Pride in Healthcare: Reflections on Finding my Voice and Supporting LGBTQ+ Young People to Find Theirs

In 1988, the Conservative UK government passed a law that stopped councils and schools from teaching the acceptability of homosexuality. By the time it was repealed, I had started university, missing out on so many opportunities to learn about myself, my community, and the joy to be found in a world where you can be yourself and have a voice. The effects of such oppression on a generation of people cannot be underestimated and this has implications for professional lives too – LGBTQ+ teachers who worked under Section 28 continue to report viewing their teacher and sexual identities as incompatible (Lee, 2019).

Training and working in a profession that has often historically colluded with damaging ideas about difference (Ellis et al., 2020) has brought experiences that haven’t always been a friend to developing my voice as a queer professional, an experience shared by other LGBTQ + students working toward a career in healthcare (Lockman, 2020). Qualifying as a Clinical Psychologist in 2020, I had access to very little teaching around LGBTQ+ psychology (trainee psychologists have expressed a wish for more teaching around LGBTQ+ mental health generally; Hayward & Treharne, 2021) and none about navigating the workplace as a queer person. Although it has been suggested that around 90% of therapists self-disclose in some respect, (Henretty & Levitt, 2010), like many other queer therapists (Moore & Jenkins, 2012), I have approached how much I bring myself into the work with great caution. Experiences like overhearing a homophobic comment from a healthcare worker while on a training placement were met with indifference from supervisor (‘it’s too busy a time to address it’), directly communicating to me that I should just tolerate it. There have been many times where I felt stuck, the pressure to be silent feeling a lot less explicit than it was growing up, but just as effective in terms of allowing me to take up space.

Thanks to a very supportive placement where I had a queer supervisor, and a service lead who encouraged us to bring ourselves into the work, I began to find my voice, and this was transformative. But it took a long time to find my voice, and since qualifying as a psychologist I’ve been working to try and support queer young people to have their say in improving psychology and health services (one project described in Huckridge et al., 2021). This pride month, I would like to share some of my learning in trying to ensure that young people, and indeed the next generation of professionals, are able to take up some space and perhaps later on in their lives, bring themselves into the work.

Despite some significant social and political change around LGBTQ + rights and visibility, LGBTQ + young people continue to face significant challenges to their mental health (Fish, 2020). Often ‘coming out’ at younger ages (Dunlap, 2016), LGBTQ + young people today are living with rumblings of legislation being rolled out to deny rights and services to transgender youth, which will exacerbate existing health disparities, facilitate risky health behaviours, and lead to preventable deaths (Barbee et al., 2022). The way that LGBTQ + young people access information about health and community has also changed. In the UK today, young people have access to a wealth of internet-based media – effects of which include access to resources, exploring identity, finding likeness, and digitally engaging in coming out (Craig and McInroy, 2014), and they are more likely to engage with these online communities than offline ones (McInroy et al., 2019). LGBTQ + young people have wisdom about these specific challenges and experiences and have advice for their peers around how to persevere, feel proud of their identities, and support development and wellbeing through connections to others (Goffnett, and Paceley, 2020). As such, it is vital that we support LGBTQ + young people to be confident in sharing their experiences, so that support and research is relevant to their needs.

Article 12 of the United Nations Convention on the Rights of the Child (UNCRC) states that it is every child/young person’s right to have their voice heard in decisions that affect them, and NHS England have ambitions for 95% young people to be involved in their healthcare decisions (NHS England, 2023). However, amongst the current discourse about services for LGBTQ + youth, the failure to include young people and their families’ voices in discussions around gender care has been acknowledged by professionals (Guardian, 2022). It has been suggested that for trans and gender diverse particularly, there is an absence of informed consent, violations of confidentiality, and lack of opportunities for active participation in research processes that result in Trans voices being reduced to ‘testimony’ (Suess Schwend, 2020). We must protect the rights of LGBTQ + youth (and their families) to have a say in decisions that affect them, make sure they know they have this right, and give them diverse ways of meaningfully having a voice. I also echo calls to give space for hearing and amplifying stories of resistance, power, strength, and joy in LGBTQ + youth’s lives to broaden understandings of life for queer youth (Robinson and Schmitz, 2021).

Young people have described the adverse consequences to their psychological well-being when they raise their voice and participate in activism (Conner, Crawford, and Galioto, 2023aConner, Crawford, & Galioto, 2023), with a sense of belonging to an activist community being an important protective factor in preventing burnout (Conner, Greytak, Evich, and Wray-Lake, 2023bConner, Greytak, et al., 2023). Peer support and a sense of belonging have been shown as protective factors against burnout from youth activism (Conner, Greytak, Evich, and Wray-Lake, 2023bConner, Greytak, et al., 2023) and social connectedness has frequently been associated with positive outcomes for queer youth, including providing affirmation of identity, increasing self-esteem, and creating forums for collective action within the SGM community (Detrie and Lease, 2007; DiFulvio, 2011; Snapp, Watson, Russell, Diaz, and Ryan, 2015). ‘Visual cues’ such as rainbow flags (Paceley et al., 2018), LGBTQ + information or publications (Eisenberg et al., 2018), increased visibility of LGBTQ + adults and allies, including organisation leaders (Davis et al., 2009; 2010; Eisenberg et al., 2018; Wells et al., 2013) have all been shown as supporting young people to access queer youth spaces. As healthcare professionals we can have a valuable role in creating these spaces for young people to come together, and build their individual and collective voices.

It took me a long time to find my voice in a world that told me I shouldn’t have one. Although progress has been made in the UK with the repeal of Section 28, equal marriage, and a shift from pathologising difference, the climate toward LGBTQ + young people – particularly young trans and gender expansive people – is an oppressive one that I bear witness to everyday in my work. This pride month, I invite you to consider how you might stand alongside these young people – perhaps read some papers that centre the voices of LGBTQ + people, speak to them directly, or think about your own service and opportunities to learn more about how it is experienced by the queer people who use it. By doing this, we have an opportunity to do things differently to our predecessors, and prepare the next generation of our colleagues to bring themselves, their unique perspectives, and wealth of experience into the world and possibly eventually, the work.