Ensuring inclusion of LGBTQ patients in the bush

  • Holding hands in front of rainbow flag
Claire Allen
Claire Allen (She/Her),
National Program Manager,
Pride in Health + Wellbeing

Often, our regional health services are the glue that holds small communities together – the hub of health, human services and wellbeing for the community they serve. There is a wonderful whimsy to the unconventional way things are done ‘in the bush’, along with an undercurrent of conservatism that can be daunting for some.

Due to this, LGBTQ young people often leave regional and rural areas for the anonymity and support of big cities – where they feel accepted and celebrated for their diverse gender and/or sexuality, and ‘find their tribe’.

HWEI Health + Wellbeing Equality IndexThis creates a narrative that gender and/or sexuality diverse people are scarce in remote, rural and regional areas. However, our research in 2022 has shown this not to be the case. Our free, annual national Health + Wellbeing Equality Index (HWEI) survey has shown some interesting demographics of respondents.

Unsurprisingly, the number of Aboriginal and Torres Strait Islander respondents increases three-fold from city to rural areas and, conversely, culturally and linguistically diverse (CALD) communities are approximately one-quarter of the city proportion in more regional areas.

Interestingly, we did see an increase in trans and gender-diverse people (those whose gender does not match the sex they were assigned at birth) in remote areas (from 0.6 to 2.6 per cent), whereas diverse sexuality stayed constant at approximately 14 per cent of respondents, irrespective of location.

We also saw similarities in healthcare providers’ attitudes, with 3.5 per cent of city respondents agreeing they ‘cannot look after service users of diverse sexualities and/or genders’ compared to 2.8 per cent of rural and remote respondents. However, the ‘unsure’ cohort doubled when moving from city to rural and remote (from 4.4 to 9.3 per cent). This potentially shows a lack of education, support and guidance in more regional areas aimed at the provision of inclusive care, and the link to more gendered framing of services such as ‘women’s health care’.

How can regional, rural and remote healthcare providers ensure they are inclusive of their LGBTQ patients?

Be visibly inclusive. Show your inclusiveness on your website, brochures and door, in waiting rooms and more. This flags to the community that they are welcome and stops people avoiding care out of fear of discrimination. Also, as not everyone is inclusive, have the allies within your service identifiable by a rainbow badge or lanyard (or similar) – so we know who it is safe to ask questions of.

Update your forms. Ensure the data you’re collecting from your service users also has inclusive options. Not only does this flag your inclusiveness, but it also allows your users to self-identify in a way that best fits them – including male, female, non-binary and self-described options.

Educate yourself. Use reliable sources for information and best-practice advice, rather than grey literature (such as Wikipedia). Sources from clinical experts (such as AusPATH) or community-led organisations (such as ACON) are a great start. Some formal training from a peak body is ideal – but possessing a lifelong learning mindset is also key.

Confidentiality is vital. Gossip can travel like wildfire, especially in a small community where overlap of professional and private lives is common. If you provide assurances to the community of confidentiality if they disclose their identity to you, this will alleviate a lot of concern. This means having a conversation about how they want to identify publicly and if they want their identity disclosed to other staff within the service or when writing referrals to external services.

Pride in health + wellbeing logoMeasure your inclusiveness. Are you as good as you think you are? You can take our two-minute audit (prideinhealth.com.au/audit) or participate in our free, annual national benchmarking index and survey (prideinhealth.com.au/hwei) to anonymously benchmark your LGBTQ inclusiveness across the sector. You will receive results and commentary for improvement, which is provided to all participating organisations.

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