Letters

Doctors must be more aware of problems of gay, lesbian, and bisexual youth

EDITORIn their editorial on suicidal behaviour in gay, lesbian, and bisexual youth Bagley and D'Augelli refer to the effects of societal and institutional homophobia on the mental health of these young people.¹ We agree that restrictive legislation allows intolerance in the community and its institutions to rest unchallenged.

The medical profession, as an important social institution, has a role in working against prejudice. It also has a duty to do so, at least partly to atone for its treatment of gay, lesbian, and bisexual people in the past. Almost all people seek medical advice at some time. One way or another, the success of many clinical interventions is partly determined by a trusting relationship between doctor and patient.

Several studies have shown that lesbians and gay men still have adverse experiences when consulting health professionals, especially mental health professionals. ^{2 3} Such experiences include the health professional ignoring the effects of living as a stigmatised person, ascribing problems to the person's sexuality, focusing on sexuality when it is not the issue, and failing to acknowledge the importance of the person's partner.

Legislative change is critical as part of a broader social process leading towards acceptance of all minority groups in our society. New Zealand's human rights legislation has helped reduce prejudice by making exclusionary employment, educational, housing, and other policies and practices illegal. As a profession, however, we still have much to do. In a study that we were involved in many of the lesbians concerned considered that ignorance was the cause of problems that they had had with clinicians³a view supported by other researchers.⁴

Our undergraduate and postgraduate training needs to include material on different sexual orientations and the relevant developmental and life issues. We are not especially good at this in New Zealand, despite our legislation. In the United Kingdom the profession should take a lead by tackling these issues to show that at least some sectors of the wider community are ready for change.

S C D Collings, visiting fellow. 
Department of Psychiatry and Behavioural Sciences, Royal Free and University College Hospital Medical School, University College, London NW3 2PF sunnyc{at}wnmeds.ac.nz

Sarah Welch, registrar. 
Auckland Hospital, Auckland, New Zealand

1.	Bagley C, D'Augelli AR. Suicidal behaviour in gay, lesbian, and bisexual youth. BMJ 2000; 320: 1617-1618[Free Full Text]. (17 June.)
2.	McFarlane E. Diagnosis homophobicthe experiences of lesbians, gay men and bisexuals in mental health services. London: Project for Advocacy, Counselling and Education, 1997.
3.	Welch S, Collings S, Howden-Chapman P. Lesbians in New Zealand: their mental health and satisfaction with mental health services. Aust NZ J Psychiatry 2000; 34: 256-263[Medline].
4.	Lapsley H. Mental health issues for lesbians. In: Romans S, ed. Folding back the shadows: a perspective on women's mental health. Dunedin: University of Otago Press, 1998:137-146.