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Wardipedia – 44. Gay patients

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Somewhere Over the Rainbow

Introduction

‘We are often asked what “makes a hotel gay friendly”. For me the main clue is in the word ‘friendly’. I don’t need a constant corporate smile and I don’t need my towels tying into flamingos. I do however expect to be treated with the same respect as other guests and their partners, and want to be made to feel relaxed and comfortable from the get go…

 There is training out there to help hotels and their staff put gay travellers at their ease, avoid the wrong language and daft questions, and while that may help, it is really the ethos and values of the people who run and manage the hotel which are crucial. For me it is about whether they are genuinely gay welcoming or are they just “box ticking”…’

Simon Forrester, founder of Further Afield – Handpicked Gay Friendly Places To stay.

So much of this is transferable to a ward setting: being friendly, genuine and respectful and providing a relaxed and comfortable environment. This Idea is about gay patients but much of it (and all the values stuff) applies equally (in both senses of the word!) to gay staff. In fact, it’s all good practice for all – being open-minded, not making assumptions, being empathetic and practical. All things that ward staff are highly skilled in.

Stonewall’s Sexual Orientation: A guide for the NHS sets out clearly why gay people are particularly vulnerable to poor mental health and how this is compounded by problems accessing empathetic services:

  • One in five lesbian and bisexual women have deliberately harmed themselves in the last year, compared to 0.4 per cent of the general population
  • Three per cent of gay and bisexual men have attempted to take their life in the last year, compared to just 0.4 per cent of men in general
  • Half of gay and bisexual men have experienced at least one incident of domestic abuse from a family member or partner since the age of 16
  • One in eleven lesbian, gay and bisexual people over 55 have taken drugs within the last year compared to 1 in 50 heterosexual people

The NHS’ Choices website outlines the main reasons why gay people are so vulnerable to poor mental health. It’s worth pausing to note that none of these factors are to do with gayness itself but with the stereotyping, stigma and exclusion that being gay (whether openly or not) can inflict. Many gay people have experienced:

  • hostility or rejection from family, parents and friends
  • bullying and name calling at school
  • rejection by most mainstream religions
  • danger of violence in public places
  • harassment from neighbours and other tenants
  • casual homophobic comments on an everyday basis
  • embarrassed response (and occasionally prejudice) from professionals, such as GPs
  • no protection against discrimination at work
  • negative portrayal of gay people in the media

 Experiencing these difficulties can mean many gay and bisexual people face mental health issues, including:

  • difficulty accepting their sexual orientation, leading to conflicts, denial, alcohol abuse and isolation
  • trying to keep their sexuality a secret through lying, pretending or leading a double life
  • low self-esteem
  • increased risk of self-harm and suicide attempts
  • damaged relationships or lack of support from families
  • post-traumatic stress disorder and depression from long-term effects of bullying

The Stonewall report (see below) has lots of really practical ideas for and examples of helping gay patients to feel comfortable and trusting. For example, simply not presuming everyone is straight! That goes a long way. But some trusts are highly active in meeting gay patients’ needs; Kudos to Leeds Partnership Trust for the excellence of their services for LGBT patients.

BTW, we’re using  gay and LGBT interchangeably here. LGBT is the currently embraced label of choice for the lesbian, gay, bisexual and transgender communities. As is the rainbow the global gay symbol. There we go. That’s exactly the sort of simple and disproportionately helpful knowledge provided by gay organisations and inspired by gay hotels which you can read about below.

Ward examples

  •  Training for staff to be sensitive to the needs of gay and lesbian patients.
  • Sexual orientation equality is part of mandatory training.
  • Link nurses specialise in issues like women’s groups, and the lesbian and gay (and the BT bit of LGBT) communities, linking up with community services and specialists.
  • Queer Notions – local lesbian and gay mental health support group.
  • Volunteers increase diversity of support available to patients, especially from minority communities, like lesbian and gay patients.
  • Causal links between patients’ sexual orientation and their mental health problem are avoided.
  • Information (leaflets, posters etc) are available on LGBT related issues, services and advice.
  • Posters have been put up in waiting rooms that tell patients they won’t be discriminated against if they are gay.
  • Staff make it clear that gay patients can bring along their partner to appointments.
  • Patients are able to access support websites while on the ward.
  • The chaplaincy team are always very happy to support gay patients.
  • Sexual orientation is recorded in admission documentation (patients’ can opt out from answering this question).
  • Gay staff members mostly open about their sexuality but sensitive and mindful.
  • Links with local LGBT have been made.
  • Affirmation as an individual and specifically as an LGBT person.
  • LGBT advocates visit the ward each week.
  • Staff are aware of stereotyping clients’ character or behaviour on the basis of their own sexual orientation empathise with the challenges, views and experiences of LGB patients.
  • Gay staff can informally educate their colleagues about gay related issues.
  • Trusts are running simple but highly effective campaigns which raise awareness of the higher prevalence of self-harm and suicide attempts among gay people. Some campaigns also recognise publicly that not everyone who uses the health service is heterosexual.
  • Inclusive language is used in interviews, assessments and documentation.

Word from the ward

“A gay-friendly ward environment would have to be defined by each individual. You just know when it’s a friendly atmosphere, don’t you? Like in a shop or health club. I don’t think it’s possible to give a definition as such. It’s just like any other difference: being male or female, small or tall, Chinese or British. There are distinctions and similarities to acknowledge and be mindful of, but more than anything I think it’s about meeting each person where they’re at and tailoring their care with that in mind”.Healthcare Worker

I allow the patient to instigate the conversation about sexuality. I’m open to them talking to me about it with me just as I am with anything else. Until then we don’t assume or put people in sexuality boxes”.  – Staff Nurse

“As a gay member of staff I’m happy for other staff to refer gay patients to me if they wish to talk with someone who has the same sexuality”.Healthcare Support Worker

 

The Civil Partnership Act 2004

Since 2005 same-sex couples have been able to enter civil partnerships and gain the same rights as married couples. For the NHS this could cover, for example, providing patients the opportunity to declare they are in a civil partnership on forms which ask about marital status.

The phrase ‘next of kin’ doesn’t have a legal definition in Britain, so patients can nominate anyone to be their next of kin – it doesn’t have to be a civil partner (or husband or wife). NHS staff should bear in mind that a patient’s next of kin may be a same-sex partner, and may ask this person about what a patient’s wishes might be.

Civil partners have certain rights in relation to their partner’s mental health treatment, under the Mental Health Act 2007. Couples who aren’t in a civil partnership don’t have these rights.

Gay-friendly policies, practices and services

  • Targeting services specifically at lesbian, gay and bisexual patients where appropriate, for instance if lesbian, gay and bisexual people are under-represented in taking up a particular service.
  • Conducting patient experience surveys to find out the views of lesbian, gay and bisexual people
  • Auditing policies to examine their impact on lesbian, gay and bisexual patients

Communicating with gay people

  • Display gay-friendly policies where patients will see them
  • Use images of same-sex couples and their families in promotional materials
  • Make sure that preventative health messages don’t exclude gay people – for example, saying ‘smoking will make you unattractive to the opposite sex’ doesn’t include gay people
  • Promote the work they’re doing on sexual orientation through their website and local media
  • Join the Stonewall Diversity Champions programme and use the logo in recruitment advertising
  • Attend lesbian, gay and bisexual community events.

Training frontline staff

  • The organisation’s policies on discrimination, dignity and respect and patient confidentiality
  • The laws on discrimination in providing services
  • Health inequalities experienced by lesbian, gay and bisexual people
  • How best to encourage patients to tell health professionals they are lesbian, gay or bisexual
  • The diversity of the gay communities, including gay people from different ethnic backgrounds and gay people with disabilities

 

 

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