Inequalities in the Health and Wellbeing of Greater Glasgow and Clyde’s Lesbian, Gay, Bisexual and Transgender Population Nicky Coia Glasgow City CHP November 2014

Legal and Policy Framework Equality Act 2010 Public Sector General Equality Duty –Sexual Orientation –Gender Reassignment –Marriage and Civil Partnership A Fairer NHS

Who are our LGBT populations? What to count? How to define? Feelings? Behaviours? Why are you asking? LGBT intersection with other protected characteristics

UK Government Estimates AreaMale populationFemale Population Glasgow17,43318,496 Renfrewshire4,9095,329 Inverclyde2,2702,482 West Dunbartonshire2,5782,843 East Dunbartonshire3,0243,249 East Renfrewshire2,5852,805 NHSGGC32,79935,204

Glasgow City

Sexual Attraction by Year Stage YearHetBiLGUnNot S494.3%2.7%1.1%0.5%1.5% S393.5%1.5%1.1% 2.7% S292%1.4%0.9% 4.7% S186%1.3%1.2%1.5%10%

Total Numbers AttractionNumbersPercentage HET BI LG811.1 UN741 NA TOTAL

Wider Attitudes ‘NHSGGC recognises that good health is not evenly distributed across our communities. The chance of a long, happy and healthy life are affected by many factors, including a range of social determinants and the persistent prejudicial attitudes, beliefs and behaviours in society.’

What are attitudes in Scotland? Trends in Social Attitudes Same sex relationships wrong 36% Someone having had a sex change would be unsuitable as a primary schools teacher 31% Living Together 62% acknowledge public prejudice against LGBT people in Scotland today 58% of 18 to 29 year olds say there was homophobic bullying in their school Religious attitudes, lack of acceptance in schools and workplaces and parental attitudes are the main perceived sources for public prejudice. 60% say LGBT people are most likely to conceal their identity in Sport.

PRE COMING OUT COMING OUT EXPLORATION FIRST RELATIONSHIPS INTEGRATION PARENTS AND FAMILIES SCHOOL AND FE/HE MEDIA THE LAW RELIGION FRIENDS & PEER GROUPS THE WORKPLACE PUBLIC SERVICES HEALTH SERVICES

Coming Out Average age of first realising 12.5 years, average age of coming out is 15 years in Glasgow In Glasgow 47% of young LGBT people have not come out to their parents Those coming out to mothers reported 28% reacted negatively/very negatively Those coming out to fathers reported 31% reacted negatively/very negatively

Mental Health Stress and Anxiety Depression Eating Disorders Self Harm Suicidal Ideation Suicide Attempts HIV/STI Alcohol Smoking Abuse and Violence Physical Inactivity COMING OUT Transitioning LGBTLGBT

The School Report 2012 More than half (52 per cent) of lesbian, gay and bisexual pupils have experienced direct bullying Almost all (99 per cent) gay young people hear the phrases ‘that’s so gay’ or ‘you’re so gay’ in school and ninety seven per cent of gay pupils hear homophobic language such as ‘poof’ or ‘lezza’ One in four (26 per cent) lesbian, gay and bisexual pupils who experience homophobic bullying say that teachers who witness the bullying never challenge it Half (49 per cent) of lesbian, gay and bisexual pupils don't feel that they are achieving their best at school, One in four (26 per cent) have attempted to take their own life and more than half (54 per cent) deliberately harm themselves, which can include cutting or burning themselves

Life For LGBT Young People in Scotland (2012) Education is the environment where most discrimination is experienced Schools are the place where LGBT young people feel least protected 70% of all LGBT young people had experienced homophobic bullying in school (77% of Trans young people) Less than half would feel confident reporting this to the school More than half felt this had impacted on their education 14% had left education as a result of bullying (42% for Trans young people)

The Teachers Report 75 % primary, 44 % secondary school staff in Scotland say they either aren’t allowed to, or aren’t sure if they are allowed to teach about LGBT issues in their school Primary School Staff 39% acknowledge homophobic bullying in their school 61% hear the phrase you’re so gay or that’s so gay as an insult 37% language like faggot, poof, dyke, queer 89% had no training on how to handle homophobic bullying 93% agree that staff have a duty to respond to bullying 32% of staff have heard homophobic language from other staff

Secondary Schools 88% acknowledge pupils are bullied and harassed 83% of staff have had no training Only 47% staff intervene when they hear homophobic language Only 43% believe their head teacher demonstrates leadership around tackling homophobic bullying

Glasgow School Health & Wellbeing Survey Gay boys are three time more likely to have low self esteem than heterosexual boys. Over 40% of bisexual girls have low self esteem, the highest incidence of low self esteem. Lesbian and gay young people are three times more likely to smoke than heterosexual young people. Lesbian and gay young people are twice as likely to drink alcohol once a week or more and have 12% higher rate of weekly drunkenness. Gay boys are drunk once a week or more at rate of more than twice that for heterosexual young people.

Smoking Lesbian and gay young people in Glasgow schools are three times more likely to smoke than heterosexual young people Bisexual young people in Glasgow schools are more than twice as likely to smoke than heterosexual young people oTwo thirds of lesbian and bisexual women have smoked compared to half of women in general. oJust over a quarter currently smoke. oMore than three in five gay and bisexual men in Scotland have smoked at some time in their life compared to half of men in general

Alcohol Lesbian and gay young people in Glasgow schools are twice as likely to drink alcohol once a week or more and have 12% higher rate of weekly drunkenness. Gay boys in Glasgow schools are drunk once a week or more at rate of more than twice that for heterosexual young people. Lesbian and gay adults (34%) and Bisexual adults (27%) are more likely to report hazardous drinking than heterosexual adults (24%) in Scotland Exceeding alcohol daily limits is more common in lesbians and gay men (50%) and bisexual people (49%) compared to the Scottish average (39%) o40% of lesbian and bisexual women drink three times a week compared to a quarter of women in general. 45 % of older LGB people drink alcohol at least ‘three or four days’ a week compared to just 31 % of heterosexual people.

Bisexual Young People (26.4%) and lesbian and gay young people (32.9%) in Glasgow Schools are less likely to meet the physical activity target than heterosexual young people (36.7%) Bisexual Young People (43%) and lesbian and gay young people (33.8%) in Glasgow Schools are less likely to never participate in sports club outside school than heterosexual young people (18.1%) otwo in five (40 per cent) gay and bisexual men meet recommendations for 30 minutes or more of exercise four times or more per week compared to 45 per cent of men in general Physical Activity

Abuse and Violence oLesbian and Gay young people are twice as likely while bisexual young people are three times as likely to experience bullying in Glasgow schools compared to heterosexual young people oOne in four lesbian and bisexual women have experienced domestic violence, the same as women in general. In two thirds of cases, the perpetrator was another woman. oHalf of gay and bisexual men in Scotland have experienced at least one incident of domestic abuse from a family member or partner since the age of 16 oMore than a third of gay and bisexual men have experienced at least one incident of domestic abuse from a partner compared to one in seven men in general oFour in five lesbian and bisexual women have not reported incidents of domestic violence to the police. oThree in four gay and bisexual men who have experienced domestic abuse have never reported incidents to the police.

Sexual Health and Relationships 15% of lesbian and gay young people and 10.9% of bisexual young people in Glasgow schools have no one to talk to about sexual health and relationships 45% of gay or bisexual boys feel they can talk to parents about about sexual health and relationships compared to 50.4% of heterosexual boys in Glasgow schools. 46% of people attending Brownlee for HIV care are men who have sex with men 75% of all newly acquired HIV in Scotland is through sex between men 28% of gonorrhoea in males is through sex between men

Mental Health In Glasgow schools low self esteem is reported by one in four lesbian and gay young people and one in three bisexual young people compared to 14% of heterosexual young people. One in four (26 per cent) LGBT young people in school have attempted to take their own life and more than half (54 per cent) deliberately harm themselves, which can include cutting or burning 40% of LGBT Young People report mental health concerns 63% of bisexual women and 43% of lesbian women report mental health concerns. Only 43% of young women feel safe accessing health services.

Mental Health (II) oOne in five lesbian and bisexual women have deliberately harmed themselves in the last year, compared to 0.4 per cent of the general population. Half of women under the age of 20 have self-harmed compared to one in fifteen of teenagers generally. oFive per cent of women have attempted to take their life in the last year and sixteen per cent of women under the age of 20 have attempted to take their life. ChildLine estimate that 0.12 per cent of people under 18 have attempted suicide. oOne in five women say they have an eating disorder, compared to one in 20 of the general population. oIn the last year, three per cent of gay men and seven per cent of bisexual men in Scotland have attempted to take their own life oOne in sixteen gay and bisexual men aged 16 to 19 have attempted to take their own life in the last year oOne in sixteen gay and bisexual men deliberately harmed themselves in the last year oOne in seven gay and bisexual men aged 16 to 19 harmed themselves in the last year.

Mental Health in Older LGBT People Are more likely to have a history of mental ill health and have more concerns about their mental health in the future. Lesbian and bisexual women are more likely to have ever been diagnosed with depression and anxiety – two in five have been diagnosed with depression, one in three with anxiety. Gay and bisexual men are twice as likely to have ever been diagnosed with depression and anxiety than heterosexual men. 49 per cent of lesbian, gay and bisexual people worry about their mental health compared to 37 per cent of heterosexual people

Mental Health & Trans People o88% had or felt they had depression o80% had or felt they had stress o75% had or felt they had anxiety o53% lifetime self harm prevalence rate, 11% current o84% lifetime suicidal ideation, 27% in the last week o48% lifetime suicide attempts o33% multiple suicide attempts o35% avoided mental health services when in crisis because they were trans o25% will not access mental health services in future o29% said their gender identity was not valued as genuine and seen as symptom of mental illness

Summary Lesbian, Gay, Bisexual and Trans people have markedly poorer health than the rest of the population. The poorest outcomes are in relation to mental health and wellbeing, especially suicidal ideation suicide attempts, self harm, eating disorders as well as higher rates of alcohol use and smoking. These poorer outcomes become apparent from a young age and continue throughout the life course of LGBT people Within LGBT populations Trans people have the overall poorest outcomes Bisexual people also have significantly poorer outcomes than lesbian and gay people It is the experience of discrimination and adverse reactions of others to LGBT identity that have the biggest impact on health and wellbeing This also acts as a barrier to accessing health services or disclosing LGBT identities to health services.