When Nix Campbell came out as gender fluid early last year to a friend, after living with social anxiety for over a decade, the relief was palpable.
Even when the coronavirus crisis began to seep into every aspect of life, Nix chose to consider it a blessing rather than a curse.
‘The pandemic actually aided my coming out,’ they remember. ‘Trying to fit in with certain norms was a massive source of anxiety for me, so when society essentially ground to a halt, that pressure to fit in was stripped away.’
However, estranged from most of their family and having spent almost a year in relative isolation – while unable to seek the face-to-face support they relied on before the pandemic struck – Nix has been forced to cope alone and their initial sense of calm has been replaced by feelings of extreme loneliness and frustration.
Being unable to access mental health services has also affected them in a big way.
‘It’s challenging at times,’ Nix admits. ‘I’ve often felt trapped and alone. I’ve relied a lot on my friends and I’m so grateful for them, but there are moments where I feel I need to reach out to other places and there just isn’t much out there.’
Recent research has revealed that more than half of LGBT+ people have suffered depression in the last year, while three in five experience anxiety. At the same time, 31% of LGBT+ people have thought about taking their own life.
Meanwhile, a study earlier this year from University College London, the University of East Anglia and City, University of London outlined a clear mental health disparity between sexual orientations, with 40% of bisexual and 24% of lesbian and gay respondents suffering from depression and anxiety – compared to 16% of straight people.
Yet despite such high figures among LGBT+ community, Paul Martin, Chief Executive of the LGBT Foundation, feels that although much has been done to raise important awareness surrounding the mental health impact of lockdown, ‘lesbian, gay, bisexual and trans communities have been absent from much of the narrative.’
‘LGBT communities already face a wide range of health inequalities throughout their lives so will likely be disproportionately affected by the crisis in many ways,’ he adds.
What makes this all the more alarming for many is that pre-pandemic figures from the government’s own LGBT Action Plan had already highlighted that sexual orientation and gender identity could have an impact on physical and mental wellbeing, with self-harm, drug use and depression more common with the LGBT+ community, according to the Mental Health Foundation.
Add to the mix the restrictions that have forced many to stay inside, feel isolated, unable to access support and fearful of their health, the spread of Covid-19 has basically injected rocket fuel to a mental health crisis within a community already at a higher risk.
Nix was first diagnosed with social anxiety 13 years ago and complex post traumatic stress disorder in 2019 following a difficult childhood.
‘It is an ongoing process of healing, understanding and acceptance,’ they explain. ‘It’s always going to be there. It leaves a permanent hole inside of you.’
Before lockdown, Nix was under the care of a community link worker to help access wellbeing services in the local area, but as the pandemic struck availability hit rock bottom.
‘It came to a standstill as there was nothing I could be linked to since everything was closed or inoperative,’ they say. ‘They’d call every so often to check in with me, but there wasn’t a lot more they could do.
‘But for me, even just a point of contact would have been good – a person or place to reach out to that understands my needs and actually cares about my wellbeing.’
Since the pandemic began the impact of coronavirus has continually laid bare the pressures placed on support services that were already at breaking point.
In response, the government announced a Mental Health Recovery Action Plan in March this year, with a £500m boost in funding as part of its expansion in mental health services, which aims to respond to the consequences of the pandemic by specifically targeting groups that have been most impacted.
However, for some LGBT+ people, poor mental health is just the tip of the iceberg – the result of a combination of other issues exacerbated by the pandemic.
According to research conducted by charity OutLife, social isolation has more than doubled during lockdown, with over half of LGBT+ people experiencing it ‘very often’ or ‘every day’.
Additionally, Home Office figures show that drug use amongst gay and bisexual men was three times higher in the last year compared to heterosexual men, while for lesbian and bisexual women, usage was more than four times higher than heterosexual women.
Data from May 2020 also revealed that nearly 20% of LGBT+ people were concerned that the coronavirus crisis would lead to substance misuse, or even trigger a relapse.
‘The pandemic has had a huge impact on our access to health and social care services, and this includes lesbian, gay, bi, trans and queer people,’ explains Kieran Aldred, Heald of Policy at Stonewall.
‘Covid-19 has affected all of our lives but marginalised groups, including some members of the LGBTQ+ community, will have been disproportionately impacted by unemployment, homelessness and lack of healthcare access. At Stonewall, we will continue to fight for a world where all LGBTQ+ people are free to be themselves, wherever they are.’
Following the NHS decision to cancel all non-emergency surgical procedures so staff could focus on Covid-19 patients, around 10million people are currently waiting for ‘non-essential’ surgery.
For trans people, this is no exception. With an increasing number of gender-affirming surgeries also being put on hold, many are now facing a crisis of identity.
When the first wave of the pandemic hit, Evan (not his real name) had waited over 30 months for his first appointment with an NHS gender identity clinic (GIC) to discuss the next stage of his transition. Prior to that, he had spent almost £8,000 on private hormone therapy and top surgery in 2017, following a diagnosis of gender dysphoria.
Yet, despite significant progress in his journey towards full medical transition, Evan’s transfer to the NHS that same year meant he was forced to go through the entire system again – another diagnosis, requiring two more opinions before the approval of hormone treatment, then a further two opinions before surgery referrals could be made.
Finally, in March 2020 Evan attended his first face-to-face appointment – two days before the UK entered its first lockdown.
‘The meeting itself went well,’ he remembers. ‘The doctor was friendly and seemed to appreciate the binder full of medical notes detailing my transition up to that point.
‘However, on my journey home, sitting in the middle of an eerily empty train with the pandemic bearing down on the UK like an approaching sandstorm, I couldn’t help but feel intensely frustrated. Almost cheated, in a way.
‘I’d waited so very long to finally be seen by the NHS and get my official transition underway.’
Describing the impact of having his surgery cancelled, Evan says, ‘I cannot even begin to tell you how soul-crushing it is for me, having been on hormones for nearly four years and more than three years post-top surgery, looking for all the world like a cisgender man.
‘To have had a brief taste of essential care, only to wonder when or if it will continue, has really impacted my mental health in a negative way,’ he explains.
Although official NHS guidelines suggest a maximum waiting time of 18 weeks for a first GIC appointment In the UK, the reality is it can take up to three years. It can then take several years to receive gender-affirming healthcare, such as hormone replacement and other procedures. An investigation by the BBC in January just last year revealed that more than 13,500 trans and non-binary adults were on a waiting list for an NHS identity clinic in England.
Despite having socially transitioned nearly four years ago – coming out to his partner, family and close friends while changing his name – Evan feels the delays have made it increasingly difficult for him to embrace his new identity.
‘I live with dysphoria everyday about this in-between body I’m in; it affects my self-confidence, my relationship with my partner – and even things as mundane as how far I can travel.’
Stonewall’s Keiran Aldred adds that the distress caused by waiting lists will have ‘undoubtedly been exacerbated by the suspension of these services during the pandemic’.
But while Covid-19 has heightened the extensive range of health inequalities among LGBT+ people, the pandemic has magnified another issue that has always plagued the community – homelessness.
According to Jesse Ashman, Partnerships Manager and Recovery Worker at the Outside Project, which runs the UK’s first permanent LGBT homeless shelter, the pandemic is a ‘crisis situation’.
Research by Stonewall found that 20% of LGBT+ people will experience homelessness at some point in their lives, while the Albert Kennedy Trust found that nearly 70% of LGBT+ homeless youth are likely to have experienced rejection, abuse and violence.
‘For many people, there’s no single event that results in sudden homelessness’, Jesse explains. ‘Instead, it is due to a number of unresolved problems building up over time.
‘LGBTIQ+ people are more likely to face discrimination in their daily lives and are less likely to be able to access identity-responsive or inclusive services, both of which compound and make homelessness more likely.’
But while the shelter has been able to stay open, being one of the few spaces that homeless LGBT+ people can still access, the pandemic has placed immense pressure on its ability to carry out services.
‘There’s really no part of our work that the pandemic hasn’t touched – making it more challenging, more urgent and more important to be able to support people than ever before.
‘We’ve also not been able to do our usual dual-purpose outreach and fundraising visits to local LGBTIQ+ venues, meaning fewer people will have heard about the work we do.’
Jesse adds that the actions that would be required to improve outcomes for LGBT+ people in times of crises ‘are the same as are needed to support those of us more marginalised to begin with.’
According to Rob Cookson, Deputy Chief Executive of the LGBT Foundation, not enough has been done by the government and other public bodies to understand and act on the needs of LGBT+ communities.
While the future is unclear for Nix and Evan, both say it hasn’t prevented them from embracing some feelings of positivity during such an uncertain time.
Despite being ‘nervous’ about the eventual lifting of all coronavirus restrictions, Nix is looking forward to being able to socialise with friends, and has found support in the form of virtual LGBT+ mental health groups.
‘Some of the old anxieties about trying to fit in are creeping out,’ they admit. ‘But they are not as strong, as I know things about myself that I didn’t know before – like embracing my wild side – and that gives me some confidence in holding myself in public.
‘It would also be nice to talk to someone in person about the uncovering of my identities. Online and Zoom socialising can only go so far.’
Now over a year since Evan’s first appointment with the gender identity clinic, he is still yet to hear from his clinician about a follow up.
‘At this point, it’s anybody’s guess as to when I’ll be seen next and how many times I’ll need to be seen overall before I can be referred for gender-affirming surgery,’ he says.
‘It’s difficult to find hope in the current situation as it stands. No gender-affirming surgeries of the type I require are being performed at all for the foreseeable.’
However, Evan refuses to give up.
‘I find strength in my relationships with my partner, and my sister, and with my close friends who have made it clear that my gender has no bearing on their love and support for me,’ he insists.
‘But it’s the young people with whom I work and interact, especially the trans and non-binary ones that motivate me to carry on,’ he explains. ‘To be a young person coming out as trans in the UK in 2021 takes an incredible amount of bravery.
‘If they can do it, without the advantages of financial security that I enjoy as an adult, then I can carry on as best as I am able to.
‘To every trans person who hasn’t completed their medical transition, whether or not a surgery is involved, I’d say: don’t give up; you are worth fighting for, and we are fighting for you.’
With the pandemic continuing to pose an unprecedented challenge for society, experts are worried about just how much it will carry on discriminating against the LGBT+ community.
‘We are already seeing the disproportionate impact on LGBT communities, particularly on those who are most marginalised – LGBT people of colour, disabled LGBT people and older LGBT people,’ explains Rob Cookson.
‘The next phase of the pandemic is going to be equally as challenging. That’s why It is vital that more is done by public bodies to understand the specific needs of communities so that we can ensure no one is left behind.’
Who to contact for support
If you are having a difficult time, no matter how large or small call the Samaritans on 0845 7909090.
For emotional support, you can contact the LGBT Foundation on 0845 3 30 30 30 or 0161 235 8034 (10am-10pm, daily) or email [email protected] Alternatively, you can call the National Lesbian and Gay Switchboard on 0300 330 0630 10am-11pm seven days a week.
For practical guidance for anyone affected by self-harming, you can access the Self-Injury Guidance & Network Support.
If you’re a young LGBT+ person struggling with a housing situation, you can contact akt’s live chat 10am-4.30pm five days a week. Alternatively, you can make an online referral here.
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