With a recent report showing that over 47 percent of Irish LGBTQI+ people live with depression, Chris O’Donnell speaks about societal attitudes to our community’s mental health as well as their own experience in accessing services.

Just before June, 2016, admitted myself to the Mater psychiatric ward because of a mood disorder that had been spiralling out of control.

I was the only out LGBTQI+ person on the ward: there were about 15 of us in total. It had a communal area, which was of no interest to anyone except Mick - a truck-driver who was trying to cut down on the smokes, and then there was the electric pulse of the psych ward- the smoking area, a tiny room with an odour of tobacco so dank it even got to me, a heavy smoker. It was nestled in the corner of the communal area, and practically all the patients - heavy smokers also would pile in first thing at ten in the morning when they opened the smoking room door after the medications had been doled out. listened to everybody’s story in that opaque room. Not long into my stay, was sitting in the smoking room alone, for once, lost in thought. Something must have given away the stifling depression was smiling my way through, since Mick, who kept himself to himself, came in and offered me a cigarette, lighting one up himself. Once he’d shared a bit about his depression, which was extreme and devastating, he asked me if knew anything about the ‘Black Dog’.

‘That’s what landed me in here in the first place,’ conceded.

‘And do you have a partner to help you through the Black Dog days?’

I could tell by the pause, and the way he said ‘partner’ that he had an inkling was gay.

‘No, me and my girlfriend broke up three years ago. Old news.’

‘You know gay Pride is in two days?’

‘I know. never miss Pride. I’ve been marching since was 13. That’s 17 years!’

‘Well ya can’t stop now,’ said Mick.

‘But how the hell would ever get out of here? They won’t let me out the door I’ve only had shoe privileges for one day now!’

‘You’re right’ he said co-conspiratorially, ‘they’ll never let ya out of here for a parade. Let alone Pride. Don’t forget the head psych almost definitely voted ‘No’. But can see you could do with a break.’

‘And when come back covered in glitter?’

He smiled., ‘Kid’s birthday party. You’re meeting your family for a quiet mental health break.’

Two days later my brother came to pick me up to take me to the ‘party’. Identity were marching - an LGBTQI+ group for asylum seekers - and wanted to show my support. So was preparing to go out in shoes with no shoelaces on, and my nurse, who had taken a particular dislike for me, said sternly ‘come back in an hour.’

‘Oh, it’s at a restaurant,’ said nonchalantly. ‘With terrible service. might be longer.’

My brother popped his head round the door of the communal area. ‘All good to go?’

‘Have her back in two hours’ were the last words could hear as headed out to Pride.

According to the LGBTIreland report carried out in conjunction with BeLonG To and GLEN, 60 percent of LGBTQI+ people have had suicidal thoughts, with almost half reporting that they had taken place in the past year. When you break it down, that roughly equates as two thirds of your queer circle having been so consumed with suffering that they have experienced thoughts of ending their own life. Those statistics are telling of the kinds of shame and inner-loathing that our society can force us to internalise, whether it happens on an unconscious, or conscious level. On a much more human level, they are a distressing indicator of how many LGBTQI+ people consider suicidal thoughts at some point in their lifetime.

On top of that, the report showed that 47 percent of LGBTQI+ people live with depression, with 20 percent in the ‘extreme’ range. But when we begin to look at the historical and social institutionalisation of Ireland’s queer community, these statistics, depressingly, can be contextualised. Besides the oft-quoted, landmark years of 1993 (when homosexuality became decriminalised), and 2015 (with the caveat: let’s not forget the 40 percent who voted ‘No’), we can look further back and see how Irish society created a language of psychopathology around LGBTQI+ people. With roots in the conservative rule of the Church, it was traditionally considered ‘sexually deviant’, with the most homophobic of all claiming ‘perversion’, to be constitutional in LGBTQI+ identity. This has been played out many times in the past through the institutional acceptance of gay conversion therapy, (for which there is now legislation to outlaw). That’s not even to mention the amount of LGBTQI+ people who have been shunned by family and community in the past and present, although attitudes are starting to change - at least towards the LGB communities.

Banning gay therapy conversion is definitely a step further, but is it enough? We need look no further than our trans communities, who were outlined as an especially vulnerable cohort in the LGBTIreland mental health report, and who are being labelled mentally ill for experiencing gender dysphoria. According to the HSE’s guidelines, the first place for a transgender person to go is a psychiatrist to ‘cure’ their ‘illness’. In fact, it was only in June 2018 that WHO decided to state that being transgender is ‘not a mental illness’, as it had so previously been classified.

I spoke with Dr Brian Keogh and Dr Louise Doyle of Trinity College Dublin both actively involved in research and bringing LGBTQI+ issues into the curriculum for students in the School of Nursing and Midwifery - about this particular issue for transgender communities. Dr Keogh pointed out the inner circles of support that can be vital in getting people through the first steps. He stated “In my opinion, being transgender is not a mental illness, but it can be a lot to cope with, coming out as transgender. So the person may feel the need to speak to somebody. TENI have great resources for pointing people in the right direction, as do Outhouse.”

Dr Doyle also pointed out a more gradual route to the psychiatrist: “A potential good outcome would be for a GP to refer their patient to some of the services available. There are plenty out there. A GP could refer to TENI, where the transgender person could get support, or if they’re younger perhaps BeLonG To. But if the person is experiencing mental health difficulties alongside their gender identity, a psychiatrist is important.”

There is general consensus that the level and intensity of care depends on the transgender individual. But Ireland hasn’t caught up. WPATH (the World Professional Association for Transgender Health) outlines in its Standards of Care that medical professionals should not pathologise the transgender or gender nonconforming individuals they are treating, yet this is exactly what we are doing by assuming that every single transgender person has an inherent mental health disorder.

The LGBTIreland report also showed that the bisexual and intersex communities presented as particularly vulnerable groups within the LGBTQI+ spectrum alongside transgender people. In fact, intersex people had the highest levels of depression, anxiety and stress. The sheer lack of visibility and dialogue with this community is telling in the face of these facts. TD Clare Daly, a tireless human rights activist, has asked the parliamentary questions around intersex infant procedures, and found that in the year 2014, and the year 2016, there were surgeries being carried out on intersex children in Irish hospitals. As the EU Rapporteur on Torture openly stated - this is a gross violation of human rights for intersex people.

The mental health implications for such medicalised stigma literally so unacceptable to society’s assumed male/female paradigm that surgery has to be carried out are hugely complex. On top of that lies a superimposed culture of secrecy and shame, leading to invisibility and lack of support. It is no wonder that the way in which the medical profession (and society at large) has treated and typecast intersex people has led to such a state where it remains, to many, such a taboo. On that note, though, it was heartening to see that there had been some intersex representatives’ submissions included in the LGBTI+ Youth Strategy launched by Minister Zappone earlier this year. Issues around infancy, medicalisation and intersex identity are addressed in the three-year Strategy, which will hopefully signal a change from the current medical and visibility-based status quo for our intersex communities.

“The report showed that 47 perecnt of LGBTQI+ people live with depression.

These are positive signs, but they cannot disguise the limitations in the current provision for mental health care in Ireland, for LGBTQI+ people but also more broadly. My experience on the ward was just one insight into the ways in which those with mental health issues are treated.

In the end never did get to march. Between the time taken getting to Parnell Square, and delays with the parade, had to leave before things got started. was wearing shades to block out the sunlight having spent so long under fluorescent lighting.

On the walk back to the ward, my brother consoled me, telling me could do the whole march with Identity next year. was feeling low, yet couldn’t help but be lifted by the presence of the friends I’d bumped into as we gathered before the parade started. A melancholic sense of resilience replaced the so-called ‘Black Dog.’ A meaningful encounter with friends from my LGBTQI+ community gave me a renewed sense of self.

Otherwise my memories of the ward are overwhelmingly negative. The fact that felt couldn’t be open with the nurses only demonstrates Dr Louise Doyle’s point, “there can be a fear of misunderstanding for the LGBTI community”. In fact, the entire Pride incident came to seem darkly comedic, like a surreal burst of activity in the middle of a long spell of inertia. There were no activities on the ward. In the eight days was there, the nurses organised just one ‘music night’, where patients chose songs on Spotify to be played on a speaker in the communal area, then clapped. chose a song and most of the group left immediately. Nurses would roll their eyes (desensitised, no doubt), when patients got uncontrollably afraid and upset, their manner becoming urgent, tense, fearful. was lucky enough to be released after little more than a week. There had been an oversight regarding a change in my medications. It was quickly remedied. In short, the mental health services are strained, there is a postcode lottery (conditions in wards vary wildly across the country), and, as Dr Shari McDaid of Mental Health Reform stated, “overemphasis on medication over therapy is just one part of the problem”.

There was one quote from the LGBTIreland report that really struck a chord (among others). The individual quoted is intersex and gay, and the quote reads: “I’m proud of the journey I’ve made personally in going from hating myself for my sexuality to accepting and approving of myself. If wasn’t LGBTQI don’t know if would have learnt such self-acceptance.” Within this quote can be detected a profound humanity that has been learned through suffering, and, along with it, compassion and wisdom. We cannot forget the human capacity for post-traumatic growth: the positive psychological change experienced in the face of adversity for our LGBTQI+ communities.