Politicians have a "moral and ethical responsibility" to drastically alter laws and policies in order to reduce psychiatric disorders among sexual minorities, says Professor Dinesh Bhugra, president of the World Psychiatric Association.
In an exclusive interview at BuzzFeed News' London office, Bhugra, a former president of the Royal College of Psychiatrists, called for "radical solutions" to combat the high levels of mental illness among the LGBT population, describing the "clear correlation between political and social environments" and how persecutory laws against LGBT people are leading to greater levels of depression, anxiety, self-harm, and suicide.
A number of studies this year have highlighted the disproportionate levels of mental illness among LGBT people. In Britain, one of the world's most legally equal countries for this community, research in the last few months has revealed that LGBT people are nearly twice as likely to have attempted suicide or harmed themselves, gay men are more than twice as likely to have a mental illness than heterosexual men, and 4 in 5 transgender people have suffered depression in the last five years.
"There is still a lot of homophobia and transphobia, so people feel stigmatised against, and that affects self-esteem and mental health," said Bhugra. "LGBT individuals are still seen as outsiders, not like 'us'. If you've legally ended discrimination, great, but stigma hasn't gone away."
It's clear that in countries with laws that continue to discriminate against LGBT people, there are high rates of mental illness as a result, he said, citing new research data from the University of Foggia in Italy and King's College London – seen by BuzzFeed News – that is yet to be published.
"There have been a series of studies showing that in America, for example, rates of psychiatric disorders have dropped when state policies have recognised the equal rights of LGBT individuals," he said. "It's a message that needs to get to policymakers – they need to look after the vulnerable, as every civilised society should."
Governments, he added, "have to take responsibility for the mental health of the whole population. To say 'I'm going to support the 90%' – or whatever – 'who are heterosexual' is against basic human respect and human rights."
The World Psychiatric Association, which represents over 200,000 psychiatrists in 117 countries, is currently embarking on a series of studies into the social discrimination against people with mental illness – with one study specifically focusing on the experiences of LGBT people. The outcome will inform both policy recommendations for governments and guidance for psychiatrists to improve clinical care for LGBT patients.
Bhugra, 63, was raised in northern India before coming to the UK in the early 1980s to train as a psychiatrist. In 2008, after decades as a leading authority on cross-cultural and psychosexual psychiatry, Bhugra became the first president of a royal college from an ethnic minority, and, in 2014, the first British president of the World Psychiatric Association. He came out in 2013, making him the most senior psychiatrist in history to do so. At the time, he promised to "make a stand" against countries who "still see it [homosexuality] as an illness".
In the 79 countries that outlaw homosexuality – or homosexual activity – psychiatrists and mental health practitioners are failing to adequately treat LGBT patients, because they do not ask about sexual orientation and patients feel unsafe disclosing it, said Bhugra. And across the globe, he added, even in comparatively liberal countries with laws protecting the equal status of all citizens, higher levels of mental ill-health among LGBT people remain a "chronic problem".
"There is a double jeopardy," said Bhugra. "If you have a mental illness you are stigmatised against, and if you are a sexual minority you are stigmatised against. If you have both it means alienation on both counts, and it is harder to seek and receive help."
Bhugra recommended several "radical solutions" for governments to combat the disparity in mental health between heterosexual and LGBT people. These included sending clinical teams into the LGBT community.
"The ideal scenario would be to have counsellors, nurses, and clinicians in gay clubs," said Bhugra. "You could go to a club, where no one knows you're going to a psychiatrist, and you could discreetly have a discussion about dealing with your anxiety, depression, alcohol or drug use. It would destigmatise seeking help and would make psychological treatment much more accessible at an earlier stage."
He also urged governments to force coroners to, where possible, record the sexual orientation in suicide cases, so that policymakers are aware of the scale of disproportion between communities. "That way you have clear data," he said. When approached by BuzzFeed News, the Coroners' Society of England Wales declined to comment on this proposal.
Sex education involving discussion of sexual minorities should also be made compulsory in schools, said Bhugra, to pre-empt the psychological effects of homophobia, biphobia, and transphobia. "Teachers have a duty to be open about LGBT issues – knowledge helps deal with stigma."
But efforts to transform the mental health of both LGBT and heterosexual patients within the NHS are being hampered by budget cuts, reorganisation, and changes to benefits and social care, said Bhugra. Between 2011 and 2014, funding to mental health services in Britain were cut three years in a row, according to the Royal College of Psychiatrists.
"In the last five years, politicians have talked endlessly about mental health, but they have not followed it up with proper resourcing and funding," he said. "Until we have that, people who are vulnerable and who have this double jeopardy will lose out, because you're losing out on both fronts: sexual orientation and mental illness."
He added: "There seems to be a rush towards a lowest common denominator – the notion that everyone on benefits is a scrounger is a stereotype because it suits people. Policies are mostly ideologically based: welfare cuts, the bedroom tax – where's the evidence? Yet there is very clear evidence that LGBT individuals are suffering psychiatric disorders, so surely their needs must be taken into account. We're in serious danger of losing humanity."
Psychiatrists' capacity to adequately treat patients is under threat, said Bhugra.
"It [psychiatry] is becoming more of a tick-box exercise. You're having to sit there ticking boxes rather than looking at the needs of the person in front of you. Do [NHS] managers and the powers that be really care whether you've seen a patient as a clinician? Probably not. They're more interested in whether the forms have been filled in."
A Department of Health spokesperson told BuzzFeed News that LGBT people may be at a higher risk of mental health issues such as anxiety and depression and may find it harder to access services, but added that the department invested a record £11.4 billion on mental health last year and therefore expects all people to receive high-quality mental healthcare.