1. Clarify our position on the rights of LGBTQ+ people to eliminate discrimination and stigma
2. Understand the needs of LGBTQ+ children and young people
3. Support health professionals in their role of providing support to LGBTQ+ children and young people
LGBTQ+ stands for lesbian, gay, bisexual, transgender, queer or questioning and the + is inclusive of all identities and sexualities, regardless of how people define themselves. The terms used when discussing gender and the trans and non-binary community are many and varied, and can change and shift over time. Equally, the expression of gender by a particular person can vary over time, and so terms such as gender variant have emerged to include younger children whose gender identity has not fully established.
We recognise the discrimination that arises as a result of misleading and prejudiced information, and the additional significant harm this can cause to LGBTQ+ children, young people and their families.
Health outcomes are worse for LGBTQ+ people than for the rest of the population. A 2018 Stonewall survey estimates that one in five LGBTQ+ people are not out about their sexual orientation to any healthcare professional when seeking general medical care, and that one in seven LGBTQ+ people have avoided treatment for fear of discrimination. In the last year alone, 20 per cent of trans people have witnessed discriminatory or negative remarks against LGBTQ+ people by healthcare staff.1
The NHS Long Term Plan commits to tackling health inequalities for LGBTQ+ people within a decade.2 This will not be possible to achieve without action at all levels of the NHS and social care system.
The NHS Rainbow Badge initiative that originated at Evelina London Children’s Hospital,3 and which was developed with RCPCH &Us,4 works to make a positive difference by actively promoting a message of inclusion. NHS healthcare staff who wear a badge show their patients and colleagues that they work in an open, non-judgemental and inclusive place, and that they are a good and positive person to raise these issues with. By raising awareness of these issues, it is hoped that healthcare for LGBTQ+ patients will be improved. It is encouraging that nearly 75% of Trusts in England have a rainbow badge scheme in place.
Key messages for health professionals
RCPCH talked to young people about their experiences of being LGBTQ+ and accessing health care, and their hopes for when they are using services.5 Young people shared their priorities for improving healthcare experience for LGBTQ+ young people:
- Have people to support them - so young people have someone to talk to, know the local support groups and have someone who can listen without judgement.
- Increase awareness of LGBTQ+ issues among health professionals so they can create an open and welcoming atmosphere - this is particularly important for young people who have not been able to get support at home or school.
- Be mindful of the support they might need and how sensitive it is - for example, when a trans young person who identifies and lives as male needs to get support from a school nurse, GP or hospital for heavy periods.
- Be aware that young people may be not as confident, have all the knowledge or know how to ask about sex and relationships, and so need to have good people to talk to for the right information and advice.
- Remember they might still be living with family or with friends and in school/work environments where there are openly negative views about the LGBTQ+ community.
- The use of pronouns and gender identifiers are important to children and young people. When health care professionals use identifiers inappropriately, or don’t ask children and young people in the first place, they lose trust in those caring for them. Additionally, administrative items and processes like sign in screens and name call outs are often pre fixed with Mr or Miss, which creates anxiety about appointments.
Role and responsibilities of health professionals
- Act at all times in an accepting, non-discriminatory way towards LGBTQ+ children and young people, and demand the same from your colleagues.
- Understand that gender questioning and gender diversity are common, not pathological and frequently begin in early childhood.
- Help parents, schools and other agencies to adopt a supportive, flexible and responsive attitude to affirm a child’s expressed sexuality and gender, whilst being sensitive to change over time. This will involve making appropriate adjustments.
- Be able to enquire about the mental health of LGBTQ+ children and young people and know when they may need specialist referral.
- Be aware that LGBTQ+ children and young people are likely to have higher rates of low mood, anxiety and thoughts of wanting to die.
- Remain mindful that sometimes mental health needs do not relate to LGBTQ+ identities. Many young people require support for issues relating to academic pressures or family relationship difficulties. LGBTQ+ children and young people should be able to access all available mental health services.
- We will continue to foster, within our organisations and in our work, an LGBTQ+ inclusive attitude.
- We will advocate for LGBTQ+ inclusive services in health and other sectors.
- We will include attention to LGBTQ+ issues within training curricula.
- We will co-operate with other bodies in the delivery of LGBTQ+ training content.
- We will contribute positively to evidence-based media reporting of LGBTQ+ issues in the health arena.
- We will maintain awareness of the developing evidence base, and do so in collaboration with LGBTQ+ people and their families.
Planned review date: June 2023.