Article: Suicide prevention and older LGBTQ+ adults

“Earlier this year, I had the privilege of working together with some amazing people, to co-produce the Samaritans policy position on what needs to change to prevent suicides in LGBTQ+ communities.

As a diverse group, we talked about many issues, often sharing our own lived experiences and stories from our respective communities.

It became a period of intense personal reflection for me, considering how my identity, as a lesbian, has shaped my life and experiences over six decades, including my experience of being bereaved by suicide, and my hopes and concerns for the future.

Research and reflections

We know from existing research that LGBTQ+ communities are at a higher risk of suicidal thoughts, suicide attempts and self-harm compared to people who don’t identify as LGBTQ+ . The reasons for this difference are complex and likely due to many interacting factors and experiences.

We also know that LGBTQ+ communities are diverse, and experiences are not uniform. Different identities and intersecting factors can lead to very different experiences.

I recently spent some time with a life-long friend, reflecting on what it means to us, as older adults, to identify as LGBTQ+. For the purposes of this discussion, we define ‘older’ as 60+ years.

Over a mug of tea and slice of cake (ok, three slices!), we took a trip down memory lane. Our friendship and connection afforded some buffering against the prejudice and discrimination we faced growing up, and into adulthood. Still, we both felt the need to hide our identities for periods of time, which ‘internalised’ many difficult feelings and emotions, and negatively impacted our mental health over time.

Minority stress

It is not uncommon for older LGBTQ+ people to have experienced a lifetime of ‘minority stress’, and this may be a contributory factor to the poorer physical and mental health outcomes, often reported by older people who identify as LGBTQ+.

It is difficult to shake off the effects of years of discrimination, stigma and social exclusion. Older LGBTQ+ people may fear accessing the very healthcare and support they need, because of perceived, and sometimes real, bias and misunderstanding of both sexual identity, and the intersection with advancing age.

As my friend and I continued our discussion, we reflected on how different parts of our identity can intersect and overlap to create both vulnerability and resilience. We both agreed that understanding the nuances can be empowering. It wasn’t until I became a Lived Experience Influencer for the NSPA, that I really began to see how our experiences are not lived separately. I started to gain some insight into the complex feelings and emotions that often threatened to overwhelm me, when I was bereaved by suicide. Understanding the layers of emotion arising from perhaps a lifetime of vulnerability, meant that I could not only show myself some self-compassion, but also seek out more personalised support.

Common threads

It is interesting that my friend and I have both adopted different strategies to keep well, but there are common threads. We have both sought connection. My friend has developed a very strong network of friends from within the LGBTQ+ community, which they often refer to as their ‘chosen family’. This is most definitely a protective factor. Apart from being a valuable support network, they often engage in activities important for both physical and mental health, such as hiking and outdoor swimming. This is how my friend stays well, and in their words, “averts a crisis”.

It is interesting to ponder how these strategies, which have largely developed from a need to counter stigma and social exclusion, and perhaps an absence of family, may actually have given my friend a degree of resilience for coping with later life.

It is important to remember, however, that older LGBTQ+ adults, who may not be able to make these connections so easily, perhaps due to chronic health problems, disability, or other factors, can be more susceptible to feelings of isolation and loneliness.

Ageing well

Social connections, and health and well-being, are cornerstones of ageing well. It is important to understand the diverse needs of an ageing population. Sometimes older adults can feel invisible in society, simply because of their age. If you consider the additional layers of discrimination, stigma and social exclusion, that may have been experienced by older LGBTQ+ people, the need to provide appropriate and inclusive support is clear. It is important to listen to the lived experiences of older people within LGBTQ+ communities, and to involve them in co-designing and co-producing services.

I have been so fortunate to find connection and support through local suicide bereavement services. I participate in activity-based groups (walking, creative art, singing for well-being) run by community organisations and the voluntary sector, in partnership with the NHS. In my mind, this very much represents ‘hope through action’. These groups are not specific to LGBTQ+ people, or to older adults, but they do feel inclusive, and play an important part in keeping me well and free of suicidal thoughts and feelings. Importantly, they offer flexible, longer-term support which is so important in maintaining health and wellbeing.

The future

As the conversation with my friend drew to a close, and we scrabbled over the last crumbs of cake, we realised that there was so much more to discuss. We seemed to avoid voicing our concerns about the future, but they do exist, and centre mainly on the potential loss of protective factors. We are fearful of ageing alone, poor mental or physical health, financial hardship, health and social care, including care homes, that might not be inclusive, and many other factors.

What simple things can LGBTQ+ people do to support the older people within their community? Certainly, it is important to create opportunities for inclusion. This can be an important contributor to improving the mental health of LGBTQ older adults. My friend and I discussed buddy support to bring younger and older generations together. It struck us that we have much to offer each other, and this may be particularly helpful in suicide prevention. It is likely that, as older LGBTQ+, we have developed some wisdom, and possibly resilience, from years of dealing with stigma, prejudice and discrimination. Maybe we can offer advice and generate hope. Younger LGBTQ+ people will also have much to offer, through practical support, and possibly supporting older people to feel included in activities.

There are growing numbers of older LGBTQ+ people because we have an ageing population, and more older people are identifying as LGBTQ+ later in life. Health and social care systems will need to plan how to identify older LGBTQ+ peoples’ different needs in order to better understand, and reduce, inequalities. It is crucial that local suicide prevention strategies harness the expertise of voluntary sector organisations and networks to inform planning, remembering that LGBTQ+ communities are diverse, and ‘one size cannot fit all’. Policies of the future that address ageing and suicide prevention must be inclusive, and research, consultation and community involvement must be meaningful.

A little support can go a long way, as we have discovered. It is our hope that all older LGBTQ+ people have access to the help they need, whatever their circumstances, and without ever facing stigma, discrimination or prejudice.”

About The Author

As a NSPA Lived Experience Influencer, Penny uses her experiences in diverse settings to influence suicide prevention policy and practice. Penny is passionate about embedding lived experience in healthcare systems, and improving services through collaboration and partnership. She is a Public Governor for an NHS Foundation Trust, and a Patient Safety Partner.