Mind > Information > Factsheets and booklets by subject > Diversity > Lesbians, gay men and bisexuals and mental health

Copyright note for Mind factsheets: Both individuals and organisations are welcome to print and photocopy any complete factsheet from the 'Information' section of Mind's website. Organisations are free to distribute them to service users and colleagues, but must ensure they always use the latest version of the factsheet, as available on the website, at the time of distribution.

The campaigning organisation Stonewall estimates that between five and seven per cent of the UK population is either gay or bisexual. Like many other minorities in our society, gay men, lesbians and bisexual people face discrimination, in schools, workplaces and within the wider community. And gay people may also face violence. Breaking the chain of hate, the National Advisory Group’s 1999 survey of homophobic crime, found that 66 per cent of the 2,500 respondents had been a victim of a homophobic incident, of which only 18 per cent were reported to the police.

This factsheet aims to address some of the mental health issues specific to the lesbian, gay and bisexual communities. A 2003 survey by Mind and University College London showed that gay men and lesbians reported more psychological distress than heterosexual people. And while the idea that homosexuality itself is a mental illness is (gradually) being countered, the gay community still faces discrimination within the mental health system.

People are defined as lesbian or gay men if they are attracted to people of the same gender.

Since the pioneering Kinsey reports into human sexuality in the late 1940s,[2] many now accept the idea that sexual identity is fluid and exists along a continuum. Some are heterosexual or, at the other end of the continuum, homosexual, but most of us are to a greater or lesser extent bisexual. If sexuality is ‘fluid’ in this way, it could be argued that individuals should not ‘fix’ their identities by declaring themselves gay, lesbian or heterosexual. The problem with this position, as Crouan points out, is that it can be used to deny gay persons the power to define themselves and establish an identity.[3]

It can be psychologically important to establish an identity, especially if you belong to a minority group.

‘Homophobia’, which was first used as a concept by the psychologist George Weinberg in the late 1960s, is the hatred, intolerance and fear of lesbian, gay and bisexual people. It has been defined as “The fear of feelings of love for members of one's own sex and therefore the hatred of those feelings in others. The belief in the inherent superiority of one pattern of loving and thereby its right to dominance.” [4]

While there is a need for a word to describe anti-gay attitudes, there are conceptual problems with the term ‘homophobia’. The ‘-phobia’ suffix suggests an irrational fear, something which is beyond our control. But we can recognise our own homophobic attitudes and overcome them – we are all responsible for our own prejudices. And there is the implication that the homophobic person wants to avoid, to remove himself from the object of his fear. But many homophobic people actually seek out gay people to assault and/or harass them.

There are four interrelated types of homophobia: personal, interpersonal, cultural and institutional.

As we grow up we are taught the values of our society. In our homophobic, discriminatory culture, we may learn negative ideas about homosexuality. Like everyone else, gay people may be socialised into thinking that being homosexual is somehow ‘wrong’. This can lead to feelings of self-disgust and self-hatred. This personal form of homophobia is also known as ‘internalised homophobia’.

‘Interpersonal homophobia’ refers to behaviour between individuals. Hatred may be expressed by telling jokes, name calling or even physical violence. Families often pressurise their members to conform to the beliefs deemed to be acceptable. Anything outside this is often rejected. Peers may be uninterested in hearing about relationships between persons of the same sex.

‘Cultural homophobia’ refers to the norms and social values which portray heterosexuality as superior to homosexuality. For example, most mainstream films feature characters in heterosexual relationships.

Many of our social and economic institutions promote heterosexuality as the ‘norm’, as being superior to homosexuality. For example, in terms of inheritance laws, our legal system offers protection to the ‘traditional’ nuclear family, but not to same-sex couples. This is a form of ‘institutional homophobia’.

“We recognise the cumulative effect of discrimination in all our social systems – housing, employment, the judiciary and the mental health services.”

The majority culture has the power to discriminate against gay persons. As shown above, many of our social, economic and cultural institutions are ‘homophobic’ in that they reflect the idea that heterosexual relationships are normal and mainstream, and any other lifestyles are deviant and ‘abnormal’.

Ultimately, the media has the power to decide what information reaches the public and how it is presented. The popular press has been responsible for many instances of negative stereotyping of gay men and lesbians. When homosexuality is portrayed, lesbians, gay men and bisexuals are often stereotyped as sick, unbalanced, unhappy, etc. Lesbians have been portrayed as humourless and ugly. Gay men are characterised as effeminate and weak.

Some religions have taught their followers that certain groups of people are inferior, including lesbians, gay men and bisexual men and women.

The education system helps teach us what our culture considers ‘normal’. From 1986, ‘Section 28’ effectively stopped local authorities providing information on gay issues to school children. This notorious section of the Local Government Act prohibited local authorities in England and Wales from ‘promoting’ homosexuality. The Act prevented “a local authority from giving financial or other assistance to any person for the purpose of publishing or promoting homosexuality as an acceptable family relationship, or for the purpose of teaching acceptability in any maintained school”. It also labelled gay family relationships as ‘pretend’.

While the Act technically only applied to local authorities, it had the effect of making teachers wary of providing any information about homosexually, including homophobic bullying and abuse. After a sustained public debate, Section 28 was overturned by the Labour Government in 2003.

While our legal system continues to reflect the idea that heterosexuality is the ‘norm’ and to uphold the ‘traditional’ nuclear family, there have been some significant recent changes in legislation which have increased the recognition and rights of gay people.

Until relatively recently, it was a criminal offence to be in a male gay relationship. In 1885 all gay male relationships were declared illegal. Many gays served time in prison and there were many cases of blackmail. In 1957, the report of the Wolfenden Committee recommended the decriminialisation of male gay relationships. Some of the recommendations were brought into law a decade later in the 1967 Sexual Offences Act. For the first time, men over 21 were permitted to have sexual relationships with each other.

The Wolfenden Report and the resulting Sexual Offences Act 1967 did not refer to lesbians. In fact, lesbians have never been directly legislated against and relationships between women have never been officially illegal. However, the absence of legislation did not mean that lesbian relationships were more socially acceptable.

The age of consent for gay men remained at 21 (compared to 16 for heterosexuals) until 1994, when it was lowered to 18 after a fierce debate in the Commons and Lords. In 1999, the Labour Government introduced a Sexual Offences Bill equalising the age of consent. This was passed in the Commons, but was defeated in the House of Lords. The Government decided to use the Parliament Act, which gives the Commons the power to pass Bills that have been defeated in the Lords. A new Sexual Offences Act was passed and the equal age of consent became law in January 2001.

Gay persons still face legal discrimination if they are in long-term relationships. Unlike heterosexual couples, if one dies the other may have no pension rights, may have problems inheriting property and will have no status as next of kin. The new Civil Partnership Act 2004 will give some limited recognition under the law to same-sex couples. From autumn 2005 (at the earliest), same-sex couples will be able to register as ‘registered civil partners’. Among their new rights and responsibilities, the couple will have the right to a joint state pension, parental responsibility for each other’s children, will be able to claim a survivor pension and will be recognised under inheritance rules.

Historically, lesbians, gay men and bisexual people have had no legal recourse if they have, for example, been dismissed from a job because of their sexuality. There is, as yet, no parallel to the Race Relations Act or the Sex Discrimination Act. This may change with the introduction in 2006 of the new Single Equality Commission, which will have responsibility for tackling discrimination on the grounds of sexuality as well as religion, race, age, sex and disability.

Many of us belong to several different communities. We may identify ourselves as being Black, gay and a woman, for example. As a result we may experience discrimination at several levels, perhaps racism and homophobia. This is known as ‘multiple discrimination’.

Lesbian, gay and bisexual young people face particular problems. They may not have access to information about their sexuality. At an age where conformity and acceptance is important, they may try to conceal their sexuality from their family and friends to avoid rejection. They may have already internalised a negative self-image and find it hard to accept themselves.

Young people who identify themselves as lesbian, gay or bisexual have been found to be more susceptible to bullying at school. A 1997 London survey of young gay, lesbian and bisexual people under 25 found that verbal abuse was common: nearly 90 per cent of females and 80 per cent of males reported verbal abuse. Nearly half of these incidents took place in an educational institution.[5]A study in 2001 found that 82 per cent of gay men, lesbians and bisexuals had been verbally abused, and 60 per cent reported being physically attacked during their time at school. In the same study, 53 per cent of those participants who had been bullied had contemplated self-harm or suicide as a result of the violence experienced.[6]

The experience of being bullied has a variety of effects on academic performance and future mental health. Ian Rivers has conducted research into bullying and its subsequent effects on the mental health of gay and lesbian young people. Fifty three per cent of participants said that they had contemplated self-harm as a result of being bullied. Forty per cent indicated that they had attempted self-harm or suicide on at least one occasion.[7] In later life, some of those bullied said that they experienced nightmares or flashbacks related to the bullying. Others said that they tended to avoid social situations or large gatherings for fear of experiencing a panic attack.

Jan Bridget of the Lesbian Information Service has reviewed British and American research on lesbian and gay youth suicide. Her analysis reveals that lesbian and gay young people are up to six times more likely to attempt suicide than heterosexual youth, with the highest rates of suicide among those who are isolated from support.

The term 'older' actually embraces several different generations. Some people like to identify themselves as 'older' and others do not. The issues facing a 40-year-old lesbian or gay man are likely to be different from those relevant to a person of 80. Rigid categorisation can be disempowering and unhelpful.

Some older lesbians and gay men may have been subjected to psychiatric treatment in the past in an attempt to 'cure' them. This may have left them with a legacy of guilt and emotional damage. Many others will have stayed 'closeted' throughout their lives. Others were active with the gay liberation movement and the women's movement.

Ageism within society has meant that older people are generally seen as unattractive and socially boring. The 'gay scene' is no exception and is more often than not geared towards younger people. Despite the lack of social opportunities generally, some older lesbians and gay men have long-established support networks. Others will be more isolated, perhaps due to the deaths of partners and friends, lack of mobility, or simply because they have lost touch with others.

Some organisations working with older people fail to take into account the fact that a service user may not be heterosexual. Sheltered housing and residential care is usually mixed-sex and geared towards heterosexuals, driving some older lesbians and gay men to get together to discuss the alternatives.

Black lesbians and gay men face double oppression because of their race and their sexuality. Some feel they have been forced to choose between the gay and the Black and minority ethnic cultures. Black communities can be homophobic, in the same ways white ones can be.

Anne Hayfield points out that when homophobia occurs within Black communities this can mean that an individual is cut off from support networks of family and friends, which are important to enable a person to develop a positive Black identity and to counter the racism faced on a daily basis. Black lesbians and gay men therefore have to consider the importance of 'coming out', weighing the possible loss of family and community support against the gains.[8]

Black lesbians, gay men and bisexual women and men also face discrimination from organisations that exist to support them. It seems that Black issues are often ignored within political/campaigning groups and in social/support groups, as well as out on the 'scene'. Anne Hayfield claims that Black lesbians have often been refused admission to lesbian spaces and have been subjected to racism from white lesbians.[9]

Quibilah Montsho, a Black lesbian poet and survivor who was wrongly diagnosed as mentally ill and forced into hospital against her will, believes that as many as 60 per cent of Black lesbians in this country have had, or will have, some experience of the mental health system. She says that it is impossible for a Black lesbian to complain of sexism, racism and/or homophobia in a psychiatric setting because complaining may be interpreted as an aspect of paranoid psychosis. This psychosis is seen to be suppressible, either by increasing the dosage of medication or prescribing additional drugs. In these circumstances it is unlikely that a Black person will feel safe to 'come out' within the mental health services. Montsho also makes the point that because of language and cultural differences the service user/survivor can be misunderstood and further labelled as defensive or uncommunicative.[10]

Lesbians, gay men and bisexual women and men with disabilities, like all people with disabilities, are not expected to have any sexuality at all, let alone an attraction to people of the same sex. Disabled people have generally been pressurised to play down their sexuality, both in wider society and in residential settings. Where the issue of sexuality is raised, most people with disabilities are assumed to be heterosexual.

Of course, the gay community is also affected by the discrimination against disabled people that exists in society generally. Gay people are also responsible for sometimes regarding people with disabilities as asexual and genderless. Gay, lesbian and bisexual events and venues are often difficult to access for people with disabilities.

Some lesbians, gay men and bisexuals may be dependent on heterosexual carers. This makes the process of declaring their sexuality risky. Some individuals rely on vital support networks and may be afraid of losing this support because of homophobia. This places considerable pressures on the individual.

Some gay men encounter fear, harassment and/or discrimination on the grounds that they could be HIV positive or have AIDS. There is a common myth, encouraged by sections of the media, that most gay men are HIV positive. The reality across the world is that HIV is predominantly affecting heterosexual people, although in the West, gay men have been the first to develop HIV-related illnesses in significant numbers.

Since the early 1980s, HIV and AIDS organisations have paid particular attention to the emotional needs of people with HIV and AIDS. The Terrence Higgins Trust, for example, runs a helpline and offers counselling for anyone 'with or concerned about HIV or AIDS’. Some mental health professionals have specialised in the mental health needs of people with HIV and AIDS. Such services have generally had a strong input from gay men and are less likely than mainstream mental health services to be discriminatory.[11] The impact of AIDS has also raised awareness of the need for bereavement support that acknowledges the grief of gay partners and friends.[12]

There is no doubt that, within our culture, discriminated groups are over-represented within the mental health system. Black women, working class women and young Black men, for example, are far more likely to be given neuroleptic drugs and ECT than white, middle class professionals.

The issue of minority communities and mental health is a complex one. There is no doubt that the mental health system continues to discriminate, and that people from the minorities are more likely to be labelled as being ‘mentally ill’ because they may not conform to what the majority culture believes is ‘normal’. The majority culture has, after all, the power to define mental illness. But, at the same time, the experience of being discriminated against can contribute to mental distress.

(The following is adapted from Sayce. 1995, Breaking the link between homosexuality and mental illness: an unfinished history, Mind.)

Pre World War II: professional literature viewed homosexuality as an illness caused by problems in early development.

1930s: in Germany repression of homosexuality included re-educating gay men and lesbians into heterosexuality, through psychology. Many were sent to concentration camps.[13]

1951: last known example of lobotomy (psychosurgery) used to treat homosexuality in the USA.[14] But hospitalisation and other treatments, like aversion therapy, remained common throughout the 1960s and beyond.

1957: Dr Evelyn Hooker published research showing that gay men could not be distinguished from heterosexual men on the basis of psychological tests such as Rorschach. Gay men were “within the normal range psychologically”. Her research was met with ridicule and disbelief by many mental health professionals.[15]

1960: research by Armon showed there was no greater pathology or immaturity in lesbians than in other women.[16]

1967: homosexual relations between men over 21 in private was decriminalised in England, following the Wolfenden Report.

1969: the birth of the Gay Liberation Front (GLF) following rioting in response to a police raid on the Stonewall gay bar in New York. Gay and women's rights campaigners argued for de-classifying homosexuality as a mental illness.

1970s: professional literature lagged behind the idea that homosexuality per se was not a mental illness. In 1975 The British Medical Journal included an article discussing the potential of different ‘treatments’ for homosexuality and therapy to “mobilise the heterosexual elements”.[17]

1971: the Gay Liberation Front in the UK published a manifesto which listed psychiatry among gay people's oppressors.[18]

1973: the American Psychiatric Association declassified homosexuality as a mental disorder – but replaced it with 'egodystonic homosexuality', where people had disturbance or confusion about their sexuality. The World Health Organization did not de-classify homosexuality as a mental illness until 1992.

1974: formation of Gay Switchboard, later called Lesbian and Gay Switchboard.

1980s: development of self-help by and for people infected or affected by HIV/AIDS. Much activity was by gay men and also lesbians. Birth of organisations such as the Terrence Higgins Trust, London Lighthouse and Body Positive, which pioneered dealing with the trauma of AIDS and addressing the emotional needs of gay men.

1984: European Parliament adopts the Squarcialupi Report, recommending equal rights for lesbians and gay men, including rejection of the “classification of homosexuality as a mental illness”.

1986: ‘Section 28’ of the Local Government Act makes it illegal for local authorities to ‘promote’ homosexuality.

1988: the American Psychiatric Association removes egodystonic homosexuality from its classification system.

1992: the Vatican puts out a statement describing homosexuality as an “objective disorder”.

1993: Department of Health (DoH) publishes Health of the nation key area handbook: mental illness, which includes the first reference to lesbian and gay mental health issues in DoH policy.[19] A DoH leaflet says that those at risk of suicide include people “whose sexual orientation brings them into conflict with their family or others.”[20] The Government decides to strike homosexuality off its central computer list of psychiatric disorders.[21]

Islington Mind sets up a support group for lesbians and gay men who have used mental health services. Other local Mind groups set up lesbian and gay counselling services (for example, Greenwich, Waltham Forest).

1994: An attempt to equalise the age of consent for homosexual and heterosexual sex fails. It is lowered to 18, not 16.

Research by Ellis confirms that openly gay or lesbian people are not accepted to train as therapists or analysts in some British training institutions.[22]

1995: Mental Health Foundation funds two projects focusing on lesbian and gay mental health issues: LYSIS and 42nd Street.

Islington Mind hosts a day for lesbians and gay men who have experienced mental distress. The outcome is a proposal for a network of lesbian and gay users of mental health services, which could be affiliated to Survivors Speak Out and Mind Link (Mind's user network).

Mind organises a conference in London 'Prejudice and pride: exploring gay, lesbian and bisexual mental health'.

1996: Mind begins Without prejudice: lesbian, gay and bisexual mental health awareness project. The project has several components: a conference; a research project aimed at uncovering the experiences of lesbians, gay men and bisexuals within mental health services; the production of training materials and a series of nation-wide training events aimed at purchasers and providers of 'mainstream' mental health services.

1998: a Bill aiming to lower the age of consent for homosexual sex to 16 (to bring it in line with that for heterosexual relations) was defeated in the House of Lords.

2001: a research team at the Royal Free Hospital in London embarked on a large-scale lesbian and gay research project.

Age of consent equalised to 16, after the Parliament Act was used to introduce a new Sexual Offences Act.

2003: ‘Section 28’ of the Local Government Act taken off the statute book.

Mind and University College London publish the findings of a large-scale survey of the experience of gay, lesbian and bisexual people of the mental health system. [23]

2004: Civil Partnership Act sets up ‘registered civil partnerships’, which will give limited rights to same-sex couples.

There is a history of homosexuality itself being labelled as a mental illness. As shown above, the Government did not strike homosexuality off its central computer list of psychiatric illnesses until 1993. Although blatant examples of bigoted, misinformed theory are no longer common in psychiatric writing, evidence shows that homosexuality continues to be referred to as a mental disorder in some psychiatric texts, and anecdotal evidence shows that homosexuality continues to be thought of as a mental illness per se by society in general and by some mental health professionals.

A recent edition of The Oxford textbook of psychiatry, for example, discusses homosexuality under the heading of 'problems of sexuality and gender'. In a section entitled 'Helping the homosexual', the authors discuss various techniques for curing homosexual people by “developing heterosexual behaviour patterns by methods similar to those for the treatment of sexual dysfunction.”[24]

Another major concern relates to the theoretical models used to underpin counselling and psychoanalytic training. While not labelling homosexuality a mental illness, some approaches perpetuate the belief that only heterosexuals can reach emotional maturity. Freud, for example, described lesbians as immature women at a lower point in development, and believed homosexual women rejected femininity and wanted to be masculine.

There is no doubt that lesbians, gay men and bisexual women and men face discrimination within the present day mental health system – as users, carers and professionals. The 2003 Mind/University College London report on the mental health of lesbian, gay men and bisexual people found that up to 36 per cent of gay men, 26 per cent of bisexual men, 42 per cent of lesbians and 61 per cent of bisexual women recounted negative or mixed reactions from mental health professionals when being open about their sexuality.

Mind’s 1997 report Without prejudice also exposed the discrimination and prejudice that lesbians, gay men and bisexual men and women receive within mental health services. Of the 55 people surveyed, 73 per cent “…reported actual experiences of prejudice, discrimination, harassment and even physical and sexual violence or rape.”[25] The report confirmed that many people find that their doctors or therapists see their sexual orientation as the problem or cause of their mental distress. A 1998 report by PACE (The Project for Advice, Counselling and Education) Diagnosis: homophobic – the experiences of lesbians, gay men and bisexuals in mental health services produced similar findings.

To take just one aspect of the mental health system – there is evidence that the declassification of homosexuality as a mental illness has had very little effect upon the attitudes and practice of counsellors and therapists. Lyndsay Man reports that between 25-65 per cent of gay people seek counselling at some stage of their lives, and up to 50 per cent of these individuals report discontent with their experiences.[26] It has been suggested that this dissatisfaction stems from counsellors' negative prejudicial attitudes toward, and lack of understanding of, homosexuality. Other research shows that up to a third of counsellors have negative attitudes towards lesbians and gay men.[27]

Counsellors and psychotherapists do not exist in isolation – they are part of the broader society in which we all live. They are not, therefore, immune from the discriminatory attitudes and values held within society and may bring these attitudes into their counselling or psychotherapy practice, whether they are aware of it or not.

Lyndsay Man found that although all of the counsellors she surveyed had worked or were working with lesbian and gay clients, none had received any specific training related to counselling these clients. She suggests that, prior to working with lesbians and gay men, counsellors need to work through their own attitudes, myths, stereotypes and sexual feelings (both attractions and aversions) towards persons of the same or opposite sex. She believes that, in order to work effectively with lesbians and gay men, counsellors need to be aware of how the values and beliefs of their client differ from their own. If they cannot respect these differences they should not be in a position to offer a service.[28] As Crouan points out, counsellors should aim to develop congruence, unconditional acceptance and empathy with all of their clients.[29]

It should be recognised that mental distress can be caused by many factors unconnected with sexuality. But gay people do face particular psychological pressures living in a discriminatory, heterosexist society. Internalised homophobia, with associated feelings of low self-esteem and self-hatred, can specifically lead to emotional distress. Being gay is not in itself a mental health problem, but coping with the effects of discrimination can be highly detrimental to lesbian, gay and bisexual mental health.[30]

The evidence does suggest that higher than average numbers of lesbian, gay men and bisexual people have tried to kill themselves, that many suffer from depression, and that many misuse substances. As shown above, young lesbians and gay men are particularly at risk of suicide.[31]

A Health Education Authority mental health promotion on ‘sexual identity’ states that: “Some studies have suggested that internalised homophobia is a risk factor for alcohol and drug dependency. Anxiety, depression, self-harm, suicide and attempted suicide have all been linked with the combined effects of the experience of prejudice and discrimination and internalised negative feelings.” [32]
A Department of Health leaflet states that those at increased risk of suicide include people “whose sexual orientation brings them into conflict with their family or others”.[33]

Levels of substance abuse in the gay population are high. Statistics suggest that alcoholism affects the gay community at a rate of 20-33 per cent, which far exceeds the general population rate at 10 per cent. Reasons suggested for this include the problems of dealing with societal oppression, using alcohol and drugs as a means of coping with depression, and the pivotal role of bars in gay social networks.[34]

Lesbians, gay men and bisexuals may decide to challenge internalised homophobia, increase their self-esteem and develop healthier ways of dealing with oppression. Gay organisations have highlighted the importance of the process of ‘coming out’ – coming to terms with your own sexuality as a gay man, lesbian or bisexual person. Not only does coming out lead to greater self-acceptance and self-esteem, but the visibility of increasing numbers of gays, lesbians and bisexuals will have a wider impact, challenging the stereotypes and prejudices of society.

Stonewall outline a five-step process towards coming out on their website (www.stonewall.org.uk). It also gives a list of organisations that may be able to help.

Mind is campaigning, along with other groups, to highlight mental health issues faced by lesbian, gay men and bisexual people.

Following the 1997 Without prejudice report, Mind produced Mind’s policy on lesbians, gay men, bisexual women and men and mental health. The proposals include:

A series of guidelines have been produced covering how to implement this policy.

The findings of the 2003 Mind/University College London report are specifically being used to call for the better training of mental health professionals on the needs of the gay, lesbian and bisexual community. In particular, Mind is calling for more professional training on how concerns about same-sex attraction can often spur people towards self-harm and suicide. A summary of the main recommendations of the report is available on the Mind website.

[1] Garnets, L. & Kimmel, D. 1991, ‘Lesbian and gay male dimensions in the psychological study of human diversity’, in J. Godchild (ed) Psychological perspectives on human diversity in America: master lectures, Washington DC, American Psychological Association, pp.143-192.

[2] Ibid.

[3] Crouan, M. 1996, ‘Pushing against the wind: the recognition of lesbians in counselling training’, in Journal of the British Association for Counselling, vol.7, no.1.

[4] Lorde, A. 1984, Sister outsider, California, The Crossing Press.

[5] GALOP 1997, Homophobic violence youth survey, London.

[6] Rivers, I. 2001, ‘The bullying of sexual minorities at school’ in Educational and Child Psychology, vol. 18 (1) pp.32-46.

[7] Rivers, I. 1997, The long-term impact of peer victimisation in adolescence upon the well-being of lesbian, gay and bisexual adults, paper presented at the Psychological Society of Ireland’s Annual Conference, Ireland, 13-15 November 1997.

[8] Hayfield, A.1995, ‘Several faces of discrimination’in Valerie Mason-John (ed) Talking black: lesbians of African and Asian descent speak Out, Cassell, pp.186-206.

[9] Ibid.

[10] Montsho, Q. 1995, ‘Behind locked doors’ in Valerie Mason-John (ed) Talking black: lesbians of African and Asian descent speak out, Cassell.

[11] Sayce, L. 1995, Breaking the link between homosexuality and mental illness: an unfinished history, a Mind discussion document.

[12] Ibid.

[13] Grau, G. 1995, Hidden holocaust? Gay and lesbian persecution in Germany 1933-45, Cassell.

[14] Falco, K. 1991, Psychotherapy with lesbian clients: theory into practice. Brunner Mazel.

[15] Hooker, E. 1957, Journal of Protective Techniques 21.

[16] Armon, 1960, cited in Falco, K. 1991, Psychotherapy with lesbian clients: theory into practice. Brunner Mazel.

[17] Hyatt Williams,A.1975, ‘Problems of homosexuality’ inThe British medical journal, 16 August.

[18] Mason M. 1994, ‘Out of the closets onto the streets: gay men's history’ inHealey & Mason (eds) Stonewall 25, Virago.

[19] Department of Health 1993, Health of the nation key area handbook: mental illness.

[20] Department of Health 1993, Sometimes I think I can't go on anymore.

[21] Capital Gay8 January 1993.

[22] M Ellis quoted in The Independent on Sunday 21 August 1994.

[23] Mind 2003, Mental health and social wellbeing of gay men, lesbians and bisexuals in England and Wales, Mind.

[24] Gelder, M. Gath, M. & Mayou, R. 1989, Oxford textbook of psychiatry, Oxford University Press. pp. 556-562.

[25] Golding, J. 1997, Without prejudice: Mind lesbian, gay and bisexual mental health awarenessresearch. Mind, p.17.

[26] Man, L. 1994, ‘Working with lesbian and gay clients’ in Journal of the British Association for Counselling, vol 5, no 1.

[27] Rudolph,J. 1988, ‘Counsellors' attitudes towards homosexuality: a selective review of the literature’ in . Journal of counselling and development, vol 67.

[28] Man, L. Op Cit.

[29] Crouan, M. 1996, ‘Pushing against the wind: the recognition of lesbians in counselling training’ in Journal of the British Association for Counselling, vol.7, no.1.

[30] Sayce, L. 1995, Breaking the link between homosexuality and mental illness: an unfinished history, a Mind discussion document.

[31] Bridget, J. 1994, Treatment of lesbians with alcohol problems in alcohol services in north west England. Lesbian Information Service.

[32] Health Education Authority 1998, World Mental Health Day, ‘Sexual identity’.

[33] Department of Health 1993, Sometimes I think I can’t go on anymore.

[34] Herbert, Hunt & Dell 1994, “Counselling gay men & lesbians with alcohol problems” Journal of Rehabilitation (USA)