Lily May Fox and Becky Murray from Meath getting ready to take part in the Gay Pride Parade in Dublin in June. Sam Boal / RollingNews.ie Sam Boal / RollingNews.ie / RollingNews.ie

THERE HAS BEEN much progress in terms of LGBTI+ rights in recent years in Ireland – marriage equality and the Gender Recognition Act, to name two significant milestones.

However, people working in the area say a lot more needs to be done – with a major issue being the lack of mental health supports available.

22 May 2015 was a momentous day in Irish history: we became the first country to legalise same-sex marriage by popular vote.

There were celebrations among the LGBTI+ community and beyond after a long-running campaign for equal marriage rights. The result, 62% in favour of Yes, was hailed a huge step forward for gay rights and it sent an important message to gay youth in particular.

However, Research by BeLonG To, a national organisation that supports LGBTI+ youth, found that many young people felt they couldn’t speak out about mental health struggles after the referendum because, on paper, things were ‘fine’ now.

In reality, things are far from fine for many people. Gay, lesbian and transgender teenagers are twice as likely to self-harm and three times more likely to attempt suicide than others. 

There are a number of programmes and youth groups across the country which are trying to tackle this issue. 

Sinéad Murray works with Donegal Youth Service (DYS) and has helped run its LGBTI+ programme since 2009.

While the issue is often more pronounced among the LGBTI+ community, Murray told TheJournal.ie: “We have a massive problem in Donegal across the board regarding mental health and suicide.”

The suicide rate in the county from 2015-2017 was 11.4 per 100,000 people – above the national average of 8.6. Almost 400 suicides were registered in Ireland last year, with men accounting for almost four in five deaths.

Murray said the marriage equality referendum result was, of course, welcome but didn’t magically fix every issue being faced by young LGBTI+ people.

“There is that kind of feeling, ‘You’ve got everything now, you should be fine’, almost ‘Put up and shut up’,” Murray said.

In the run-up to the referendum, there was a 100% increase in the number of LGBTI+ young people seeking one-to-one support in Donegal. Murray said some of the issues raised by the No campaign had a profound effect on some young people.

A lot of young people had never heard some of the really negative things that some people think about gay people, like the way we would have in the ’80s and ’90s.

“The really negative comments were everywhere, on the different TV debates, etc.”

Murray said it’s “imperative” that people talk about what they’re going through and said the local BreakOUT youth group is “like a family” where people are “used to talking about how they feel”.

Some young people need extra support and seek one-on-one sessions, either before or after joining the larger group.

“A lot of it is about removing the shame and stigma about accessing one-to-one support, so young people don’t feel embarrassed about accessing support,” Murray said.

In some cases, family members such as parents are involved. Murray noted that parental support can play a “massive part” in terms of LGBTI+ young people “achieving their full potential”.

“I see young people walking down the corridor to BreakOUT with parent support and without, it’s like chalk and cheese.”

Sometimes parents also attend counselling sessions with their child, if this is what the young person wants. 

‘An extra line of defence’

David Clarke is a youth worker with FDYS in Wexford town, where he coordinates the local LGBTI+ group, which is merged with the Cloister Youth Programme.

He agrees that while “it’s great that we have [marriage quality], there’s still so much we have to do”. 

Clarke said having a group with membership open to both members of the LGBTI+ community and other young people makes sense from logistical and inclusion points of view, and benefits everyone involved.

He said it can be particularly helpful for people who wish to attend a support group but have yet to come out to their parents. 

File photo of a group of young people with a facilitator. Shutterstock / Photographee.eu Shutterstock / Photographee.eu / Photographee.eu

“It’s not going to suit if you’re trying to sneak out to go to the group, parents will want to know where you’re going and maybe you haven’t come out yet,” Clarke said, adding that some young people rely on public transport or need a lift to get to the group so “privacy kind of goes out the window”.

“The young people can just say they’re going to a youth group, which they are.”

Clarke said that by being open about their sexuality or gender within the group, people get to “see that not everyone will react badly to them coming out”.

In some cases they receive support from other people in their school who are members of the group but don’t ‘out’ them in school. It’s almost like an extra line of defence.

Both DYS and FDYS provide teacher training so schools can better support LGBTI+ young people.

Clarke said, in his experience, there is a “huge want” among teachers to be more aware of how they can help. He said something that was “holding them back” was fear of using the wrong language or terms.

“You have a multitude of sexualites that have started coming up – they’ve always been there but now they’re being spoken about.

There’s a fear among teachers, ‘What if I say the wrong thing? I don’t want to make it worse.’

“We tell them it’s okay to make a mistake, ‘The child will help you and you’ll help them.’ Once they’re told this, you see the pressure lifting, in my experience anyway.”

The LGBTI+ National Youth Strategy 2018-2020 was launched during the summer. It was compiled after consultation with more than 4,000 young people and campaigners.

In terms of mental health, the report notes that the “challenges young LGBTI+ people face are often the product of broader social attitudes, and so it is acknowledged implicitly throughout this Strategy that changing attitudes of non-LGBTI+ people towards LGBTI+ people through awareness and education improves the lived experiences of LGBTI+ young people themselves”.

“We need to ensure that any LGBTI+ young person who is experiencing challenges with their mental health has the proper supports they require, and encounters informed and respectful health care professionals. Work is ongoing, building on the recommendations of the Youth Mental Health Task Force.

“It is also important to point out the different requirements within the LGBTI+ population. Transgender young people in particular have different needs, including healthcare needs, to their LGB siblings.”

Trans issues

The issued faced by people coming out in terms of their sexuality are often multiplied for people coming out as transgender.  

Murray said trans people often have a harder time coming out than gay or bisexual people – for various reasons. She said similar fears stop or delay many people from coming out – fear of rejection, stigma, and a lack of access to appropriate services.

Murray said nowadays more trans people are choosing to come out at a younger age, compared with when the local LGBTI+ group was first set up nine years ago.

“In Letterkenny in 2009 no trans young people were coming out, they went to college and then came out. People are coming earlier which is great to see.”

However, this is still a daunting prospect for many people – particularly in more rural areas.

It depends where you are, if you’re from Glenties, for example – that’s rural, rural Ireland. Many young people had never seen LGBTI+ people in their community, they were less visible.

Murray noted that going to school can be difficult for trans people as hearing “their birth name being called out eight times a day in class” or statements like ‘Hello girls’ or ‘Morning boys’ can be “really, really damaging” as it reaffirms gender dysphoria.

Attending a youth group is sometimes the first and, for a period, only place someone is referred to by their preferred name and pronouns.

Murray said this is hugely important in terms of building a young person’s confidence and sense of pride in who they are – particularly at an age when their bodies are changing and becoming more ‘male’ or ‘female’, something that “can impact them traumatically”. 

Choosing a new name 

Murray noted that, in her experience, one element that parents of a trans child tend to struggle with is them changing their name. Choosing a new name is a very important step for trans people and often done without consulting parents.

“Ask any mum or dad out there, they have a story about how they chose [their child's] name … Parents might not be consulted regarding the new name and may have an issue with this,” Murray stated.

File photo of a teenage boy at a therapy session. Shutterstock / Monkey Business Images Shutterstock / Monkey Business Images / Monkey Business Images

In a bid to help this process Murray said it can be helpful for the young person, once they are comfortable with this, to sit down with their parents to talk about their new name.

They tell the parent or guardian the story of their new name and why they chose it. By sharing this, the parents can also feel a sense of ownership of the new name because they know the story behind it.

“That’s a really powerful exercise, you can see it all unravelling throughout the meeting.”

CAMHS

Many young trans people are referred to CAMHS, Child and Adolescent Mental Health Services, but often have to wait several months or over a year to get an appointment due to long waiting lists. 

Conditions treated in CAMHS include moderate to severe depression, anxiety, eating disorders and self-harm. Murray and Clarke said some trans people are incorrectly referred to CAMHS as doctors may be unsure of where to refer them. 

As of August, 2,403 people under the age of 18 were on the national waiting list.

There are three types of CAMHS referral: urgent, emergency and routine. A HSE spokesperson said: “Every effort is made to prioritise urgent referrals so that young people with high risk presentations are seen as soon as possible and this can often be with 24- 48 hours.

“This may impact on wait times for cases that are considered, by a clinician, to be less severe. The CAMHS referral teams meet every week to review all referrals and to assess the risk to the young person.”

The spokesperson added that, as of August, 80% of referrals accepted by child and adolescent teams nationally were offered an appointment within 12 weeks. However, delays occur due to a number of issues, such as high demand on services and recruitment difficulties.

A number of initiatives are under way in a bid to tackle this – including 10 new posts for Advanced Nurse Practitioners, an additional 20 beds planned for the new children’s hospital and an additional 10 forensic beds in the National Forensic Mental Health Service.

Gender recognition and reassignment 

For trans people who choose to have gender reassignment surgery, generally travelling to the UK to do so, the process is often even more arduous than seeking psychiatric help.

“It’s like Limboland really. The different services are maxed out and they don’t know what’s the best way forward. It’s primarily a waiting game,” Murray said, adding that many people wait until they’re over 18 and go through the private system – if they can afford to.

The Gender Recognition Act 2015 provides a process enabling trans people to achieve full legal recognition of their preferred gender and allows them to get a new birth certificate. 

An application can be made on behalf of a 16 or 17-year-old if a court order is obtained that exempts the teenager from meeting the age requirement. For this, they must have parental consent, which may not be an option, and undergo psychiatric assessment. 

Ninety-nine people had gender recognition certs granted last year.

‘Massive impact’ 

Some young trans people who are doing well in terms of their overall mental health develop issues while waiting for official recognition of their gender or to undergo the reassignment process. 

“Trans young people are some of the strongest people I’ve ever met, they have great resilience, but when they’re waiting so long … that can have a massive, massive impact,” Murray said. 

Clarke added: “It’s bad enough to wait for a small [procedure], let alone something you’ve been waiting for since you realised you were trans. 

Some people are waiting such a long time to begin the process or start taking hormone replacement therapy … that’s bound to have some negative mental health effects.

He noted that turning 18 is meant to be one of the best times of a person’s life, when many people start college and gain a new sense of independence. 

“On top of the stress of coming out, they’re deciding what to do with their lives. At 18 they’re meant to be going to college, enjoying themselves, but they could be waiting to see a consultant and surgeon.

“That’s a huge amount of extra pressure. It’s like you’ve to put your life on hold, you’re not yourself.”

Wexford is currently without a serving CAMHS psychiatrist. “I’m still in shock that we ended up in that situation,” Clarke noted.

When asked asking the situation in Wexford and Waterford, which is also without a CAMHS psychiatrist, a spokesperson for the HSE said the organisation is “working to address the filling of any vacancies” in both counties.

“The HSE is currently operating a national and international recruitment campaign for Consultant Child and Adolescent Psychiatrists. This resource will be drawn on to fill positions on a permanent basis in the Waterford and Wexford areas.

“In order to maintain continuity of service within CAMHS, the HSE South East Community Healthcare Mental Health Service is operating weekend CAMHS clinics in both Waterford and Wexford which are facilitated by CAMHS Consultants from neighbouring Community Healthcare Services.”

FDYS has an in-house counsellor who young people can talk to, but Clarke added: “I’m a firm believer in counselling but if you need psychiatric help, that’s only a bandage until you get it.”

Need help? Support is available:

• Samaritans 116 123 or email jo@samaritans.ie
• Aware 1800 80 48 48 (depression, anxiety)
• Pieta House 1800 247 247 or email mary@pieta.ie (suicide, self-harm)
• Teen-Line Ireland 1800 833 634 (for ages 13 to 19)
• Childline 1800 66 66 66 (for under 18s)

You can read about BeLonG To’s services here, DYS here, FDYS here, and services provided by the Transgender Equality Network Ireland here.