DEATH BY DIVERSITY?

WORKING WITH THE LGBT COMMUNITY

Lesbian/gay/bisexual/transgender services are a rarity, reports Sarah Graham. At the same time, where gay clubs go, straight ones usually follow – and they are succumbing to crystal meth.

Back in 1992 on an OutRage! demo – lying in the middle of London’s Charing Cross road under a Gay Rights Now! banner (the photo shows me sandwiched between Derek Jarman and Jimmy Sommerville ) – we chanted our demands for equality as we were dragged out the road and arrested.

Few of us would have believed how much things would change for the LGBT community in the next 17 years. Under a Labour government we have seen serious legislative change for the better, in many key areas: education (the repeal of Section 28), employment (Employment Equality (Sexual Orientation) Regulations 2003), recognition of our relationships (Civil Partnerships Act 2004) and even equal protection in the provision of goods, facilities and services (Equality Act 2006).

So, the straight world could be forgiven for assuming that all is now rosy in the LGBT garden – that we’re all equal now, here in the UK. And that life living under the rainbow banner, signifying our colourful coalition of diverse sexualities and genders, is free, gaily happy and full of pride. These days “pretty police” officers are not always trying to entrap gay men in “cottages”. They are marching arm-in-arm, in uniform, on our annual Pride celebrations.

BULLIED CHILDREN

As a lesbian/intersex woman/person in recovery and counsellor, I sadly tell you that, – despite many legal gains – appearances are deceptive. British culture is still homophobic and young gay people in schools still suffer enormous prejudice and bullying.

When I was counselling in schools last year, the thing that shocked me most was the amount of homophobia in the playground. Even more surprising was the teachers and heads failing to act to protect their LGBT young people – and those straight kids deemed to be “SO, gay”.

There is a strong evidence base that homophobia negatively impacts on young LGBTs’ mental health. Last year, the equality organisation Stonewall’s Prescription for Change: Lesbian and bisexual women’s health check found that half of the lesbian and bisexual women under the age of 20 have self-harmed compared to one in 15 teenagers generally. We are more likely to commit suicide, abuse drugs and alcohol and are less likely to access health services.

American LGBT therapist Joe Amico reports that one-third of the LGBT community in the US has an addiction. And professionals working with LGBT clients here tell me not only that it is substantially higher in the UK but that it is getting worse, not better.

GETTING INSIDE CLUBLAND

“Clubland’s therapist” David Parker – aka the Swarmite – recently set up Homovision Rehab (www.homovision.tv/category/rehab-withthe-swarmite) to reach out to the thousands of gay men on “Comedown Tuesday”. He thinks addiction is such a problem because “there’s no real understanding in the gay scene as to what is healthy and what is unhealthy; to look at that would be questioning our sense of morality, and churches and religions do that to us already”.

Unlike straight people, most of us don’t start families nor have to grow out of partying. We often have two disposable incomes. And in our clubs and pubs, if everyone else seems to be doing it too, it’s very easy to overlook an issue developing.

Problems can take hold of us at an early age: when we start to experience dissonance between who we feel we are and society and family expectations. When I set up my company this year (www.sarahgrahamsolutions.com), the first client through the door was a 16-year old binge-drinking lesbian. She was referred by her godmother, who had heard me give a talk to DrugFam in which I had shared a little of my own story: about growing up queer, in Wiltshire.

 My new young client was overflowing with anger and turning it against herself and society. She had dropped out of schooling and been arrested twice for serious violent behaviour, including hitting her girlfriend which she committed during blackout. This young woman had been bullied, from school years 8-11, for having a gay friend and being gay by association. Once she stood up for him and was punched hard in the mouth, by a boy. She reported homophobia to the Head of Year on a regular basis. No action was taken – as opposed to racism where one word could lead to serious sanction.

Growing up in an unsafe environment where you are always different creates toxic levels of shame and other harmful emotions. When I asked my client what alcohol meant to her, she replied “freedom”. That is a powerful reason to get hammered.

Coming to see me, I am sure that a lot of her healing has not been solely because of my counselling skills. It has come about because of my being “out”, a positive role model and knowledgeable about LGBT issues. Our therapeutic alliance has affirmed and nurtured her sense of self. She felt safe to reveal her pain and anger.

I have reflected to her that what happened in school was not OK. She wrote to the headmaster and is now free to be herself – without alcohol. She hopes to return to education this autumn.

What happens when we therapists do care to look below the LGBT surfaces and ask some open questions? The shiny, happy, buffed-up boys (Muscle Marys), lipstick lesbians, scene queens, closet cases, baby dykes, trannies, queers, drag kings and queens, AC/DCs, bi-curious, bears, clones, luppies, fags, bareback pigs, queer kidz, chems and all the various straight actors tell us that under those masks, things in the “community” are a lot darker, scarier and more dangerous than we can imagine.

At this year’s Pride London, there was a very serious message on some of the placards: “Gay Men Are Dying in London Due to GHB”. Is G, or GHB/GBL, really killing gay men?

It is not being talked about in the mainstream media. G does pop up in the tabloids, but when pretty straight girls die or are “date raped”. What’s really happening in the LGBT “recreational” drugs world?

Gay DJs, club promoters and drugs workers at Antidote, Turning Point’s LGBT treatment service in Soho, all agree that there has been an epidemic of G in the past two years. It has got so bad that many clubs, worried that calling ambulances brings the police in their wake and thus threatens their licences, now operate a G zero-tolerance policy.

Despite this, respected gay DJ Fat Tony says that G use is out of control.

“I did a party in Vauxhall recently. The music had to be turned off : there were three people lying on the floor outside waiting for ambulances. People were standing, smoking over them. One guy had to be worked on by the paramedics. The party had to end.”

Antidote reports that some GHB/GBL users are so physically and psychologically dependent on G that they must take it on the hour every hour 24 hours a day; these users need a medically-managed detox. There is an emerging detox protocol which must be followed to avoid sometimes-severe withdrawal side effects, characterised by psychosis and delerium (details on AT website).

Like the X-Files, the truth about LGBT polydrug abuse, dependency and multiple cross-addictions is Out There: it is visible in our clubs, pubs, saunas, on our gay dating sites. It is even found in the iPhone Apps store – Grindr finds the nearest up-for-it guy, who fits your spec, in seconds. It enables sex, internet and substance addictions to harness GPS and have free roam 24/7.

Where you won’t find this truth reflected is in the vast majority of our treatment services. Or at the National Treatment Agency. Our issues and data have so far eluded their boxes.

WHEN WILL NTA SUPPORT DIVERSITY?

But perhaps they are just not very interested? When I called one their senior communications officers to ask for an interview about how the NTA is responding to last year’s drugs strategy, Drugs: protecting our families and communities, and its inclusion of LGBT in the diversity framework for the first time, I was met with: “LGBT, that’s... lesbian, err, gay?.....”. I had to help her out with bisexual and transgendered.

No-one from the NTA would speak to me. But they did send me a short statement, with a link to a 28-page report, called Diversity: Learning From Good Practice in the Field. The word “sexuality” is mentioned only once, on page 11. There it explains that, when the 2007/08 review was conducted, commissioners and treatment providers were required to comply with six strands of equality and diversity law: gender, sexuality, religion, age, race and disability. “Under law, they only had positive duties for three: disability, race and gender”. So this report was of no use to me or the LGBT community; luckily for them, they didn’t have to read it.

The statement continues: “The National Drug Treatment Monitoring System does not report the sexual orientation of clients centrally, though the data collection software does allow partnerships to record information locally for treatment planning purposes”.

No irony here: “The NTA has no evidence so far that there is a differential treatment need among members of the LGBT community”. How strange. Reminds me of the military’s “Don’t ask, don’t tell” – and it’s not what I found when I asked the community.

But then, how safe do we feel in current treatment environments? Not very! And how much effort is being made to meet our needs?

The Equality Impact Assessment process, of which I was a part, for the new 2008 drugs strategy flags up (in Appendix 3, Diversity and Equality) to commissioners and providers of services that there are “significant gaps in evidence” – such as the needs of lesbian, gay, bisexual transgender and transsexual people – and the importance of finding ways to determine patterns of drugs use and service needs.

“Members of particular groups may be culturally inhibited from approaching mainstream drugs services and may, as a result, suffer discrimination. Service providers have a duty to proactively tackle such discrimination” it explains on pages 43-44. Addressing this discrimination in service provision is in all our best interests.

WHERE GAY CLUBS GO, STRAIGHT CLUBS USUALLY FOLLOW

All the people on the scene I spoke to said that the same thing – the clamp down on G, combined with cocaine being cut “to smithereens” – is fuelling a dramatic rise in crystal meth use.

A quick look at Gaydar, a gay men’s dating website, or googling “chems” and “pigs”+ UK will bring up plenty of talk about PnP (pipe and play: meth drug slang) and slammin’ (sharing a needle of crystal meth).

“Everyone who used cocaine leaves it behind for crystal. It’s a natural progression. And our numbers are showing that,” confirmed David Stuart, a volunteer at Antidote and recovering meth user.

Asked why such a dangerous drug is so attractive to gay men? “It’s about sex. The high is so disinhibiting and energetic. It’s totally about sex.” The health risks are obvious.

LGBT-friendly services are a rarity and not well-resourced. Antidote’s success comes from being run by LGBT people for the community. The small staff is mainly volunteers, who are now being stretched to the limit by G/meth users coming in after being up all weekend.

“When they come down, two days later, they’re at our door, saying ‘Oh my god, I did this and I shouldn’t have. I never do this kind of sex’. And they’re mortifi ed and embarrassed; and they need help,” said Toni Hogg, Antidote’s coordinator and a counsellor.

DJ Fat Tony recently set up an LGBT Narcotics Anonymous meeting in Soho, called Get Over it!. In its first week there were 16 people. Five weeks later, 60-70 people are cramming in a room. The need for help is clear.

He has a message for the NTA. “They need to get their heads out of their arses – cause it is happening. It’s happening here. It’s blowing cocaine out of the water. You don’t get cocaine in gay clubs anymore. The majority of people are on G and crystal meth. That’s the reality. Go to St Thomas’ Hospital and ask them how many gay men they had in A&E in the last two weeks, admitted through GHB. Ask them how many people they have in from crystal meth. It’s rife”.

I did ask St Thomas’. They don’t know the answer. The questions are not being asked.

We do have a problem. Nobody really knows just how big it is already. The answers aren’t in the NTA but in the 24-hour saunas, rushing through the blood stream, an insatiable desire…

SARAH GRAHAM is an experienced counsellor, auricular acupuncturist, drugs and addictions expert, consultant to ‘Frank’ and director of Sarah Graham Solutions. After completing her training at Priory Healthcare, she joined the charity In-volve. She pioneered a successful holistic stimulant drugs service, which led to being asked to sit on the ACPO Meth and Precursors Working Group.

Comments

[Eleanor Levy, St Mungo's]

Sarah has presented some strong reasons for taking a perspective regarding how our society responds to needs in the LGBT community, which I think go wider than just substance use services.

I am particularly aware of the continuing consequences of prejudice experienced by LGBT clients. St Mungo's peer research appears to indicate that there are about twice as many LGBT clients in homeless services than the proportion of LGBT people in the background population. This response to peer research also revealed that many more LGBT clients disclosed their identity to peers than to staff.

The damage experienced by some LGBT people as a result of prejudice appears to be a co-factor in the development of a range of problems including mental health and substance use and homelessness. Sarah has alluded to the different circumstances likely to prevail for LGBT clients, but it is rare that we see housing, mental health or substance use treatment services that specifically cater for LGBT needs.

This is a specific example of a more general case that most services are designed for the main stream and are not particularly attractive for clients who have multiple or complex needs. Having already suffered exclusion and persecution on the basis of a minority identity, it is unlikely that services that mirror a lack of positive attention to minority needs will be as effective as they could be.

In my teens I sought to redefine my male identity in Soho at a time when sex between men was illegal. It was a dark and dangerous time. Eventually substance use nearly destroyed me and I was fortunate that an enlightened employer found treatment for me in the mid eighties. However, while my recovery has been the basis for me to resume my search and establish a gender identity as a woman in which role I am happier, I received little if any support with respect to my LGBT identity from substance use treatment. The "scene" is sometimes the only option for people seeking to develop their queer identity. While I have no wish to return to those dark days, I am increasingly disturbed by the rigidity of the stereotype that has developed, and concerned that any criticism of the "scene" including concerns about alcohol and other drugs is characterised as homophobic.

I previously worked in the criminal justice system. It is my opinion, based on research I conducted, that substance use, homelessness and offending behaviour are strong indicators that are often related to traumatic histories, particularly childhood abuse. It is also my experience that LGBT people are particularly vulnerable to predatory behaviour and are more likely to have experienced abuse; this is quite horrific, considering the high prevalence of child abuse among the general population.

It is clear then that some standard models of treatment are not going to be that accessible for minorities, exemplified by LGBT needs, unless some preparatory work is conducted to acknowledge the pain and anger caused by prejudice and abuse, build coping skills and allow some trust to grow. It is unlikely that this can be achieved within the shorter and shorter treatment times that are now common. Some acknowledgement of these factors in treatment design would I think go towards improving effectiveness.

[Frugal Dougal]

When my daughter was in the first year of secondary school, aged 11, she called her pen "gay" because it wasn't working, which is one of the directions in which semantic change is bringing the word. She was dressed down by her locum teacher, who said that one quarter of her class was homosexual. Sexuality is by no way fixed by age 11, and this sort of pronouncement does not endear gay people to stright people who want to see an end to the unconscionable prejudices that are unfortunately still around.