Last week saw the latest reports on the risks of ‘chemsex’, the sexualised use of some drugs by gay, bisexual and other men who have sex with men. The European Monitoring Centre for Drugs and Drug Addiction cites increasing evidence of drug use at sex parties in London and other European cities. It’s a trend we’ve seen for some time here in Antidote, our specialist LGBT drug and alcohol service.
The report adds to the growing body of evidence surrounding chemsex and its related harms. Earlier this year Sigma Research published the Chemsex Study which confirmed what people had been telling us in our service: drug use has changed, and whilst the use of the three main chemsex drugs – crystal methamphetamine, GHB/GBL and mephedrone – is still less widespread than the use of say alcohol or cannabis, use is much higher amongst gay and bisexual men, and these three drugs are causing a disproportionate amount of harm.
The risk posed by use of these drugs has not gone unnoticed. Last week Public Health England (PHE) published their draft strategic framework to improve the health and wellbeing of gay, bi and other MSM. The strategy has three broad focuses: sexual health, mental health and the use of drugs, alcohol and tobacco. I’m really pleased to see the issues we’ve worked with and raised with officials over the past few years given such prominence on the public health agenda and hope this is the start of a new approach to wellbeing for this group of men. I hope too that we can work to widen the remit to include lesbian and bisexual women and trans people.
Supporting LGBT clients when their drug use or drinking has begun to cause them problems is a complex skill. So often the three strands identified by PHE are interconnected, and need time and trust to unpick. Just as the Chemsex Study found, many of the people we support experience anxiety around their identity as LGBT people, or struggle with aspects of ‘how to be’ an LGB or trans person. When exploring in treatment or counselling how this relates to problematic drug or alcohol use our clients need to feel safe to disclose and confident that the person listening to them understands the environments and contexts in which they use or drink. Feeling unsafe or misunderstood are the most common reasons people tell us they avoid mainstream health services.
Improving drug and alcohol treatment services
We’ve provided training to mainstream health and care services for many years on how to better support their LGBT service users. Sessions are usually lively, with great discussion, and an opportunity to ask the questions people have never been able to ask before. After 15 years I’m still struck by just how many people tell me they’ve never had the opportunity to discuss LGBT issues in a professional setting before, so it’s no wonder staff and volunteers sometimes feel out of their depth, or fearful of ‘saying the wrong thing’.
Training days are useful to introduce topics, but they’re just part of the picture. Real improvements in the experiences of LGBT service users will only come if all parts of the system are working in accord. Approaches have to start at the top, with inclusive policy and strategy, combined with a systematic approach to planning and delivering services locally. Commissioners and local Public Health Teams play a vital role in ensuring the services they procure can demonstrate how they’ll meet the needs of their LGBT clients, and that successful outcomes for LGBT people can be measured. Front line staff can take responsibility for developing their own ability to understand and support the LGBT clients and patients they work with. Finally researchers can cover the topics we know less about, helping to fill the gaps in our evidence base.
We’ve examined this approach in our new report Out Of Your Mind, a scoping study looking at how drug and alcohol treatment can be improved for LGBT people. Too often it feels like the treatment needs of LGBT service users are literally out of people’s minds when planning and delivering drug and alcohol services. We hope this report will encourage those involved in providing drug and alcohol treatment to be more mindful of LGBT people in their work. The report looks at these key players and makes a series of recommendations for change. I’m pleased to see that actions already being proposed by PHE in their draft MSM strategy are in line with the recommendations we have made.
Out Of Your Mind also includes a set of practical toolkits to assist commissioners, drug and alcohol service providers, and substance misuse practitioners to examine their own understanding and practice relating to LGBT people, and develop simple action plans to work on those areas that require more thought.
For more information about our Antidote service and the drug and alcohol support available to LGBT people see here. For more information about London Friend’s training and professional services see here.