The unique challenges of LGBTQ+ mental health care

Author of The Queer Mental Health Workbook discusses his research

This article contains discussion of self-harm.

Research has consistently shown that members of the LGBTQ+ community face significant disparities in physical and mental health outcomes when compared to their heterosexual and cisgender counterparts, linked to societal stigma and discrimination. Speaking to Trinity News, Dr. Brendan J Dunlop—a clinical psychologist and clinical lecturer from the University of Manchester—provided an insight into his area of expertise: queer mental health.

Much of Dunlop’s research centres on the experiences of those who identify as bisexual, and “the kind of mental health difficulties that disproportionately affect bi people”. For his doctoral thesis, Dunlop analysed the risk of non-suicidal self-injury (NSSI) amongst bisexual people, finding that they are up to six times more likely to engage in NSSI compared to other sexualities. During our conversation, Dunlop highlights the unique challenges faced by bi people, including biphobia. His research found a relationship between self-esteem levels and self-injury urges in bi people, as well as highlighting the detrimental impact that a lack of a sense of belonging has amongst those who identified as bisexual.

“Dunlop emphasises the ‘need to understand and reflect on our own prejudices and assumptions.'”

Speaking to Trinity News, Dunlop says: “We know that the LGBTQ+ community as a whole has got a disproportionate rate of mental health difficulties when compared to heterosexual and cisgender people but when we break it down and we look at the different groups of people within the community we find consistently that bi people tend to have the highest prevalence of mental health difficulties [compared to gay or lesbian people].” He notes that “despite this being the case they are really under-researched.”

Speaking of Bisexual+ Health Awareness Month—which just took place in March—Dunlop emphasises the “need to understand and reflect on our own prejudices and assumptions” and to “call out biphobic discrimination”, not only during this month but throughout the whole year. He concludes: “As healthcare professionals, as educational institutions, as any kind of institution that has power,” we need to consider the various ways in which our “structures and processes and the stories that exist within our cultures and systems could be directly or indirectly discriminatory.” “There are multiple levels in which we need to be thinking about helping people that are bi to feel more connected and more valid and more worthy.” Bi Health Awareness Month offers a crucial opportunity to highlight the unique challenges faced by this marginalised community, advocating for resources and inspiring allyship and actions which improve bi people’s well-being.

Throughout the interview, Dunlop highlights the crucially important role that history plays in shaping the queer experience today, stating that “queer history colours the present day”. The knock-on effect of harmful legislation such as Section 28 of the Local Government Act 1988, which was enacted in Britain under Margaret Thatcher’s government is one such example. This prohibited the “intentional promotion of homosexuality” within educational institutions and the broader public sphere. Dunlop points out that some “lecturers in our higher education institutions today would have lived through” this era “where people were explicitly silenced”. He continues, “LGBTQ+ books were removed from school libraries and LGBTQ+ societies within schools were disbanded.” Dunlop emphasises the importance of understanding the impact that Section 28 still has on queer students in educational institutions in the UK today: “Sometimes educational institutions might still have, whether they are aware of it or not, stains of section 28, such as teaching staff who still hold these prejudiced views, or policies that might not have actually been reviewed in a long time.”

“We need to make sure curriculums are inclusive. We absolutely now need to be teaching about diverse relationships, teaching about the fact that gender isn’t binary.”

When asked what higher education institutions can do to be more supportive of their LGBTQ+ community, Dunlop replies “We need to make sure curriculums are inclusive. We absolutely now need to be teaching about diverse relationships, teaching about the fact that gender isn’t binary…that sexuality and gender diversity has always existed.” He also highlights the importance of creating queer spaces for students such as “LGBTQ+ societies or lunch clubs”, where students can feel a sense of belonging and community and have somewhere to discuss the unique challenges that they face.

“Various systems, structures and stories in a heteronormative society render maintaining good mental health for LGBTQ+ people challenging.”

Dunlop discusses how “queer existence is quite intimately tied to racism and supremacy”, shedding light on the devastating impact of British colonialism in particular, which “systematically exterminated any [preexisting] kind of gender diversity in many different colonies.” “Difference threatens control”, he explains, is a mentality key to understanding why colonisers strove to completely restructure the gender dynamics of many African and Indian societies that they encountered. The widespread criminalisation of homosexuality on the African continent today is a legacy of colonialism. Dunlop identifies that with many of these “countries which have got really damaging anti-LGBTQ+ laws, you’ll notice that they have a history of colonisation”. He also highlights the evolving narrative of the Hijra community in India, another former colony of Britain. The Hijra people, who identify outside of the gender binary and are commonly referred to as India’s third gender, were once “well-esteemed” and “people would go to them for blessings”, however they have now become increasingly marginalised and hostility towards them has “grown subtly”. Evidently, an understanding of queer history is of the utmost importance if we are to understand the unique challenges faced by the LGBTQ+ community today.

Dunlop recently delivered the first public lecture series organised by the Equality, Diversity and Inclusion (EDI) group at the Faculty of Health Sciences in Trinity, speaking about how “various systems, structures and stories in a heteronormative society render maintaining good mental health for LGBTQ+ people challenging”, and how the queer community might “overcome these barriers using methods underpinned by psychological theories.” This series included a lecture open to staff and students as well as the general public, a clinical formulation workshop open to mental health practitioners in Trinity, and an informal student seminar on resilience.

Dunlop also published his first book this March, entitled The Queer Mental Health Workbook, having worked on it over lockdown. Speaking of the process, he shares that he “was managing lockdown by trying to funnel these thoughts into something which I hoped would be ultimately helpful”. Describing his inspiration for undertaking the project, Dunlop explains that he combined his “lived experience of being a gay man, [his] professional knowledge of being a clinical psychologist”, and “the themes and ideas” discussed in his work with clients. “It was motivating me to think about the people I worked with who could benefit from this” Dunlop states.

He describes the content of the book, explaining that the first section covers “the basics of queer mental health” whilst the second section is “a deeper dive into specific challenges” that affect the queer community. This is all accompanied by optional worksheets and other interactive elements. Dunlop stresses that there are “things larger than us that cause some of the difficulties that we experience”.

Dunlop’s work crucially highlights that many of the mental health challenges facing the queer community today are intrinsically linked to and rooted in history. From legacies of colonialism to lingering discriminatory government policies, trauma is ultimately inherited by LGBTQ+ people. Together, we must all reflect on these histories and learn from them, in order to understand how to cope with their pervasive negative effects in a productive and healthy manner.

Ella Sloane

Ella Sloane is the current Life Editor of Trinity News, and a Junior Sophister English Literature and Sociology student.