James Zanotto, Policy and Research Manager, LGBTIQ+ Health Australia
Despite considerable resilience and recent reform, lesbian, gay, bisexual, transgender, intersex and other sexuality, gender and bodily diverse (LGBTIQ+) people continue to experience high levels of discrimination and violence compared to the general population.
Many national strategies, including the National Mental Health and Suicide Prevention Plan, recognise LGBTIQ+ people as a priority population. These acknowledge disproportionately high rates of illness, the limited impact of existing approaches and the need for targeted responses.
Despite that, outcomes remain poor or are getting worse. Members of LGBTIQ+ communities are more likely than the broader population to experience depression and anxiety, engage in self-harm and have suicidal thoughts. Suicide rates are higher, especially for LGBTIQ+ young people, transgender people and people with an intersex variation.
That’s because a fundamental driver of these worse outcomes is stigma and discrimination.
Personal experiences of violence and rejection—by family, at school and in workplaces—undermine self-esteem and contribute to social isolation. Discriminatory structures reinforce heteronormativity and cisgenderism, while perpetuating homophobia, transphobia, biphobia and intersexphobia.
Minority stress is an effective framework to understand why people who are sexuality, gender and bodily diverse experience worse outcomes. Societal prejudice leads to internalised stigma, constant vigilance against prejudice, and pressure to conform or conceal.
On 29 October, LGBTIQ+ Health Australia (LHA) launched ‘Beyond Urgent: National LGBTIQ+ Mental Health and Suicide Prevention Strategy’. Developed with careful research and consultation, it identifies 63 actions across four overarching goals for prevention, intervention, First Nations and systemic reform.
The strategy recognises that nothing short of a paradigm shift is needed to embrace sexuality, gender and bodily diversity, and deliver the supportive environment that is an essential protective factor for LGBTIQ+ health and wellbeing. A lynchpin is visible, active leadership at all levels.
Our strategy specifically recommends banning deferable medical interventions on intersex persons without personal consent, recognising gender-affirming healthcare as medically necessary services, and prohibiting conversion practices that seek to change sexual orientation or gender identity.
It calls for an improved evidence base about what is needed and what works. The recent Australian Bureau of Statistics (ABS) standard for LGBTIQ+ data is yet to be implemented and we have no useful data from the national census due to the lack of appropriate questions on sexual orientation, gender identity and intersex status.
Most LGBTIQ+ people access health in mainstream settings. However, a majority of LGBTIQ+ people say they prefer the inclusive care, peer support and cultural safety of LGBTIQ+ specialist services. LGBTIQ+ people with lived experience have a key role in the design and delivery of these services.
It will take reform of funding models to increase priority for LGBTIQ+ community-controlled organisations and LGBTIQ+ specialist services. The LGBTIQ+ community sector receives negligible funding for suicide prevention and needs strengthening to meet our community’s needs.
Finally, stronger national governance and whole-of-government focus is needed to put consistent focus on the acknowledged national priorities for LGBTIQ+ suicide prevention, including within the new National Suicide Prevention Office.