Prejudice and Asking the Difficult Questions About Mental Health Outcomes for the “GLBTQI” Community
Before you read this, let alone leave a comment, let me just ask you for one thing - engage with the argument being made and the questions being asked. That's all.
I received an email this afternoon via change.org, the online campaign website. Here's what they had to say,
Tom Ballard’s petition calling on Kennett to support the mental health of Gay and Lesbian young people has exploded across social media and unified almost 4000 people from all over Australia. Tom is close to success - but needs an urgent push in the next 24 hours to make sure a victory is secured.
Sign the petition now before it’s too late: http://www.change.org/petitions/jeff-kennett-end-discrimination-support-mental-health-for-glbtiq-young-people
Kennett is feeling the heat, and working to control the damage. Tomorrow at 12pm EST he’s appearing on Joy 94.9 FM (Melb) to clarify his comments and indicate where he stands. There has never been a better chance for him to play a leadership role and create an inclusive and supportive environment for GLBTQI (Gay, Lesbian, Bisexual, Transgender and Queer Identifying) youth.
We’ve got 24 hours. Let’s ramp up the pressure and demonstrate overwhelming community support for a personal commitment from him, to issues of GLBTQI mental health.
So what's this all about? Well the email helpfully explains…
Have you seen the news? Jeff Kennett - former Victorian Premier and Chair of national mental health initiative beyondblue - is being slammed for contributing to a culture of homophobia and discrimination that’s having a terrible effect on the mental health of young people all over Australia.
Just last month Kennett claimed that children in a homosexual family would have worse mental health outcomes. But that’s not all - Kennett has also compared a bisexual trainer to a paedophile.
Statements like these build a culture of exclusion and discrimination which have created a mental health crisis for gay and lesbian young people. They’re 5 times more likely to suffer from depression, and up to 6 times more likely to attempt suicide.
The mental health crisis for gay and lesbian young people is real and critical. Every day depression impacts on the lives of more young people - but this story can be changed. Beyond Blue’s own research shows that the incredibly high rates of depression and attempted suicide can be lowered by showing young people they are accepted and supported as they are. There is now an urgent need to reshape public conversation to be more inclusive and supportive, and there has never been a better opportunity to start this change.
Beyondblue are feeling the heat - and public scrutiny of Kennett as the Chair of beyondblue’s Board is increasing every day. We can ratchet up the pressure even more - and build a massive public call for Kennett to send a message of respect, support and inclusion to young homosexuals.
Now before I get into this, let me just make a few things clear. I'm all in favour of promoting good mental health. In my work I am regularly referring people on to get the professional help they need in various areas of mental health. I'm a big believer in the value of cognitive behaviour models (not least the Family Systems model). I also recognise that while some of these issues are psychological, others are physiological.
I also despise discrimination. Real discrimination. So (as one example) I've gone into bat in a previous workplace for a potential employee who was quite clearly transgendered, or at least well on the way. In other places I've argue for legal protection for same-sex partnerships in probate, hospital visitation rights etc. However, I also reject the nonsensical notion that simply disagreeing with someone and refusing to affirm their choices is "discrimination". As we'll go on to see, that kind of false definition is really unhelpful. So let's not paint this issue as one of simple prejudice.
Well, of course this is an issue of prejudice - pre-judging - but perhaps not in the way that you first thought. Now, back to the main issue.
Tom Ballard's central argument is this - that the poor mental health outcomes that homosexual people (and, in particular, young homosexual people) experience are (and I quote the email directly now) due to "a culture of exclusion and discrimination". That homosexuals do suffer much poorer mental health is a fact not in dispute. Ballard's email states as much: "They’re 5 times more likely to suffer from depression, and up to 6 times more likely to attempt suicide". Now, on anyone's reckoning that is a terrible thing and, if true, the figures are staggering. Some estimates suggest that the level of depression in the general population may be up to 25% (ie one in four of us will, at one time, suffer from a form of depression). If levels amongst homosexuals are 5 times as great then it doesn't take much to see that there is a serious problem. Of course, given the way that the maths works I suspect that the measures used are not identical - but the fact still stands: this is a real blight. And then there is suicide - 6 times more likely.
No person with even an ounce of compassion can fail to be moved by these statistics. There is a segment of our youth that is suffering terribly and the question before us must be why? and then what can we do about it?
For Ballard, the answer to the first is obvious - it's discrimination and an aggressive environment. The answer to the second is to campaign for a change of the environment. The second, of course, logically follows from the first. It is not necessarily drawn directly from a need to legitimise homosexual behaviour - again, we should not doubt that this is more than simple political posturing; there is a real concern here for young people.
But now the catch. It has long been recognised that homosexuality is correlated with much poorer mental health outcomes. Again, this much is conceded by Ballard - indeed it's a key in his argument. The question before us, however, is whether this is due simply to "discimination" or whether there are other factors at work - even simply the homosexuality itself (ie, is it a "disorder" that inexorably leads to other mental disorders)? This question is not impossible to test since there are some cultures where homosexual behaviour is much more widely accepted, not only in the social climate but also legally (with the provision of structures such as "gay marriage" etc.). In such cultures we would expect a much reduced level of poor mental health for homosexuals. Indeed, this is Ballard's own expectation since he is actively campaigning for such a change in our culture in order to lead to a commensurate reduction in poor mental health outcomes for homosexuals.
The results of research into this question, however, are interesting. A prominent study carried out in 2001 in the Netherlands produced some disturbing results. Same-sex sexual behavior and psychiatric disorders: findings from the Netherlands Mental Health Survey and Incidence Study (NEMESIS) by Sandfort TG, de Graaf R, Bijl RV and Schnabel P (Arch Gen Psychiatry. 2001 Jan;58(1):85-91. pdf here) showed that (and I quote from the abstract)
Psychiatric disorders were more prevalent among homosexually active people compared with heterosexually active people. Homosexual men had a higher 12-month prevalence of mood disorders (odds ratio [OR] = 2.93; 95% confidence interval [CI] = 1.54-5.57) and anxiety disorders (OR = 2.61; 95% CI = 1.44-4.74) than heterosexual men. Homosexual women had a higher 12-month prevalence of substance use disorders (OR = 4.05; 95% CI = 1.56-10.47) than heterosexual women. Lifetime prevalence rates reflect identical differences, except for mood disorders, which were more frequently observed in homosexual than in heterosexual women (OR = 2.41; 95% CI = 1.26-4.63).
Simply put, even in the Netherlands where homosexuality is much more widely condoned and even supported, there are still strikingly different mental health outcomes for homosexuals. The paper itself makes this comment:
It is unclear to what extent findings from this Dutch study can be generalized to other cultures or nations. Compared with other Western countries, the Dutch social climate toward homosexuality has long been and remains considerably more tolerant. To the extent that the level of social acceptance of homosexuality induces differences in mental health status in relation to homosexuality, the observed differences might be greater in other Western countries than in the Netherlands.
So how do we take findings like these and respond to Ballard? Well, the wrong thing to do would be to claim that the Dutch study categorically demonstrates that homosexual mental health states have nothing to do with a hostile environment. There is discrimination against homosexuals which is simply unacceptable. All the more so when it is directed against young adults who are struggling to come to terms with their sexual self-identity. But we also need to recognise that the issue of mental health of homosexuals cannot be isolated to discrimination. The Dutch study (and others like it) make it abundantly clear that there is something else going on. The very extreme lower boundaries of the 95% confidence-level intervals on the Dutch results show that even in a much more supportive culture homosexual men are at at the very minimum at least 50% more likely than heterosexual men to suffer mood or anxiety disorders - and the actual level is almost certainly much higher still.
Simply changing the culture is not enough for these young persons. It is not sufficient to do away with discrimination. If we want the very best for these young persons then we need to face up to the fact that the reasearch is showing us that there is a much higher level of mental illness in homosexuals.
Ballard's email states,
There is now an urgent need to reshape public conversation
and I couldn't agree more. The thing is, perhaps the conversation should not be to simply be "more supportive and inclusive" (ie affirming of homosexuality) but, rather, be one that gets to grips with the detailed research.
This is, ultimately, an issue of prejudice. Ballard, and those like him, are prejudging the issue - they appear to not be willing to accept the statistics, or at least seem to be ignorant of them. So, friends, let's courteously and generously but bravely "reshape public conversation". Let's reshape it in 2 fundamental areas:
- By refusing to accept prejudice against homosexual persons where they are discriminated against purely on the basis of their sexual behaviour or orientation.
- By refusing to accept prejudice against homosexual persons when they are discriminated against by those who refuse to allow the clear research to speak into their situation and therefore prevent them from properly addressing mental health outcomes.
And yes, that might ultimately mean we have to say "look, homosexual behaviour leads to poorer mental health outcomes". If the stats all push that way then why would it be so bad? Surely only the prejudiced would disagree.
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