Less than half of LGBTQI people feel accepted by healthcare providers

Compared to work, family and educational settings, healthcare is where lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI) Australians feel least accepted (43.4%).
 
That is among the findings of the largest national health and wellbeing survey of 6835 LGBTQI people conducted by the Australian Research Centre in Sex, Health and Society at La Trobe University in the second half of 2019.
 
Mainstream health services were more frequently accessed by participants than those that are known to be LGBTQI inclusive, but had the lowest proportion of participants who felt that their sexual orientation (58.6% compared to 90.7%) or gender identity (37.7% compared to 78.6%) was very or extremely respected.
 
Co-author Ruth McNair, a GP and honorary Associate Professor in the Department of General Practice at the University of Melbourne, told newsGP the findings come as little surprise.
 
‘This confirms our suspicions that people aren’t really receiving the care that they need, and there’s a reluctance to disclose in those mainstream services, potentially, because people are worried about discrimination or just people not understanding their needs,’ she said.
 
The survey also found LGBTQI people less likely to report having a regular GP, with 65.5% compared to 80% of the general Australian population.
 
A quarter (24.7%) reported that they did not have a regular GP but attended the same health centre, and nearly one in 10 (9.8%) attended multiple health centres.
 
Associate Professor McNair says the lack of continuity of care is of particular concern, given the higher levels of depression, anxiety, suicidality, homelessness and substance use – particularly among transgender, gender diverse, and queer pansexual people.
 
By not feeling accepted, she says, there are a number of direct consequences on LGBTQI patients.
 
‘They can’t understand, or at least get the health provider to understand, the background issues – why do they feel not accepted at home? Why are they living on the street? Why are they using alcohol for trauma?’ Associate Professor McNair said.
 
‘A GP might drill down to some of that, but if they don’t know the gender identity or sexual orientation, they’re not going to ask the right questions.’


New research has found that compared to work, family and educational settings, healthcare is where LGBTQI Australians feel least accepted.

Compared to previous sample surveys, there was a notable rise in the number of people who identify as ‘non-binary’.
 
‘That confirms what we see in practice, that more and more transgender people are identifying as non-binary, and they had much greater health needs than even some of the transgender binary people,’ Associate Professor McNair said.
 
Through first-hand experience in training GPs, she says there is a clear need for greater education regarding the nuances within the transgender community – but for that to happen, this patient cohort needs to be better acknowledged.
 
‘A lot of GPs are very uncertain about the differences within the transgender community and … non-binary. What’s gender diverse? Why should I use they/them pronouns?’ Associate Professor McNair said.
 
‘So they’re right back at the beginning of understanding this group.
 
‘A lot of them don’t really believe that they’ve got this population. But they do, they just don’t ask, which makes it hard to incentivise training because if you think you’ve got no patients in that group, you’re not going to prioritise it.
 
‘I’ve just worked with the Victorian Population Health Survey LGBTQI analysis and about 5.4% were LGBTQI in the Victorian population. That was a big sample of 35,000 people.
 
‘So if you think 5% of my patients are in this group, that’s probably more than the Indigenous population, more than the diabetics, and you justify that level of scrutiny and training for other minority groups that are disadvantaged.’
 
Associate Professor McNair acknowledges, however, that some GPs may not feel they have the resources to refer people, and in turn may be less likely to ask certain questions. That is where Primary Health Networks, and creating allyships with LGBTQI peak bodies can help, she says.
 
‘It’s the Pandora’s Box idea that you see in domestic violence or in childhood sexual abuse. It’s all very well to uncover something, but what do you do about it?’ she said.
 
‘Getting information out to GPs about the increasing number of LGBTQI-specific counselling services and drug and alcohol work, and the homeless services that have done training in the area are all important parts of building skills and capacity.’
 
But it’s not just about the GP. All practice staff need to be trained in ‘appropriate communication’.
 
‘Patients look for signs from the very beginning that the practice is inclusive. It doesn’t take much for them to let their guard down a little bit, and feel like it’s going to be okay,’ Associate Professor McNair said.
 
‘So language that reception uses, trying not to use Mr and Mrs – drop the titles altogether – and make sure they’re using the person’s affirmed name and pronouns. Not assuming a person accompanying the patient is their partner or their parents, but understanding that these families of choice are much more diverse.
 
‘Focusing on confidentiality really carefully [is also important] because it’s a minority community with a lot of trauma and there’s a huge amount of hesitancy about that, especially in rural areas.
 
‘All those things are fairly simple changes you can make in a practice that don’t really cost you anything. It’s just about commitment to training the staff and careful placement of promotional materials through the practice, and making sure your intake process is inclusive.’
 
Having already witnessed some of the side effects of the pandemic on the LGBTQI community in her own practice, with a rise in drug and alcohol use and unstable housing, Associate Professor McNair fears for what’s to come.
 
‘GPs have forever turned a blind eye to this group or said, “Look, it doesn’t matter, we’re all the same, it’s fine”. But that’s not good enough,’ she said.
 
‘They have to step up and say, “I’ve got to understand these sub-groups and their specific health needs, otherwise I’m not doing a good job”.’
 
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continuity of care LGBTQI health primary care transgender health