LGBT Youth Scotland survey highlights hostile NHS healthcare

Cara Spence, Head of Programmes at LGBT Youth Scotland, which coordinated the survey, said young people had raised concerning issues around mental health provision and gender identity services in particular.

This included not being believed by health professionals, facing discrimination in medical settings and feeling they had to laboriously explain or, conversely, conceal their identity. 

She said some young people had faced "explicit discrimination". 

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Ms Spence added: "It was quite alarming the way that LGBTQ+ young people are still pathologised within mental health services and are told their identities are to blame for their poor mental health, rather than their experiences of prejudice or something else entirely.

"LGBT+ people are multi-faceted but there are assumptions on where that poor mental health is coming from once they disclose their identity."

This, the report showed, gave young people pause in seeking help for mental health issues or from disclosing information about themselves that could be relevant.

For others, there was a desire to talk about being LGBT but the issue being "ignored".

Research Officer Dr. Kathleen Cronie added: "Sometimes being LGBT was not taken into account or was almost taboo, when it was something the young person wants to talk about and it being ignored.

"The risk is inherent in making a disclosure because young people don't know how it will be received and so young people are having to weigh up the pros and cons in disclosing."

Currently, waiting lists at gender identity services are between two and five years depending on which area of Scotland a person is accessing support. 

In Glasgow, the Sandyford Clinic offers a gender identity service for under-18s but the waiting list there is three years.

Ms Spence said: "Waiting lists are really concerning across the piece in health services but for gender identity services particularly. 

"Three years is a huge amount of time in a young person's life."

Around 1300 young people from across Scotland responded to the survey with their experience of the NHS in Scotland. 

One young person told researchers: "Patient-facing experiences of the health service can vary so widely depending on nurse attitudes towards the patient, their appearance, and the nurse’s perceptions of what a patient in pain or distress should look like."

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The comment was one of a number that painted a picture of patchwork provision across the country where some young people felt comfortable and supported by medical professionals while others struggled to be understood or taken seriously.

Another said: "I’ve been treated like I’m either confused or confusing. 

"This doesn’t foster an environment which makes me feel able to discuss things with them honestly."

One teenager said that they felt they had to support medical staff to understand them, before they could be supported in turn. They said: "Mental and sexual health professionals are still often very ignorant to trans issues, which makes interacting with them emotionally taxing as they have to walk on eggshells around my identity or I have to take the time to educate them on topics that all healthcare providers really should be in the know about."

Another said medics' reaction to them made them "feel broken".

They said: "A psychologist in CAHMS (children and adolescent mental health services) told me my asexuality and sex repulsion 'would go away once I had a husband' this invalidated the fact that I might not ever get married and even if I do could have a wife. 

"It made me feel broken like something was wrong with me not wanting to have sex and that I needed to be fixed."

One teen said she was left feeling isolated and with nowhere to turn after a nurse told her she was "too young" to know her own sexuality. 

She said: "I only ever mentioned my thoughts on my sexuality once and they told me I was too young to know if I was queer and I needed to change my language. 

"I wasn’t a lesbian, I was just experiencing passing feeling of same sex attraction. 

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"If I didn’t already feel like I had nobody to talk to I definitely did now."

Others, however, said they had had good experiences and met doctors and nurses who were accepting of their identities and knowledgeable. 

Young people said waiting lists can be distressing due to the wait itself, but also the lack of communication while on a waiting list, leaving them feeling like they "don't matter". 

LGBT Youth Scotland is at pains to stress it is not critical of the NHS, as a service facing an extended period of crisis. 

But it said urgent change is needed to ensure that young people are not waiting before approaching the NHS for necessary care. 

Dr Cronie said: "Young people are even weighing up whether to go in to the service or not because once you know that system is going to be tough to navigate that's an additional barrier before they even get inside that system.

"There's an understanding waiting lists are long but that additional stress of not hearing anything about the wait is an additional distress and additional barrier. 

"They also don't know if someone is going to display prejudice or not." 

A spokesperson for NHS Greater Glasgow and Clyde said: "As is the case throughout the country, services across NHS Greater Glasgow and Clyde – including gender services at the Sandyford Clinic – are under considerable pressure. 

"All our staff are doing all they can to address these challenges, and we would like to thank them for their continuing commitment and professionalism.

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"People wishing to access our gender services are unfortunately experiencing considerable waiting times, and we would like to apologise to them for that." 

NHS GGC said a recent package of Scottish Government funding has enabled the expansion of the capacity of its gender services.

The spokesperson added: "However, we are also committed to providing care and support to those on our waiting lists, and we will now be able to expand that area, working with other health boards to identify those who may need additional help and direct them to appropriate services."

He said all staff at NHS Greater Glasgow and Clyde are required to undertake mandatory training in equality, diversity and inclusion, which must be completed every two years.

LGBT Youth Scotland has made a raft of recommendations it is calling on the Scottish Government and health boards to implement in order to improve outcomes for young people.

Among others, these include mandatory training for staff; allowing young people to choose when they transition to adult services rather than having a mandatory transition at 18; for NHS services to take a children and young people's rights approach to providing care; and to substantially reduce lengthy waiting times for first appointments at NHS gender identity services as a matter of urgency.

Ms Spence added: "Vitally, to meet their needs, it's really important to listen to young people directly so they are able to shape what the way forward might be." 

A Scottish Government spokesperson said: "The Scottish Government is committed to advancing equality for all LGBTI people, and promoting, protecting and realising their rights.

"The Scottish Government remains committed to improving access and delivery of gender identity healthcare in NHS Scotland.

"This work is now well underway and £2 million has been allocated this financial year to continue to deliver commitments set out in our 2021 NHS Gender Identity Services Strategic Action Framework."