Enhancing Mental Wellness Among LGBTI Individuals in Europe

1. Improving the mental health of LGBTI people in Europe: challenges and good practicesDublin8 December 2015 Jürgen ScheftleinUnit C1 "Programme Mangement and Diseases"Directorate-General for Health and Food Safety European Commission

2. The EU approach to mental health • Mental healthand well-beingEssential dimensionofpopulationhealth. Mental capital – resource for learning, socialcohesion, innovation, productivity. • The economiccrisisRiskfactor for mental healthstatus, budgetcutsin mental healthsystems • DemographicchangeIncreases in lifeexpectancyare not matchedbyhealthylifeyears • Mental disordersContributingto a growingburdenofchronicdiseases. Co-morbidityofphysical and mental disorders – commonriskfactors – e.g. Alcohol

3. Mental Health in the Life Course Disability patter by broad cause group and age Source: The Global Burden of Disease: Generating Evidence, Guiding Policy – European Union and European Free Trade Association Regional Edition. Seattle, WA: IHME, 2013.

4. Major chronic diseases Health systems Environment Cancer Mental Diseases Lack of physical activity Neuro-degenerativeDiseases Musculo-skeletalDiseases GeneticBackground Obesity Over nutrition Tobacco Alcohol cardiovascular disease Diabetes Chronic obstructivepulmonary disease Socioeconomic factors Communicable diseases

5. Inequalities in LGBTI people • Compared to heterosexuals, LGBT individuals had poorer mental health (higher levels of psychological distress, greater likelihood of having a diagnosis of depression or anxiety, greater perceived mental health needs, and greater use of mental health services), more substance use (higher levels of binge drinking, greater likelihood of being a smoker and greater number of cigarettes smoked per day), and were more likely to report unmet mental healthcare needs. Burgess D, Tran A, Lee R, van Ryn M J LGBT Health Res. 2007 • There is a need to raise the profile of mental health issues amongst LGBT people, even if higher rates of depression and/or anxiety have been observed in older LGBT people, compared to their heterosexual counterparts (Guasp, 2011).TinneyJet al. • A study in Australia showed that it was significantly more likely that depression was mentioned in the cases of LGBT suicides than in non-LGBT cases.

6. Inequalities in LGBTI people • Several cases of unequal access (discriminations and barriers) have been mentioned: trasgender people denied treatement, trasgender abuse and stigma, discrimination, stereotyping, compulsory treatment, violation of privacy rules or lack of adeqate understanding. • The growing adoption of electronic health records (EHRs) presents an important opportunity to optimize care for LGBTI individuals by routinely capturing in structured form patient sexual orientation and gender identity (SO/GI). Donald C, Ehrenfeld JM

7. Improving mental health and prevention is central to economic and social growth. • Investing in mental health requires partnership action and joining forces • The move from institutional care to community-basedmental health services is notable across many Member States. • Substantial economic gains with suicide prevention programmes focused on GP. • Community mental health services appeared present in all countries in one form or another • Comparable data as a key challenges • An agreement for good practices criteria is another challenge

8. EU-policies supporting Member States Exchange and coordination • Group of Governmet Experts on Mental Health • Joint Action Mental Health and Well-being (Involving 25 Member States plus Iceland and Norway; over 3 years (2013-2016). Led by Portugal. Policy activities • Mainstreaming mental health into EU policies Financial Instruments • EU Health Programme • EU-Structural Funds. • FP7/Horizon 2020 and ICT for Health-Programme; Information / raising awareness • Activities of Eurofound, FRA and EU-OSHA

9. The EU approach to LGBTI Severalcases of unequalaccesshavebeenmentioned: transgenderpeopleweredeniedtreatment, transgenderabuseandstigma • Inequalities in healthSocialandeconomicalinequalitiesDiscriminationandstigma: • Directive 2000/43/EC and 2000/78/EC • Structural Funds, therightsandCitizenship Programme 2014-2020 • The non-discriminationstrandof PROGRESS (2007-2013) • The European Year ofEquqlOpportunites for All (2007). • The Europe 2020 strategy

10. EU projects • TAMPEP works to reduce the HIV vulnerability of migrant and mobile sex workers through the development, exchange, promotion and implementation of appropriate policies and interventions across Europe. • The high degree of stigmatisation and resulting discrimination against sex workers lead to wide-reaching social isolation and exclusion of sex workers (16%), as many are hesitant to speak about what they do and known sex workers are often ostracised within their local community. http://tampep.eu/documents.asp?section=reports The online directory of services for sex workers across Europe was created, available in 4 languages (EN, FR, ES, RU) www.services4sexworkers.eu, was launched on the 17 December 2008 (International Day to combat violence against sex workers), covers the listing of services (health, social, legal) available for sex workers, legal information regarding sex work, migration and access to health.

11. http://www.sialon.eu/en/ • Substance use is prevalent among MSM in Europe and elsewhere (The EMIS Network, 2013). This has been explained by higher reporting of depressive symptoms and other mental health problems, driven by both external and internal stigma, resulting in increased vulnerability for HIV and other STIs. These multiple health problems have been conceptualized within syndemic theory (6), suggesting that the interaction between the different health problems results in an excess of disease burden. • Young MSM (<25 years) presented a particularly vulnerable subgroup

12. http://www.emis-project.eu/publications.html Self-stigma is one dimension of sexual stigma: this as internalised homophobia, "the gay person's direction of negative social attitudes towards the self, leading to a devaluation of the self and resultant internal conflict and poor self-regard" . Meyer and Dean (1998) Internalised homophobia, has been described as a source of stress for MSM and linked with mental health problems (Berghe et al., 2010; Meyer 2003; Williamson 2000), poorer sexual health outcomes (Rosser et al., 2008) and most significantly behaviours that place them at risk of HIV transmission (Ratti et al., 2000; Ross et al., 2001).

13. key population groups • (Lesbian, gays, bisexual, transgender, intersex, elderly, etc.) and • health professionals and experts (general practitioners, nurses, psychologists and medical students). • Outcomes will be: • • the state-of-art study (health inequalities experienced and barriers faced by health professionals when providing care), • • and the training modules designed and tested.

14. European Pact for Mental Health and Well-being 2008:Launch in EU-high-level conference An informal commitmenttoworkingtogetherbetweenGovernments and stakeholders on mental healthchallenges and opportunites 2009-2011:Thematicconferences Depression andsuicide Mental health in youngpeopleandeducation Mental health at workplaces Mental healthofolderpeopleCombatingstigmaandsocialexclusion 2011:Council Conclusions on thePact and futureaction 2013:Launch of Joint Action on Mental Health and Well-being LithuanianPresidencyconference "Mental Health: ChallengesandPossibilities" 2014 YOUTH MENTAL HEALTH: FROM CONTINUITY OF PSYCHOPATHOLOGY TO CONTINUITY OF CARE (STraMeHS).

15. Situation in Countries • Literature Review • Best Practices Review European Pact for Mental Health (2008) Stigma / Social Exclusion Workplaces Youth and Education Depression/Suicide Older People 5 Thematic Conferences Aims: Prevention, Promotion and Care JOINT ACTION MENTAL HEALTH AND WELL-BEING (2012) JA Areas Depression/Suicide & E-Health Transition-Inclusion Workplaces Children/Schools MH in All Policies Public Health perspective Focus on policy Objectives Contribute to the promotion of mental health and well-being, the prevention of mental disorders and the improvement of care and social inclusion of people with mental disorders in Europe. JOINT ACTION EXPECTED RESULTS JAMHWB

16. A framework for action on Mental Health will be developped • To provide orientation based on best European knowledge on how to promote mental health, and prevent and treat mental disorders. • To support Member States review their policies and share experiences in improving policy efficiency and effectiveness through innovative approaches, whilst taking into account specific needs at local, regional and national level. • Furthermore, a framework for action can also provide guidance for the review and development of the EU's own policies. It WILL BE PRESENTED AT THE JOINT ACTION FINAL CONFERENCE 21-22 January 2016, Brussels

17. Recommendations • Ensure the setup of sustainable and effective implementation of policies contributing to promotion of mental health, prevention and treatment of mental disorders • Develop mental health promotion and prevention programmes through multisectoral cooperation • Ensure transition to comprehensive mental health care in the community, emphasizing the availability of mental health care for people with common mental disorders, coordination of health and social care for people with severe mental disorders as well as integrated care for mental and physical disorders. • Strengthen knowledge, evidence base and good practices • Partnering for progress

18. WP 4: PREVENTION OF DEPRESSION AND SUICIDE AND MAINSTREAMING E-MENTAL HEALTH • Depression and suicide are characterized by gender and age differences, nevertheless socioeconomic factors shows the strongest association with depression in both genders. • Numerous high risk groups are identified: the socially disadvantaged, vulnerable groups like the unemployed, LGBTQ and immigrant groups.

19. WP 4: PREVENTION OF DEPRESSION AND SUICIDE AND MAINSTREAMING E-MENTAL HEALTH Recommendations • Promote and support the empowerment of high-risk groups with specific support programs: life skills training, stress management training, problem solving training. • Raise awareness of high-risk groups (unemployed, LGBTQ, migrants etc.) and market options for these groups. • Stimulate investment in programmes targeted at families and high risk groups with support to build resilience and reduce stress.

20. EU Compass for Action on Mental health & Well-being Mental Health Policy Consortium • Trimbos Institute (the consortium leader) • Faculty of Medicine, NOVA University of Lisbon (FCM NOVA) • Finnish Association for Mental Health (FAMH) • EuroHealthNet (EHNet)

21. Objective • Further the mental health agenda in EU Member States and instigating policy dialogue and commitment for it. • Build on the previous European efforts and mobilize key stakeholders in view of enhancing the work of the EU Compass tor Action on Mental Health & Wellbeing (Mental Health Pact, Joint Action) • How will we achieve this: • Collecting information on a policies, good practices, ongoing developments in EU Member States; • Engaging with broad and inclusive stakeholders throughout Member States and among non-governmental actors, raising their awareness and seeking their support and endorsement • widely disseminating the activities and information in the Compass to reach a greater number of stakeholders which should become an operational tool tor stakeholders and the EC.

22. Thank you! Jurgen.Scheftlein@ec.europa.eu