This article reflects on the closure of specialist community-based LGBTQ mental health support from the perspective of people who have used or work in such services. The authors discuss the need for community-based specialist support for LGBTQ people who experience mental health problems or work in mental health services

Carr, S.

Edwards-White, T.

Taylor-King, S.

English

Middlesex University Research Repository

	1		AUTHOR	ACCEPTED	MANUSCRIPT		Asylum	Magazine,	Autumn	2016,	Vol.	23	No.	2	pp.10-12		Unkindest	cuts:	Reflections	on	destruction	and	resilience	in	LGBTQ	community-based	mental	health	support			Stephanie	Taylor-King,	National	Survivor	User	Network	(NSUN)	Sarah	Carr,	Middlesex	University	London		Taz	Edwards-White,	METRO	Centre,	London		On	January	29th	2016,	the	community-led	mental	health	charity	PACE	(Project	for	Advocacy,	Counselling	and	Education)	closed	its	doors	after	over	30	years	serving	London’s	LGBTQ	(lesbian,	gay,	bisexual,	trans*	and	queer)	communities.			The	authors,	Stephanie	and	Sarah	reflect	on	the	closure	from	the	perspective	of	people	who	used	PACE’s	mental	health	services,	and	Taz,	from	the	perspective	of	someone	who	provides	mental	health	support	to	LGBTQ	people	at	a	specialist	community-based	charity.		Stephanie:	From	a	self-destructive	lost	soul	into	a	good	advocate		Austerity	isn't	kind	to	minority	groups.	Things	are	so	bad	that	the	UN’s	Committee	on	the	Rights	of	Persons	with	Disabilities	is	looking	into	'human	rights	abuses	caused	by	Tory	Government	welfare	reforms'i.		Practically	every	week,	disability	and	other	minority	groups	express	their	suffering	and	frustration	on	social	media	and	public	demonstrations	because	official	media	remains	frighteningly	silent.			I	am	a	member	of	the	suffering,	frustrated	minorities.	I	say	minorities	because	I	belong	to	at	least	two:	those	branded	with	a	mental	health	diagnosis	and	the	LGBTQ	community.	Being	at	the	receiving	end	of	austerity	measures	doesn't	surprise	me.	When	the	Coalition	government	got	elected,	I	knew	we	'mad	queers'	were	in	for	hard	times.	But	I	wasn't	expecting	a	long	serving	organisation	like	PACE	to	be	forced	to	cease	operations	after	31	years	of	providing	amazing	support	to	people	like	me.			Ironically,	PACE	closed	their	doors	just	after	publishing	research	highlighting	the	continued	need	for	their	services.	The	‘RaRE	Report’,	published	at	the	end	of	2015,	clearly	states	that	'negative	reactions	from	professionals	can	limit	lesbian	and	bisexual	women’s	engagement	with	treatment	and	support,	causing	them	to	disengage	with	treatment	altogether'.	It	also	says	that	'that	discrimination	perceived	by	LGB	people	may	partially	explain	their	greater	psychiatric	morbidity	risk'.	ii		PACE	was	one	of	the	few	places	for	LGBTQ	Londoners	of	all	ages	struggling	with	their	mental	health.	The	demise	of	this	apparently	resilient	organisation,	which	managed	to	survive	the	Thatcher	era,	may	seem	surprising	for	those	who	are	not	part	of	an	LGBTQ	community.	Sadly,	PACE	is	only	one	of	many	organisations	that	are	either	being	destroyed	or	forced	to	severely	cut	back.	Journalist	Patrick	Strudwick	has	observed	that	'beneath	the	confetti	of	same-sex	marriage,	as	the	government	basks	in	its	headline-grabbing	policy	completing	legal	parity	for	lesbian,	gay,	bisexual	and	transgender	people,	comes	the	cold	reality	of	how	the	coalition's	cuts	are	disproportionately	affecting	this	community'iii.				2		Local	LGBTQ	support	charities	such	as	Mosaic	Youth	in	Camden,	London	are	seriously	threatened	with	closure	and	Broken	Rainbow,	the	UK’s	only	LGBTQ	domestic	violence	charity,	finally	ceased	operations	on	2nd	June	2016.	iv			Back	in	2006,	I	was	recovering	from	a	suicide	attempt	resulting	from	a	brutal,	and	very	poorly	handled,	redundancy.	I	turned	to	PACE,	where	staff,	offering	the	unique	support	atmosphere	that	can	only	be	found	in	LGBTQ	run	services,	managed	to	rebuild	my	self	confidence.	I	enrolled	on	their	excellent	mental	health	advocacy	training	and	was	transformed	from	a	self-destructive	lost	soul	into	a	good	advocate.	It	is	thanks	to	PACE	that	not	only	did	I	manage	to	rebuild	my	sanity	but	also	found	a	new	career	in	the	mental	health	sector.	Without	PACE	I	would	not	be	making	the	contributions	I	do	to	the	service	user	and	survivor	movement.	Without	PACE	I	would	possibly	not	even	be	alive.		As	I	take	this	trip	down	memory	lane,	I	am	reminded	that	I	find	myself	in	a	precarious	situation	again:	my	job	at	NSUN	is	shrinking	because	of	reduced	funding	and	increased	competition	caused	by	austerity,	and	I	am	on	the	brink	of	needing	support	again.	But	PACE	is	not	there	to	provide	it.	Minority	groups	are	being	relentlessly	bashed	by	austerity	measures	and	with	safe,	specialist	services	like	PACE	disappearing,	the	LGBTQ	community	is	losing	the	vital	safety	net	we’ve	woven	for	ourselves	over	the	years.		Taz:	A	safe	place	to	be	ourselves		The	government	cuts	and	welfare	reforms	are	having	a	direct	detrimental	impact	amongst	those	who	are	in	situations	that	make	them	vulnerable.		In	health	and	social	care,	the	term	‘vulnerable	adult’	was	used	for	someone	in	need	of	care	services	due	to	disability,	age	or	illness.	We	all	experience	varying	mental	and	physical	health.	We	also	have	various	social	and	biological	identities.	But	some	of	these	identities	are	extremely	stigmatised	by	our	society,	with	the	risk	of	people	being	treated	less	favorably	or	with	shame	associated	with	a	particular	characteristic.	These	things	can	result	in	making	people	vulnerable.		Identifying	as	LGBTQ,	non-heterosexual	or	expressing	ourselves	outside	of	societal	gender	norms	can	create	vulnerability	when	accessing	statutory	mental	health	services.	One	can	fear	and	experience	homophobic,	biphobic	and	transphobic	staff	attitudes	as	well	as	left	to	feel	excluded	when	heterosexist	language	is	used	or	assumptions	made.			Working	as	a	mental	health	nurse	on	the	wards	I	experienced	daily	homophobia,	with	others	telling	me	that	I	was	sinning	or	going	to	hell,	or	always	assuming	I	had	a	boyfriend.	These	attitudes	didn’t	come	from	the	service	users,	but	from	my	colleagues.	I	thought	if	this	is	how	mental	health	professionals	were	treating	one	another,	then	what	impact	were	these	attitudes	having	on	service	users?	The	Stonewall	‘Unhealthy	Attitudes’	survey	found	that	'one	in	ten	[of	3000	people	surveyed]	have	witnessed	staff	within	their	workplace	expressing	the	belief	that	someone	can	be	'cured'	of	being	lesbian,	gay	or	bisexual'v.		My	own	experience	of	discrimination	as	mental	health	service	staff	led	me	to	find	METRO,	a	health	and	wellbeing	charity	specialising	in	diversity	and	difference.	I	started	volunteering	just	to	be	in	a	space	where	I	didn’t	need	to	monitor	what	I	said	–	a	place	where	I	could	be	myself.	Eventually,	I	started	working	at	METRO,	running	the	mental	health	and	wellbeing	service	which	provides	a	weekly	social	based	peer	supportive	drop-in.	I	created	a	one-to-one	crisis	support	service	and	an	advocacy	service	for	those	who	identify	as	LGBTQ	and	who	feel		3		they	are	experiencing	mental	health	issues.		From	my	own	experience	of	working	in	mainstream	mental	health	services,	if	you	have	a	stigmatised	identity	and	don't	feel	comfortable	to	share	that	in	your	surroundings,	then	for	protection	it’s	easier	to	try	to	conceal	it.	If	you	feel	threatened	by	your	environment	you	will	conceal	a	part	of	yourself	to	protect	yourself	from	danger.	This	concealment	is	a	cognitive	burden	and	the	effects	of	the	constant	discrimination	and	stigma	can	be	the	direct	cause	of	mental	health	issues.	The	more	stigmatised	identities	you	have	for	example	being	'a	black,	gay	disabled	woman'	the	more	of	a	heightened	risk	of	illness	due	to	experience	or	fear	discrimination.			Sadly,	in	mainstream	mental	health	services	both	LGBTQ	service	users	and	staff	are	often	forced	into	concealment	and	experience	considerable	psychological	stress	as	a	result.	This	is	why	mental	health	support	provided	by	community-sector	charities	like	METRO	and	PACE	are	vital	in	providing	a	safe,	supportive	space	where	LGBTQ	service	users	and	staff	can	be	themselves,	reducing	social	isolation,	building	a	strong	sense	of	community	solidarity	and	cohesiveness.	The	LGBTQ	mental	health	and	wellbeing	drop-in	group	helps	people	to	feel	safe	and	safety	in	accessing	LGBTQ	counselling	services,	crisis	one	to	one	support	and	advocacy.			The	cuts	are	affecting	local	voluntary	and	community	sector	mental	health	support	across	the	UK.	Services	are	being	pushed	to	provide	'courses	to	wellness	and	recovery'	and	to	see	more	people	than	ever	before.	Harsh	competition	with	large	providers	is	squeezing	out	brilliant	community-led	services	that	have	been	providing	mental	health	support	and	crisis	prevention	for	those	who	were	discharged	from	their	CMHTs	for	being	either	'too	well',	'not	ill	enough',	'not	treatable'	or	'too	difficult	to	engage	with'.		Social	connectedness	and	peer	support	is	vital	for	mental	wellbeing.	Specialist	services	for	specific	groups	need	to	remain	open.	Local	specialist	community-led	services	need	all	the	support	possible	right	now	before	vast	numbers	of	our	people	whose	identities	and	status	can	make	them	vulnerable	fall	through	the	net	like	never	before.			Sarah:	The	evidence	is	clear,	including	our	own	experiential	evidence		When	I	was	19,	suicidal	and	self-harming,	I	sought	the	help	of	a	therapist.	But	instead	of	supporting	me	through	my	mental	health	crisis,	he	tried	to	change	my	sexual	orientation.	Unsurprisingly,	as	a	result	I	became	very	wary	of	therapists	and	afraid	of	what	could	happen	in	the	isolation	of	the	therapy	room.	Ten	years	later	I	found	myself	in	a	similar	mental	and	emotional	crisis.	I	knew	I	needed	to	talk	and	to	be	supported	to	understand	myself	and	why	I	got	into	such	terrible	states,	but	going	to	a	therapist	again	seemed	almost	too	risky.			However	PACE	enabled	me	find	a	lesbian	therapist	who	helped	and	affirmed	me.	Never	once	did	I	fear	being	pathologised	for	my	sexual	orientation	or	stigmatized	for	my	distress.	By	holding	a	list	of	therapists	approved	as	safe	and	supportive	for	LGBTQ	people,	PACE	eliminated	the	risk	and	vulnerability	I	felt	in	trying	to	find	help.	Later,	I	volunteered	for	PACE	as	a	Trustee	and	advised	on	research	projects.	It	was	the	least	I	could	do	after	they	kept	me	safe	from	potential	harm.	Their	approach	to	mental	and	emotional	support	was	entirely	responsive	to	the	strengths,	needs,	diversities	and	complexities	of	LGBTQ	communities	and	families.				4		It	is	well	documented	that	LGBTQ	people	are	at	higher	risk	of	developing	mental	health	problems	and	have	a	greater	risk	of	suicide	and	self-harm,	and	evidence	shows	the	impact	of	discrimination	on	LGB&T	mental	health,	including	within	mental	health	services.	vi	vii		LGBTQ	young	people	have	an	increased	risk	of	discrimination	that	impacts	on	their	life	chances	and	are	at	higher	risk	of	becoming	homeless	or	experiencing	mental	health	problems	most	frequently	owing	to	familial	rejection	or	abuseviii.	Older	LGBTQ	people’s	mental	health-related	quality	of	life	is	positively	affected	by	having	a	positive	sexual	identity,	but	negatively	affected	by	lifetime	victimisation	and	discriminationix.			It	is	estimated	that	nearly	half	a	million	LGBTQ	people	from	black	and	minority	ethnic	(BME)	communities	in	the	UK	whose	multiple	identities	and	needs	are	not	recognised	by	public	services	that	adopt	a	‘one	minority	at	a	time’	tick	box	approachx	Intersectional	discrimination	has	been	identified	as	a	key	concern	for	LGBTQ	people	from	faith	or	refugee	communities	or	those	who	identity	as	BME,	including	within	mental	health	services	xi	xii.			LGBTQ	communities	have	created	community-based	mental	health	projects	that	are	trusted,	supportive	and	safe,	drawing	on	peer	support,	community	networks	and	specialist	knowledge	of	the	complexities	involved	in	LGBTQ	mental	healthxiii.	Access	to	peer	support	has	been	identified	as	particularly	important	for	LGBTQ	people	from	BME	communitiesxiv		In	response	to	unsafe	and	inaccessible	mainstream	mental	health	services,	we	have	pulled	our	socks	up,	got	on	our	bikes	and	taken	care	of	ourselves	and	each	other.	Surely	the	Tories	should	approve	of	and	invest	in	our	endeavours?!		The	evidence	is	clear,	including	our	own	experiential	evidence,	that	LGBTQ	mental	health	outcomes	can	be	improved	and	lives	saved	by	community-based	support	services	like	PACE,	Mosaic,	Broken	Rainbow	and	METRO.	However,	such	evidence	is	being	ignored	when	it	comes	to	making	counterproductive	decisions	about	where	and	who	to	cut	during	ideological	and	increasingly	brutal	austerity.	Cutting	such	support	will	inevitably	lead	to	cutting	short	the	lives	of	many	LGBTQ	people	who	experience	mental	and	emotional	distress.																																																									i	Taylor-King,	S	(2015)	'Human	rights	Inquiry	could	lead	to	better	times	for	people	with	mental	ill	health',	Mental	Health	Today,	Sept-Oct	2015	(www.mentalhealthtoday.co.uk/network-human-rights-inquiry-could-lead-to-better-times-for-people-with-mental-ill-health.aspx)	ii	Nodin,	N.	et	al	(2015)	The	RaRE	Research	Report:	LGB&T	Mental	Health	–	Risk	and	Resilience	Explored.	Project	Report.	PACE	(Project	for	Advocacy	Counselling	and	Education),	London	(www.queerfutures.co.uk/wp-content/uploads/2015/04/RARE_Research_Report_PACE_2015.pdf)	iii	‘Lesbian	and	gay	groups	face	funding	crisis’,	The	Guardian,	3	September	2014.	(www.theguardian.com/society/2014/sep/03/lesbian-gay-transgender-community-groups-funding-crisis-cuts)	iv	‘Services	for	LGBT	young	people	will	just	disappear’,	The	Guardian,	2	February	2016	(www.theguardian.com/society/2016/feb/02/services-for-lgbt-young-people-will-just-disappear)	v		Somerville,	C	(2015)	Unhealthy	Attitudes:	The	treatment	of	LGBT	people	within	health	and	social	care	services	London:	Stonewall	(www.stonewall.org.uk/sites/default/files/unhealthy_attitudes.pdf)	vi	King,	M.	et	al.	(2008)	A	systematic	review	of	mental	disorder,	suicide,	and	deliberate	self-harm	in	lesbian,	gay	and	bisexual	people.	BMC	Psychiatry,	18,	8:70.	(http://bmcpsychiatry.biomedcentral.com/articles/10.1186/1471-244X-8-70)	vii	Chakraborty,	A.	et	al	(2011)	Mental	health	of	the	non-heterosexual	population	of	England.	British	Journal	of	Psychiatry,	198,	pp.	143-48.	(http://bjp.rcpsych.org/content/198/2/143)	viii	Albert	Kennedy	Trust	(2015)	LGBT	Youth	Homelessness:	A	UK	national	scope	of	cause,	prevalence,	response	and	outcome	Manchester:	Albert	Kennedy	Trust	(www.akt.org.uk/webtop/modules/_repository/documents/AlbertKennedy_ResearchReport_FINALInteractive.pdf)		5																																																																																																																																																																ix	Fredriksen-Goldsen,	K.	et	al	(2014).	Successful	Aging	Among	LGBT	Older	Adults:	Physical	and	Mental	Health-Related	Quality	of	Life	by	Age	Group.	The	Gerontologist,	55(1),	154–168	(http://gerontologist.oxfordjournals.org/content/55/1/154.short)	x	Guasp,	A	&	Kibiridge,	H	(2012)	One	minority	at	a	time:	Being	black	and	gay	London:	Stonewall	(www.stonewall.org.uk/sites/default/files/One_Minority_At_A_Time__2012_.pdf)	xi	Albert	Kennedy	Trust	(2015)	LGBT	Youth	Homelessness:	A	UK	national	scope	of	cause,	prevalence,	response	and	outcome	Manchester:	Albert	Kennedy	Trust	(www.akt.org.uk/webtop/modules/_repository/documents/AlbertKennedy_ResearchReport_FINALInteractive.pdf)	xii	Carr,	S	(2010)	Seldom	heard	or	frequently	ignored?	Lesbian,	gay	and	bisexual	(LGB)	perspectives	on	mental	health	services	Ethnicity	and	Inequalities	in	Health	and	Social	Care	3(3),	14	-	23	(www.emeraldinsight.com/doi/abs/10.5042/eihsc.2010.0506)	xiii	Carr,	S	(2014)	HSMC	Policy	Paper	18:	Social	care	for	marginalised	communities:	balancing	self-organisation,	micro-provision	and	mainstream	support	Birmingham:	University	of	Birmingham	(www.birmingham.ac.uk/Documents/college-social-sciences/social-policy/HSMC/publications/PolicyPapers/policy-paper-18-sarah-carr.pdf)	xiv	Guasp,	A	&	Kibiridge,	H	(2012)	One	minority	at	a	time:	Being	black	and	gay	London:	Stonewall	(www.stonewall.org.uk/sites/default/files/One_Minority_At_A_Time__2012_.pdf)	

Unkindest cuts: reflections on destruction and resilience in LGBTQ community-based mental health support

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Unkindest cuts: reflections on destruction and resilience in LGBTQ community-based mental health support

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