There is evidence that anti-bullying policies reduce the incidence of suicides in gay and lesbian students. The key lies in fostering an atmosphere that is inclusive and understands the rights of the LGBTI people in the society (Hatzenbuehler & Keyes, 2013).
In Australia prevention of suicide among the LGBTI is a work in progress, through organisations such as, beyondblue and Headspace. But reaching out to the target population has not been easy. The main concerns of the LGBTI people – fear of discrimination and the fear of their confidentiality being breached remain to be addressed. These unresolved issues have either kept them away from seeking help or delayed access that causes their symptoms and suffering to worsen.
Suicides among adolescents and youth are a public health concern and often the impulsiveness of youth contributes to the problem. In a longitudinal evaluation that compared the risk factors in general population with that of the LGBTI-specific factors, not much difference was observed (Liu & Mustanski, 2012). Another study examines whether religion plays a protective role in LGBTI persons. But it was found that the anti-homosexuality stance preached by religion leaves the LGBT with  sense of confusion about religious beliefs (Gibbs, 2015).
Sensitization of mainstream health services for mental health treatment of the LGBTI people is important so that the facilities can be accessed by those who need and seek help to treat suicide ideation. Barriers of discrimination and prejudice should be removed by providing adequate training to the healthcare staff. Suicide prevention services need to be made aware of the fears of the gay, lesbian and transgender patients. In order to portray the healthcare as appropriate for the LGBTI people it is important to display posters, notice boards and images that depict the organisation as being sensitive to their needs. Doing so will make it easier for the patients to access healthcare with more confidence and reduce their fear of being discriminated against (Rosenstreich, 2013).
Social determinants of mental health that lead to suicidal tendencies encountered by the LGBTI should be focussed upon. The health outcomes need to be reached through focus on tackling suicide ideation, homophobia, transphobia and the social stigma that surrounds the existence of LGBTI people. Interpersonal encounters at the healthcare facility, socio cultural sensitization of staff and the institution are important while delivering prevention strategies aimed at reduction in suicide.
A collaborative approach that includes LGBTI organisations, government agencies, suicide prevention services and the mainstream health services is a must. This will ensure expertise from different domains to work towards the common goal of treating patients with suicidal tendencies. Once initiatives are designed, the inputs from the LGBTI community should be used to device a mechanism of effective healthcare delivery that is sensitive to their needs. Particularly marginalised sections from among the patients should be identified and encouraged to seek treatment.
Attachment based family therapy has been found to be effective in the treatment of adolescents exhibiting suicidal behaviour. Mental health treatment that is specifically designed for the LGBTI people appears to be a distant goal. They have to rely on treatment available in the mainstream health care services. Training of mental health care professionals in treating the sexual minorities has now begun. But it will take time to develop specialised services.
Work needs to be done to prevent deterioration of the mental health of the sexual minorities due to the various social stressors. Advocacy has now begun to protect the LGBTI persons from violence, hate crimes, bullying at schools, discrimination in housing, at the work place, getting insurance benefits for the spouses and several social discriminatory practices. The need for gay men and lesbian women to hide their reality when serving in the armed forces is one such discriminatory policy (Haas, et al., 2011). Once the need to hide their identity is done away with, better social acceptance, coming out in  positive environment where their sexual preferences are treated with respect and dignity is ensured will lead to reduced cases of mental illnesses, reduced societal pressures will lead to better mental health and suicidal behaviour will be seen less often. Prevention of suicides among the LGBTI is an objective that requires changes in the mindsets of mainstream community.
Incidence of high rate of suicide among the LGBTI is a problem that stems from the deep rooted social problems faced by them. The mainstream society has largely remained homophobic causing social distress to the sexual minority. To begin with their sexual preferences were labelled as a mental illness. The consequence was severe social oppression of the LGBTI persons that led to mental health problems. Their troubles begin at home when they face rejection from their parents. They suffer from ridicule, bullying, violence, humiliation and physical and emotional abuse at the hands of the mainstream society. The lack of understanding about their sexuality by the their family, peers, co-workers, health professionals makes them vulnerable to mental health issues. Major depressive disorder, generalized anxiety disorder, suicidal thoughts, attempt to suicide and suicide are the several mental afflictions that plague the LGBTI. The gay revolution has increased public acceptability of the community in society but they still suffer from social stigma. They struggle with finding rental accommodation, finding and retaining jobs, and health insurance for  a same sex spouse.
Prevention of suicides among the LGBTI is a challenge that calls for better training of healthcare professionals, so that they adopt a sensitized approach and understand the mental health needs of the LGBTI persons.
Facts and Stats about suicides in Australia. (2014). /facts-and-stats. Retrieved from https://himh.clients.squiz.net: https://himh.clients.squiz.net/mindframe/for-media/reporting-suicide/facts-and-stats
Buffie, W. (2011). Public Health Implications of Same-Sex Marriage. American Journal of Public Health, 101(6): 986–990.
Cartwright, C., Hughes, M., & Lienert, T. (2012). End-of-life care for gay, lesbian, bisexual and transgender people. Culture, Health and Sexuality, 14(5):537-48.
Gibbs, J. (2015). Religious Conflict, Sexual Identity, and Suicidal Behaviors among LGBT Young Adults. Archives of Suicide Research, 19(4): 472–488.
Haas, A., Eliason, M., Mays, V., Mathy, R., Cochran, S., D’Augelli, A., Ros, M. (2011). Suicide and Suicide Risk in Lesbian, Gay, Bisexual, and Transgender Populations: Review and Recommendations. Journl of Homosexuality, 58(1), 10–51.
Hatzenbuehler, M. (2009). How does sexual minority stigma “get under the skin”? A psychological mediation framework. Psychological Bulletin, 135(5):707-30.
Hatzenbuehler, M., & Keyes, K. (2013). Inclusive anti-bullying policies and reduced risk of suicide attempts in lesbian and gay youth. Journal of Adolescent Health, 53(1 Suppl):S21-6.
Hickson, F. (2016, August 13). /mental-health-inequalities-gay-bisexual-men/. Retrieved from https://blog.oup.com/: https://blog.oup.com/2016/08/mental-health-inequalities-gay-bisexual-men/
Hickson, F., Davey, C., Reid, D., Weatherburn, P., & Bourne, A. (2016). Mental health inequalities among gay and bisexual men in England, Scotland and Wales: a large community-based cross-sectional survey. Journal of Public Health, 1-8.
Liu, R., & Mustanski, B. (2012). Suicidal ideation and self-harm in lesbian, gay, bisexual, and transgender youth. American Journal of Preventive Medicine, 42(3):221-8.
Morris, S. (2016, July). /snapshot-mental-health-suicide-prevention-statistics-lgbti-people/. Retrieved from https://lgbtihealth.org.au: https://lgbtihealth.org.au/resources/snapshot-mental-health-suicide-prevention-statistics-lgbti-people/
Quinn, G. P., Sanchez, J. A., Sutton, S., Vadaparampil, S., Nguyen, G., Green, L., Schabath, M. (2015). Cancer and Lesbian, Gay, Bisexual, Transgender/Transsexual, and Queer/Questioning Populations (LGBTQ). CA: A Cancer Journal for Clinicians, 65(5): 384–400.
National Survey of Mental Health and Well being. (2007). 43260_2007.pdf. Retrieved from https://www.ausstats.abs.gov.au: https://www.ausstats.abs.gov.au/ausstats/subscriber.nsf/0/6AE6DA447F985FC2CA2574EA00122BD6/$File/43260_2007.pdf
Rosenstreich, G. (2013). /bw0258-lgbti-mental-health-and-suicide-2013-2nd-edition.pdf?sfvrsn=2. Retrieved from https://www.beyondblue.org.au: https://www.beyondblue.org.au/docs/default-source/default-document-library/bw0258-lgbti-mental-health-and-suicide-2013-2nd-edition.pdf?sfvrsn=2
Skerrett, D., Kõlves, K., & De Leo, D. (2015). Are LGBT populations at a higher risk for suicidal behaviors in Australia? Research findings and implications. Journal of Homosexuality, 62(7), 883-901.
Smit, P., Brady, M., Carter, M., Fernandes, R., Lamore, L., Meulbroek, M., Thompsonb, M. (2012). HIV-related stigma within communities of gay men: A literature review. AIDS Care, 24(3-4): 405–412.

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