Mental health and other issues if you’re gay, lesbian, bisexual, trans, queer + others

Imagine knowing at a young age that you are different. Imagine you learn that being different is okay. Imagine that you feel safe and nurtured in your families, culture and society. Imagine that you develop a strong sense of connection to a diverse community. Imagine that you are taught to love what makes you different. Just imagine…



The reality is very different. Both sexual orientation and gender identity may be most usefully understood as existing along a continuum. Sexual orientation refers to how we think of ourselves in terms of our emotional, romantic, or sexual attraction, desire, or affection for another person. It is very important to note, however, that sexual behaviour is not always related to sexual orientation or identity. It is also important to note that our gender identity is totally independent of our sexual orientation. Gender identity is our internal and psychological sense of ourselves as male, female, both, or neither. If we accept this, our sexual behaviour, sexual attraction, or self-identity should be a private/personal matter, but for minority groups such as lesbian, gay and bisexual and trans individuals the social stresses of stigma, prejudice and discrimination, in addition to internalised feelings of negativity and expectations of rejection, or abandonment are thought to be part of the explanation for higher rates of depression, anxiety, self-harm, phobic disorders, OCD, suicidality and substance abuse than their heterosexual counterparts.

For many lesbian, gay, bisexual, transgender, queer +  others, (the plus + is included to recognise that many people do not identify as LGBTQ+, but do not fit into traditional categories of gender or sexuality),  people, this has been the reality of their childhood and development into adulthood.

The lasting effects of experiences with such prejudice and discrimination are profound. For example, before 1973, homosexuality was labelled a mental disorder and many individuals experienced prejudice and judgment from those who were supposed to help. Members of  LGBTQ+ are twice as likely to experience violence, and personal loss and their risk of  post-traumatic stress disorder (PTSD) is double that of those that identify as heterosexual

LGBTQ+ groups are often stereotyped, which minimises their experience of, homophobia, lesbophobia, biphobia, and transphobia which leads to being objectified in society. In a survey: Whittle, S., Turner, L., Al-Alami, M. Engendered Penalties: Transgender and Transsexual People’s Experiences of Inequality and Discrimination. (2017).

  • 19% of LGBTQ+ employees have experienced verbal bullying from colleagues, customers or service users because of their sexual orientation in the last five years.
  • 15% of LGBTQ+ employees have experienced verbal homophobic bullying from their colleagues in the last five years.
  • 25% of trans people are made to use an inappropriate toilet in the workplace, or none at all, during the early stages of transition.
  • Over 10% of trans people experienced being verbally abused and were physically assaulted.

A report by The Scottish Transgender Alliance indicates that 80% of LGBTQ+ people had experienced emotional, sexual, or physical abuse from a partner or ex-partner. The National Intimate Partner and Sexual Violence Survey 2010 Findings on Victimization by Sexual Orientation released in 2013 (US) found that bi women are almost twice as likely to be abused as straight women.

For transgender people, lack of access to both hormonal and surgical treatment can adversely impact their mental health. Alarmingly, due to the coronavirus pandemic, transgender individuals are now facing unprecedented difficulties accessing health care, such as a shortage of specialised healthcare professionals and very few transgender individuals are receiving gender-affirming surgeries and hormone interventions and most hospitals have cancelled or postponed elective procedures to save resources.


What can employers Do to support the LGBTQ + community?

Healthwatch North Yorkshire conducted a survey and most respondents felt that being LGBTQ+ was integral to their identity, but some feared negative reactions. or questioned the relevance of disclosing their LGBTQ+ status. Issues raised in employment include;

  • The use of appropriate language when speaking to, working with and referring to our LGBTQ+ colleagues.
  • Supportive, friendly, accepting staff
  • Being able to support and recognise specific LGBTQ+ needs
  • Availability of support and professional knowledge of them for signposting purposes (including LGBTQ+ specific and non-specific availability)
  • recognising the need for support during treatment/surgery and providing support services specific to the LGBTQ+ community and reducing inequalities and making services more inclusive through:
  • Better training (including LGBTQ+ specific and mental health in general)
  • Availability and provision of services (including LGBTQ+ specific and mental health)
  • Visibility and promotion of LGBTQ+ mental health needs
  • Strategic and service-level improvements such as policies and more effective contract monitoring to ensure more inclusivity is achieved


What can employees Do?

So, what support is there for employees who identify as LGBTQ+  in the workplace?

Talking therapy

It might not be easy, but getting help with issues you’re struggling to deal with on your own is one of the most important things you can do. Talking with a therapist who’s trained to work with LGBT people may help with issues such as:

difficulty accepting your sexual orientation

coping with other people’s reactions to your sexuality

feeling your body does not reflect your true gender (gender dysphoria)


low self-esteem


suicidal thoughts


coping with bullying and discrimination

anger, isolation or rejection from family, friends or your community

fear of violence

Problems in relationships

Pink Therapy has a directory listing qualified therapists throughout the UK who work with the LGBT+ community from a positive stance. Telephone: 07971 205323 Address: BCM 5159, London, WC1N 3XX




if you are facing barriers to services or experiencing discrimination related to your gender identity, trans advocacy is a form of practical support which can help you overcome these issues. An advocate can work alongside you, helping to amplify your voice when speaking to the organization that has put the barrier in place or discriminated against you. The goal of advocacy is to empower you to access the services to which are entitled and to help ensure that your rights are protected. Empowering you to speak and, in complex cases, speaking with the third party organization on your behalf, to advocate for the protection of your rights.* This can include attending advocacy focused meetings within the Manchester area.

Direct Payments

Disabled and older LGBT+ people may get help with their social care needs. One way to do this is through direct payments. If you have eligible needs, your local authority gives you the money to buy the services you want. This can give you more freedom to organise your own care. This means that you can choose a carer who understands and respects your lifestyle. And that you feel comfortable with. You can find more information about ‘Direct payments’ at Or call the General Enquiries team on 0121 522 7007 and ask them to send you a copy of their factsheet.

LGBT+ support services

Many organisations are offering social and practical support to the LGBT+ community. There may be LGBT+ social groups, sports clubs or activities in your area that you could become involved in.

Many areas have services for younger people that can help with advice, support and meeting others.

What are my rights as an LGBT+ person?

Under the Equality Act 2010, it is illegal for a service provider to directly, or indirectly, discriminate against anyone who identifies as LGBT+. The NHS and any other organisation that offers services is a service provider. Stonewall have a guide called ‘Protecting Patient Rights’ with the General Medical Council. This is about protecting the rights of LGBT+ people in health services. You can find it at:

Written by:

Marie Church
RN BSc Specialist Community Public Health Nurse (OH) Expert Witness
Cognitive Behavioural Psychotherapist MSc (BABCP Accredited)