Sexual Orientation Monitoring - nosy or necessary?

Rhys Davies, Primary Care Mental Health Liaison Nurse and co-founder of the Rainbow Alliance, talks about the plan to introduce sexual orientation as a routine question to ask when working with service users.

You may already know that next year, NHS England will make it a requirement for all health professionals to ask service users what their sexual orientation is, just as they already do for religion, disability, gender, and ethnicity.

You may be questioning why, but I’m wondering what took so long?

In healthcare, the reason we ask questions about religion, disability, gender and ethnicity is because they’re ‘protected characteristics’ under the Equality Act 2010. This means we’re required to gather and monitor this information for service users and employees. It’s used to identify and take steps to address discrimination, as well as implementing anti-discriminatory policies and practice.

Information gathered about the ethnicity of people using mental health services has highlighted that people from Black and Minority Ethnic (BME) backgrounds are disproportionately detained under the Mental Health Act compared with white British people. This is a great example of the importance of gathering this information and it’s something the NHS needs to address.

Sexual orientation has now been added to the list of protected characteristics. But while it’s a requirement for the NHS to routinely ask its employees about their sexual orientation, it’s not yet required to ask its service users. My question is, why aren’t we protecting and supporting our service users in the same way?

Numerous studies, including one carried out in Leeds, have shown that lesbian, gay and bisexual (LGB) people experience higher rates of depression, anxiety, self- harm, and drug and alcohol problems than heterosexual people. The problem is, we don’t officially know how many are using mental health services and which ones they’re using. How can we know how about the overall health needs of LGB people using our services when we don’t gather any official data about them?

I’ve come to understand that some health professionals feel embarrassed about asking what could be perceived as an intrusive personal question. However, as part of our job we constantly ask very personal questions to gain an understanding of the issues and needs of the people we’re working with. People give this information because they know why we need it and they trust us not to misuse it. Surely a question about sexual orientation is no more personal than asking about current trauma or risky behaviour they may engage in?

I work in GP surgeries as a mental health liaison nurse, and sexual orientation is a question I ask every patient I see. I’ve been doing this for almost a year and a half, and I’ve not yet come across one person who’s complained about being asked. A few people have asked why I want to know, but after explaining the reasons why, they’ve answered quite happily. They do of course have the right to refuse to answer, but to date no one has.

While it’s frustrating that we aren’t there yet, it’s important to talk about the positives of asking this question. As well as gaining vital data, it can open doors to important conversations.

As a gay man who uses health services I believe that when people ask, they’re taking my needs much more seriously because they don’t assume I’m straight. It’s also a message that it’s safe to be ‘out’ to health workers, and that being gay is not a shameful embarrassing secret, rather part of what it is to be human.

It can have a huge positive impact when we create a climate where LGB people can talk freely without shame or embarrassment about how issues relating to their sexual orientation is affecting their mental health. It can also enable healthcare workers to have a greater understanding of the needs and experiences of LGB people and develop more positive, trusting relationships.

The Rainbow Alliance see Sexual Orientation Monitoring as a priority, so we’re taking the lead on this and aim to roll it out across the Trust from October 2018.

We can be thinking about it in advance, and we’ll need to speak with staff, service users and carers about how we’re going to do this, why we’re doing it and how it can help us all.

For more information about the Rainbow Alliance and the plans for Sexual Orientation Monitoring, please email rainbow.lypft@nhs.net.