Why Identity Matters

Last year was the 50th anniversary of the partial decriminalisation of male homosexuality.

It was remarkable to see how much has been achieved in a relatively short space of time. However, what really struck me was the testimony of young people, and young LGBTQ+ people in particular.

So many of them talked about the anxiety, the depression, the trauma, the shame and the body dysmorphia they experience. The link between poor mental health and being LGBTQ+ for today’s young people was really strong and worrying.

In preparing for a recent presentation to the Equality and Diversity Council, I talked to a number of staff and patients about their experiences. I was struck by how “don’t ask, don’t tell” they said the NHS can still be.

A nurse from an eating disorders service said how white the patient group is and what some of the reasons are for this. Discussing whether there were any patterns in terms of the male admissions around sexual orientation, they said: “Oh, we wouldn’t ask that.”

Visiting an LGBT patient group and talking to a young man who had attempted suicide when his boyfriend had left him, he said that when he tried to talk to his nurse about this the reply had been: “I am not interested in your private life”.

Many trans patients have talked about feeling unsafe in services and some Child and Adolescent Mental Health Services (CAMHS) patients feel strongly, among other things, that the NHS needs to catch up with changing attitudes to gender identity. One psychiatrist said 50% of attempted suicides in one London Borough were by young people who are LGBTQ+, adding: “We know that because we know our patients”.

Talking to a ward manager who is LGBTQ+ and BAME, he felt unsupported by colleagues when he was abused. Talking to a senior nurse who is LGBTQ+ and BAME, he felt he was tired of doing the heavy lifting with little or no support.

This is reflective of the experience of ‘minorities with minorities’ and consistent with the findings of the 2015 Stonewall survey on the levels of bullying and harassment experienced by staff in health and social care.

Of course, for every negative experience there are stories of teams working really hard to address these issues. They recognise that this is about safe, effective, compassionate care. It is about seeing the person in the context of family – as defined by them – neighbourhood and community. So, we are looking at the person as a whole rather than as the presenter of a treatment episode.

Some of the issues raised are really complex and need time to work through. People have deep-seated cultural or religious issues that need to be respected and that are not addressed by an on-line training module.

The Sexual Orientation Monitoring Information Standard is an important first step. It puts the question into the system and it challenges the “don’t ask – don’t tell” culture that some perceive there to be. It will help us to ensure that we are fulfilling our commitment to providing comprehensive services for all.

We need to do more work to ensure that it gets traction and that we understand what the outcomes are telling us. The CQC’s focus within the provider inspection regime is also a helpful step. However, it will only take us so far and needs to be supported by a programme of work.

We need to learn as much as we can from the experience of Workforce Race Equality Standard (WRES) implementation and why this is important to the NHS as an organisation. We need staff and patients to work together to produce a body of evidence about what works, to change perceptions and to see what we can learn from those organisations that are further ahead in this area.

A focus on identity benefits everyone. I believe that the NHS is at its best when it focuses on the individual in the context of their identity, not as a credential but rather as a way of ensuring that we are recognising all who are vulnerable and tackling inequity in all its forms.

At the end of the day it is about safe, effective and compassionate care.

This article originally appeared on the NHS England site.