Reporting Back: Bis and Mental Health

BCN 119 cover

This originally appeared in BCN issue 119, Summer 2013

At the 2011 and 2012 BiCons, I helped run workshops about bisexuals’ experience of mental health care.  The focus was not on bis’ mental health as such, but on what we could feed back to the NHS and other health care providers who might be interested.

This project began with a local-to-us in Greater Manchester NHS trust approaching BiPhoria (Manchester’s social and support group for bis) at a Pride stall to ask if we were interested in talking to their staff on an LGBT training day.  So from the beginning there has been interest from their side, which has encouraged us to gather this information to be shared with them and any other care providers who might have a similar interest in improving the experiences that bisexual patients/clients have with them.

In the past two or three years, volunteers from BiPhoria have put together a couple of resources for people who work in mental health starting with some basics – what bisexuality is (and isn’t!), what biphobia is and what it can look like. We also feature some facts and figures, and quotes or stories from bi mental health service users themselves that powerfully illustrate the potential difficulties for bisexuals in a biphobic system.

Since the theme of BiReCon 2012 was mental health, we volunteers also ran the workshop there, which means that there have been three sessions in the last two years asking people to share their experiences of mental health care.

My fellow workshop runners and I continue to be grateful to everyone who came along, shared their stories, and offered written anonymous feedback.  This wouldn’t have been possible without their willingness to participate.

The full resources can be downloaded from the BiPhoria website, but here are some highlights of the new results and recommendations based on the input of the participants in our BiCon workshops:

Almost all the answers emphasise the importance of the service user knowing how the information about their sexual orientation will be used.  Why does the service want to know?  Will someone saying they’re bisexual be beneficial to their care, or do they risk prejudice and judgement?   One person said, “I haven’t had informed reactions in the past and would like to be confident that whoever I was coming out to wouldn’t make assumptions about me.”  Some people said they would need to know that the information can be kept confidential or anonymous.

Will saying they’re bisexual derail the treatment the person is seeking?  While there were a few people who said that coming out hadn’t been an issue, overwhelmingly many feel that they have to “educate” health professionals about bisexuality. Good experiences seemed remarkable because they were relatively rare.  People said things like “Counsellors have generally been supportive, only 1 out of 5 needed major educating,” and “my only positive experience comes from mental health staff who are LGBT themselves.” Bi people report that they don’t expect professionals will understand bisexuality – and if the health care providers do have any awareness of bi people, their impressions are likely to be unfair and incorrect.
Of course bi people aren’t just bi.  The mental health service users among them also came up with general advice in how things could be improved.  “I’d make mental health services better for everyone,” one person wrote, echoing what a lot said.

Here’s how…
Do
 Trust/believe service users’ Intellect, experience, and self-reporting
 Deal with people as if they can be intelligent/articulate/educated
 Ensure service users know about expectations and penalties for mental health professionals (so that if their treatment is very poor, they can be assured there will be consequences)
 Try to be aware of your own therapeutic blind-spots / recognise the limits of your professional competence
 Communicate clear expectations and standards of care
 Read the notes before appointments
 Remember mentally ill people are made worse by poor treatment
 Show empathy and compassion
 Be open-minded

Don’t
 offer telephone-only services/appointments or require people to make or attend appointments early in the morning.  These are both access issues – many people find telephones difficult or impossible to use, and someone said “With the meds I take, I can’t always make sure I’ll wake up in the mornings. The only way I can be sure I’ll be awake is to stay up all night.”
 assume partners exist or are willing to be carers
 limit treatments to just “cost effective” services; as someone said, “good health & recovery aren’t always cheap!”
 present a façade of fundamental difference from service users – we’re all human, with our struggles, quirks and difficult times
 misuse power that professionals have over service users (using sectioning as a threat, affecting benefits, etc.)
 offer only CBT or short-term options; a range of therapies is needed
 be patronising