*Please take care with this article as it discusses hate crime and discrimination against LGBT+ people, as well as suicide statistics.*
Whilst researching and writing my book, I examined numerous studies on stigma and borderline personality disorder within healthcare and, more specifically, mental health services. I also looked at research on the experiences of LGBTQ+ people within mental health services.
However, when it came to finding specific studies on the experiences of stigma within mental health services for LGBTQ+ people diagnosed with BPD, I couldn’t find anything. It appears to me that nobody has researched LGBTQ+ people with a diagnosis of BPD and their experience of mental health care. I am going to share some general statistics from a couple of Stonewall’s reports about life in Britain for LGBT people, followed by some statistics about the experiences of people with BPD as a whole.
After I share these statistics, I will speculate on what they could possibly say about the experiences of stigma within healthcare for LGBTQ+ people diagnosed with BPD. I am no statistician or population researcher, however I can’t help but wonder what these two areas of research might be able to say about the experiences of LGBT+ people diagnosed with BPD and their interactions with the services and professionals that are supposed to be helping them. I hope one day soon some studies will be done in this area and I won’t have to conjecture like this.
I also want to preface my thoughts by saying I have no doubts there are some excellent clinicians who are fully respectful towards LGBTQ+ people and do a lot to ensure that everyone is treated equally and with an understanding of the additional challenges they may, at times, face in society.
Let me begin with Stone Wall’s 2017 report ‘LGBT in Britain - Hate Crime and Discrimination’. This report paints a picture of how dire the situation is for LGBT people in the UK right now. Even daily life is, or feels unsafe, for a huge proportion of LGBT people, especially those who are BAME.
A third of black, Asian and minority ethnic LGBT people have experienced a hate crime or incident based on their sexual orientation and/or gender identity in the last year compared to one in five white LGBT people.
Two in five trans people have experienced a hate crime or incident because of their gender identity in the last 12 months
More than a third of LGBT people (36 per cent) say they don’t feel comfortable walking down the street while holding their partner's hand. This increases to three in five gay men (58 per cent).
This report also reveals what many already know- that health and social care services aren’t psychologically safe, or fit for purpose, for LGBTQ+ people. Again, BAME LGBTQ+ people are more likely to be discriminated against than white LGBTQ+ people.
One in eight LGBT accessing social services in the last year has been discriminated against because of their sexual orientation and/or gender identity. The rate of discrimination is even higher in this area for trans people.
A quarter of trans people who contacted emergency services in the last year were discriminated against based on their gender identity.
One in six black Asian and minority ethnic LGBT people were discriminated against by emergency services compared to five percent of white LGBT people.
This report provides a snapshot into the reality of just how uncomfortable and/or unsafe life can be for LGBT people, particularly BAME LGBT people. As this report points out too, hate crimes are underreported due to fear of not being believed or being blamed by police or other institutions that hold power.
Let’s now look at Stonewall’s 2018 report on Health and LGBT people in Britain. Here are some statistics on the mental health of LGBT people:
Half of LGBT people experienced depression in the last year.
Two thirds of trans people have experienced depression in the last year.
13 percent of LGBT people aged 18-24 (13 per cent) said they’ve attempted to take their own life in the last year. The rate is significantly higher for trans people.
LGBTQ+ people are far from guaranteed respect and empathetic care when they access health services:
Almost one in four LGBT people have witnessed discriminatory or negative remarks against LGBT people by healthcare staff. This figure rises to 20 percent of trans people.
One in twenty LGBT people (five per cent) have been pressured to access services to question or change their sexual orientation when accessing healthcare services.
One in seven LGBT people avoid seeking healthcare for fear of discrimination from staff.
I am not saying that the above statistics mean that every LGBTQ+ person is at risk of having a negative experience when they access medical care. I am just saying that healthcare systems need to be made much, much safer for LGBTQ+ people.
We need to get to a place where there is very minimal risk of being insulted, disrespected, judged, harmed or made to feel uncomfortable in a healthcare setting. LGBTQ+ people have every right to be as safe, as respected, as cared for as people who are not LGBTQ+. More needs to be done to ensure this.
Let me now turn to some statistics on the stigmatisation and discrimination of individuals diagnosed with BPD:
One study found that inpatient mental health nurses were more likely to ‘belittle’ patients with BPD than those with schizophrenia (Gallop, Lancee and Garfinkel 1989). Whilst mulling over this statistics, it is worthwhile bearing in mind that schizophrenia is one of the most stigmatised mental health conditions.
A 2007 study found that mental health nurses were more helpful to patients with major depressive disorder than those with BPD (Forsyth 2007).
Another study showed that patients with diagnosis of BPD were judged more negatively by staff than patients with other diagnoses (such as schizophrenia) even when their behaviour was the same (Koekkoek, Berno Van Meijel and Hutschemaekers, 2006).
A 2017 study showed that in England, 84% of organisations (English NHS mental health trusts and independent organisations) reported having at least one dedicated personality disorder service. However, only 55% of organisations reported that patients could access these dedicated services equally across localities (Dale, Sethi and Stanton, 2017).
The gaps are still there in service provision for people with BPD; many are not being offered the support they need. It is not uncommon for people to be on waiting lists of a year or more for psychological treatments.
So, what might all of this mean LGBTQ+ people with a diagnosis of BPD? I want to hazard a guess that discrimination on the basis of gender identity and/or sexual orientation affects LGBTQ+ people with BPD at the same or higher frequency than LGBTQ+ people who don’t have a BPD diagnosis or people with a BPD diagnosis who are not LGBTQ+.
I would love to hear from you if you are LGBTQ+ and have a diagnosis of BPD (or relate to this diagnosis, even if you haven't been formally diagnosed).
If you would like to share, what are your experiences? Have you faced inequalities? Have you been discriminated against, treated unfairly or stigmatised? Do you think you have a harder time within mental healthcare services being LGBTQ+ and having BPD compared to someone with this condition who is not LGBTQ+?
If you would like to write a blog post about this or share something of your experience on this blog, then please email me at firstname.lastname@example.org. Anonymity is fine if that is needed or preferred.
Information and support is available from Stonewall's Information Service. Their freephone number is 0800 0502020.
'LGBT in Britain - Hate Crime and Discrimination' report by Stonewall, 2017.
LGBT in Britain - Health report by Stonewall, 2018.
Further reading- an article I found that may be of interest:
‘Distinguishing and Addressing Gender Minority Stress and Borderline Personality Symptoms’, H. Goldhammer, C. Crall and A. Keuroghlian. Harvard Review of Psychiatry, 2019.