Lesbians, gay men and bisexuals and mental health

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Introduction

Definitions

Mental health of LGB people

Effects of homophobia and heterosexism on mental health
Introduction
Internalised homophobia
Interpersonal factors
Cultural factors
Institutional homophobia
Legislative change

The impact of homophobia

LGB experiences of mental health services
Homosexuality as a 'mental illness'
Discrimination in mental health services
LGB-friendly services

Other diverse groups
Introduction
Young people
Older people
Black and minority ethnic people
People with disabilities
People with HIV/AIDS

Taking action
Introduction
‘Coming out’
Information and support services
Social opportunities

Further reading

Useful organisations

References

Introduction

This factsheet is for lesbians, gay men and bisexuals (often referred to using the collective initials LGB; see below), especially those with experience of mental distress. It may also be of interest to the friends and family of LGB people, to students and to people who work in public, voluntary and community services.

This factsheet provides information on the types of mental distress experienced by LGB people, the social factors that affect their mental health, and the experiences of LGB people in mental health services. The final section describes ways that LGB people can develop and maintain good mental health in the context of a positive sexual identity.

This factsheet does not cover transgender or gender identity issues. Mind produces a separate online booklet, Understanding gender dysphoria, which includes a list of useful organisations.

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Definitions

'Sexuality' or 'sexual orientation' describes the combination of emotional, romantic, affectionate and sexual attraction towards another person. Lesbians and gay men experience this attraction towards members of their own sex; bisexuals experience this attraction towards members of both sexes. It is estimated that 5–7 per cent of people in the UK are lesbian, gay or bisexual. [1]

Although the initials 'LGB' are used by service providers and government policy makers to refer collectively to people who are lesbian, gay or bisexual, people whose sexuality is defined under this term are not a homogeneous group. The attitudes, values and degree of shared identity within and between lesbians, gay men and bisexuals varies widely.

Many people who experience same-sex attraction reject the terms 'lesbian' or 'gay' and chose to define their sexuality by other terms. Some people chose not to define their sexuality at all and identify as 'label free'. More information about these issues can be obtained from the LGB campaigning organisation Stonewall (see ‘Useful organisations’).

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Mental health of LGB people

Little is known about the mental health of LGB people in the UK. Information is not collected at national level, and health authorities are not required to monitor the sexuality of service users. However, several studies have been carried out in recent years by statutory mental health services, as well as by voluntary and community organisations such as Mind. [2]

The available evidence suggests that anxiety, depression, self-harm and suicidal feelings are more common among LGB people than among heterosexual people. Rates of drug and alcohol misuse are also higher among LGB people. In all studies, bisexual men and women were usually found to have the highest levels of mental distress. [3] [4]

These findings reflect those of a recent review of international literature on the mental health of LGB people. [5] This review showed that LGB people are at significantly higher risk than heterosexual people of suicidal feelings, self-harm, drug or alcohol misuse and having a mental health problem. The findings were generally similar for men and women; however, lesbian and bisexual women were at particular risk of suicidal feelings and drug or alcohol dependence, while gay and bisexual men were over four times more likely than heterosexual men to attempt suicide.

The reasons for these findings are complex and not yet fully understood. However, poor mental health in LGB people has often been linked to experiences of homophobic discrimination and bullying; [6] this is explored later in this factsheet.

LGB people, like heterosexual people, can experience mental distress for reasons unconnected with their sexuality. However, it is widely accepted that a range of social factors can affect the lives of LGB people and are likely to have an impact on mental health. For some, other personal and social characteristics such as age or ethnicity can further complicate an experience of mental distress. These issues are discussed later in this factsheet.

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Effects of homophobia and heterosexism on mental health

Introduction
Social factors that adversely affect the mental health of LGB people have their roots in homophobia or heterosexism.

• Homophobia has been defined as 'the irrational hatred, intolerance and fear of LGB people.' [7] 
• Heterosexism is 'bias shown by a society or community where cultural institutions and individuals are conditioned to expect everyone to live and behave as heterosexuals.' [8] 

While homophobia can cause the most obvious harm to LGB people, such as bullying and violent attacks, heterosexism can cause more subtle damage to self-image and self-esteem. Most societies, including those in the UK, are homophobic and heterosexist to varying degrees, although there is evidence that this situation has been improving in the UK in recent years, and continues to do so.

Internalised homophobia
LGB people who are brought up in a homophobic society can come to believe these homophobic ideas, and develop negative feelings towards their own sexuality. This is known as 'internalised homophobia' and can result in low self-esteem and feelings of self-hatred. [9] Internalised homophobia is likely to have serious adverse effects on mental health.

Interpersonal factors
'Interpersonal homophobia’ refers to behaviour between individuals. Homophobia may be expressed through jokes, verbal bullying or even physical violence. Examples of interpersonal homophobia include negative attitudes from staff in customer service environments, homophobic bullying in schools and homophobic 'hate crime'.

Cultural factors
'Cultural homophobia’ refers to the ways in which homosexuality is either ignored or presented negatively throughout a culture. Homophobic beliefs and values are transmitted through traditional rules and rituals (such as the marriage ceremony in its religious context), through literature and the arts, and through the mass media, including television and film. Mainstream culture has been predominantly homophobic and heterosexist. Research by Stonewall in 2005 revealed that LGB people were under-represented on the BBC and were most likely to be used as the subject of a joke or portrayed in a negative way. [10] However, in recent years LGB people have gained more positive visibility in the mainstream media through films such as Brokeback Mountain and several prime-time television programmes.

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Institutional homophobia
Many of our social and economic institutions have a history of promoting heterosexuality as the norm, running services and developing policies that do not take account of the needs of LGB people. Where LGB people have been recognised, their sexuality has often been seen as inferior or morally wrong. The legal system, the armed forces, public services, including health and education, and many religions have histories of institutionalised homophobia.

Legislative change

Organisations in the LGB sector have been campaigning against institutional homophobia for many years. More recently, the issue has been recognised by many institutions themselves, and action has been taken to improve the situation. The following key pieces of legislation have been developed.

Repeal of Section 28 (2003)
Section 28 of the Local Government Act (1988) made it illegal for teachers to 'promote' homosexuality in schools, and labelled gay family relationships as 'pretend'. The repeal of Section 28 gives scope for LGB issues to be accorded the same status as other personal and social issues within the education system.

Employment Equality (Sexual Orientation) Regulations (2003)
This Act protects people in the workplace from discrimination relating to their sexual orientation. It covers the full range of workplace issues, from terms and conditions and pay to recruitment and dismissal.

Civil Partnership Act (2004)
Since this Act came into force in 2005, same-sex couples have been able to register as civil partners and gain the same legal rights and responsibilities as married couples. This includes pensions and inheritance rights, and 'next of kin' status under the Mental Health Act. Further information about the Mental Health Act is provided in the Mind booklet The Mental Health Act 1983 – an outline guide.

Sexual Orientation Regulations (2007)
This Act protects people from discrimination relating to sexual orientation by any provider of goods or services. The regulations cover all sectors (public, private and voluntary) and include services as diverse as healthcare, housing, finance and leisure.

More information on anti-discrimination legislation and how it is being applied can be obtained from Stonewall (see ‘Useful organisations’).

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The impact of homophobia

Being lesbian, gay or bisexual is not in itself a mental health problem; however, coping with the effects of homophobia can be highly detrimental to the mental health of a lesbian, gay or bisexual person.

Over the past ten years, studies have suggested that internalised homophobia (defined above) is a risk factor for alcohol and drug dependency among LGB people. Anxiety, depression, self-harm, suicide and attempted suicide have also been linked with the combination of prejudice or discrimination and internalised negative feelings. [11]

A study by Imperial College London in 2004 demonstrated a possible link between levels of homophobic discrimination and mental ill-health among LGB people. Researchers found that the incidence of mental distress, including anxiety, depression and self-harm, was higher than average among the LGB participants. The majority of this sample (83 per cent) had experienced damage to property, physical attacks or verbal bullying. [12]

Research by Stonewall has highlighted the association between homophobic bullying and mental ill-health, including low self-esteem, fear, stress and self-harm, [13] and the organisation is currently campaigning to address the problems of homophobic bullying and discrimination in schools.

Research from Stonewall focusing specifically on the health of lesbians and bisexual women has found rates of self-harm, suicide attempts and eating disorders are significantly higher than those found among heterosexual women. The same report drew attention to widespread discrimination and negative attitudes towards lesbians and bisexual women within health services. Examples included inappropriate comments from healthcare professionals and unwelcoming attitudes to same-sex partners. [14]

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LGB experiences of mental health services

Homosexuality as a 'mental illness' [15]
For most of the twentieth century, LGB people who were open about their sexuality experienced oppression and abuse within mental health services. This occurred partly because mental health services reflected the homophobia of the wider society, but also because such homophobia was given legitimacy within psychiatry and psychology by theories of mental illness that ‘pathologised’ homosexuality. Homosexuality could be seen as the cause or effect of a mental illness, or even as a mental illness in itself. LGB people were subjected to damaging attempts to 'cure' them of their sexuality, including hospitalisation and aversion therapy. Such treatments remained common throughout the 1960s and 1970s. The Government did not officially strike 'homosexuality' off its list of psychiatric disorders until 1993.

Discrimination in mental health services
Fortunately, such pathologising of homosexuality and overt discrimination against LGB people is rare nowadays. However, some problems remain. LGB people who have used statutory mental health services and counselling or psychotherapy services outside the NHS continue to experience discrimination relating to their sexuality. Such discrimination is likely to be the result of a lack of awareness among practitioners and service providers rather than an intention to discriminate. [16]

A study by Mind and University College London [17] found that the main issues for LGB people in mental health services are:

• encountering mixed or negative reactions when being open about their sexuality with health professionals
• a lack of empathy around sexuality issues on the part of health professionals
• visible discomfort on the part of health professionals, and deliberate attempts to avoid discussing sexuality
• the assumption that all service users are heterosexual
• the assumption that being gay, lesbian or bisexual must be a problem for LGB service users
• a minority of health professionals still make a causal link between homosexuality and mental ill health
• a minority of health professionals still display overt homophobia.

The British Association for Counselling and Psychotherapy (BACP) has conducted a literature review of the experiences of lesbian, gay, bisexual and transgender people who have received counselling or psychotherapy services. The review identified gaps in knowledge and negative attitudes among some therapists, and BACP recommends that these problems should be addressed and part of therapists' training. [18]

Research from Stonewall focusing specifically on the health of lesbians and bisexual women found discrimination and negative attitudes towards lesbians and bisexual women within health services. Examples included inappropriate comments form healthcare professionals and unwelcoming attitudes to same-sex partners. [19]

In 2006, the annual census of inpatient mental health facilities in England and Wales [20] included a question on sexuality for the first time. However, it is believed that the results of this census under-represent the actual number of LGB people on inpatient wards – reflecting the reluctance of some LGB patients to disclose their sexuality, and discomfort among ward staff in asking the question. [21]

As described in the section ‘Sexual Orientation Regulations’, LGB people are now legally protected from discrimination relating to their sexual orientation from providers of goods and services; this includes providers of mental health services. However, evidence suggests that legislation has not yet led to the cultural change that would bring about full equality for LGB people in mental health services.

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LGB-friendly services
Some LGB people who seek counselling or psychotherapy services wish to choose a practitioner who identifies themselves as lesbian, gay or bisexual, or who has stated that they have a positive attitude towards LGB issues. [22]

Local LGB-friendly counsellors or therapists can be found in local directories if there is an LGB information and support service (often called a 'switchboard') in the area. Alternatively, national services, such as MindinfoLine or the London Lesbian and Gay Switchboard (LLGS; see ‘Useful organisations’) can help. In addition, the organisation Pink Therapy provides a list of counsellors and therapists who either identify as lesbian, gay or bisexual, or who have adopted a positive approach to working with sexual or gender minority clients; see 'Useful organisations' for contact details.

Local LGB groups or services may be able to recommend individual counsellors and therapists based on their members' personal experiences.

It has also been noted that counsellors and therapists who specialise in sexuality or sexual identity are likely to be positive towards LGB issues.

As when choosing any counsellor or therapist, it is important to check that the practitioner is registered with a relevant professional association such as the British Association of Counselling and Psychotherapy (BACP). General information on choosing a counsellor or therapist can be found in the Mind booklet Understanding talking treatments.

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Other diverse groups

Introduction
Everyone has personal and social characteristics that can affect their private lives and their treatment in society. Some of these characteristics are temporary (such as age), while others (such as ethnicity) stay with us for life. Our awareness and experiences of being part of any social group is likely to change over time.

In addition to being lesbian, gay or bisexual, LGB people may find that other characteristics such as age, ethnicity or other health issues can affect their mental health or complicate an experience of mental distress.

Like LGB people, people from other diverse groups are now protected by law against discrimination on the basis of age, disability, gender, race/ethnicity, religion and sexual orientation. Currently, different groups experience different levels of protection under law, though there are currently moves to rationalise the law and give all groups equal protection. More information on equality and diversity issues can be obtained from the Equality and Human Rights Commission (see ‘Useful organisations’).

Young people
Young LGB people may 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 already experience 'internalised homophobia' and find it hard to accept their sexuality.

Young people who identify themselves as lesbian, gay or bisexual have been found to face a higher risk of being bullied at school. Recent research by the campaigning organisation Stonewall found that almost two-thirds (65 per cent) of lesbian, gay or bisexual pupils had experienced homophobic bullying in school; this figure was 75 per cent for faith schools. Such bullying has a powerful negative effects on pupils' health and wellbeing. Among LGB adults who had been bullied at school, 50 per cent had contemplated suicide or self-harm. [23]

More positively, the combination of legislative change, the increased visibility of LGB people in the mainstream media and the availability of new communication technologies has given young LGB people unprecedented opportunities for social contact and support. Age-appropriate services now exist across England and Wales for LGB people seeking information, advice, support and the opportunity to meet other LGB people.

Local directories will list any local LGB information and support service (often called a 'Switchboard') operating. Alternatively, you can contact a service with national coverage, such as MindinfoLine or the LLGS (see ‘Useful organisations’).

Older people
The term 'older' embraces several different generations. Some people like to identify themselves as 'older' and others do not. The issues facing a 50-year-old lesbian or gay man are likely to be different from those relevant to a person of 80 years. 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, which may have left 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 often depicted as unattractive and socially boring. The 'gay scene' is no exception and is mostly geared towards younger people.

Despite the lack of social opportunities generally, some older lesbians and gay men have long-established support networks. In addition, a number of organisations at both local and national level provide social opportunities, information, advice and support specifically for older LGB people. Moreover, the new communication technologies such as social networking sites can be just as useful to older as to younger LGB people.

Some organisations that work with older people fail to take into account the fact that a service user may not be heterosexual. Sheltered housing and residential care are usually mixed sex and are geared towards heterosexuals. However, some of the main national organisations that work for older people have now publicly recognised their LGB members and service users. Two examples are The Alzheimer's Society, which now runs a telephone support service for lesbian, gay, bisexual and transgender carers, [24] and Age Concern's 'Opening Doors' programme, which has developed a programme of publications and other resources for and about older LGB people. [25]

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Black and minority ethnic people
Black and Asian LGB people may face double discrimination, being at risk of negative perceptions and treatment on the basis of both their sexuality and their visible ethnicity. LGB people whose minority ethnicity is less visible (for example, Eastern European people) are less likely to experience some forms of racial discrimination. However, they may face language barriers and other cultural problems when trying to access LGB services and social opportunities.

As discussed in the section ‘Effect of homophobia and heterosexism on mental health’, most ethnic groups, both majority and minority, have a history of homophobia. This means that LGB people from black and minority ethnic groups may feel that they have to choose between their sexuality and their cultural identity; they may fear exclusion from the support networks of friends, family and culturally specific organisations if they 'come out' (i.e. tell other people about their sexuality).

Black and minority ethnic people now have increased visibility and face less discrimination within the LGB sector than was formerly the case. [26] The main LGB organisations such as Stonewall and the LLGS provide resources on issues relating to black and minority ethnic groups, reflected in their media publicity.

Several organisations work to promote and support LGB people from particular ethnic groups. Contact details and descriptions of these services can be found under ‘Useful organisations’.

People with disabilities
People with disabilities are frequently assumed not to have any sexuality at all, and this applies equally well to disabled LGB people. 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 – like most non-disabled people – are assumed to be heterosexual.

LGB people are affected by the discrimination against disabled people that still exists in society generally, including the perception that people with disabilities lack sexuality. This discrimination can result in practical barriers for people with disabilities who wish to participate in LGB events and services: many LGB venues are not fully accessible for people with disabilities.

Some disabled people may require the input of unpaid carers (such as family members) or paid personal assistants to carry out the tasks of everyday life. Some disabled people draw on the support provided by networks or communities who define themselves by health status, disability or experiences of social exclusion. A suspicion of homophobia in such valued sources of support can make the process of 'coming out' extremely risky for a disabled person.

Fortunately, in addition to improving awareness of disability issues within the LGB community, several organisations work to promote the needs of and support LGB people with specific disabilities. Contact details and descriptions of these services are given under ‘Useful organisations’.

People with HIV/AIDS
Some gay men encounter fear, harassment and/or discrimination on the grounds that they could be HIV-positive or have AIDS. In reality, HIV/AIDS predominantly affects heterosexual people worldwide, even though gay men were the first to develop HIV-related illnesses in significant numbers in the West.

Since the early 1980s, HIV/AIDS organisations have paid particular attention to the emotional needs of people with HIV/AIDS. For example, the Terrence Higgins Trust has a helpline and offers counselling for anyone with or concerned about HIV/AIDS. Some mental health professionals have specialised in the mental health needs of people with HIV/AIDS. Such services have generally had a strong input from gay men and are less likely to be discriminatory than mainstream mental health services. [27] The impact of HIV/AIDS has also raised awareness of the need for bereavement support that acknowledges the grief of gay partners and friends. [28]

Advances in the treatment of HIV infection in recent years have led HIV/AIDS organisations to focus on eradicating stigma and discrimination, as well as promoting safer sex practices and HIV testing. [29]

All people living with HIV/AIDS now have the same legal rights as other disabled people under the Disability Discrimination Act (2005).

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Taking action

Introduction
Whether or not we have experienced mental distress or used mental health services, it is likely that the way we experience our sexuality will affect our health and wellbeing. LGB people can take action to develop good mental health in the context of a positive sexual identity in many ways.

‘Coming out’ [30]
'Coming out' is the process of telling others about our sexuality. This is not usually a one-off event: LGB people may come out to different people in different ways over the course of their lives. Deciding whether or not to come out, and the process of doing so, can have a powerful impact on health and wellbeing.

Whether or not coming out improves health and wellbeing will depend on the person's individual circumstances and needs. Some people decide that coming out as gay, lesbian or bisexual would cause problems in their family (e.g. if they are married) or in other areas of their social or personal life (e.g. if they believe that a social group they are part of holds homophobic views). Coming out may be particularly difficult if a person has not yet 'come out to themselves' (i.e. recognised and accepted their own sexuality) or if they are experiencing 'internalised homophobia'.

While there is no one prescribed way to come out, many people have found the following tips useful.

• Don't feel under pressure to come out – take your time. Only you will know when you feel comfortable and ready to do it.
• If you decide to come out but are unsure how others might react, consider making contact with a support group first. (The following section explains how to find a support group.)
• People who feel safe being visible and honest about being LGB can challenge the stereotypes and prejudice others may have about being LGB.
• If you do come out but get a negative reaction, don't despair. You might find it helpful to speak to one of the information and support services listed in the ‘Useful organisations’ section.

Most people who do come out find the process to be more positive than they had expected, even if is it difficult at times. Long-term benefits can include release from the strain of hiding sexuality, and having access to information and support on emotional, sexual and social issues.

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Information and support services
Information and support on LGB issues are available from various sources across England and Wales. Most local areas are served by an LGB information and support service known as a switchboard, which is usually listed in local telephone directories. LLGS has national coverage, and other switchboards may have access to information resources covering other parts of the country. Switchboards answer enquiries and provide support on topics as diverse as social events, coming out, sexual health, relationships and emotional issues.

Switchboards can also provide information on 'face to face' support that is available in the community. These will differ between local areas but can include support groups, counselling and befriending services.

Social opportunities
Social contact has well known benefits for our mental health. [31] For people in minority social groups, meeting others who identify in similar ways can be empowering as well as enjoyable. Consequently, all switchboards provide information on social opportunities for LGB people. Stonewall also provides the resource, 'What's in my area?' [32] which covers arts and leisure activities as well as health and support services.

Social opportunities vary between local areas. Events and services may include:

• discussion groups
• sports clubs
• arts groups (e.g. reading groups, art groups, film clubs)
• bars, pubs or nightclubs that are either aimed at LGB people or have a mixed clientele and a positive attitude to LGB customers
• ‘pride’ events, which celebrate the political empowering of LGB people and present-day LGB life in all its diversity. (More information on prides and mardi gras can be obtained from the Stonewall Info Bank.)

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Further reading

The following publications are available from Mind Publications on 0844 448 4448.

How to cope with doubts about your sexuality, Mind 2007
Making sense of counselling, Mind 2008
Making sense of psychotherapy and psychoanalysis, Mind 2004
Mental health and social wellbeing of gay men, lesbians and bisexuals in England and Wales, King, M. & McKeown, E. Mind 2003
The Mental Health Act 1983, Mind 2006
Understanding gender dysphoria, Mind 2004 (online only)
Understanding talking treatments, Mind 2005

Useful organisations

British Association for Counselling and Psychotherapy (BACP)
tel: 01455 883 300 (general enquiries)
tel: 0870 443 5220 (to find a therapist)
web: www.bacp.co.uk
See website or phone for details of local practitioners

Broken Rainbow
helpline: 08452 60 44 60 (Mondays and Thursday 2pm – 8pm, Wednesdays 10am – 1pm)
web: www.broken-rainbow.org.uk 
Broken Rainbow provides support for LGB and transgender people experiencing domestic violence. Although it is now working in partnership with the London Lesbian and Gay Switchboard (see below), Broken Rainbow operates on a separate helpline, run by workers who have had additional training on domestic violence.

London Lesbian and Gay Switchboard (LLGS)
PO Box 7324, London N1 9QS
tel : 020 7837 6768 (office) helpline: 020 7837 7324
email: admin@llgs.org.uk 
web: www.llgs.org.uk 
Provides information and support through a confidential helpline. Also maintains an online database of LGB services and organisations throughout the UK.

Mind Out Cymru
PO Box 79
Carmarthen SA31 3XB
email: contactwales@mind.org.uk 
Mind Out Cymru is the all-Wales network for LGB people who have had contact with mental health services through being users or workers, paid or unpaid. It is part of an ongoing commitment by Mind Cymru to an LGB mental health rights awareness programme.

PACE
34 Hartham Road, London N7 9LJ
tel: 020 7700 1323 helpline: 0808 1807 223 (for family and relationship support; Monday 9.30–12.30 and Thursday 3.30–6.30)
email: info@pace.dircon.co.uk email helpline: pacehelpline@pace.dircon.co.uk 
web: www.pacehealth.org.uk 
A London-based charity providing a range of services for LGB people, including a telephone helpline, counselling, family support, youth work and advocacy. Most services are also available to people outside London. PACE also produces publications relating to LGB and transgender issues.

Pink Therapy
Archer Street, London W1D 7AP
tel: 020 7434 0367
email: info@pinktherapy.com 
web: www.pinktherapy.com
This is the UK's largest independent therapy organisation working with clients with minority gender and sexual identities. The website includes an online directory of qualified therapists who have adopted a positive stance on minority sexual and gender identities.

Stonewall
Tower Building, York Road, London SE1 7NX
tel: 020 7593 1860 (office) free phone: 08000 50 20 20 fax: 020 7593 1877
email: info@stonewall.org.uk 
web: www.stonewall.org.uk 
Stonewall campaigns to achieve equality and justice for LGB people and also runs an information service, including an information line that provides education on the legal status of LGB people.

Diverse groups

Black Gay Men's Advisory Group (BGMAG)
email: admin@bgmag.org.uk 
web: www.bgmag.org.uk 
BGMAG is an independent group of black gay and bisexual men of African and African Caribbean parentage working for and on behalf of other black gay men.

Brothers and Sisters Club
email: Hons.Secretary@brothers-and-sisters-club.org.uk 
web: www.brothers-and-sisters-club.org.uk 
The first established club for deaf LGB and transgender people in the UK.

Education for All
email: info@stonewall.org.uk 
web: www.stonewall.org.uk/education_for_all 
Education for All is a coalition of organisations across England and Wales working to ensure that young LGB people fulfil their potential, and tackling homophobic bullying in schools.

Equality and Human Rights Commission (EHRC)
tel: 0845 604 6610 (England helpline) tel: 0845 604 8810 (Wales helpline)
email: info@equalityhumanrights.com 
web: www.equalityhumanrights.com 
The EHRC works to eliminate discrimination against all diverse groups and to promote understanding of the Human Rights Act. The Commission also runs an advice line on equalities and human rights issues.

GEMMA
BM Box 5700, London WC1N 3XX
email: gemmagroup@hotmail.com 
GEMMA is an organisation working to lessen the isolation of disabled lesbian and bisexual women via a national friendship network, quarterly newsletter and social events.

Jewish gay and lesbian group
BM JGLG, London WC1N 3XX
tel: 07504 924 742
email: info@jglg.org.uk
web: www.jglg.org.uk 
Provides an atmosphere of friendship and support for Jewish gay men, lesbians, bisexuals and their partners. Organises social, religious and informative events for members and their guests.

Polari
5th Floor, Central House, 14 Upper Woburn Place, London WC1H OAE
tel: 020 7255 4480
email: policy@polari.org 
web: www.casweb.org/polari 
Works on issues affecting older LGB and transgender people, aiming to influence policy and services.

Safra project
PO Box 45079, London N4 3YD
email: info@safraproject.org 
web: www.safraproject.org 
A resource project working on issues relating to lesbian, bisexual and transgender women who identify as Muslim religiously and/or culturally.

Terrence Higgins Trust
Central office, 314–320 Gray's Inn Road, London WC1X 8DP
tel: 020 7812 1600 helpline: 0845 1221 200
email: info@tht.org.uk
web: www.tht.org.uk 
Originally set up in response to the HIV epidemic, the Terrence Higgins Trust has now merged with local community-based HIV/AIDS charities and works to improve sexual health through campaigning and provision of information. The Trust has offices and centres across the UK.

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References

[1] Stonewall 2008 'Frequently Asked Questions' www.stonewall.org.uk/information_bank/frequently_asked_questions/default.asp (accessed 3 June 2008)
[2] King, M. and McKeown, E. 2003, Mental health and social wellbeing of gay men, lesbians and bisexuals in England and Wales, Mind.
[3] Warner, J. et al. 2004, 'Rates predictors of mental illness in gay men, lesbians and bisexual men and women', British Journal of Psychiatry, vol. 185, pp. 479–85.
[4] King, M. et al. 2003, 'Mental health and quality of life of gay men and lesbians in England and Wales', British Journal of Psychiatry, vol. 183, pp. 552–8.
[5] King, M. et al. 2008, Mental disorders, suicide and deliberate self harm in lesbian, gay and bisexual people: a systematic review, Care Services Improvement Partnership (CSIP).
[6] Warner, J. et al. 2004, 'Rates predictors of mental illness in gay men, lesbians and bisexual men and women', British Journal of Psychiatry, vol. 185, pp. 479–85.
[7] Stonewall 2008, 'FAQs: What is homophobia?' www.stonewall.org.uk/information_bank/frequently_asked_questions/81.asp (accessed 3 June 2008).
[8] Stonewall 2008, FAQs: 'What is heterosexism?' www.stonewall.org.uk/information_bank/frequently_asked_questions/82.asp (accessed 3 June 2008).
[9] Stonewall 2008 'FAQs: What is homophobia?' www.stonewall.org.uk/information_bank/frequently_asked_questions/81.asp (accessed 3 June 2008).
[10] Cowan, K. and Valentine, G. 2005, Tuned out: The BBC's portrayal of lesbian and gay people, Stonewall.
[11] Health Education Authority 1998, World Mental Health Day: Sexual identity.
[12] Warner et al. 2004, 'Rates and predictors of mental illness in gay men, lesbians and bisexual men and women', British Journal of Psychiatry, vol. 185, pp. 479–85.
[13] Stonewall 2007, Education for All: Research: Facts and figures: Mental health. www.stonewall.org.uk/education_for_all/research/1731.asp#Mental_health (accessed 3 June 2008).
[14] Hunt, R. and Fish, J. 2008, Prescription for Change: Lesbian and bisexual women's health check 2008, Stonewall.
[15] Adapted from: Sayce, L. 1995, Breaking the link between homosexuality and mental illness: an unfinished history, Mind.
[16] Warner, J. et al 2004, 'Rates and predictors of mental illness in gay men, lesbians and bisexual men and women', British Journal of Psychiatry, vol.185, pp.479-485 .
[17] Warner, J. et al 2004,. 'Rates and predictors of mental illness in gay men, lesbians and bisexual men and women', British Journal of Psychiatry, vol.185, pp.479-485.
[18] King, M. et al 2007, A systematic review of research on counselling and psychotherapy for lesbian, gay, bisexual and transgender people, British Association for Counselling and Psychotherapy.
[19] Hunt, R. and Fish, J. 2008, Prescription for Change: Lesbian and bisexual women's health check 2008, Stonewall.
[20] Healthcare Commission 2007, Count me in: Results of the 2006 national census of inpatients in mental health and learning disability services in England and Wales.
[21] Perkins, R. 2007, 'Count me in?' Openmind, July/August, p. 14.
[22] Warner, J. et al 2004, 'Rates and predictors of mental illness in gay men, lesbians and bisexual men and women', British Journal of Psychiatry, vol.185, pp.479-485.
[23] Stonewall 2007, Education for All: Research: Facts and figures: Mental health.
[24] www.alzheimers.org.uk/Gay_Carers/ (accessed 3 June 2008).
[25] www.ageconcern.org.uk/AgeConcern/openingdoors_about.asp (accessed 3 June 2008).
[26] For a description of such discrimination, see 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.
[27] Sayce, L. 1995, Breaking the link between homosexuality and mental illness: an unfinished history. Mind.
[28] Sayce, L. 1995, Breaking the link between homosexuality and mental illness: an unfinished history. Mind.
[29] National Aids Trust www.nat.org.uk (Accessed 3 June 2008).
[30] This section draws substantially on the 'Coming out' section of Stonewall's online Info Bank. See www.stonewall.org.uk/information_bank/coming_out/default.asp (access 3 June 2008).
[31] Mind 2004, Not alone? Isolation and mental distress, Mind.
[32] Stonewall, 'What's in my area?' www.stonewall.org.uk/information_bank/whats_in_my_area/default.asp

This factsheet was originally written by George Stewart, Mind. It was updated in June 2008 by Rachael Twomey.