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Essential reading for the London drug and alcohol sector

Out of Your Mind: improving drug and alcohol services for LGBT people

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Monty Moncrieff, Chief Executive at London Friend, writes about drug and alcohol services for LGBT people, and the Out of Your Mind report, which examines how these services can be improved.

This summer the Government provided official data on drug use by lesbian, gay & bisexual people for the first time in five years. The Crime Survey for England & Wales provided some stark findings: gay & bisexual men were three times more likely to have used an illicit drug in the past year than heterosexual men. For lesbian & bisexual women the figure was more than four times that of heterosexuals.

Use was higher across all drugs, including heroin and crack, but particular patterns emerged; dig around a bit and you’ll find that almost all of the reported methamphetamine use is by gay or bisexual men, for example.

This mirrors our own experiences at Antidote, London Friend’s drug & alcohol service that works exclusively with lesbian, gay, bisexual and trans (LGBT) users. The increase of sexualised drug use – known as ‘chemsex’ – has brought a new cohort of gay & bisexual men into drug treatment, men with a different set of needs to those of what might be deemed a more traditional user group. Sexual health and a worrying rise in HIV diagnoses is now firmly on our agenda and forms the basis of treatment interventions as much as the drugs themselves.

Lesbian & bisexual women, and transgender people, remain conspicuous by their relative absence however; barriers in accessing treatment remain firmly in place for these groups.

When we talk to our colleagues in mainstream treatment services we ask how well equipped they feel to work with the men who are now increasingly presenting – and how they would tackle the barriers that prevent others from coming in. How would you respond to disclosure of a weekend long ‘slamming’ and sex party where the client wasn’t sure exactly what activities had gone on, for example?

Encouragingly we find a genuine empathy and a will to support, but a lack of knowledge or a fear of ‘saying the wrong thing’. In 12 years of providing LGBT training I’m yet to find more than a handful of people who’ve had the opportunity to discuss issues of sexual orientation or gender identity in a professional setting, never mind how this relates to a changing drug scene, legal highs, new psychoactive substances and a plethora of new smartphone apps to ease sexual encounters.

Over the past three years we’ve been examining how LGBT people can be best supported through drug & alcohol treatment. We’ve looked at a variety of delivery models, including taking ourOut Of Your Mind postcard snip services out into sexual health clinics. We’ve spoken to LGBT people in treatment to find out what approaches they would prefer: most opted for LGBT-specific treatment, but the main concerns were that services felt safe, both physically and emotionally; that they understood the drugs used and the contexts they were used in; and that they felt welcoming to LGBT people.

During the course of the research we also looked at what London local authorities published in relation to LGBT need in their Joint Strategic Needs Assessments. The results were disappointing; most mentioned this only in relating to HIV and only one had completed an LGBT drug & alcohol needs assessment.

To help improve services – from commissioning to the front line – for LGBT people we recently published Out Of Your Mind, a report which looks at provision and makes a number of recommendations for central and local government, substance misuse providers, and front line staff.

The report includes a set of simple toolkits aimed at commissioners, managers and practitioners to review their existing knowledge and practice in relation to procuring and providing services which meet the needs of their LGBT users.

Using the toolkits is the first step to identifying a personal or organisational LGBT action plan to help you, your commissioned services, or your staff develop an understanding of the changing face of drug use within LGBT communities, and what role you can play in helping to improve treatment outcomes for your LGBT clients.

Out Of Your Mind can be downloaded here

For more information contact monty@londonfriend.org.uk

Official data on drug use by sexual orientation may be found here, and further reading on access to appropriate services for black and ethnic minority gay and bisexual men may be found in a recent paper by Public Health England.

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