COVID-19 Webinar 17: LGBTQIA+ mental health
The Lancet Psychiatry, Mental Health Innovation Network, MHPSS.net and United for Global Mental Health run a weekly webinar series designed to provide policy makers and the wider health community with the latest evidence on the impact of COVID-19 on mental health and how to address it.
Chair: Michael King, University College London
Speakers:
Raj Mariwala, Mariwala Health initiative, India
Adrian Hyyrylainen-Trett, The Employers Network for Equality & Inclusion, UK
Bonnie Sepora, Friends of Diversity Organisation - Open Hands Project, Botswana
The recording of this webinar can be found here.
Michael King: Introduces topic and panellists. Raj, can you tell us about the repeal of penal code 377 that happened in India in 2018? Has that changed the lives of LGBTQIA+ people in India and does it affect how they access mental health services?
Raj Mariwala: The repeal of section 377 which was a colonial law meant that it decriminalised sexual relations between consenting homosexual adults. But this was only one small part of it, and the Indian supreme court has used other laws and provisions since they repealed 377. The supreme court passed a very important judgment on trans rights in April 2014 - that the right to life, dignity and autonomy would include the right to one's gender and sexual orientation. The second important law is the mental health care act of 2017 which stated that all persons have the right to access mental health care without discrimination based on class, caste, religion, culture, sex, gender, sexual orientation and disability. This is particularly important when we look at how trans communities and intersex people have been historically excluded and discriminated against in accessing public services such as mental health and socio-economic rights. The problem comes in when we look at 377 as a catch all, when there are other laws that are a great threat to LGBTQIA+ communities, and LGBTQIA+ mental health. For example this act takes away the right to determine our own gender, to be recognised as a trans person you have to be screened and certified by a district magistrate. The idea of screening, certifying and pathologising gender has very deep roots in mental health and side disciplines. As mental health advocates we must recognise the damage this does to trans people.
Michael: Can you clarify, does the repeal of 377 mean that people can have same sex relationships and the law has taken away the criminality of homosexual sex?
Raj: Yes the law has decriminalised it — before the repeal, anything that was not penal vaginal intercourse was a criminal offence.
Michael: Yes like the old British colonial laws. Adrian, can you describe challenges facing the LGBTQIA+ community in the UK?
Adrian Hyyrylainen-Trett: There are a range of challenges regarding the mental health of LGBTQIA+ people in the UK, especially during COVID-19. There are a variety of implications that add on to each other — for example, people who are lonely, people in relationships that are coming under pressure, people who are not out and are living in families where they are not welcome or they feel discriminated against. Some feel they need to leave and the crisis of youth LGBTQIA+ homelessness has increased over this time. Another challenge is body image issues and fat-shaming. There are also issues with conversion therapy, where people are persuaded to be people they are not.
Michael: Bonnie - In June 2019, the High Court in Botswana legalised homosexuality. How is this reflected on the ground?
Bonnie Sepora: Yes, last year the High Court made a ruling to decriminalise same-sex acts and relationships. In terms of impact, there have been some perception changes and some people are becoming more receptive and accepting. At the same time, the ruling has made other sections of society more radical against the LGBTQIA+ community and it seems to have caused a backlash, with even harsher stigmatisation. But at least the ruling created a platform for asking for mental health support — now people can ask more readily for mental health support. In the “Open Hands” platform, we’re trying to make it possible for the LGBTQIA+ community to talk about their mental health and wellbeing.
Michael: This sounds like some very positive news. We are moving in the right direction, as equality legislation drives changes in attitudes. Raj, your initiative runs queer-affirmative counselling practices. Can you tell us more about that?
Raj: We run a course called “Queer-Affirmative Counselling Practices”. This is a course taught by queer and trans mental health professionals, to recognise inequalities in mental health and promote tools to prevent distress and promote the wellbeing of LGBTQIA+ people specifically. We also have peer supporter courses which we run with LGBTQIA+ collectives and community-based organisations to teach some mental health practice skills, ethics around power and boundaries, as well as provide shelter, legal and medical support. Our learnings are that it’s very important to foreground the historical violence from the area of mental health itself and side disciplines and to use the knowledge from the margins to support and ally with the LGBTQIA+ community and promote affirmative action policies as mental health advocates.
Michael: Thank you, have you learnt anything about the resilience of LGBTQIA+ people through your work?
Raj: When we talk about LGBTQIA+ mental health, many times we forget to centre the decades of activism and support that these communities have created for themselves. Activism and community building has been a real strength. There are some trans women politicians in India as well, at the forefront of the movement.
Michael: Adrian, can you tell me a bit about your work as an ambassador for an LGBTQIA+ mental health space?
Adrian: I do this in a range of different guises. Being your authentic self at work is critical — organisations need to have better understanding of inclusion and diversity and be aware that this is important for people to thrive. I’ve been very open about my mental health challenges over the years — and the more open we are about it, the better for everyone.
I also work at Create Space, which focuses on the mental health of gay men, including body-shaming and eating disorders. I also do some modelling for worldwide RAW, which is a sports allies men’s mental health charity (all men, not only LGBTQIA+) which aims to highlight that all men struggle with mental health. A high proportion of suicides are middle aged men and this is because men aren’t encouraged to talk about their feelings.
Michael: In sport, there are very few LGBTQIA+ people. Can you comment on this?
Adrian: I work with many different sports and have also worked with the Sports Media LGBTQIA+ group, to ensure advocates and journalists talk about LGBTQIA+ people in sport in the right way — especially from a trans perspective. But you are right, there are very few LGBTQIA+ people in sport. For me, I loved sport as a child, but felt I didn’t fit, so stopped doing it and was only able to return 27 years later.
Michael: Bonnie – what is the focus of the work you do at ‘Open Hands’ to promote and protect the mental health of LGBTQIA+ individuals.
Bonnie: Initially, we did self love sessions, so people can share their experiences with each other. COVID-19 has caused a shift in strategy, e.g. more digital engagement. Now we do 1-2-1 calls to reach out to our community. We rely heavily on our stakeholders’ support, e.g. online therapy services from other organisations.
We also embrace the principles of diversity and care. One of the key things that we focus on is the value of care. We try to provide safe spaces for people to share their experiences and difficulties. This inclusive model is very important, this is the reason the programme is called Open Hands, because it needs to be a space of safety for people who are experiencing hardships. LGBTQIA+ people need to be at the forefront of the project. It’s important to include many different types of people, plus we must provide a holistic approach and bring in as many professionals as possible to get the community members the support they need.
Things are also difficult when there are no financial resources, e.g. during COVID-19. Most donor funds have been frozen. People are short of money, and maybe even don’t have the funds to get internet data, so it's very hard because you want to help people, but it’s hard to reach them. This is one of the key issues we have faced in our work.
Michael: We don’t often think about this in Europe – the costliness and even ability to get online. Thank you for raising this issue. Our next question is from the audience for Raj — wIth regards to queer-affirmative counselling - how can we make this programme accessible to more mental health professionals across India?
Raj: Yes, we are trying to reach as many mental health professionals as possible. We are hoping to publish a queer-affirmative counselling manual soon, that will be free to download and use (in English and other languages). We are also running in-house courses.
Michael: Another question from the audience, Raj, how does caste play a role in the LGBTQIA+ experience in India?
Raj: Caste touches all aspects of life. It of course touches LGBTQIA+ life as well. This is definitely noticeable in terms of the LGBTQIA+ community — activism and leadership representation is far more upper-caste. We need to call this out even more aggressively and try to correct this. We need to have a very strong anti-caste lens to take this on.
Michael: Panellists: what is your top-priority message or action?
Adrian: To ensure that mental health awareness is a mandatory thing throughout all organisations and part of routine training. This awareness training in the workplace helps people to avoid micro-aggressions. As a result, people can be even more open about their mental health conditions, which can help us be more inclusive and celebratory of all people, rather than critical.
Bonnie: Emphasising the importance of an intersectional approach and stressing that LGBTQIA+ people don’t live in a vacuum. People in my country often don’t know how to support LGBTQIA+ people. We should empower and educate people about mental health difficulties that affect the LGBTQIA+ community. We are already doing this, but we should accelerate the rate at which we are doing this in order to keep sensitising the population to the needs and rights of LGBTQIA+ people.
Religion plays a factor – LGBTQIA+ people still belong to a social and religious system, so it’s important to integrate these things, as stigma can come from religion and the church as well.
Raj: Before we talk about improving access, we need to talk about a real historical legacy of violence and oppression from the institution of mental health. The way to go against this is to bring knowledge from the margins into the conversation on mental health. Mental health advocates need to ally with LGBTQIA+ community in other ways as well.
Michael: Your historical point is hugely important. Diagnoses and conversion therapy arose from mental health professionals. But they were a product of their time, where mental health professionals could not see past their societal prejudice. Even today, LGBTQIA+ issues are not well-integrated into mental health professional development. Are there any books you would recommend?
Raj: Our faculty have published a few manuals. There are also a few academics in the UK.
Framing Queer Mental Health: from deviant subjects to knowledge producers
Gay-Affirmative Counselling Practice Resource and Training Manual
Adrian: I’m reading a book now that gives a good grounding, called How to Become a Mental Health Leader Within the Workplace by James Fairview.
Michael: I will now go to each of you for your closing remarks.
Bonnie: The key is to design programmes that are tailor-made for the needs of LGBTQIA+ people. In the past, it’s been on biomedical needs (e.g. HIV testing) but mental health and psychosocial wellbeing has been neglected. It’s high time for the world to rise up and ensure mental care of LGBTQIA+ people is promoted and protected.
Adrian: Intersectionality is key in this space. There are a tonne of perspectives to take on board. Being inclusive, authentic and holistic is key.
Raj: I’ll also swivel back to the intersectionality point; it is very important to look at the expert knowledge, and critique it. We must critique the Western approach, we need to have more diverse voices from different contexts and we need to decolonise mental health and queer mental health.
Michael: Absolutely, I think one of the themes from today is to get away from the European and North American perspective and hear about what is going on in other contexts. Thank you to Adrian, Bonnie and Raj for your wonderful contributions.
