IRP commission: sexual minorities and mental health: global perspectives.

Sexual orientation is a key determinant of the identity of human beings. It has also been seen as a social determinant of health. People whose sexual orientation is non-heterosexual or sexual minorities or sexually diverse are included in the broad umbrella term LGBT (Lesbian, Gay, Bisexual, and Transgender) which is a commonly used acronym in activism, social policy, and subsequently cultural literature. For this reason, this Commission focuses primarily on sexual orientation i.e. lesbian, gay and bisexual (LGB) groups. We have used terms non-heterosexual, sexual minorities or sexual variation interchangeably. We have not considered asexual individuals as research in the field is too limited. We are cognisant of the fact that topics relating to mental health and sexual orientation discussed in this Commission will intersect with other issues of personal, cultural and social identity, and will thus be relevant to individuals including many transgender individuals. The inclusion of mental health issues relevant to gender-diverse individuals as well as gender identity is important and deserves its own separate detailed discussion. The exact number of sexually diverse individuals in a population is often difficult to estimate but is likely to be somewhere around 5% of the population. Rates of various psychiatry disorders and suicidal ideation and acts of suicide in LGB populations are higher than general population and these have been attributed to minority stress hypothesis. Elimination of inequality in law can lead to reduction in psychiatric morbidity in these groups. However, these are all diverse groups but even within each group there is diversity and each individual has a distinct and unique experiences, upbringing, responses to their own sexual orientation, and generating varying responses from families, peers and friends as well as communities (including healthcare professionals). The mental healthcare needs of sexual minority individuals vary and these variations must be taken into account in design, development and delivery of healthcare and policies. Improving access to services will help engagement and outcomes and also reduce stigma. The commission recommends that there is no role for so-called conversion therapies and other recommendations are made for clinicians, researchers and policymakers.

Assessing patient satisfaction with a multidisciplinary gender dysphoria clinic in Melbourne.

OBJECTIVES: The Gender Dysphoria Clinic in Melbourne, Australia, assessed patient outcome by focusing on patients' subjective evaluation of the healthcare services they received through the clinic. METHODS: A satisfaction survey, which was previously used in two established gender clinics in the US and UK, was adapted and then administered to consecutive patients who attended the Gender Dysphoria Clinic during a 1-month period. RESULTS: A total of 127 surveys were available for analysis: 88% of patients reported being satisfied with the services they received. Patients' perceived level of distress reduced significantly, following their involvement with the Gender Dysphoria Clinic. Feeling understood and heard in a non-judgmental manner by a specialist in the field of gender dysphoria was the most positive aspect of service provision. The most negative aspect of the clinic was a lengthy waiting list. CONCLUSIONS: Although the majority of trans-and-gender-diverse patients attending the Gender Dysphoria Clinic were satisfied with the service they received, there is a need to identify strategies to facilitate timely access to the clinic.