Mental Health Nursing: Suicide

Discuss about the Mental Health Nursing for Suicide.

Suicide is the leading cause of death in the present world (Swannell et al., 2016). It is observed since several decades there is a growth in the suicide rate among individuals identified as gay, lesbian, bisexual, or intersexual abbreviated as GLBTI. A significant part of the Australian society consists of GLBTI people. Researchers have identified a significant correlation between increasing suicide attempts and severe psychological distress amongst this population. The author welcomes the opportunity to discuss the issue of higher rate of suicide among (GLBTI) when compared to the general population in the world. The purpose of this essay is to acquire a better understanding of the suicidal behavior and suicidal ideation among the sexual minority population using the existing research findings. In this essay, the identified problems related to GLBTIs will be discussed in detail along with the associated contributing factors. A thorough literature review will be performed to support the facts and the arguments. Lastly, the essay discusses the strategy that has been adopted to address this issue and finally draw a conclusion.

Individuals who are gay, lesbian or bisexual are attracted and enjoy the sexual relationship with partners of the same sex as themselves. In Australia 2% of individuals belong to this category (Plöderl & Tremblay, 2014). However Skerrett et al., (2014) reported that 15% of women and 9% of adult men in Australia have sexual attraction and relationship with people of the ame sex. Transgender people have a gender identity that differs from their birth sex (Swannell et al., 2016). Intersex people are born with atypical genitals due to hormonal imbalance for example XXY chromosomes. They exhibit a physical variation and do not fulfill the expectation of male or female sex (McLaren, 2016). GLBTI is an acronym which includes all the people who differ in gender identity, sex or sexual orientation from people who are heterosexual or identified as male or female sex. GLBTIs are considered to be a particular marginalized group of population with specific health needs (Lea et al., 2014).

According to Swannell et al., (2016), the people within and between GLBTI communities have diverse experiences and identities. The common influencing factors of this group of individuals (GLBTI) include age, disability, geographical location, ethnicity, migration experience, socioeconomic status and other. A disproportionate number of GBLTI Australians experience worse mental health and suicidality. According to Matarazzo et al., (2014) GLBTIs experience significantly poorer mental health and have a higher rate of suicide (20.2%) when compared to other Australians (9.2%). The rate of suicide is even higher among the Indigenous member of GLBTI population (Swannell et al. 2016). The rate of anxiety disorders among GLBTIs is twice (31%) of that experienced by heterosexual people (14%) (Swannell et al., 2016). Rozbroj et al., (2015) identified that Trans and bisexual people (mainly women) have high rate of depression, self-harming behavior and psychological distress equivalent to that found in non-intersex women with the history of physical or sexual abuse.

Qualitative studies conducted by Pompili et al., (2014) identified that discrimination and exclusion are key contributing factors of elevated suicide rates among GLBTI population. They are highly vulnerable to harassment, violence, and discrimination from other general people. This situation is also considered as minority stress. Wang et al., (2015) argues that it is a wrong notion that GLBTI people commit suicide due to their different sexual orientation or gender identity. The situation is worsened in case of people belonging to remote areas, different ethnicity, migrated from different nations, or any disability. It adds to mental frustration. Skerrett & Mars, (2014) explained that heterosexual people experience homophobia and transphobia. It is the fear of and prejudices against individuals who are identified to be homosexual or transgenders and others who do not fulfill the mainstream male or female gender norms. It is reflected as stereotyping, discrimination, ostracizing, harassment, and violence. Gibbs & Goldbach, (2015) referred that discrimination against GLBTI people and for heterosexuals as heterosexism. It also encloses homophobia and transphobia which are together the key determinants of health of GLBTIs. Hawton et al., (2012) highlighted that the exposure to discrimination, heterosexism, and isolation significantly affect the mental health.

According to Gibbs & Goldbach, (2015) 80% of the adult homosexual, trans and intersex Australians experience harassment (16%), written (7%), verbal and physical abuse (25%). 12% of the people experience obscene phone calls, messages, emails, and damage to personal property. Haas & Drescher, (2014) reported that 49% of trans population undergo sexual assault. It is often heard that GLBTI students experience neglect from peers in schools and name calling such as “faggot” or "queer." These students show high absenteeism and are not career oriented. They showed the high level of frustration due to loneliness and eventually adopted malpractices in adult life. GLBTI youths showed high engagement in alcohol and drug abuse (Pompili et al., 2014). Studies conducted on intersex population revealed that majority of the suicides among these group was due to shame and secrecy associated with their condition and discrimination. It further exacerbates the risk factor of psychological distress (Lea et al., 2014). Moreover, it has been understood that GLBTI people is significantly affected by the suicide of relatives and friends and similar characters like them depicted in books and films (Wang et al., 2015). This has also increased the likelihood of contagion and of perceiving suicide as a final option among other GBTIs.

Plöderl & Tremblay, (2014) analyzed that GLBTIs have limited social connectedness due to fear of discrimination. As a result it hinders the development of well being and resilience. This social exclusion leads to low self-esteem, self-efficacy, and serious psychological distress among GLBTIs which is leading to suicidal thoughts. Unlike the heterosexual peers the GLBTIs are excluded from specific jobs and tax concession leading to economic disadvantage (Wang et al., 2015). It was after 1992, that the consensual sex between men was not considered as criminal offence and World Health Organization removed "Homosexuality" from its international classification of disease (Gibbs & Goldbach, 2015). Plöderl & Tremblay, (2014) identified that being “trans” is still considered to be a psychological disorder. Hence, transsexual people are required to have this diagnosis and psychiatrist approval to access medical intervention. It is impossible without medical intervention for these individuals to “change their sex” on their legal documentation. Consequently, it increases tension and stress among people seeking to affirm a positive identity. Haas & Drescher, (2014) observed there was a decrease in suicide rates among transgender people undergoing gender reassignment due to increase in satisfaction from lives. The barriers to access of such services include psychiatric approval, financial costs, and decreased economic opportunities. The fear of experiencing transphobia, feeling of embarrassment, loss of employment, family support, and poor surgical outcomes mainly prevents transgender from accessing medical intervention. Change of gender on official documents leads to the problem in providing job references and academic transcripts (Haas & Drescher, 2014). It leads to serious mental distress, anxiety and finally suicide. The other factor associated with high GLBTI suicide rate includes absence of bereavement support services, lack of source of empowerment, friends and family support and positive role model (Lea et al., 2014).

It is evident from the above discussion that GBLTI people have diverse and complex mental health needs. In order to address these needs, there is a requirement of specific efforts and interrelated mechanisms. In spite of the robust evidence base provided by international research regarding self-harm behavior, suicidal ideation, and mental health indicators of GLBTI people there remains a knowledge gap. It relates to comorbidity, protective factors, effective intervention, and issues related to GLBTI people (Gibbs & Goldbach, 2015). There are several existing initiatives for these high-risk groups.  However, they are not effective being poorly resourced and isolated from generic actions and stakeholders. Therefore, these services fail to deliver the required level of support (Wang et al., 2015). This evidence base provided calls for the development of policies and programs to protect GLBTI people and prevent suicide attempts.

In Australia, the organization that is working hard to improve the health and well being of GLBTIs is “National LGBTI Health Alliance” (Gibbs & Goldbach, 2015). It offers services considering the social and medical determinants and combines consumer/carer and practitioner perspectives. This body is a member of the “Mental Health Council of Australia and Suicide Prevention Australia”, among other national peak bodies. It has initiated various suicide prevention projects such as “MindOUT!” (Swannell et al., 2016). With this project, it increases awareness and strong policy recommendations by linking “LGBTI sector and the mainstream mental health and suicide prevention agencies”. It supports other organizations with tools and resources to work inclusively of LGBTI people and has it has robust referral pathways. It provides the framework for Australian mental health professionals for counseling and therapy for GLBTIs and suicide prevention services. It is helping in enhancing awareness by proactively building and disseminating knowledge. It delivers speech at national conferences, such as “National GLBT Mental Health Roundtable 2009” on framework and pathways to include GLBTI people in “mental health and suicide prevention services and organizations”. It effectively coordinates and collaborates with government agencies and other organizations working on GLBTI issues to bring together the respective expertise of the sectors (Lea et al., 2014). 

Conclusively, the GLBTI people have high suicide rates and it can be diminished by developing positive initiatives at school and home. School and parents are primary sources that the have greatest influence on GLBTI youths and suicides. Change in the attitude and public perception has the capacity to reduce suicides, substance abuse, and educational failure. The government should formulate more policies and regulations to prevent discrimination against GLBTIs. Discriminations against them should be made punishable by law. Intense research is required to identify any improvement in suicide rates of GLBTIs and effectiveness of such services. Thus essay has enhanced my knowledge related to traumatic experiences of GLBTIs. Thus, this essay has highlighted in detail all the relevant significant factors contributing to the higher rate of suicide among GLBTIs. A thorough literature review was performed to explain and analyze the concepts related to the identified issue. 

References

Gibbs, J. J., & Goldbach, J. (2015). Religious conflict, sexual identity, and suicidal behaviors among LGBT young adults. Archives of suicide research,19(4), 472-488.

Haas, A. P., & Drescher, J. (2014). Impact of sexual orientation and gender identity on suicide risk: implications for assessment and treatment.Psychiatric Times, 31(12), 24-24.

Hawton, K., Saunders, K. E., & O'Connor, R. C. (2012). Self-harm and suicide in adolescents. The Lancet, 379(9834), 2373-2382.

Lea, T., de Wit, J., & Reynolds, R. (2014). Minority stress in lesbian, gay, and bisexual young adults in Australia: Associations with psychological distress, suicidality, and substance use. Archives of sexual behavior, 43(8), 1571-1578.

Matarazzo, B. B., Barnes, S. M., Pease, J. L., Russell, L. M., Hanson, J. E., Soberay, K. A., & Gutierrez, P. M. (2014). Suicide risk among lesbian, gay, bisexual, and transgender military personnel and veterans: What does the literature tell us?. Suicide and life-threatening behavior, 44(2), 200-217.

McLaren, S. (2016). The interrelations between internalized homophobia, depressive symptoms, and suicidal ideation among Australian gay men, lesbians, and bisexual women. Journal of homosexuality, 63(2), 156-168.

Morris, S., McLaren, S., McLachlan, A. J., & Jenkins, M. (2015). Sense of belonging to specific communities and depressive symptoms among Australian gay men. Journal of homosexuality, 62(6), 804-820.

Plöderl, M., & Tremblay, P. (2014). Complementing remarks to Skerrett et al.(2014)“suicides among lesbian, gay, bisexual, and transgender populations in Australia: An analysis of the Queensland Suicide Register”. Asia?Pacific Psychiatry, 6(3), 350-351.

Pompili, M., Lester, D., Forte, A., Seretti, M. E., Erbuto, D., Lamis, D. A., ... & Girardi, P. (2014). Bisexuality and suicide: a systematic review of the current literature. The journal of sexual medicine, 11(8), 1903-1913.

Rozbroj, T., Lyons, A., Pitts, M., Mitchell, A., & Christensen, H. (2015). Improving self-help e-therapy for depression and anxiety among sexual minorities: An analysis of focus groups with lesbians and gay men. Journal of medical Internet research, 17(3).

Skerrett, D. M., & Mars, M. (2014). Addressing the Social Determinants of Suicidal Behaviors and Poor Mental Health in LGBTI Populations in Australia. LGBT health, 1(3), 212-217.

Skerrett, D. M., Kolves, K., & De Leo, D. (2014). Suicides among lesbian, gay, bisexual, and transgender populations in Australia: An analysis of the Queensland Suicide Register. Asia?Pacific Psychiatry, 6(4), 440-446.

Swannell, S., Martin, G., & Page, A. (2016). Suicidal ideation, suicide attempts and non-suicidal self-injury among lesbian, gay, bisexual and heterosexual adults: Findings from an Australian national study. Australian and New Zealand Journal of Psychiatry, 50(2), 145-153.

Wang, J., Plöderl, M., Häusermann, M., & Weiss, M. G. (2015). Understanding suicide attempts among gay men from their self-perceived causes. The Journal of nervous and mental disease, 203(7), 499-506.

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