Mental health services in London are excluding LGBT+ people and other vulnerable groups who need its services most urgently, a new report has concluded.
The London Assembly’s health committee found huge variations in mental health across the capital, with poor mental health significantly higher in LGBT+ communities and people who are disabled, deaf or have a criminal record.
“Being misgendered by others contributes to feelings of isolation and anxiety”
And yet these groups were also most likely to be marginalised from mental health provision, warned the cross-party committee.
It noted that about 40% of the LGBT+ community, along with similar levels of disabled and deaf people experienced mental health issues, compared to 25% of the general population.
Prisoners were found to be another vulnerable group going unsupported – a fifth of suicides by former inmates occurred within the first 28 days after release, stated the report titled Supporting mental health for all.
In addition, it noted that people bereaved by suicide were themselves 300% more likely take their own lives than the general population.
Disability and poor health was cited as yet another factor. The report highlighted that only 17% of people with a long-term physical health condition or disability were offered any emotional support at the time of their diagnosis.
The five assembly members who make up the healthcare committee heard from a range of charities and mental health practitioners before identifying four main problems.
“When cuts are made to mental health services it is so often marginalised groups who are left without access”
They said vulnerable groups came up against physical barriers in accessing services, such as when and where they needed them. “This means that some people are being excluded from the outset,” said the report.
But it said they were often then confronted by off-putting or discriminatory language from health professionals, while specialist services were being cut and replaced by generalist provision and primary care staff regularly lacked the correct skills or time to help them.
“Many GPs and other primary care staff lack the skills and/or the capacity to deal appropriately with mental health issues in ways that are supportive and inclusive of the diversity of London’s population,” noted the report.
“The mayor should lead efforts to change this, recognising that the significant capacity and workload pressures facing GPs across London increase the challenge,” it said.
The question of language was particularly important for transgender patients, the report highlighted.
“Being misgendered by others contributes to feelings of isolation and anxiety, which have a negative impact on mental health, especially if repeated over time,” it warned.
Specific training for primary care staff who came into contact with the wider public was “critical”, the report said.
“Generalised equality and diversity training is not sufficient: as a minimum, there is a wider need for specific training on deaf awareness, disability awareness (including hidden and learning disability), sexual orientation and gender identity,” it said.
The report also highlighted basic access problems. For example, healthcare staff described how patients in prisons frequently missed appointments because there was no staff member to escort them.
HMP Pentonville’s Independent Monitoring Board reported that one-to-one mental health treatment sessions were taking place on a landing and sometimes through the locked doors of cells.
In the forward to the report, committee chair and Labour assembly member Dr Onkar Sahota, a practicing GP, said: “Without additional focus on these groups we run the risk that the same people will remain shut out of opportunities to live mentally healthy lives.”
The report noted that, in July 2017 London mayor Sadiq Khan had launched the Thrive LDN action plan to improve mental health wellbeing across the capital.
It set out six key aspirations for boosting wellbeing, such as ending the “stigma” of mental health and bringing about a “zero-suicide city”.
If it was to have any chance of success, the strategy would “need to demonstrate clearly that it represents a genuine change of approach to including marginalised groups”, said the committee.
The Royal College of Nursing said the assembly’s report revealed the damage that cuts to mental health services were doing.
The college said that, since 2010, London had lost hundreds of beds, one in four mental health nursing posts were now vacant and specialist services were being lost.
“These findings are deeply disappointing – when chronic and sustained cuts are made to mental health services it is so often those in marginalised groups who are left without access to the specialist treatment they need,” said RCN London operational manager Jude Diggins.
“The rhetoric around prioritising mental health services must finally become a positive, visible action with the appropriate resources” she added.