LGBTI people and healthcare professionals involved agreed that mandatory training around LGBTI issues is needed by all staff in healthcare services.
The study, part of a 24-month project launched in 2016, is funded by the European Parliament and is being carried on behalf of the European Commission.
Key findings include:
1. Root causes likely to contribute to the experience of health inequalities by LGBTI people are:i) still prevailing cultural and social norms that assume people are non-LGBTI by default; ii) minority stress associated with sexual orientation, gender identity and sex characteristics; iii) victimisation; iv) discrimination (individual and institutional), and; v) stigma.
2. Significant mental and physical health inequalities exist for LGBTI people. For example, LGBTI people are at significantly higher risk of poor mental health compared to the general population which includes higher incidence of suicidal thoughts, substance misuse, anxiety, and deliberate self-harm.
3. LGBTI people face barriers when accessing healthcare. Examples include prejudicial attitudes and discriminatory behaviour of healthcare staff; unequal treatment; needs not being recognised; fear of disclosure of gender identity, sexual orientation, or sex characteristics. Cases were reported where LGBTI people see themselves being refused healthcare services due to their sexual orientation, gender identity, or sex characteristics.
4. Many health professionals lack knowledge and cultural competence concerning the lives and healthcare needs of LGBTI people. Firstly, medical literature regarding LGBTI people needs to be updated, secondly health professionals’ assumptions can be a barrier to LGBTI people seeking healthcare. These include assumptions that people are non-LGBTI by default; that being LGBTI is irrelevant; and that LGBTI people do not experience significant discrimination. Thirdly, they can find it difficult to challenge anti-LGBTI attitudes from both colleagues and patients.
5. Specific groups within LGBTI (particularly bisexual, trans and intersex people) encounter their own specific barriers, and healthcare professionals’ knowledge of these groups is limited.
6. Although scarce, in some Member States, examples of promising practice in meeting the needs of LGBTI people are evident.
The study revealed significant gaps in research on the topic and limited research with trans and intersex people to better understand their general health profile, experiences, and physical and mental health needs in relation to service provision. Similarly, further research that adopts an intersectional perspective on health inequalities experienced by LGBTI people is required.
Where research does exist, it showed that living in rural areas, being a migrant, refugee, and/or asylum seeker, being on a low income, being young or old, and living with disabilities can contribute to health inequalities for LGBTI people and have implications for access to health services.
Findings and feedback about training needs are being used to develop a new training package for healthcare professionals across the EU. This modular training package will expand healthcare professionals’ skills regarding LGBTI people’s healthcare, in order to help address the barriers and inequalities identified.