The Place of Creative Health in LGBTQIA+ Personalised Care

In 2019, the NHS published its Long Term Plan, which introduced Personalised Care as a practical change to its system. This means that members of the public now have increased choice over the way their health and social care is planned and delivered, using the unique assets of their local community, and responding to what matters to them.

In this article, we explore some of the unique mental health needs associated with LGBTQIA+ communities. We spotlight the way that a selection of Creative Health provisions have been designed and adapted around these needs, using examples from different local contexts. The intention of this article is to enable health and social care professionals to embed Creative Health as an instrumental component of LGBTQIA+ Personalised Care Plans.

We invite health and social care professionals to consider how active involvement in sign-posting and resource allocation within care-teams can make for more effective and sustainable mental health care. In addition to this, we encourage Creative Health providers to consider the place of person-centred design within their LGBTQIA+ services, to heighten the compatibility and distinctiveness of their mental health offer.

The State of LGBTQIA+ Mental Health and Wellbeing

LGBTQIA+ is a protected characteristic. This means that people who fall within this umbrella-of-identity are eligible for targeted support, in accordance with the NHS’s Core20PLUS5 target population strategy.

Research has shown that acute distress relating to discrimination, concealment and/or rejection sensitivity causes LGBTQIA+ individuals to be at higher risk of ‘internalising’ mental health disorders (1, 2). This act of internalising leaves LGBTQIA+ individuals at increased risk of depression, suicide, and substance use, compared to their cis-gender, heterosexual counterparts (3).

Acute Minority Stress Theory (4) proposes that to respond to this type of mental health difficulty, improvements are required in both inter- and intra- group communication. The Social Cure approach to health and social care (5) recommends that social provisions are a great way of achieving this, reconnecting individuals with mentally-protective support systems (6, 7).

Since LGBTQIA+ internalised mental health difficulties are linked to increased suicide attempts and substance abuse, improving LGBTQIA+ care not only supports the individual but reduces pressures on hospitals for cases of hypertensive crisis (8), metabolic syndrome (9), liver damage (10), needle-point infections (11), systemic inflammation (12), cancers (e.g., head and neck, gastric, liver, pancreatic) (13, 14, 15, 16), and supports the reduction of hospital readmissions (17).

Why Creative Health Matters to LGBTQIA+ Mental Health and Social Care

Many LGBTQIA+ individuals do not find traditional services compatible with their unique needs. Sophie Sykes (she/her), for example, comments:

“NHS services aren’t trained to address gender or trans issues, nor are they equipped to give the long-term counselling that’s vital in many cases like mine.”

Kain (they/them) adds:

“A common issue I know of, being trans-fem, is doctors start to ignore you more – much like the problems cis women have to deal with. […] My therapist had no knowledge at all when it came to helping people with any kind of issue with gender.”

This, coupled with the 6,000-person shortfall of clinical mental health support staff (18) demonstrates why it is important that Creative Health services offer an opportunity to diversify the workforce and improve the overall capacity of mental health care.

By looking into five factors that affect the mental health of LGBTQIA+ communities, this article showcases how mental protection can be developed through Creative Health provisions.

1. Reducing Social Isolation

Social isolation describes an insufficient quality and/or quantity of social relations. This can happen at different levels of human interaction, including between individuals, groups, communities, or society (19). Social isolation is known to affect physical and mental health, as well as risk of mortality (20, 21). When individuals find a part of their identity to be rejected or endangered by people around them, both quality and quantity of interaction can decrease. Even LGBTQIA+ people with supportive family and friends can feel social isolation if their identity is not affirmed and reflected in others around them.

A fantastic example of a Creative Health service supporting LGBTQIA+ Social Isolation is Queer Black Christmas. QBC is a ‘celebration for Black LGBTQ+ young people from London, who are experiencing homelessness, living in temporary accommodation or in hostile home environments’ (22). This is one of many events hosted by Existing Loudly, a grassroots organisation ‘committed to creating spaces of joy, community and care for Black LGBTQ+ youth from London through creative intervention’ (23).

“Our aim is to recreate a Christmas where Black LGBTQ+ youth can bring their full selves to the dinner table, a Christmas where they can feel like kids again, a Christmas where they are allowed to just exist.” - Existing Loudly

Other creative solutions to LGBTQIA+ social isolation include LGBTQIA+ Festivals, such as Out & Wild, which encourage connection through shared experience and safe spaces. Likewise, Cuddle Parties, like those hosted by Organic Space, help LGBTQIA+ attendees to explore consensual, platonic touch in a safe and supportive environment.

2. Connecting to a Shared Culture

The absence of connection to a meaningful, shared culture has been shown to lead to acculturation stress, identity conflicts, and significant health problems (24). In fact, one study into culture reported that ‘cultural access unexpectedly ranked as the second most important determinant of psychological well-being, immediately after the absence or presence of diseases (25). For members of the population whose identities do not align to the dominant culture of a society, it can be particularly beneficial to connect with an identity-based culture that affirms one's character and connects them to a collective consciousness.

A great example of how culture can be harnessed creatively in a LGBTQIA+ setting is through events such as Brown Suga – a platform that celebrates the history of ballroom and uses it as a method to bring together QTIPOC, Queer Women, Non-binary and Trans Folx. Ballroom culture emerged as a safe space for LGBTQIA+ People of Colour who were faced with discrimination and exclusion from society and/or rejection from their biological families. Voguing developed as a dance style that visually represented this community, challenged gender binaries, and encouraged collective creativity. Chosen families started to be created through this scene, using the passing on of drag knowledge as a means of replicating, renovating, and replacing biological family dynamics.

Another notable form of LGBTQIA+ culture are Pride events. Initially developed as a protest in response to the Stonewall Riots, 1969 (26), global Pride events now celebrate LGBTQIA+ people on an annual basis and advocate for the continuous protection of their rights. Highlight events include Trans Pride, Brighton & Hove and UK Black Pride.

These are particularly important in supporting intersectional identities which are at extra risk of experiencing violence, discrimination, or social rejection, due to the political landscape or institutionalised oppressions.

“Trans Pride Brighton is the first and the largest Trans Pride event outside of America, with over 10,000 people attending each year. We aim to educate and eliminate discrimination by promoting equality and diversity” - Trans Pride Brighton

In the spirit of harnessing queer culture, new events have also begun to pop up across the UK, celebrating traditions such as lip syncing and comedic quizzes. A great example of this is Nottingham’s Queer Like Funny LGBTQIA+ Comedy Cabaret events. These events highlight how queer culture can continue to be nurtured and adapted around local or temporal contexts to provide joy and belonging to LGBTQIA+ individuals.

3. Self-Awareness and Queering Life Narratives

‘Narrative identity is closely tied to the subjective interpretation of oneself as happy’ (27). For this reason, when individuals hold an identity that feels aligned to familiar stories or ways of living, they experience higher levels of joy and affirmation. Conversely, for individuals whose identity counters the dominant narrative of society, they can feel confused and isolated, or struggle to translate themselves to others. This can transform into feelings of loss, lacking, or envy, which is why activities that creatively explore personal narratives, or bring together people with similar experiences, are particularly useful for supporting wellbeing.

A great example of a Creative Health approach to narrative is showcased in Julie Tilsen’s book Queering Your Therapy Practice. This pioneering text exemplifies how Narrative Therapy can be adapted around the unique needs of LGBTQIA+ clients, using conceptual tools such as ‘the gender unicorn’ to re-imagine a world without debilitating social constructs. Tilsen advocates for ‘a therapy practice that is at once practical, full of wonder, and attentive to people's lived experience, yet ready to take flight into the imaginary. This is a practice that attends to the pain of injustice, whilst envisioning futures that are just and hope-full’ (28). Similarly, examples of queered Creative Arts Therapies can be found in the book Creative Arts Therapies and the LGBTQ Community.

Another creative pioneer, leading in the area of narrative development, is We Create Space. Their LGBTQIA+ Leadership Programme ‘takes a group of participants through a unique process of deeper self-enquiry, exploring identity and authenticity through a sequence of experiential workshops’ (29).

“With greater clarity of 'self', we become more intuitive with our decisions, and more intentional with how we show up to influence and support others.” - We Create Space

Similarly, Queer Platonic events are providing space to understand and share queer ways of living. Sophia Emmerich and Lisa Kempke’s Queer Platonic Photo and Video Series, for example, celebrates LGBTQIA+ friendships, exploring themes of allyship, acceptance, and the co-development of life narratives. Another example is Queer Platonic Co-Parenting - events designed to support LGBTQIA+ people who are looking to develop non-traditional family structures (such as those with three or more parents). Their events function as peer-support systems, developing alternative notions and narratives about the perfect family structure.

4. Sober Spaces

As beautiful as LGBTQIA+ spaces can be for the individuals that access them, they are also, traditionally, spaces that involve the consumption of alcohol or drugs, such as bars and clubs. This poses multiple problems.

Firstly, for sub-sections of the community, such as Muslim LGBTQIA+ people, who may not drink alcohol, these spaces can present a barrier to entry and engagement. Secondly, considering the substance abuse issues that can result from internalised mental health disorders, these spaces heighten the risk of mental decline for LGBTQIA+ people battling discrimination, concealment and/or rejection sensitivity. Finally, with the unsustainable nature of substance intake, even those with a measured relationship with alcohol can find themselves feeling isolated once the night-time ends. For these reasons, sober spaces are increasingly advocated for in the LGBTQIA+ community, to support mental health and wellbeing and to facilitate the protective goals outlined so far in this article.

“Clubbing and bars can be fantastic ways to connect but they aren’t for everyone. That’s why our events centre around common interests such as literature, film, crafts, history, wellbeing, advocacy, gaming, dating, outdoor activities, and lots of tea and coffee.” – Sappho Events

Creative Health events have been a fantastic way of facilitating sober activity within LGBTQIA+ communities. Providers such as Sappho Events and A Whole Orange host a wide range of events from pottery making to the Queer Farm Club & Feast. Other providers, such as Bolly Queer, offer activities that are truly intersectional at heart. Vinay explains ‘I wanted to be able to celebrate my South Asian identity and explore my queer identity simultaneously […] in Bollywood dance spaces, the gender binary is forced upon us […] Bollyqueer is a dance class which centres Queer and Trans people’ (30).

Notably, some of the most replicated sober spaces for LGBTQIA+ people are board games groups and book clubs. Book-clubs, include Lancaster’s Queer by Gum, Nottingham’s Five Leaves Book Club, Rugby and Warwickshire’s Out in the Library, Birmingham’s Bards and Books, and the various groups that meet at London’s Gays The Word bookshop. Board game groups/events include Bristol Gaymers, the Rainbow Gamers at Treehouse Sheffield, Cambridgeshire Libraries LGBTQ+ Board Games Social, and the LGBQ+ Board Games Afternoon at London LGBTQ+ Community Centre.

5. Being Seen to the Outside World

Traditional resilience theory (31) conceptualises wellbeing as the responsibility of the individual, whereby they must learn to resist, bounce-back, and withstand outside pressures. Researchers, MacKinnon and Derickson, challenge this conceptualisation in their paper on resourcefulness (32), arguing that to support the health and wellbeing of the individual we must also tackle harmful policies, systems, and societal practices that place the individual at unjust disadvantage.

Health inequality is a core concern for the NHS at present, and since much health inequality is the result of social inequality, programmes addressing health-damaging social inequalities are high on the agenda. Art that helps to express the lives of LGBTQIA+ communities is a tool for advocacy and a vital ingredient in addressing social inequalities. It helps to develop a friendlier, more accepting society that embraces the unique lifestyles of LGBTQIA+ individuals. Representing LGBTQIA+ people and lifestyles can be done by queering existing practices, expanding uniquely queer art-forms, or using popular media to reach a wider audience.

An example of queering an existing practice is Queer Life Drawing. In a political climate where visibly Transgender people are routinely under attack, and members of the LGBTQIA+ community at large are pressured to conform to labels and binaries, Queer Life Drawing events hold space for the non-conforming and act as a tool for healing and representation. A fantastic example of a regional queer life drawing group is Queer Life Drawing Brum, a monthly class based in Birmingham. Other groups prefer to meet online, for accessibility purposes. This includes @QueerLifeDrawing, which is run by a non-binary and disabled artist, based in Edinburgh. Other groups, such as Bare Life Art, focus on representing intersectional identities, with a priority of Queer POC.

Cases where an art-form is implicitly queer includes Zine-Making and Queer Diary events. Zine is short for magazine, and represents a DIY culture which celebrates low-to-no editing of content. This ethos proposes that thoughts which make it onto the page are recorded in their most raw and authentic form, thereby capturing a state of being that is at once personal and political, with content being more important that form (33). Following this ethos is Queer Diary, ‘a night which invites LGBTQ+ people to read from their teenage diaries (or teenage poetry, or fanfic, stories, etc) for a live audience’ (34).

Finally, a great way of getting LGBTQIA+ representation seen by the masses, is through the medium of film. The UK is blessed to have a number of prominent LGBTQIA+ film festivals including BFI Flare and Iris Prize, who not only screen films within their annual festival events, but also champion online and travelling programmes throughout the year.

Closing thoughts

This list of LGBTQIA+ Creative Health initiatives is not exhaustive. There are a plethora of imaginative and person-centred provisions being developed across the UK with the goal of centring the LGBTQIA+ experience. These provisions offer LGBTQIA+ individuals something that counsellors often fail to achieve otherwise – that is, an authentic celebration of who the individual is, a resonant reflection of people like them, and a sense of belonging that cannot be achieved through self-love and trauma-healing, alone.

It is for this reason that specialist Creative Health provisions are tremendously important within the context of Personalised Care Plans. This is why we urge you to consider the place of Creative Health services within your own local contexts.

TLDR:

• Internalised mental health disorders disproportionately affect LGBTQIA+ individuals, and lead to increase substance abuse and suicide
• This has a knock-on effect that links to key priorities in the NHS physical health plan and the rate of hospital admissions
• Five areas of improvement for LGBTQIA+ mental health care are: reducing social isolation; connecting to a shared culture; self-awareness and queering life narratives; sober spaces; being seen to the outside world
• Incorporating Creative Health into personalised care plans can significantly contribute to solving these problems