LGBTIQA+ Mental Health & Wellbeing
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HOW TO USE THIS REPORT
Final Report 2024: Key Findings and Principles
Acknowledgement of Country
Drummond Street respectfully acknowledges the Kulin Nation as Traditional Owners of the lands where we deliver our services. We acknowledge Aboriginal and Torres Strait Islanders as the first people of Australia. Sovereignty was never ceded, and they remain strong in their connection to land, culture and in resisting colonisation.
Acknowledgement of contribution
The authors of this report respectfully thank and acknowledge the invaluable contributions of LGBTIQA+ Australians who participated in this research. We, as members of the LGBTIQA+ community, hope that you find the language used and findings discussed, reflect LGBTIQA+ lived experiences. Through conscientious research and careful analysis, we hope to shed light on the challenges and discrimination that many LGBTIQA+ individuals still face, as well as the strides that have been made towards more inclusive support services.
INTRODUCTION
An introduction to the LGBTIQA+ Mental Health & Wellbeing Project
INTRODUCTION
LGBTIQA+ Mental Health & Wellbeing Project
The LGBTIQA+ Mental Health and Wellbeing Project, undertaken by Drummond Street Services' Centre for Family Research & Evaluation, sought to understand:
- The diverse mental health needs, experiences and challenges of LGBTIQA+ people.
- The ways LGBTIQA+ access (or do not access) services.
- The specific experiences of LGBTIQA+ sub-cohorts.
- The ways services and service systems can improve to better respond to LGBTIQA+ mental health and wellbeing needs.
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TABLE OF CONTENTS
Click on the items below to jump to a section or click the button to read through the interactive report.
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Introduction
Needs and Risk
Principles and Considerations
Acute Risk
Overview of research methods
Conclusion
Needs and risks across sub-cohorts
Prevalence and Impact of Discrimination
OVERVIEW OF RESEARCH METHODS
What data we gathered and how we gathered it.
OVERVIEW OF RESEARCH METHODS
A rapid review of the literature to illustrate how we know what we know so far about LGBTIQA+ mental health and wellbeing.
Drummond Street Services' 2023 LGBTIQA+ Health and Wellbeing Survey to understand our communities' mental health and wellbeing needs.
A client file analysis of Drummond Street Services' client record management system to explore the service experiences of our LGBTIQA+ communities.
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RESEARCH QUESTIONS
ETHICS
Demographics
The similarities and differences across the survey and client file samples.
AGE DEMOGRAPHICS
GENDER DEMOGRAPHICS
About the survey sample
About the client file sample
MORE DEMOGRAPHICS
SEXUALITY DEMOGRAPHICS
PREVALENCE AND IMPACT OF DISCRIMINATION
Key finding one
PREVALENCE OF DISCRIMINATION
This section is based on findings from the survey. LGBTIQA+ survey respondents were asked about their experiences of different forms of discrimination within different settings over the past five years.
TYPES OF DISCRIMINATION
SETTINGS
PREVALENCE OF DISCRIMINATION
This section presents the findings of the prevalence of specific types of discrimination within settings experienced by LGBTIQA+ people who answered these survey questions.
HOMOPHOBIA & BIPHOBIA
SEXISM
TRANSPHOBIA
OTHER DISCRIMINATION
RACISM
ABLEISM
IMPACT OF DISCRIMINATION
This section presents survey findings about the impact of discrimination on mental health and wellbeing, loneliness and financial stress among LGBTIQA+ people.
Lower wellbeing scores were associated with a greater number of discrimination types experienced (e.g., transphobia + sexism + ableism...) and a greater number of settings where discrimination was experienced (e.g., workplace + family + public...). This indicated that the more types of discrimination experienced across more settings, the lower mental health and wellbeing scores would be among LGBTIQA+ survey respondents. This demonstrates the compounding and pervasive nature of discrimination in relation to mental health and wellbeing among the surveyed cohort.
LONELINESS
FINANCIAL STRESS
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CUMULATIVE DISCRIMINATION
Individuals experienced multiple types of discrimination:
- 75% (n = 649) of the total sample had experienced more than one type of discrimination
- 37% of individuals (n = 314) had experienced four or more types of discrimination.
Cumulative discrimination (LGBT Discrimination Plus) was common and was associated with:
- poorer mental health and wellbeing
- increased loneliness, and
- greater financial stress.
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NEEDS AND RISK
Key finding two
NEEDS AND RISK
The survey results demonstrate how mental health and wellbeing need overlapped with loneliness and financial stress.
Mental Health and Wellbeing
LONELINESS
A total of 859 participants completed questions about their mental health and wellbeing and 58% (n = 542) had wellbeing scores below the general population indicating poorer mental health and wellbeing.
FINANCIAL STRESS
NEEDS AND RISK
Client file analysis demonstrated the complexity of needs and risk among LGBTIQA+ clients, including the interconnected nature of presenting needs, and co-occuring risks.
Presenting needs
Risk throughout service engagement
The most common presenting needs among LGBTIQA+ clients were:
Client files indicated changes in risk factors that were present throughout service engagement. Risk factors that depicted the greatest change from early engagement to case closure were:
DISCRIMINATION AND SOCIAL ISOLATION
- Mental health (84%, n = 251)
- Stress (63%, n = 189)
- Anxiety (60%, n = 181)
- Wellbeing and self-care (57%, n = 172)
- Trauma (50%, n = 151)
- Depression (47%, n = 142)
- Family relationship issues (35%, n = 106)
- A recent stressful event
- Emotional, behavioural, or mental health symptoms
- Frequent conflict and/or family violence
DISCRIMINATION AND FINANCIAL INSECURITY
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ACUTE RISK
Client files indicated prevalent risk alerts among LGBTIQA+ clients, as well as complexity of acute risk and co-occuring risks.
Complexity of acute risk
Prevalence of risk alerts
Among the clients that had a risk alert attached to their file (n=128), over a third (35%, n=45) had two or more risk alerts. To consider complexity, individual risk alerts were summed.
A total of 128 clients had a risk alert attached to their file. Among these client files, suicide risk emerged as one of the most common (41%, n = 53), alongside family violence risk (41%, n = 52) followed by mental illness (36%, n = 46). Click the image below to see it full screen.
Click the graph to see it full screen.
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ACUTE RISK
Client files indicated that the most common risk alerts were suicide risk, mental illness and family violence risk among LGBTIQA+ clients.
Most common risk alerts
SUICIDE RISK
Of the total sample of client files:
- 18% (n=53) of client files had a suicide risk alert.
- 15% (n=46) of client files had a mental illness risk alert.
- 17% (n=52) of client files had a family violence risk alert.
The most common co-occuring risk alerts were:
MENTAL ILLNESS RISK
- 16% (n=20) of client files had co-occurring mental illness and suicide risk alerts.
- 14% (n=18) of client files had co-occurring suicide and family violence risk alerts.
- 9% (n=12) of client files had co-occurring suicide and self-harm risk alerts.
FAMILY VIOLENCE RISK
CO-OCCURRING RISK ALERTS
NEEDS AND RISKS ACROSS SUB-COHORTS
Key finding two
NEEDS AND RISKS ACROSS SUB-COHORTS
There were three prominent sub-cohorts derived from the client file sample, that were selected to form case studies. These case studies demonstrate similarities and differences across sub-cohorts in presenting needs as well as risks during service engagement.
Cohort Case Studies
There was overlap across sub-cohorts in terms of identities and experiences however, each group was separated based on a different aspect of their identity, and this produced understanding of the different needs and risks. Click the icon to go to each sub-cohort case study.
PRESENTING NEEDS
Sub-cohort 1: Aged 18 - 25 years and trans, non-binary, genderqueer, or questioning (n=33)
RISK ALERTS
Sub-cohort 2: Aged 18 - 57 years and from multicultural backgrounds (n=35)
Sub-cohort 3: Aged 30 - 57 years and living with disability (n=42)
SUB-COHORT 1 CASE STUDY
client profile
Aged 18 to 25 years
Presenting needs, and risk throughout service engagement
Young trans, non-binary, genderqueer and/or questioning
REFERRAL
INTAKE
WAITLIST
CASE CLOSURE
TIME IN CARE
SUB-COHORT 2 CASE STUDY
client profile
Aged 18 to 57 years
Presenting needs, and risk throughout service engagement
Clients with multicultural backgrounds
REFERRAL
INTAKE
WAITLIST
CASE CLOSURE
TIME IN CARE
SUB-COHORT 3 CASE STUDY
client profile
Aged 30 to 57 years
Presenting needs, and risk throughout service engagement
Clients living with disability
REFERRAL
INTAKE
WAITLIST
CASE CLOSURE
TIME IN CARE
PRINCIPLES FOR EFFECTIVE SERVICE RESPONSES
Five core principles aligned with the Royal Commission into the Victorian Mental Health System
PRINCIPLES FOR EFFECTIVE SERVICE RESPONSES
This section integrates the key findings from this report into Five Core Principles to support the mental health and wellbeing of LGBTIQA+ Victorians. The principles are aligned with the Royal Commission’s findings and recommendations. They bolster and extend these recommendations where possible by providing further considerations for services and government.
Five Core Principles
Establishing Safety
Intersectional Practice
Click each principle on the diagram for more information including how the principle links to the Royal Commission recommendations and considerations for services government.
Coordinated, integrated and holistic services
Advocacy at all levels
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Flexibility in responding to client need
1. ESTABLISH SAFETY
Establishing safety is a foundational need to be prioritised in service provision. It forms a key part of any trauma-informed and person-centred approach. Physical and emotional safety are the foundation upon which trust can be built within therapeutic relationships. Part of establishing safety is recognising that people’s interactions with services are impacted significantly by experiences of discrimination.
WHAT SURVEY RESPONDENTS SAID
LEARNINGS FROM DS SERVICE RESPONSE
LINK TO RECOMMENDATIONS
CONSIDERATIONS
2. INTERSECTIONAL PRACTICE
Intersectional practice involves understanding that individuals exist with multiple aspects of identity and experiences that cannot be separated into cohorts. This includes affirmation of all parts of a person’s identity and being educated about the impacts of intersecting and compounding forms of discrimination on mental health and wellbeing. A holistic approach is required at multiple levels to create a top-down authorising environment within services, as well as bottom-up action from workers, clients, and the community.
WHAT SURVEY RESPONDENTS SAID
LEARNINGS FROM DS SERVICE RESPONSE
LINK TO RECOMMENDATIONS
CONSIDERATIONS
3. ADVOCACY AT ALL LEVELS
Advocacy involves an understanding of inequities and gaps in services, especially for LGBTIQA+ people who experience cumulative and intersecting forms of discrimination. It requires the skills to challenge and dismantle systemic barriers to advocate for clients, as well as enable clients to advocate for themselves. Advocacy strives to reshape the landscape of services, making them more inclusive, affirming, and equitable.
WHAT SURVEY RESPONDENTS SAID
LEARNINGS FROM DS SERVICE RESPONSE
LINK TO RECOMMENDATIONS
CONSIDERATIONS
4. FLEXIBILITY IN RESPONDING TO CLIENT NEED
Flexible service provision incorporates intersectional practice whilst being responsive to the needs of LGBTIQA+ people. It involves being responsive to client need and taking a human-rights and person-centred approach to support all factors contributing to health and wellbeing, such as material wellbeing and community connection.
WHAT SURVEY RESPONDENTS SAID
LINK TO RECOMMENDATIONS
LEARNINGS FROM DS SERVICE RESPONSE
CONSIDERATIONS
5. COORDINATED & INTEGRATED SERVICES
Coordinated and integrated service responses are inherently holistic. This includes within a service and across services and service systems. The integration of wrap-around supports across services is an essential element of working in coordinated ways across service systems. A holistic lens enhances coordination and integration especially if all services utilise this approach when responding to need and risk.
WHAT SURVEY RESPONDENTS SAID
LEARNINGS FROM DS SERVICE RESPONSE
LINK TO RECOMMENDATIONS
CONSIDERATIONS
Conclusion
Overall, the findings from the LGBTIQA+ Mental Health and Wellbeing Project shed a glaring light on the pervasiveness of experiences of discrimination among LGBTIQA+ communities across multiple aspects of their lives, that are associated with lower mental health and wellbeing, including financial wellbeing and social connectedness. Also, the complex and co-occurring nature of needs and risks were further compounded by experiences of discrimination, especially for marginalised sub-cohorts of LGBTIQA+ communities. These findings call for preventative efforts to address broader societal discrimination, in all its forms (e.g., homophobia, biphobia, transphobia, racism, sexism, and ableism). They also call for a reframing and shifting of the burden of alleviating ‘minority stress’ from the LGBTIQA+ individual onto society, structures and systems. LGBTIQA+ communities and other diverse communities are resilient, and their identity does not have to mean that they face exclusion and discrimination. Instead, their identity can and should be a source of celebration and connection. In the face of systemic challenges, it is crucial to consider broader system changes that are required to support effective service responses. Considerations for services and government should work in tandem to create the enabling conditions for substantive and sustainable change which works toward more impactful support for LGBTQIA+ communities’ mental health and wellbeing.
Financial Stress
Around 1 in 3 LGBTIQA+ individuals were experiencing moderate to severe financial stress, indicating that they were feeling a high level of stress at meeting basic expenses. Higher financial stress was associated with lower wellbeing and higher loneliness scores. Trans and gender diverse individuals experienced significantly increased financial stress compared to cisgender survey respondents. This related to almost all areas of finance (aside from loan repayments) and most related to having greater stress in healthcare related expenses. LGBTIQA+ individuals with disabilities also experienced greater financial stress in all areas, compared to individuals without a disability. This was strongest in relation to healthcare expenses and in paying for a $1,000 emergency.
Co-occurring Risk Alerts
This table demonstrates where risk alerts overlap or co-occur among client files. Risk alerts are presented in the first row and column of the table, and the number of times that they co-occurred is demonstrated by the numbers in the matrix. The numbers represent how many client files indicated the co-occurrence of two risk alerts.
Notable co-occurring risk alerts among client files included:
- 16% (n=20) of client files with co-occurring mental illness and suicide risk alerts.
- 14% (n=18) of client files with co-occurring family violence and suicide risk alerts.
Learnings from DS service response:
Client files indicated that DS’ reputation, strong community connections and networks with services and organisations that are safe and inclusive for LGBTIQA+ people facilitated intersectional practice. LGBTIQA+ clients and external agencies that refer clients to DS, trust DS to not only be safe and inclusive as an organisation itself, but also to link clients with other services that are known to be safe and inclusive. Examples of intersectional practice based on client files include:
- Providing identity-affirming counselling.
- Elevating diverse and marginalised voices across all levels of the service.
- Drawing on own cultural, identity, and lived experience knowledges, where safe and appropriate.
- Providing individual mental health and wellbeing support that considered people’s whole self, their context, and relationships, including with other people, communities, organisations, and systems.
Learnings from DS service response:
Client files described several examples of coordinated and integrated service responses for LGBTIQA+ clients including:
- Case conferences with external services connected with the client to coordinate care provided across the service system.
- Warmly referring clients to services.
- Supporting clients to attend services including medical, clinical, legal and police.
- Organising sessions with external service providers or professionals to support clients to connect with the service.
- Safety planning for family violence or suicidality that considered co-occurring risks. For example, family violence safety planning that did not undermine suicidality risk and instead incorporated considerations for both.
Mental Wellbeing and Discrimination
The ReQoL-10 was used to measure mental health and wellbeing. Scores range from 0 to 40, where lower scores indicate poorer mental health and wellbeing. A score of 25 or above is considered to fall within the general population.
Transphobia across settings
In the past five years, 88% of trans and gender diverse (TGD) respondents (n = 334) had experienced transphobia, most commonly within family (65%), at work (56%), in public (53%) or in healthcare (53%).
Sexism across settings
In the past five years, 62% of women and non-binary respondents (n = 678) had experienced sexism, and around 1 in 3 women experienced sexism in the workplace and/or in a public space.
Suicide Risk
Suicide risk alerts were applied when case notes specified that a client either made a suicide attempt or expressed serious intent and/or means to do so. Among client files with a suicide risk alert (n=53), clients also had up to six risk factors present:
- 89% (n=47) had two or more risk factors
- 66% (n=35) had three or more risk factors
- 34% (n=19) had four or more risk factors
- 25% (n=13) had five or more risk factors
Among clients with a suicide risk alert (n=53), 47% were experiencing frequent conflict and/or family violence, 40% were experiencing social isolation, 32% reported financial insecurity, and 19% were experiencing homelessness or were at-risk of homelessness. Almost half (47%, n=25) reported their main source of income was from the 'government'. Of the clients with suicide risk alerts who also reported their employment status (n=30), 50% (n=15) were unemployed. Socio-economic status seemingly had an influence on acute suicide risk among the client file sample.
Rapid Review
A review of the literature indicated the strengths and gaps in the available evidence about mental health and wellbeing among LGBTIQA+ communities. The findings covered:
- Current extent of population-based surveys and their data on LGBTIQA+ mental health and wellbeing.
- The prominence of minority stress theory in understanding LGBTIQA+ mental health and wellbeing.
- Gaps in population data regarding specific cohorts such as trans and gender diverse people, people with intersex variation(s) and people with intersectional identities.
- Prominent issues impacting LGBTIQA+ mental health and wellbeing (e.g., COVID-19, intimate partner and family violence, discrimination and marginalisation).
- Health and support service access and engagement.
The findings from the review provided context and guidance for the subsequent research components.
Flexibility in responding to client need
The need for flexible service responses to multiple, interconnected needs were emphasised in the findings from this report and build on recommendations from the Royal Commission. In particular, Recommendation 3 which outlines key reform areas to create a more responsive and integrated mental health and wellbeing system.
While reforms outlined in Recommendation 3 lay the groundwork for an enhanced service system and improved service access across the state, as highlighted by the client file audit, Government should consider the need for flexibility and responsiveness within services, including considering a hierarchy of needs.
What survey respondents said:
While the survey highlighted that LGBTIQA+ people had high levels of help-seeking behaviour, LGBTIQA+ survey respondents also identified several barriers that prevented them from accessing services that could be supported by better integration within and across services. Survey respondents described:
- Difficulty accessing services as a neurodivergent person
- Low motivation or self-esteem due to mental health, e.g., ‘feeling burdensome’
- Difficulty finding services to meet their needs
Survey respondents found it helpful when:
- Services were able to help them access the external supports they needed.
Considerations
1. Government should consider the links between stigma, discrimination and poor mental health and wellbeing. It is critical that any work carried out in relation to addressing stigma and discrimination of mental health should also address identity-based discrimination. 2. Government should support building the capabilities of the whole workforce to develop intersectional practice. The workforce capability framework should look beyond multidisciplinary practice to create a mental health system where clinical knowledge can be braided together with cultural knowledge, identity knowledge and lived experience to support a transdisciplinary approach.
3. Government should consider the intersectional and compounding needs of diverse communities across all areas of the mental health reforms. While there is a need for specialist responses, as outlined by recommendations relating to ‘diverse communities’, it is imperative that all services across the mental health system can provide affirming and inclusive support.
What survey respondents said:
LGBTIQA+ survey respondents identified that services were helpful when they fostered safety and provided good support when people felt their identities were affirmed and accepted.
- Respondents described positive experiences within the service system as:
- Creating a sense of safety.
- Accommodating, accepting and respectful of identities.
- Non-judgemental- they did not make assumptions around gender or sexuality.
- Providing trauma-informed and person-centred care.
Respondents also described experiences where they did not feel safe, including:
- Discrimination or fear of discrimination, as well as poor knowledge from service providers about disabilities, gender, sexuality etc. This was mostly observed in medical settings and resulted in individuals avoiding the setting or receiving inadequate care.
Ableism across settings
In the past five years, 71% of those with any disability (n = 514), 81% of those with a physical or sensory disability (n = 218) and 76% of neurodivergent respondents (n = 364) had experienced ableism. Half or more of the individuals with physical or sensory disabilities had experienced ableism at work (55%), in healthcare (54%), in public (53%) or within family (50%).
Settings
The survey also asked respondents to indicate which settings they experienced discrimination which included:
- While using public transport, including taxis, rideshare, trains, buses etc.
- By legal systems or law enforcement, including policing, prisons, courts.
- By government, whether local, state, or federal.
- While seeking social or income services (e.g., NDIS, Centrelink).
- At a public space or event.
- Within another cultural or religious community.
- Within the LGBTIQA+ community/ies.
- While seeking or receiving healthcare.
- While accessing housing or accommodation.
- From your family.
- At school, VET, university, or other education setting.
- At work on in formal volunteering.
Family Violence Risk
Family violence risk alerts were applied when there was current family violence that required risk management and safety planning. Among client files with a family violence risk alert (n=52), clients also had up to six risk factors present:
Family violence risk alerts co-occurred with suicide risk alerts in 14% (n=18) of client files. Risk factors for financial insecurity and substance abuse were notable co-occurrences with family violence acute risk. Homelessness was also the highest (21%) among the sample of clients with family violence risk alerts compared to clients with suicide risk alerts (co-occurring homelessness, 19%) or mental illness risk alerts (co-occurring homelessness, 9%).
- 87% (n=45) had two or more risk factors
- 69% (n=36) had three or more risk factors
- 44% (n=23) had four or more risk factors
- 25% (n=13) had five or more risk factors
Learnings from DS service response
The client file analysis produced findings relating to client safety which illuminated the ways in which people first accessed the service, as well as the types of support they received. Client files indicated that:
- Many clients and external services perceived DS as a safe and inclusive service, and this was one of the reasons for self-referral, or for referring a friend or family member.
- DS’ service response was accepting and accommodating of clients that were questioning and exploring gender and/or sexuality, as well as other dimensions of clients’ identity including disability, faith, and ethnicity.
- DS’ response often involved establishing safety and stability for clients, including meeting immediate and basic needs, and then connecting clients with external and more specific supports.
KEY FINDINGS SUMMARY
- Discrimination was pervasive among LGBTIQA+ survey respondents. Over 60% had experienced a form of discrimination in the past five years either at work, in public or within family. Around half of respondents had experienced discrimination within healthcare settings or the LGBTIQA+ community.
- Cumulative discrimination increased loneliness and financial stress. The more types of discrimination experienced, the higher loneliness scores were among survey respondents. The more types of discrimination experienced, the higher financial stress scores were among survey respondents.
- LGBTIQA+ clients presented with complex and interconnected needs, 87% presented with five or more needs, and 44% presented with nine or more needs.
- Among the clients that had a risk alert attached to their file, over a third (35%) had two or more risk alerts. Co-occurring risk alerts for mental illness and suicide, as well as family violence and suicide were among the most common co-occuring risk alerts.
- There were notable similarities and differences in presenting needs and risks among sub-cohorts of LGBTIQA+ clients specifically young, trans and gender diverse clients, clients with multicultural backgrounds, and clients with disability.
Note: Survey respondents were able to choose more than one sexuality
Discrimination and financial insecurity
Client files described the compounding nature of discrimination on need related to financial insecurity. Some clients experienced discrimination at work that led to reduced shifts or resignation. Clients looking for employment experienced discrimination that prevented them from obtaining work and compounded their financial insecurity. Some clients were asked inappropriate questions during interviews or at work about their gender. Other clients were ineligible for income support due to their visa status which compounded their need related to financial insecurity, housing instability and isolation.
Discrimination and Financial Stress
Financial stress was measured using the Drummond Street Financial Stress Scale. The Drummond Street Financial Stress Scale includes seven items that cover finances across utilities, healthcare, food and household, work or school, housing or household repairs, loans, debts, and payment plans, as well as emergency fund access. Survey respondents could indicate for each item how stressed they feel about being able to pay from ‘No stress at all’ to ‘Overwhelming stress’.
Higher financial stress was associated with a greater number of discrimination types experienced (e.g., transphobia + sexism + ableism...) and a greater number of settings where discrimination was experienced (e.g., workplace + family + public...). Both compounding and pervasive discrimination were associated with higher financial stress in the surveyed cohort.
Note: Survey respondents were able to choose more than one sexuality
Discrimination and Loneliness
Loneliness was measured using the UCLA Loneliness Scale. Scores range from 0-9, and higher scores indicate greater loneliness. Lower scores (0-3) can be interpreted as social connectedness.
Higher loneliness scores were associated with a greater number of discrimination types experienced (e.g., transphobia + sexism + ableism...) and a greater number of settings where discrimination was experienced (e.g., workplace + family + public...). This indicated that the more types of discrimination experienced across more settings, the higher loneliness scores would be among LGBTIQA+ survey respondents.
Mental Illness Risk
Mental illness risk alerts were applied when case notes specified that a client experienced an acute episode of severe mental illness that may have led to psychiatric triage, assessment, and care. Among client files with a mental illness risk alert (n=46), clients also had up to six risk factors present:
Mental illness risk alerts and suicide risk alerts were the most common to co-occur among the client files (16%, n=20). Client files described the impact of discrimination on help-seeking behaviours when clients experienced mental illness. Clients experienced systemic discrimination within acute mental health settings after involuntary admission and during psychiatric triage and assessment. One client file described a client avoiding contacting crisis lines even during a mental health episode because of previous experiences of racism and homophobia from within psychiatric clinical settings.
- 73% (n=33) had two or more risk factors
- 42% (n=19) had three or more risk factors
- 30% (n=14) had four or more risk factors
- 13% (n=6) had five or more risk factors
Learnings from DS service response:
It was clear that flexible service provision took a human rights-based and social justice approach that enabled practitioners to navigate and advocate for clients in the face of structural and systemic barriers. Flexible service provision meant being responsive to needs interconnected with mental health, including material need and community connection. Examples of flexible service provision based on client files include:
- Being responsive to material need, mental health need and need related to community connection.
- Providing outreach services to improve accessibility and reach certain cohorts of clients that may be experiencing higher levels of risk.
- Providing support to the client’s family members.
- Re-opening client files for previous clients if they presented with heightened risk to avoid clients having to retell their stories or face waitlists.
Other Discrimination
Discrimination did not just impact the individual but also other people in their life (e.g., parent, carer or partner and dependants). There were several participants who explained they were close to someone who experienced discrimination that was a barrier to accessing necessary health services or mental health supports. This meant that the person close to the individual experiencing discrimination took on a greater caring role. Survey respondents also described how witnessing or hearing about discrimination against their partner/child/person in care, resulted in their own experience of stress.
Many individuals also described avoiding discrimination by not disclosing parts of themselves (e.g., sexuality, gender, disability) in different settings.
The above diagram is based on qualitative descriptions of survey respondents experiences of discrimination. Additional forms of discrimination that were commonly experienced included classism, ageism, fatphobia and ace-phobia (discrimination against asexual people).
Learnings from DS service response:
Client files demonstrated the importance of purposeful advocacy that was guided by, and responsive to, the needs of clients as they arose. DS’ service responses included advocating for clients in the face of structural and systemic barriers. Examples of purposeful advocacy based on client files included:
- Providing support letters for clients to access services, resources, mitigate financial issues (e.g., debt), access income support, visa applications, legal matters.
- Advocating for more subsidised sessions under a Mental Health Care Plan.
- Advocating for access to Hormone Replacement Therapy or gender-affirming treatment.
- Openly listen to clients to understand their perspective and barriers to service use they may have experienced.
Considerations
9. Government should consider extending funding to specialist LGBTIQA+ services. While the mental health reforms seek to improve the service system and service responses, the Royal Commission and this research highlight high levels of intersectional identity-based discrimination experienced by LGBTIQA+ communities. Reforming the system will take time. In the meantime, it is critical to support, through funding and commissioning processes, specialist LGBTIQA+ services to provide wrap around and coordinated mental health support. This should be considered across metropolitan, regional and rural areas.
10. Government should consider further collaboration and integration of family violence and mental health services and support. This is particularly important for marginalised cohorts, who may experience family violence at higher rates because of their identity. This is particularly important in the design and delivery of suicide prevention and aftercare services, where strong links relating to cooccurring need were emphasised.
About the client file sample
A total of 300 clients who identified as LGBTIQA+ and had completed their service engagement with Drummond Street Services (i.e., the client files were closed and inactive) were included in the analysis. Clients were aged 18-68 years, with the majority under 35 years (60%). Gender identities were grouped into women (46%), men (27%), non-binary or gender queer (20%) and other (7%, mostly comprised of undisclosed). Around half of clients were either multi-gender attracted (25%) or queer identified (23%).
Clients received services at one of seven DS locations within Victoria (Collingwood, Carlton, Coburg, North Melbourne, Wyndham, Geelong, and Epping) with the majority of clients seen at the Carlton site.
2023 Health and Wellbeing Survey
The survey was adapted from previous years for the purposes of this project to develop a better understanding of the mental health and wellbeing needs and service use among LGBTIQA+ individuals and communities. It included questions covering:
- Mental health and wellbeing
- Loneliness
- Financial stress
- Experiences of discrimination, inequality and harm.
- Help-seeking and service use.
- Barriers to service access.
The survey gathered both quantitative and qualitative responses.
Five Core Principles
While this research looked specifically at the needs of LGBTIQA+ communities, the considerations take an intersectional framing to consider the broad and intersectional needs of other marginalised communities and groups. The principles ask us to consider the need to:
- establish safety for marginalised groups
- bolster intersectional practice across the entire mental health service system
- advocate at all levels of our social ecology for the needs of marginalised groups, including across the umbrella of diverse LGBTIQA+ communities
- respond flexibly to diverse and cooccurring client or consumer needs
- provide coordinated, integrated and holistic mental health services
Racism across settings
There were only a small number of individuals who identified as a person of colour and/or culturally and linguistically diverse (POC/CALD) within the sample and who completed questions on discrimination (n = 80). Of these individuals, 59% had experienced racism, most commonly in public spaces (37%) and at work (32%). Due to the small sample of culturally and linguistically diverse and people of colour, these findings are not generalisable to broader experiences of racism.
Considerations
6. LGBTIQ+ inclusive training and capacity building should be expanded to increase the cultural competency of services in providing services to LGBTIQA+ people in responsive and affirming ways. This training should centre intersectional practice at its core, considering the need for affirming and inclusive practice that considers the whole person within their context and relationships.
7. Government and services should advocate with and for marginalised communities. This is particularly important when reflecting on the findings of this report, which highlight the pervasive nature of discrimination on the mental health and wellbeing outcomes of marginalised groups across systems, structures and society.
Risk Alerts
All client sub-cohorts experienced similar rates of risk alerts for mental illness, suicide, and family violence. LGBTIQA+ clients living with disability did experience a notably higher number of family violence and suicide risk alerts compared to other sub-cohorts. Young trans and gender diverse people had a slightly higher number of mental illness risk alerts compared to other sub-cohorts. However, this sample size was smaller compared to the other sub-cohorts and numbers should be interpreted with caution.
Considerations
8. Government supports flexibility in commissioning processes to enable services to respond to client needs, upholding a hierarchy of needs in the support of mental health and wellbeing.
Advocacy at all levels
Several of the recommendations from the Royal Commission acknowledge that advocacy is crucial for system reform, including Recommendation 41 which recognises that in order to address systemic discrimination, advocacy is essential. Recommendation 6 and Recommendation 7 focus on helping people find and access treatment, care and support. Importantly, Recommendation 29 emphasises that lived experience workforces are essential to systemic advocacy, and Recommendation 34 identifies the need for community-led organisations to support communities to navigate the mental health system.
Cumulative Discrimination
There was a small group of individuals who had only experienced LGBT discrimination, i.e., homophobia or biphobia and/or transphobia (n = 165). These individuals had higher mental health and wellbeing scores, lower financial stress and decreased loneliness scores compared to individuals who had experienced cumulative forms of discrimination (n = 625).
Discrimination and social isolation
Client files described that clients who were discriminated against commonly expressed loneliness and feelings of isolation. They were excluded from employment, housing, as well as health and social services. They were mocked, bullied, harassed, and violently attacked by family members, friends, intimate partners, housemates, colleagues, employers, health professionals, and acquaintances on the street. Some clients also reported trauma symptoms related to these experiences of discrimination and exclusion. Suicidal ideation was a common theme among clients who experienced discrimination and social isolation.
What survey respondents said:
Survey respondents highlighted that both mainstream and identity-specific services were helpful for LGBTIQA+ people when they:
- Affirmed identity.
- Listened and were open to learning about identities and expressed empathy and understanding.
- Had visible signs of inclusion (e.g., rainbow flags).
- Had practitioner(s) which came from a place of understanding (lived experience).
- Had practitioners who were well informed of LGBTIQA+ perspectives so clients did not need to explain their identity.
- Had practitioners who were informed of issues relating to identity and were knowledgeable of LGBTIQA+ useful resources.
“My therapist is trans and has helped me greatly. They are the first therapist I’ve had who I feel completely safe with and who has helped me the most. They acknowledge and engage with the intersecting parts of my identity even ones that they don’t have lived experience with” (survey respondent)
What survey respondents said:
Survey respondents identified that services were helpful when they:
- Provided connection to another LGBTIQA+ service delivering mental health support.
- Considered context within service response.
Importantly, the survey found that experiences of discrimination were pervasive across multiple settings for LGBTIQA+ communities. Discrimination, especially cumulative and intersecting discrimination, negatively impacted mental health, as well as increased financial stress and loneliness. Advocacy is essential for effective service responses to LGBTIQA+ mental health and wellbeing needs, as experiences of discrimination within healthcare settings are often linked to poor help-seeking behaviours and create barriers to accessing support services.
Presenting Needs
All client groups were on the waitlist for an average of 7 to 8 weeks and attended 15 to 18 sessions across 42 to 50 weeks.
All client sub-cohorts presented with high rates of need related to mental health, trauma, stress, community participation and financial issues. LGBTIQA+ people with disability experienced a notably higher amount of need related to stress and financial issues.
About the survey sample
There were 937 LGBTIQA+ respondents who resided in Australia. Almost half of respondents were women (49%), 20% men and around one third had a gender identity that fell outside the gender binary (30%). Around 2% of survey participants were intersex and 8% were unsure.
Survey participants were aged 18-71+ years, with almost half of participants being under 35 years. The most common sexualities were multi-gender attracted (58%) or queer (51%), followed by lesbian (49%), gay (24%), or asexual (14%). A small percentage of respondents identified as straight (3%).
The survey sample was limited in representation of culturally and linguistically diverse LGBTIQA+ respondents (16%). Additionally, a small percentage of respondents were of Aboriginal and/Torres Strait Islander descent (3.2%). Participants were highly educated with the majority completing tertiary education.
Considerations
4. Government should consider the need for intersectional approaches when commissioning services. To create a ‘safe, responsive and inclusive’ system it is imperative that intersectional identities and factors are considered across the mental health system reforms. As this research demonstrates, it is not simply enough to add cohort specific considerations but rather, services throughout the mental health service system should consider the complex and compounding impacts of discrimination on a person.
5. Services should consider how they will elevate lived experience, cultural knowledge and identity knowledge. This includes adequately supporting and supervising lived experience staff, helping staff to challenge their own assumptions, and establishing safety and accountability to engage with diverse communities.
Presenting needs
Presenting needs are identified when the client enters the service and during their initial engagement with DS. There are a total of 33 presenting needs including mental health, anxiety, depression, and stress. Unsurprisingly, the overwhelming majority of clients presented with mental health related needs, which likely sat alongside and were related to other forms of need. On average, clients presented with approximately eight needs and a maximum of 20. Highlighting the complexity of presenting needs, 87% (n =261) of clients presented with five or more needs, and 44% (n = 132) of clients presented with nine or more needs. Click the images on the right to see them full screen.
Coordinated and Integrated Services
The Royal Commission called for improved service coordination and integration. Recommendation 3 in particular, calls for a responsive and integrated mental health and wellbeing system. A number of recommendations emphasised the importance mental health services working alongside other services. While the integration of systems and services is critical to a responsive service system, it is important to link this coordination to the other principles outlined in this report, including establishing safety, intersectional practice, strong advocacy and flexible service responses to diverse and cooccurring needs.
How to use this report
This is an interactive report. It's designed to minimise the amount you have to read and emphasise the points you want to know. There will be things you can click on to get more information along the way. Click on the hand icon in the top right-hand corner to show the interactive elements on each page.
Client File Analysis
A sample of 300 client files were analysed to better understand:
- The mental health and wellbeing needs and risk factors among LGBTIQA+ clients.
- How discrimination, inequality and other forms of marginalisation impact the mental health and wellbeing of LGBTIQA+ clients.
- Enablers and barriers to service access for LGBTIQA+ clients.
- How DS responds to the needs of LGBTIQA+ clients.
- What is needed to improve wider service provision to better respond to the needs of LGBTIQA+ communities.
The client file analysis was conducted in two phases; collecting both quantitative and qualitative data.
Loneliness
There was a high rate of loneliness in the sample. Overall, 67% (n = 560) of LGBTIQA+ respondents were experiencing loneliness . Increased loneliness was related to lower mental health and wellbeing, and greater financial stress. Loneliness was notably high among some sub-cohorts:
- LGBTIQA+ young adults aged 18-25 reported the highest rates of loneliness (78%, n=105).
- There was also a significantly higher rate of loneliness among LGBTIQA+ individuals with disabilities (75%) compared to individuals without (54%).
- Trans and gender diverse individuals also had significantly higher rates of loneliness (77%) compared to cisgender LGBIQA+ individuals (58%).
Research Questions
The LGBTIQA+ Mental Health & Wellbeing Project sought to answer the following research questions:
- What are the mental health and wellbeing risk factors and needs among LGBTIQA+ people? How do these vary within LGBTIQA+ communities?
- How does discrimination, inequality and other forms of marginalisation impact the mental health and wellbeing of LGBTIQA+ people?
- What are the enablers and barriers for LGBTIQA+ people accessing services to support their mental health and wellbeing? How do these vary within LGBTIQA+ communities?
- How does Drummond Street respond to the needs of LGBTIQA+ clients?
- How could service provision be improved to better respond to the needs of LGBTIQA+ people?
Ethics
Ethics approval was obtained from the Department of Health and Department of Families, Fairness and Housing Human Research Ethics Committee on 4th May 2023 for all components of the LGBTIQA+ Mental Health and Wellbeing Project. A waiver of consent was obtained for the client file audit based on ethical guidelines, yet all client files included in the research provided written consent for their de-identified data to be used for research and evaluation purposes. The Centre for Family Research and Evaluation follows the National Health and Medical Research Council's National Statement on Ethical Conduct in Human Research.
Click here to access the National Statement.
Establishing Safety
Reducing Stigma and Discrimination The Royal Commission made a number of key recommendations to reduce stigma and discrimination, including Recommendation 16 and Recommendation 41. It is imperative to focus on intersectional identity-based discrimination, in addition to mental health stigma and discrimination. As this research highlights, over 60% of survey respondents had experienced a form of discrimination in the past five years either at work, in public or within family. Around half of respondents had experienced discrimination within healthcare settings and even from within the LGBTIQA+ community. Improving Workforce Capabilities The Royal Commission recommended a range of structural workforce reforms to attract, train and transition the staff needed for Victoria's mental health services, including in non-government organisations, community services, and Local, Area and Statewide Mental Health and Wellbeing Services. Improving Service Access The Royal Commission acknowledged that the mental health system was complex and fragmented.
Risk factors throughout service engagement
Risk factors with the least reduction throughout service engagement were social isolation and financial insecurity. Client files were analysed to explore these two risk factors in further detail.
As can be seen in the graph, risk factors seemed to reduce throughout service engagement. However, this data cannot attribute reduction in risk to service engagement as there are many other interconnected and contributing factors in LGBTIQA+ clients' lives that interact with these risk factors.
Types of Discrimination
Incidents of discrimination may fall into more than one of the following categories (for example, an incident may be both transphobic and sexist).
This included:
- Ableism
- Transphobia
- Racism
- Sexism
- Homophobia or Biphobia
- Cultural or religious discrimination
- Other
Intersectional Practice
The Royal Commission called for a ‘safe, responsive and inclusive’ mental health and wellbeing system to meet the needs of Victoria’s diverse populations. Recommendation 34 in particular, recognised that this would entail a whole-of-system effort through the coordination of funding, commissioning, design and delivery of services. Particular target cohorts included:
- LGBTIQA+ Victorians
- Victorians from culturally and linguistically diverse backgrounds
- Victorians with disability.
While there is a need to think about and support the distinct needs of each of these diverse cohorts and communities, fundamental is the need to consider where these communities overlap and what the service system can do to respond in an intersectional way to marginalisation and its impacts. The findings from this report highlight the profound impact that discrimination has on people’s health and wellbeing needs.
What survey respondents said:
The survey found that LGBTIQA+ people experienced lower wellbeing related to higher financial stress, higher loneliness, and greater need related to family violence risk. This indicates that responding to need related to mental health and wellbeing should consider financial wellbeing, social connectedness, and any related risks. Survey respondents identified that services were helpful when they were responsive and flexible to need.
“...it is helpful because I do not worry about having to explain/prove myself, they are responsive and flexible to my needs and they understand, respect and even celebrate my relationship.” (survey respondent)
Homophobia and biphobia across settings
In the past five years, 81% of LGBQ respondents (n = 820) had experienced homophobia or biphobia, most commonly within a public setting (48%), within the family (44%), or at work (41%).
LGBTIQA+ Mental Health & Wellbeing
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Transcript
LGBTIQA+ Mental Health & Wellbeing
START
HOW TO USE THIS REPORT
Final Report 2024: Key Findings and Principles
Acknowledgement of Country
Drummond Street respectfully acknowledges the Kulin Nation as Traditional Owners of the lands where we deliver our services. We acknowledge Aboriginal and Torres Strait Islanders as the first people of Australia. Sovereignty was never ceded, and they remain strong in their connection to land, culture and in resisting colonisation.
Acknowledgement of contribution
The authors of this report respectfully thank and acknowledge the invaluable contributions of LGBTIQA+ Australians who participated in this research. We, as members of the LGBTIQA+ community, hope that you find the language used and findings discussed, reflect LGBTIQA+ lived experiences. Through conscientious research and careful analysis, we hope to shed light on the challenges and discrimination that many LGBTIQA+ individuals still face, as well as the strides that have been made towards more inclusive support services.
INTRODUCTION
An introduction to the LGBTIQA+ Mental Health & Wellbeing Project
INTRODUCTION
LGBTIQA+ Mental Health & Wellbeing Project
The LGBTIQA+ Mental Health and Wellbeing Project, undertaken by Drummond Street Services' Centre for Family Research & Evaluation, sought to understand:
+ KEY FINDINGS
TABLE OF CONTENTS
Click on the items below to jump to a section or click the button to read through the interactive report.
READ: FULL REPORT
Introduction
Needs and Risk
Principles and Considerations
Acute Risk
Overview of research methods
Conclusion
Needs and risks across sub-cohorts
Prevalence and Impact of Discrimination
OVERVIEW OF RESEARCH METHODS
What data we gathered and how we gathered it.
OVERVIEW OF RESEARCH METHODS
A rapid review of the literature to illustrate how we know what we know so far about LGBTIQA+ mental health and wellbeing.
Drummond Street Services' 2023 LGBTIQA+ Health and Wellbeing Survey to understand our communities' mental health and wellbeing needs.
A client file analysis of Drummond Street Services' client record management system to explore the service experiences of our LGBTIQA+ communities.
+INFO
+INFO
+INFO
RESEARCH QUESTIONS
ETHICS
Demographics
The similarities and differences across the survey and client file samples.
AGE DEMOGRAPHICS
GENDER DEMOGRAPHICS
About the survey sample
About the client file sample
MORE DEMOGRAPHICS
SEXUALITY DEMOGRAPHICS
PREVALENCE AND IMPACT OF DISCRIMINATION
Key finding one
PREVALENCE OF DISCRIMINATION
This section is based on findings from the survey. LGBTIQA+ survey respondents were asked about their experiences of different forms of discrimination within different settings over the past five years.
TYPES OF DISCRIMINATION
SETTINGS
PREVALENCE OF DISCRIMINATION
This section presents the findings of the prevalence of specific types of discrimination within settings experienced by LGBTIQA+ people who answered these survey questions.
HOMOPHOBIA & BIPHOBIA
SEXISM
TRANSPHOBIA
OTHER DISCRIMINATION
RACISM
ABLEISM
IMPACT OF DISCRIMINATION
This section presents survey findings about the impact of discrimination on mental health and wellbeing, loneliness and financial stress among LGBTIQA+ people.
Lower wellbeing scores were associated with a greater number of discrimination types experienced (e.g., transphobia + sexism + ableism...) and a greater number of settings where discrimination was experienced (e.g., workplace + family + public...). This indicated that the more types of discrimination experienced across more settings, the lower mental health and wellbeing scores would be among LGBTIQA+ survey respondents. This demonstrates the compounding and pervasive nature of discrimination in relation to mental health and wellbeing among the surveyed cohort.
LONELINESS
FINANCIAL STRESS
+INFO
CUMULATIVE DISCRIMINATION
Individuals experienced multiple types of discrimination:
- 75% (n = 649) of the total sample had experienced more than one type of discrimination
- 37% of individuals (n = 314) had experienced four or more types of discrimination.
Cumulative discrimination (LGBT Discrimination Plus) was common and was associated with:+INFO
NEEDS AND RISK
Key finding two
NEEDS AND RISK
The survey results demonstrate how mental health and wellbeing need overlapped with loneliness and financial stress.
Mental Health and Wellbeing
LONELINESS
A total of 859 participants completed questions about their mental health and wellbeing and 58% (n = 542) had wellbeing scores below the general population indicating poorer mental health and wellbeing.
FINANCIAL STRESS
NEEDS AND RISK
Client file analysis demonstrated the complexity of needs and risk among LGBTIQA+ clients, including the interconnected nature of presenting needs, and co-occuring risks.
Presenting needs
Risk throughout service engagement
The most common presenting needs among LGBTIQA+ clients were:
Client files indicated changes in risk factors that were present throughout service engagement. Risk factors that depicted the greatest change from early engagement to case closure were:
DISCRIMINATION AND SOCIAL ISOLATION
DISCRIMINATION AND FINANCIAL INSECURITY
+INFO
+INFO
ACUTE RISK
Client files indicated prevalent risk alerts among LGBTIQA+ clients, as well as complexity of acute risk and co-occuring risks.
Complexity of acute risk
Prevalence of risk alerts
Among the clients that had a risk alert attached to their file (n=128), over a third (35%, n=45) had two or more risk alerts. To consider complexity, individual risk alerts were summed.
A total of 128 clients had a risk alert attached to their file. Among these client files, suicide risk emerged as one of the most common (41%, n = 53), alongside family violence risk (41%, n = 52) followed by mental illness (36%, n = 46). Click the image below to see it full screen.
Click the graph to see it full screen.
+INFO
ACUTE RISK
Client files indicated that the most common risk alerts were suicide risk, mental illness and family violence risk among LGBTIQA+ clients.
Most common risk alerts
SUICIDE RISK
Of the total sample of client files:
- 18% (n=53) of client files had a suicide risk alert.
- 15% (n=46) of client files had a mental illness risk alert.
- 17% (n=52) of client files had a family violence risk alert.
The most common co-occuring risk alerts were:MENTAL ILLNESS RISK
FAMILY VIOLENCE RISK
CO-OCCURRING RISK ALERTS
NEEDS AND RISKS ACROSS SUB-COHORTS
Key finding two
NEEDS AND RISKS ACROSS SUB-COHORTS
There were three prominent sub-cohorts derived from the client file sample, that were selected to form case studies. These case studies demonstrate similarities and differences across sub-cohorts in presenting needs as well as risks during service engagement.
Cohort Case Studies
There was overlap across sub-cohorts in terms of identities and experiences however, each group was separated based on a different aspect of their identity, and this produced understanding of the different needs and risks. Click the icon to go to each sub-cohort case study.
PRESENTING NEEDS
Sub-cohort 1: Aged 18 - 25 years and trans, non-binary, genderqueer, or questioning (n=33)
RISK ALERTS
Sub-cohort 2: Aged 18 - 57 years and from multicultural backgrounds (n=35)
Sub-cohort 3: Aged 30 - 57 years and living with disability (n=42)
SUB-COHORT 1 CASE STUDY
client profile
Aged 18 to 25 years
Presenting needs, and risk throughout service engagement
Young trans, non-binary, genderqueer and/or questioning
REFERRAL
INTAKE
WAITLIST
CASE CLOSURE
TIME IN CARE
SUB-COHORT 2 CASE STUDY
client profile
Aged 18 to 57 years
Presenting needs, and risk throughout service engagement
Clients with multicultural backgrounds
REFERRAL
INTAKE
WAITLIST
CASE CLOSURE
TIME IN CARE
SUB-COHORT 3 CASE STUDY
client profile
Aged 30 to 57 years
Presenting needs, and risk throughout service engagement
Clients living with disability
REFERRAL
INTAKE
WAITLIST
CASE CLOSURE
TIME IN CARE
PRINCIPLES FOR EFFECTIVE SERVICE RESPONSES
Five core principles aligned with the Royal Commission into the Victorian Mental Health System
PRINCIPLES FOR EFFECTIVE SERVICE RESPONSES
This section integrates the key findings from this report into Five Core Principles to support the mental health and wellbeing of LGBTIQA+ Victorians. The principles are aligned with the Royal Commission’s findings and recommendations. They bolster and extend these recommendations where possible by providing further considerations for services and government.
Five Core Principles
Establishing Safety
Intersectional Practice
Click each principle on the diagram for more information including how the principle links to the Royal Commission recommendations and considerations for services government.
Coordinated, integrated and holistic services
Advocacy at all levels
+INFO
Flexibility in responding to client need
1. ESTABLISH SAFETY
Establishing safety is a foundational need to be prioritised in service provision. It forms a key part of any trauma-informed and person-centred approach. Physical and emotional safety are the foundation upon which trust can be built within therapeutic relationships. Part of establishing safety is recognising that people’s interactions with services are impacted significantly by experiences of discrimination.
WHAT SURVEY RESPONDENTS SAID
LEARNINGS FROM DS SERVICE RESPONSE
LINK TO RECOMMENDATIONS
CONSIDERATIONS
2. INTERSECTIONAL PRACTICE
Intersectional practice involves understanding that individuals exist with multiple aspects of identity and experiences that cannot be separated into cohorts. This includes affirmation of all parts of a person’s identity and being educated about the impacts of intersecting and compounding forms of discrimination on mental health and wellbeing. A holistic approach is required at multiple levels to create a top-down authorising environment within services, as well as bottom-up action from workers, clients, and the community.
WHAT SURVEY RESPONDENTS SAID
LEARNINGS FROM DS SERVICE RESPONSE
LINK TO RECOMMENDATIONS
CONSIDERATIONS
3. ADVOCACY AT ALL LEVELS
Advocacy involves an understanding of inequities and gaps in services, especially for LGBTIQA+ people who experience cumulative and intersecting forms of discrimination. It requires the skills to challenge and dismantle systemic barriers to advocate for clients, as well as enable clients to advocate for themselves. Advocacy strives to reshape the landscape of services, making them more inclusive, affirming, and equitable.
WHAT SURVEY RESPONDENTS SAID
LEARNINGS FROM DS SERVICE RESPONSE
LINK TO RECOMMENDATIONS
CONSIDERATIONS
4. FLEXIBILITY IN RESPONDING TO CLIENT NEED
Flexible service provision incorporates intersectional practice whilst being responsive to the needs of LGBTIQA+ people. It involves being responsive to client need and taking a human-rights and person-centred approach to support all factors contributing to health and wellbeing, such as material wellbeing and community connection.
WHAT SURVEY RESPONDENTS SAID
LINK TO RECOMMENDATIONS
LEARNINGS FROM DS SERVICE RESPONSE
CONSIDERATIONS
5. COORDINATED & INTEGRATED SERVICES
Coordinated and integrated service responses are inherently holistic. This includes within a service and across services and service systems. The integration of wrap-around supports across services is an essential element of working in coordinated ways across service systems. A holistic lens enhances coordination and integration especially if all services utilise this approach when responding to need and risk.
WHAT SURVEY RESPONDENTS SAID
LEARNINGS FROM DS SERVICE RESPONSE
LINK TO RECOMMENDATIONS
CONSIDERATIONS
Conclusion
Overall, the findings from the LGBTIQA+ Mental Health and Wellbeing Project shed a glaring light on the pervasiveness of experiences of discrimination among LGBTIQA+ communities across multiple aspects of their lives, that are associated with lower mental health and wellbeing, including financial wellbeing and social connectedness. Also, the complex and co-occurring nature of needs and risks were further compounded by experiences of discrimination, especially for marginalised sub-cohorts of LGBTIQA+ communities. These findings call for preventative efforts to address broader societal discrimination, in all its forms (e.g., homophobia, biphobia, transphobia, racism, sexism, and ableism). They also call for a reframing and shifting of the burden of alleviating ‘minority stress’ from the LGBTIQA+ individual onto society, structures and systems. LGBTIQA+ communities and other diverse communities are resilient, and their identity does not have to mean that they face exclusion and discrimination. Instead, their identity can and should be a source of celebration and connection. In the face of systemic challenges, it is crucial to consider broader system changes that are required to support effective service responses. Considerations for services and government should work in tandem to create the enabling conditions for substantive and sustainable change which works toward more impactful support for LGBTQIA+ communities’ mental health and wellbeing.
Financial Stress
Around 1 in 3 LGBTIQA+ individuals were experiencing moderate to severe financial stress, indicating that they were feeling a high level of stress at meeting basic expenses. Higher financial stress was associated with lower wellbeing and higher loneliness scores. Trans and gender diverse individuals experienced significantly increased financial stress compared to cisgender survey respondents. This related to almost all areas of finance (aside from loan repayments) and most related to having greater stress in healthcare related expenses. LGBTIQA+ individuals with disabilities also experienced greater financial stress in all areas, compared to individuals without a disability. This was strongest in relation to healthcare expenses and in paying for a $1,000 emergency.
Co-occurring Risk Alerts
This table demonstrates where risk alerts overlap or co-occur among client files. Risk alerts are presented in the first row and column of the table, and the number of times that they co-occurred is demonstrated by the numbers in the matrix. The numbers represent how many client files indicated the co-occurrence of two risk alerts.
Notable co-occurring risk alerts among client files included:
Learnings from DS service response:
Client files indicated that DS’ reputation, strong community connections and networks with services and organisations that are safe and inclusive for LGBTIQA+ people facilitated intersectional practice. LGBTIQA+ clients and external agencies that refer clients to DS, trust DS to not only be safe and inclusive as an organisation itself, but also to link clients with other services that are known to be safe and inclusive. Examples of intersectional practice based on client files include:
Learnings from DS service response:
Client files described several examples of coordinated and integrated service responses for LGBTIQA+ clients including:
Mental Wellbeing and Discrimination
The ReQoL-10 was used to measure mental health and wellbeing. Scores range from 0 to 40, where lower scores indicate poorer mental health and wellbeing. A score of 25 or above is considered to fall within the general population.
Transphobia across settings
In the past five years, 88% of trans and gender diverse (TGD) respondents (n = 334) had experienced transphobia, most commonly within family (65%), at work (56%), in public (53%) or in healthcare (53%).
Sexism across settings
In the past five years, 62% of women and non-binary respondents (n = 678) had experienced sexism, and around 1 in 3 women experienced sexism in the workplace and/or in a public space.
Suicide Risk
Suicide risk alerts were applied when case notes specified that a client either made a suicide attempt or expressed serious intent and/or means to do so. Among client files with a suicide risk alert (n=53), clients also had up to six risk factors present:
Among clients with a suicide risk alert (n=53), 47% were experiencing frequent conflict and/or family violence, 40% were experiencing social isolation, 32% reported financial insecurity, and 19% were experiencing homelessness or were at-risk of homelessness. Almost half (47%, n=25) reported their main source of income was from the 'government'. Of the clients with suicide risk alerts who also reported their employment status (n=30), 50% (n=15) were unemployed. Socio-economic status seemingly had an influence on acute suicide risk among the client file sample.
Rapid Review
A review of the literature indicated the strengths and gaps in the available evidence about mental health and wellbeing among LGBTIQA+ communities. The findings covered:
- Current extent of population-based surveys and their data on LGBTIQA+ mental health and wellbeing.
- The prominence of minority stress theory in understanding LGBTIQA+ mental health and wellbeing.
- Gaps in population data regarding specific cohorts such as trans and gender diverse people, people with intersex variation(s) and people with intersectional identities.
- Prominent issues impacting LGBTIQA+ mental health and wellbeing (e.g., COVID-19, intimate partner and family violence, discrimination and marginalisation).
- Health and support service access and engagement.
The findings from the review provided context and guidance for the subsequent research components.Flexibility in responding to client need
The need for flexible service responses to multiple, interconnected needs were emphasised in the findings from this report and build on recommendations from the Royal Commission. In particular, Recommendation 3 which outlines key reform areas to create a more responsive and integrated mental health and wellbeing system. While reforms outlined in Recommendation 3 lay the groundwork for an enhanced service system and improved service access across the state, as highlighted by the client file audit, Government should consider the need for flexibility and responsiveness within services, including considering a hierarchy of needs.
What survey respondents said:
While the survey highlighted that LGBTIQA+ people had high levels of help-seeking behaviour, LGBTIQA+ survey respondents also identified several barriers that prevented them from accessing services that could be supported by better integration within and across services. Survey respondents described:
Survey respondents found it helpful when:
Considerations
1. Government should consider the links between stigma, discrimination and poor mental health and wellbeing. It is critical that any work carried out in relation to addressing stigma and discrimination of mental health should also address identity-based discrimination. 2. Government should support building the capabilities of the whole workforce to develop intersectional practice. The workforce capability framework should look beyond multidisciplinary practice to create a mental health system where clinical knowledge can be braided together with cultural knowledge, identity knowledge and lived experience to support a transdisciplinary approach. 3. Government should consider the intersectional and compounding needs of diverse communities across all areas of the mental health reforms. While there is a need for specialist responses, as outlined by recommendations relating to ‘diverse communities’, it is imperative that all services across the mental health system can provide affirming and inclusive support.
What survey respondents said:
LGBTIQA+ survey respondents identified that services were helpful when they fostered safety and provided good support when people felt their identities were affirmed and accepted.
- Respondents described positive experiences within the service system as:
- Creating a sense of safety.
- Accommodating, accepting and respectful of identities.
- Non-judgemental- they did not make assumptions around gender or sexuality.
- Providing trauma-informed and person-centred care.
Respondents also described experiences where they did not feel safe, including:Ableism across settings
In the past five years, 71% of those with any disability (n = 514), 81% of those with a physical or sensory disability (n = 218) and 76% of neurodivergent respondents (n = 364) had experienced ableism. Half or more of the individuals with physical or sensory disabilities had experienced ableism at work (55%), in healthcare (54%), in public (53%) or within family (50%).
Settings
The survey also asked respondents to indicate which settings they experienced discrimination which included:
Family Violence Risk
Family violence risk alerts were applied when there was current family violence that required risk management and safety planning. Among client files with a family violence risk alert (n=52), clients also had up to six risk factors present:
Family violence risk alerts co-occurred with suicide risk alerts in 14% (n=18) of client files. Risk factors for financial insecurity and substance abuse were notable co-occurrences with family violence acute risk. Homelessness was also the highest (21%) among the sample of clients with family violence risk alerts compared to clients with suicide risk alerts (co-occurring homelessness, 19%) or mental illness risk alerts (co-occurring homelessness, 9%).
Learnings from DS service response
The client file analysis produced findings relating to client safety which illuminated the ways in which people first accessed the service, as well as the types of support they received. Client files indicated that:
KEY FINDINGS SUMMARY
Note: Survey respondents were able to choose more than one sexuality
Discrimination and financial insecurity
Client files described the compounding nature of discrimination on need related to financial insecurity. Some clients experienced discrimination at work that led to reduced shifts or resignation. Clients looking for employment experienced discrimination that prevented them from obtaining work and compounded their financial insecurity. Some clients were asked inappropriate questions during interviews or at work about their gender. Other clients were ineligible for income support due to their visa status which compounded their need related to financial insecurity, housing instability and isolation.
Discrimination and Financial Stress
Financial stress was measured using the Drummond Street Financial Stress Scale. The Drummond Street Financial Stress Scale includes seven items that cover finances across utilities, healthcare, food and household, work or school, housing or household repairs, loans, debts, and payment plans, as well as emergency fund access. Survey respondents could indicate for each item how stressed they feel about being able to pay from ‘No stress at all’ to ‘Overwhelming stress’.
Higher financial stress was associated with a greater number of discrimination types experienced (e.g., transphobia + sexism + ableism...) and a greater number of settings where discrimination was experienced (e.g., workplace + family + public...). Both compounding and pervasive discrimination were associated with higher financial stress in the surveyed cohort.
Note: Survey respondents were able to choose more than one sexuality
Discrimination and Loneliness
Loneliness was measured using the UCLA Loneliness Scale. Scores range from 0-9, and higher scores indicate greater loneliness. Lower scores (0-3) can be interpreted as social connectedness.
Higher loneliness scores were associated with a greater number of discrimination types experienced (e.g., transphobia + sexism + ableism...) and a greater number of settings where discrimination was experienced (e.g., workplace + family + public...). This indicated that the more types of discrimination experienced across more settings, the higher loneliness scores would be among LGBTIQA+ survey respondents.
Mental Illness Risk
Mental illness risk alerts were applied when case notes specified that a client experienced an acute episode of severe mental illness that may have led to psychiatric triage, assessment, and care. Among client files with a mental illness risk alert (n=46), clients also had up to six risk factors present:
Mental illness risk alerts and suicide risk alerts were the most common to co-occur among the client files (16%, n=20). Client files described the impact of discrimination on help-seeking behaviours when clients experienced mental illness. Clients experienced systemic discrimination within acute mental health settings after involuntary admission and during psychiatric triage and assessment. One client file described a client avoiding contacting crisis lines even during a mental health episode because of previous experiences of racism and homophobia from within psychiatric clinical settings.
Learnings from DS service response:
It was clear that flexible service provision took a human rights-based and social justice approach that enabled practitioners to navigate and advocate for clients in the face of structural and systemic barriers. Flexible service provision meant being responsive to needs interconnected with mental health, including material need and community connection. Examples of flexible service provision based on client files include:
Other Discrimination
Discrimination did not just impact the individual but also other people in their life (e.g., parent, carer or partner and dependants). There were several participants who explained they were close to someone who experienced discrimination that was a barrier to accessing necessary health services or mental health supports. This meant that the person close to the individual experiencing discrimination took on a greater caring role. Survey respondents also described how witnessing or hearing about discrimination against their partner/child/person in care, resulted in their own experience of stress. Many individuals also described avoiding discrimination by not disclosing parts of themselves (e.g., sexuality, gender, disability) in different settings.
The above diagram is based on qualitative descriptions of survey respondents experiences of discrimination. Additional forms of discrimination that were commonly experienced included classism, ageism, fatphobia and ace-phobia (discrimination against asexual people).
Learnings from DS service response:
Client files demonstrated the importance of purposeful advocacy that was guided by, and responsive to, the needs of clients as they arose. DS’ service responses included advocating for clients in the face of structural and systemic barriers. Examples of purposeful advocacy based on client files included:
Considerations
9. Government should consider extending funding to specialist LGBTIQA+ services. While the mental health reforms seek to improve the service system and service responses, the Royal Commission and this research highlight high levels of intersectional identity-based discrimination experienced by LGBTIQA+ communities. Reforming the system will take time. In the meantime, it is critical to support, through funding and commissioning processes, specialist LGBTIQA+ services to provide wrap around and coordinated mental health support. This should be considered across metropolitan, regional and rural areas. 10. Government should consider further collaboration and integration of family violence and mental health services and support. This is particularly important for marginalised cohorts, who may experience family violence at higher rates because of their identity. This is particularly important in the design and delivery of suicide prevention and aftercare services, where strong links relating to cooccurring need were emphasised.
About the client file sample
A total of 300 clients who identified as LGBTIQA+ and had completed their service engagement with Drummond Street Services (i.e., the client files were closed and inactive) were included in the analysis. Clients were aged 18-68 years, with the majority under 35 years (60%). Gender identities were grouped into women (46%), men (27%), non-binary or gender queer (20%) and other (7%, mostly comprised of undisclosed). Around half of clients were either multi-gender attracted (25%) or queer identified (23%). Clients received services at one of seven DS locations within Victoria (Collingwood, Carlton, Coburg, North Melbourne, Wyndham, Geelong, and Epping) with the majority of clients seen at the Carlton site.
2023 Health and Wellbeing Survey
The survey was adapted from previous years for the purposes of this project to develop a better understanding of the mental health and wellbeing needs and service use among LGBTIQA+ individuals and communities. It included questions covering:
The survey gathered both quantitative and qualitative responses.
Five Core Principles
While this research looked specifically at the needs of LGBTIQA+ communities, the considerations take an intersectional framing to consider the broad and intersectional needs of other marginalised communities and groups. The principles ask us to consider the need to:
Racism across settings
There were only a small number of individuals who identified as a person of colour and/or culturally and linguistically diverse (POC/CALD) within the sample and who completed questions on discrimination (n = 80). Of these individuals, 59% had experienced racism, most commonly in public spaces (37%) and at work (32%). Due to the small sample of culturally and linguistically diverse and people of colour, these findings are not generalisable to broader experiences of racism.
Considerations
6. LGBTIQ+ inclusive training and capacity building should be expanded to increase the cultural competency of services in providing services to LGBTIQA+ people in responsive and affirming ways. This training should centre intersectional practice at its core, considering the need for affirming and inclusive practice that considers the whole person within their context and relationships. 7. Government and services should advocate with and for marginalised communities. This is particularly important when reflecting on the findings of this report, which highlight the pervasive nature of discrimination on the mental health and wellbeing outcomes of marginalised groups across systems, structures and society.
Risk Alerts
All client sub-cohorts experienced similar rates of risk alerts for mental illness, suicide, and family violence. LGBTIQA+ clients living with disability did experience a notably higher number of family violence and suicide risk alerts compared to other sub-cohorts. Young trans and gender diverse people had a slightly higher number of mental illness risk alerts compared to other sub-cohorts. However, this sample size was smaller compared to the other sub-cohorts and numbers should be interpreted with caution.
Considerations
8. Government supports flexibility in commissioning processes to enable services to respond to client needs, upholding a hierarchy of needs in the support of mental health and wellbeing.
Advocacy at all levels
Several of the recommendations from the Royal Commission acknowledge that advocacy is crucial for system reform, including Recommendation 41 which recognises that in order to address systemic discrimination, advocacy is essential. Recommendation 6 and Recommendation 7 focus on helping people find and access treatment, care and support. Importantly, Recommendation 29 emphasises that lived experience workforces are essential to systemic advocacy, and Recommendation 34 identifies the need for community-led organisations to support communities to navigate the mental health system.
Cumulative Discrimination
There was a small group of individuals who had only experienced LGBT discrimination, i.e., homophobia or biphobia and/or transphobia (n = 165). These individuals had higher mental health and wellbeing scores, lower financial stress and decreased loneliness scores compared to individuals who had experienced cumulative forms of discrimination (n = 625).
Discrimination and social isolation
Client files described that clients who were discriminated against commonly expressed loneliness and feelings of isolation. They were excluded from employment, housing, as well as health and social services. They were mocked, bullied, harassed, and violently attacked by family members, friends, intimate partners, housemates, colleagues, employers, health professionals, and acquaintances on the street. Some clients also reported trauma symptoms related to these experiences of discrimination and exclusion. Suicidal ideation was a common theme among clients who experienced discrimination and social isolation.
What survey respondents said:
Survey respondents highlighted that both mainstream and identity-specific services were helpful for LGBTIQA+ people when they:
“My therapist is trans and has helped me greatly. They are the first therapist I’ve had who I feel completely safe with and who has helped me the most. They acknowledge and engage with the intersecting parts of my identity even ones that they don’t have lived experience with” (survey respondent)
What survey respondents said:
Survey respondents identified that services were helpful when they:
- Provided connection to another LGBTIQA+ service delivering mental health support.
- Considered context within service response.
Importantly, the survey found that experiences of discrimination were pervasive across multiple settings for LGBTIQA+ communities. Discrimination, especially cumulative and intersecting discrimination, negatively impacted mental health, as well as increased financial stress and loneliness. Advocacy is essential for effective service responses to LGBTIQA+ mental health and wellbeing needs, as experiences of discrimination within healthcare settings are often linked to poor help-seeking behaviours and create barriers to accessing support services.Presenting Needs
All client groups were on the waitlist for an average of 7 to 8 weeks and attended 15 to 18 sessions across 42 to 50 weeks.
All client sub-cohorts presented with high rates of need related to mental health, trauma, stress, community participation and financial issues. LGBTIQA+ people with disability experienced a notably higher amount of need related to stress and financial issues.
About the survey sample
There were 937 LGBTIQA+ respondents who resided in Australia. Almost half of respondents were women (49%), 20% men and around one third had a gender identity that fell outside the gender binary (30%). Around 2% of survey participants were intersex and 8% were unsure. Survey participants were aged 18-71+ years, with almost half of participants being under 35 years. The most common sexualities were multi-gender attracted (58%) or queer (51%), followed by lesbian (49%), gay (24%), or asexual (14%). A small percentage of respondents identified as straight (3%). The survey sample was limited in representation of culturally and linguistically diverse LGBTIQA+ respondents (16%). Additionally, a small percentage of respondents were of Aboriginal and/Torres Strait Islander descent (3.2%). Participants were highly educated with the majority completing tertiary education.
Considerations
4. Government should consider the need for intersectional approaches when commissioning services. To create a ‘safe, responsive and inclusive’ system it is imperative that intersectional identities and factors are considered across the mental health system reforms. As this research demonstrates, it is not simply enough to add cohort specific considerations but rather, services throughout the mental health service system should consider the complex and compounding impacts of discrimination on a person. 5. Services should consider how they will elevate lived experience, cultural knowledge and identity knowledge. This includes adequately supporting and supervising lived experience staff, helping staff to challenge their own assumptions, and establishing safety and accountability to engage with diverse communities.
Presenting needs
Presenting needs are identified when the client enters the service and during their initial engagement with DS. There are a total of 33 presenting needs including mental health, anxiety, depression, and stress. Unsurprisingly, the overwhelming majority of clients presented with mental health related needs, which likely sat alongside and were related to other forms of need. On average, clients presented with approximately eight needs and a maximum of 20. Highlighting the complexity of presenting needs, 87% (n =261) of clients presented with five or more needs, and 44% (n = 132) of clients presented with nine or more needs. Click the images on the right to see them full screen.
Coordinated and Integrated Services
The Royal Commission called for improved service coordination and integration. Recommendation 3 in particular, calls for a responsive and integrated mental health and wellbeing system. A number of recommendations emphasised the importance mental health services working alongside other services. While the integration of systems and services is critical to a responsive service system, it is important to link this coordination to the other principles outlined in this report, including establishing safety, intersectional practice, strong advocacy and flexible service responses to diverse and cooccurring needs.
How to use this report
This is an interactive report. It's designed to minimise the amount you have to read and emphasise the points you want to know. There will be things you can click on to get more information along the way. Click on the hand icon in the top right-hand corner to show the interactive elements on each page.
Client File Analysis
A sample of 300 client files were analysed to better understand:
The client file analysis was conducted in two phases; collecting both quantitative and qualitative data.
Loneliness
There was a high rate of loneliness in the sample. Overall, 67% (n = 560) of LGBTIQA+ respondents were experiencing loneliness . Increased loneliness was related to lower mental health and wellbeing, and greater financial stress. Loneliness was notably high among some sub-cohorts:
Research Questions
The LGBTIQA+ Mental Health & Wellbeing Project sought to answer the following research questions:
Ethics
Ethics approval was obtained from the Department of Health and Department of Families, Fairness and Housing Human Research Ethics Committee on 4th May 2023 for all components of the LGBTIQA+ Mental Health and Wellbeing Project. A waiver of consent was obtained for the client file audit based on ethical guidelines, yet all client files included in the research provided written consent for their de-identified data to be used for research and evaluation purposes. The Centre for Family Research and Evaluation follows the National Health and Medical Research Council's National Statement on Ethical Conduct in Human Research.
Click here to access the National Statement.
Establishing Safety
Reducing Stigma and Discrimination The Royal Commission made a number of key recommendations to reduce stigma and discrimination, including Recommendation 16 and Recommendation 41. It is imperative to focus on intersectional identity-based discrimination, in addition to mental health stigma and discrimination. As this research highlights, over 60% of survey respondents had experienced a form of discrimination in the past five years either at work, in public or within family. Around half of respondents had experienced discrimination within healthcare settings and even from within the LGBTIQA+ community. Improving Workforce Capabilities The Royal Commission recommended a range of structural workforce reforms to attract, train and transition the staff needed for Victoria's mental health services, including in non-government organisations, community services, and Local, Area and Statewide Mental Health and Wellbeing Services. Improving Service Access The Royal Commission acknowledged that the mental health system was complex and fragmented.
Risk factors throughout service engagement
Risk factors with the least reduction throughout service engagement were social isolation and financial insecurity. Client files were analysed to explore these two risk factors in further detail.
As can be seen in the graph, risk factors seemed to reduce throughout service engagement. However, this data cannot attribute reduction in risk to service engagement as there are many other interconnected and contributing factors in LGBTIQA+ clients' lives that interact with these risk factors.
Types of Discrimination
Incidents of discrimination may fall into more than one of the following categories (for example, an incident may be both transphobic and sexist). This included:
Intersectional Practice
The Royal Commission called for a ‘safe, responsive and inclusive’ mental health and wellbeing system to meet the needs of Victoria’s diverse populations. Recommendation 34 in particular, recognised that this would entail a whole-of-system effort through the coordination of funding, commissioning, design and delivery of services. Particular target cohorts included:
- LGBTIQA+ Victorians
- Victorians from culturally and linguistically diverse backgrounds
- Victorians with disability.
While there is a need to think about and support the distinct needs of each of these diverse cohorts and communities, fundamental is the need to consider where these communities overlap and what the service system can do to respond in an intersectional way to marginalisation and its impacts. The findings from this report highlight the profound impact that discrimination has on people’s health and wellbeing needs.What survey respondents said:
The survey found that LGBTIQA+ people experienced lower wellbeing related to higher financial stress, higher loneliness, and greater need related to family violence risk. This indicates that responding to need related to mental health and wellbeing should consider financial wellbeing, social connectedness, and any related risks. Survey respondents identified that services were helpful when they were responsive and flexible to need.
“...it is helpful because I do not worry about having to explain/prove myself, they are responsive and flexible to my needs and they understand, respect and even celebrate my relationship.” (survey respondent)
Homophobia and biphobia across settings
In the past five years, 81% of LGBQ respondents (n = 820) had experienced homophobia or biphobia, most commonly within a public setting (48%), within the family (44%), or at work (41%).