Ignoring the evidence dictating the practice: sexual orientation, suicidality and the dichotomy of the mental health nurse.

Abstract

International epidemiological studies demonstrate that gay and bisexual males are four times more likely to report a serious suicide attempt than their heterosexual counterparts. Data on completed suicides, usually derived from mortality statistics misrepresent the rate of suicides among homosexual populations. However, an increasing number of studies comparing representative samples of gay, lesbian and bisexual youths with heterosexual controls demonstrate increased rates of mental health problems and subsequent suicide among the homosexual population. Homosexual orientation must therefore be considered a risk factor for mental distress and as such should be a focus for any contemporary public health agenda. One of the difficulties of addressing the problem through a public health agenda is the juxtaposition proffered by our political and social environment. The Diagnostic and Statistical Manual of Mental Disorder ceased to define homosexuality as pathological in 1973 replacing it with a new 'illness' of 'gender identity disorder'. Until recently in England, Section 28 of the Local Government Act (1988), forbidding the promotion of homosexuality, further reinforced negativity towards this group of people. This compounded the negative mental health consequences for those developing a gay sexual orientation in a climate of heterosexism. Current health care policy in England concerns itself with the rising number of suicides among young people but fails to acknowledge the importance of the research findings relating to gay people by integrating them into the development of mental health policy. This paper reviews the literature relating to homosexual people and suicidality, and addresses the seriousness of a policy rhetoric which results from ignoring the evidence while dictating mental health nursing practice.