Introduction
This guide is intended for staff working in psychiatric wards, social services and primary care. Its aim is to help create a safe environment for LGBTQ+ people seeking support.
Why is this important?
LGBTQ+ people often face inequality and prejudice when seeking care. Our task is to ensure high-quality care for everyone, regardless of their identity, neurodiversity or health status.
Understanding identity: Basic concepts
For inclusive practice, it is important to understand that a person’s identity is more complex than the binary ‘male/female’ system. It comprises three interrelated elements:
- Sex assigned at birth: Assigned at birth based on physical characteristics. Important: There are intersex people — individuals born with sex characteristics (chromosomes, gonads or anatomy) that do not fit into the binary medical standards of a male or female body.
- Gender (Gender identity): A person’s internal sense of self as male, female, or outside this system (non-binary). Although the term ‘sex change’ is still used in some legal documents, in contemporary practice and within the community, the term ‘gender transition’ is preferred.
- Sexual orientation: Romantic and/or sexual attraction to other people.
Terminology
- LGBTQ+: An abbreviation for lesbian, gay, bisexual, transgender and queer people. The ‘+’ sign encompasses the entire spectrum of identities.
- Heteronormativity: The belief that heterosexuality and cisgender identity are the only ‘norm’. This leads to the invisibility of the experiences of LGBTQ+ people.
- Coming out: The process of voluntarily disclosing one’s identity to others. This is not a one-off event, but a lifelong process.
The experiences of LGBTQ+ people and mental health
Depathologisation and minority stress
LGBTQ+ people are more likely to experience depression, anxiety and suicidal thoughts. It is important to understand: this is not caused by their identity itself, but by minority stress — chronic pressure resulting from discrimination, violence, bullying and rejection by family.
Conversion practices
Attempts to ‘cure’ or ‘correct’ a person’s sexual orientation or gender identity still occur.
The position of modern medicine: Being LGBTQ+ is not an illness. Conversion therapy has no scientific basis, is harmful, discriminatory and often leads to severe psychological trauma.
Communication ethics: Practical recommendations
1. Avoid making assumptions
Do not assume by default that your client is heterosexual or cisgender.
- Use neutral language: Instead of ‘Do you have a husband/wife?’, ask: ‘Are you currently in a relationship?’ or ‘Is there someone close to you who supports you?’.
- Past experiences: Do not assume that the person’s previous experiences with healthcare professionals were positive. LGBTQ+ people often come in expecting hostility.
2. Names and pronouns
Using the correct name and pronouns is a basic level of respect and recognition of a person’s dignity.
- If you are unsure how to address someone, politely ask them.
- Misgendering and deadnaming: Using the wrong pronoun or an old name is perceived as disrespectful. If you make a mistake, calmly apologise, correct yourself and continue the conversation.
3. Confidentiality and safety
In countries with repressive laws or high levels of homophobia, coming out can be dangerous to one’s life and career.
- Treat information about a person’s identity as strictly confidential.
- Never assume that a person is open with their family or other professionals. Check whether it is acceptable to mention these details in the presence of third parties.
4. Avoid inappropriate curiosity
Only ask questions about surgery, hormone therapy or intimate life if it is directly necessary to provide assistance at that moment. Do not let curiosity breach professional boundaries.
Case studies
Case 1: Partner disclosure
Situation: Anna (in a relationship with Maria for 5 years) is admitted to the ward. A nurse asks for a ‘husband or boyfriend’ to contact. Anna, fearing a negative reaction, names her ex-husband. As a result, she feels guilty, and her actual partner, Maria, is excluded from the support process. The correct approach: Ask about their ‘closest person’ or ‘partner’, recognising the importance of ‘chosen family’ for LGBTQ+ people.
Case 2: Working with a trans person
Situation: Jessica (a trans woman) has been admitted to hospital. Some staff continue to use her birth name and do not know which ward to place her in.
Recommendations:
- Use the name the person identifies with. Do not put it in quotation marks in documents.
- Ensure access to facilities (toilets, showers) that correspond to their gender identity.
- Under no circumstances should you interrupt ongoing hormone therapy — this can drastically worsen both physical and mental health.
Creating an inclusive environment
What can your organisation do?
- Training: Include LGBTQ+ awareness in mandatory training for all staff — from receptionists to management.
- Responding to discrimination: Establish a transparent complaints system, including anonymous reporting. Do not ignore homophobic or transphobic comments from colleagues or other patients.
- Visual safety signals: Instead of bold symbols that may raise questions from regulatory bodies, display your ‘Non-Discrimination Policy’ at reception. A simple sign stating: ‘We provide care to everyone, regardless of gender, sexual orientation or family status, and guarantee strict confidentiality.’
