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For LGBT+ History Month, it is important to acknowledge how far the UK has come in advancing the rights of LGBT+ people, but also the work that still needs to be done. I say this as we are aware that risk rates and prevalence of mental health conditions are higher in the LGBT+ community compared to heterosexual and cisgender individuals, so we need to ask ourselves, why is this the case?
A useful starting point is the work by Ilan Meyer, which encourages us to explicitly consider the impact of cultural, societal and historical factors on sense of belonging for LGBT+ people and the discrimination, prejudice and harassment that LGBT+ people are victim to. It is also well reported that repeated incidences of homophobia, biphobia and transphobia can result in the development of mental health conditions including complex trauma. These negative experiences also lead to elevated risk rates for self-harm and suicide.
The pandemic has also added additional considerations for the LGBT+ community and from recent Stonewall reports, we are aware that LGBT+ people, particularly older LGBT+ people, are more likely to be socially isolated. Furthermore, LGBT+ communities already experience high rates of domestic abuse from partners and family members, which is likely to have been exacerbated by the lockdown measures. Many individuals also reported having to hide their own identity from family members and not having anyone to talk to. Moreover, the pandemic had an impact on LGBT+ specialist support services, which have only been operating remotely or not at all and this will have had a significant impact on the quality of support provided to LGBT+ people and will have further compounded feelings of loneliness.
It has also been reported that at the beginning of the pandemic, the LGBT Foundation helpline saw a 50% increase in calls about mental health. To further add to the complexity of considerations here, we are also aware that some LGBT+ individuals are sceptical of mental health services and are concerned about whether practitioners working within these services are aware and understanding of LGBT+ considerations (Cocks, Jonas and Laville, 2019). Therefore, as practitioners, we need to be well equipped to working with the LGBT+ community by developing knowledge, awareness and understanding.
In order to develop trainees’ competence in diversity and inclusion considerations, CBT training programmes need to invest in specialist teaching. My contribution to this area has been noted previously (Laville, 2013; 2017) in CBT Today, when I shared information about my working with sexual orientation teaching session, which has been delivered at a number of Higher Education institutions. Laville (2013; 2017) included a discussion on a) the importance of data collection for sexual orientation as a protected characteristic under the Equality Act (2010), b) signposting to specialist services, and c) ‘appropriate’ awareness in working with sexual orientation.
Firstly, in relation to data collection, I support trainees to reflect on the importance of collecting data on sexual orientation in their clinical practice and how this informs our assessment practice and treatment pathways. For example, Laville (2013) includes a case study of a patient who is experiencing difficulty in completing work-based tasks and is also experiencing anxiety about ‘coming out’ to his parents. In order to support this patient in a holistic way, we need to be competent in creating a treatment pathway within our service as well as providing information on appropriate signposting options. As discussed in Laville (2017), I have often found that trainees are unaware of specialist services, so a key part of my teaching session is to share and discuss a variety of specialist services that cover various modes of delivery e.g., face-to-face, telephone, online, or web-based resources. As discussed earlier, modes of delivery have become an even more important factor since the start of the pandemic and so, it is crucial for these options to be considered in detail. Feedback from trainees has stated how valuable they find the discussions within the session and how by engaging in reflection, this informs their future clinical practice.
As the session content can be new and emotive for trainees, I have embedded personal self-reflection time into the session, which supports the processing of emotive information and this has been supported by trainee feedback. I also consider an essential component to running the session is to create safe spaces where students feel able to share their own lived experience and views. To support this, I share my own lived experience in teaching sessions, which encourages students to do the same. This is important as it provides a model for professional practice.
Through using published case studies (Kell and Laville, 2021), I support trainees to develop competencies in using the ‘appropriate’ awareness framework (Laville, 2017). This framework supports trainees to a) identify the protected characteristic(s) for each patient, b) identify broader information that is provided for each protected characteristic and what further information is needed, and c) identify the knowledge one already has to plan a treatment pathway and identify which further learning needs to take place to develop clinical practice. Therefore, this framework can be used for all nine protected characteristics within the Equality Act (2010).
In closing, it is my opinion that all practitioners need to be aware of the importance of data collection, signposting and ‘appropriate’ awareness as by strengthening the knowledge and understanding of practitioners, this strengthens the quality of care provided within our practice, which reduces risks of more severe mental health conditions and/or suicide.
Dr Allán Laville is Associate Professor of Clinical Psychology at the University of Reading and has specialised in working with sexual orientation since 2011.
Cocks, L., Jonas, K., and Laville, A. (2019). Exploring LGBT mental health and recommendations for clinical practice. CBT Today, 47(3), 10-11.
Kell, L. and Laville, A. (2021). Diversity and Inclusion Vignettes: For Psychological Wellbeing Practitioner Training Programmes. British Psychological Society. Available at: PWP Diversity and Inclusion Vignettes.pdf (bps.org.uk)
Laville, A. (2013). Diversity Matters. CBT Today, 41(2), 15.
Laville, A. (2017). The importance of data collection, signposting and ‘appropriate’ awareness in working with sexual orientation. CBT Today, 41(2), 14-15.