The cost of adverse LGBTIQ+ mental health

For the first time, a cost has been placed on critically low levels of well-being among LGBTIQ+ people. Nevena Spirovska examines the key drivers and what can be done to turn the situation around.˜˜ LGBTIQ+ people's health, well-being and mental health have been at crisis levels for decades, with no signs of improvement. In 2019, Writing Themselves In 4, the largest ever study on the experiences of LGBTQA+ young people aged 14-21 in Australia, found that, shockingly, more than one in 10 participants aged 16 to 17 years had attempted suicide in the past 12 months, almost three times the number of non-LGBTIQ+ people of the same age. The LGBTIQ+ community itself understands the cost of poor mental health outcomes, but a new, first-of-its-kind report commissioned by LGBTIQ+ community-controlled organisation and healthcare service provider Thorne Harbor Health has not only put a dollar figure on it, but has also revealed that the rate of lifetime mental health for LGBTIQ+ Victorians is 73 per cent, significantly higher than the general population's 46 per cent. In Victoria, the LGBTIQ+ population is estimated to account for up to 10 per cent of the state's population, and our mental health outcomes are influenced by a variety of factors, including systemic discrimination and marginalisation within society and the health system more broadly. However, as society's understanding and acceptance of gender identity and sexual orientation evolves, more people are openly identifying as members of the community, as evidenced by higher rates of identification among younger generations. The LGBTIQ+ community is made up of many distinct and diverse individuals, and the term itself includes several distinct sub-communities with different needs and mental health outcomes. What the report articulates is that LGBTIQ+ Victorians do not face these health disparities because of a predisposition to poor mental health due to their sex, sexuality, or gender identity. Rather, these outcomes are caused by a complex and unique set of drivers, including:

• systemic discrimination and marginalisation within society and within the health system
• individual and collective trauma from past criminalisation and policing of our identities
• the impact of so-called conversion practices
• isolation from community in regional and rural areas
• increased drug and alcohol use
• the unique community impacts of suicide
• the intersections of other marginalised identities

The report calls on the broader community to recognise that there are distinct drivers of poorer mental health outcomes for LGBTIQ+ people that necessitate targeted interventions. Many of these unique drivers are societal in nature, based on values and norms that cause harm from an early age. To remedy this, there is an immediate need to invest in LGBTIQ+-specific mental health services run by LGBTIQ+ community organisations that are culturally appropriate and responsive to the diversity of needs in our communities. From the standpoint of social services, there must also be a focus on improving LGBTIQ+ inclusion in mainstream services, as well as a cessation of the expectation that LGBTIQ+ people attend services affiliated with organisations that have encouraged discrimination against our community. According to this study, the economic and financial cost in Victoria in 2019 is enormous: estimated to be $2.2 to $3 billion. Intangible costs ranged from $16.8 billion to $23.4 billion. Employers suffered losses ranging from $0.8 to $1.1 billion due to lost productivity, while the state and federal governments incurred financial and economic burdens ranging from $0.8 to $1.0 billion. This is primarily due to lost productivity, which results in significant reductions in future income streams and associated taxation revenues. However, LGBTIQ+ Victorians bear the highest costs of these poorer health outcomes, ranging from $16.8 to $23.4 billion in lost wellbeing and years of life. That is 88 per cent of the total cost and the toll it takes on LGBTIQ+ people is immeasurable. This important work focused on the significant costs of poorer mental health experienced by LGBTIQ+ Victorians, as well as the complex, systemic drivers that contribute to this. In doing so, it demonstrates the need for mental health systems that address the specific needs of LGBTIQ+ people, as well as one that encourages early intervention to mitigate the impact of poor mental health within LGBTIQ+ communities. Read "The cost of adverse mental health outcomes in the LGBTIQ+ Victorian adult population" here.