Reversing the ‘new normal’

Lesbian, gay, bisexual, transgender, intersex, queer and other sexuality and gender diverse (LGBTIQ+) people live in all areas of regional, rural and remote Australia.

Some have positive relationships with family, friends, partners and the broader community. They feel accepted, included and safe, which are all prerequisites for psychological health.

But that’s not the case for many LGBTIQ+ people in regional and remote areas of Australia. In 2020, Private Lives 3 (Australia’s largest national survey of the health and wellbeing of LGBTIQ people) found that 72 per cent of participants in regional cities or towns and 56 per cent of those in rural or remote areas reported high or very-high levels of psychological distress.

LGBTIQ+ Health Australia (LHA) provides the nationwide QLife peer-support telephone and webchat service for people wanting to talk about matters such as sexuality, identity, gender, bodies, feelings and relationships. It is delivered in partnership with LGBTIQ+ community-controlled organisations: Diverse Voices (Qld), Living Proud (WA), Switchboard (Vic) and Twenty10 (NSW).

QLife experienced a dramatic increase in contacts from people in regional and remote areas over the two-year period from 2019 to 2021 – up 121 per cent in outer regional areas, with a five-fold increase for remote and very remote areas.

Conversations about coming out, exploring gender and exploring sexual orientation were topics for which the number of contacts has increased significantly. This growth was effectively across all age ranges, with slower growth only for people aged 35 to 50 in 2020‑21.

It is not surprising that much of the growth was between 2019 and 2020, when QLife contacts nearly doubled across outer regional, remote and very remote areas. At that time, the bushfire season was the worst on record and the COVID-19 pandemic had affected much of Australia by April 2020.

In 2020, LHA asked older LGBTI people about their experiences of living through COVID-19. Most were feeling isolated. Some had moved from major cities and were struggling to establish new friendship networks, without the ability to meet face-to-face.

A clear message from older LGBTI people living in the regions is that social isolation can be extreme and the limited services that do exist are rarely LGBTI friendly.

The number of QLife contacts from regional and remote areas continued to grow in 2021. We cannot allow this to be the new normal. While LHA welcomes recent new federal funding for QLife to recruit and train volunteer peer-support workers, preventive action is also needed.

Many LGBTIQ+ people continue to experience personal rejection and violence. Stigma, prejudice and discrimination create an environment that causes or exacerbates mental health problems and can lead to internalised stigma and pressure for people to hide who they are.

LHA’s National LGBTIQ+ Mental Health and Suicide Prevention Strategy, launched in 2021 following broad consultation and research, points to the essential and fundamental changes needed. The strategy calls for action across all levels of government, between all parts of the health sector, and across multiple other sectors including education, employment, social services, housing and justice.

Discrimination is the underlying driver of the disproportionately high rates of psychological distress and suicidality among LGBTIQ+ populations. Reducing stigma and other body, gender and sexuality shaming is a priority that requires active leadership and programs for diversity and inclusion.

In parallel, improving access to safe and inclusive mental health care requires investment in LGBTIQ+ specialist and inclusive care, including peer support, while strengthening systems and training to deliver safe and effective care in mainstream services.

At the broadest structural level, we need to reform data collection, research, funding and governance to guide effective, community-led responses to LGBTIQ+ mental health and suicidality.