In this article, Mark Hughes, Professor of Social Work at Southern Cross University, shares some tips and resources that can help. Mark has published widely on the health and wellbeing of LGBTQ+ older people, and is the Australian lead on the Global Pride project. This article is one of a series sponsored by Southern Cross University’s Faculty of Health.
- Start by reflecting on yourself and your own workplace. Those who are middle aged and older, myself included, have been exposed to negative messages about LGBTQ+ people for decades and have witnessed their systematic discrimination (e.g. through the criminalisation of homosexuality and inclusion of Gender Identity Disorder in the DSM). Its hard to shake off these negative messages which can manifest in unconscious bias, as well as workplace practices that assume that people are heterosexual and cisgender (having a gender identity that conforms to sex recorded at birth). The good news is that there are resources out there to help, such as ACON’s Pride Inclusion Programs including support for workplace inclusion and for developing more inclusive health services.
- Appreciate the diversity and significance of LGBTQ+ identities and labels. The proliferation of letters in the acronym can lead to some confusion, but it does highlight the need not to treat LGBTQ+ people as one homogenous group. Here I’m using ‘LGBTQ+’ to refer to lesbian, gay, bisexual, transgender, and queer people with the ‘+’ acknowledging other gender and sexually diverse people, such as people who are non-binary, pansexual, genderqueer and asexual. The inclusion of intersex people as ‘I’ (people whose bodies do not meet the medical norms of male or female) in the grouping is debated, with intersex organisations arguing that their inclusion has obscured their specific circumstances and applied assumptions about lesbian and gay people, in particular, to intersex people, many of whom are heterosexual. Intersex Human Rights Australia provides some great resources for becoming allies to intersex people. Also, not all people who might be identified as LGBTQ+ relate in the same way to these labels. For example, some older people prefer not to use the term ‘queer’ because of its history as a term of abuse, whereas other older people and many young people use it as a way of reclaiming their power and opposition to heterosexual and cisgender norms.
- Encourage people to describe their gender and sexuality in their own way. The best way to navigate the different terminology is to encourage people to use their own terms to describe their circumstances, identities, relationships and communities. This is helped by creating a welcoming and inclusive environment – with clear messaging (e.g. around the office, in promotional material) that sexually and gender diverse people are welcome and respected in this space. Of course, that requires follow through when building a professional relationship: not assuming people are heterosexual or cis-normative; demonstrating respect for diverse identities and relationships; gaining more education about LGBTQ+ people’s unique health needs and social circumstances; and advocating for LGBTQ+ people when the opportunity presents. It’s also important to clarify with patients their preferred pronouns and titles, and to use inclusive language – such as asking about relationship status rather than marital status. The Rainbow Tick is a quality framework for health and human services to demonstrate that they are safe, inclusive and welcoming of LGBTQ+ people.
- Use the ABS Standard when collecting data. One way to help people feel acknowledged is being able to report as LGBTQ+ when first presenting to a health service, such as on patient intake forms. This is crucial as knowing that someone is LGBTQ+ provides key information for clinical decision making. Following community consultation, in 2020 the Australian Bureau of Statistics published a Standard for collecting information about sex, gender, variations of sex characteristics and sexual orientation. This is an excellent guide for framing written questions in a comprehensive and inclusive way. A great benefit of this Standard will be when it is taken up in a systematic way in research and hopefully in the Census, where lack of data has severely compromised our understanding of the health and community needs of LGBTQ+ people compared to the general population.
- Recognise and respond to the specific health challenges faced by LGBTQ+ people. Despite limitations in the research base, there is evidence that some groups of LGBTQ+ people face significant physical and mental health disparities compared to the general population. LGBTQ+ people typically report higher rates of smoking, alcohol and drug use compared to the general population, although there is some indication that this difference reduces as people grow older. LGBTQ+ people also face higher rates of depression, anxiety, loneliness and suicide compared to the general population. Many of the health inequalities faced by LGBTQ+ people have been demonstrated through research as linked to experiences of trauma, discrimination and marginalisation. LGBTIQ+ Health Australia (LHA) is the peak health organisation for organisations providing health-related services to LGBTIQ+ people and their website provides useful resources across a wide range of health and social issues impacting on LGBTIQ+ people, including suicide prevention, mental health, palliative care, and aged care. LHA also operates QLife, which is an Australia-wide anonymous LGBTIQ+ peer support and referral service, operating online via webchat and by phone, 3pm to midnight, 365 days per year.
- Value the strengths and unique characteristics of LGBTQ+ communities. Overcoming personal challenges – such as coming out or navigating homophobia, biphobia or transphobia – can facilitate personal growth and resilience. For trans and non-binary people, having their authentic genders recognised and affirmed can lead to gender euphoria (experiencing positive emotions and heightened quality of life in relation to one’s gender). You can check out some videos on gender euphoria at ACON’s Trans Hub. At a community level, LGBTQ+ people have mobilised in the face of discrimination and health challenges (such as HIV) to develop grassroots support networks and community organisations. Friends are particularly important members of ‘families of choice’ and as part of caregiving networks. Indeed, research in the United States indicates that LGBTQ+ people are more likely to be informal caregivers and volunteers than non-LGBTQ+ people. Locally, we’ve seen a range of groups and networks emerge to support LGBTQ+ people, such as Tropical Fruits and the Queers of Lismore fundraiser in response to the recent floods.
For more information and tips, check out the recently released LGBTQIA+ Health and Inclusive Healthcare in General Practice guide, produced by GP Supervisors Australia. While of interest to all GPs, it particularly aims to support GP supervisors in teaching and supervising GP registrars to provide inclusive services to LGBTIQA+ patients.