Diversity must be a focus for mental health

Until our mental health system gets its promised overhaul, we need to find cost-effective and creative ways for mental health professionals to increase their awareness across all areas of diversity, writes Gloria Fraser  

This Mental Health Awareness Week we are encouraged to “explore our way to wellbeing” – Whāia te ara hauora, Whitiora – but recent evidence suggests this isn’t easy for some groups in Aotearoa New Zealand.

The Government Inquiry into Mental Health and Addiction recently described a mental health system failing to meet the needs of many New Zealanders. In particular, rainbow communities – people of diverse sexualities, genders and sex characteristics – were cited as having especially poor experiences and treatment within New Zealand’s mental health services. 

Last year, the Out Loud Aotearoa project (by We Are Beneficiaries and RainbowYOUTH) used art to tell the stories of 75 rainbow people, reporting significant barriers to accessing services, institutional biases and a lack of education and support for mental health professionals. 

Research demonstrates that rainbow people in New Zealand experience more anxiety, depression, self-harm and suicidality than their peers. 

These mental health disparities are not the result of a person’s gender or sexuality per se – there is good evidence they are connected to the stress that comes with challenges such as prejudice, discrimination and social exclusion. 

We need to do something to help our rainbow communities access better mental health care. 

In partnership with the Youth Wellbeing Study and community organisations RainbowYOUTH, InsideOUT and Gender Minorities Aotearoa, last year I led a survey of nearly 1600 rainbow people who had accessed mental health support in New Zealand. Our findings closely reflect those of the Out Loud Aotearoa report – rainbow people's experiences of accessing support vary widely, from the positive, to the not-so-great, to the downright concerning – but also give us the data we need to help mental health professionals better support New Zealand’s rainbow communities. 

Just over half our participants said mental health professionals are helpful in supporting their mental health, but more than a third found mental health professionals unhelpful overall. 

What’s more, a quarter of our participants who accessed support in the past five years shared that a mental health professional had seemed surprised or uncomfortable when they came out, and one in five reported that a mental health professional had blamed their mental health difficulties on sexuality, gender or sex characteristics. 

Alarmingly, transgender participants described gender-affirming healthcare provision in New Zealand as a “postcode lottery” and often felt pressure to “prove” their gender in order to access health care. 

The most common feedback we heard is that mental health professionals lack knowledge about rainbow needs and experiences. Our participants told us mental health professionals tended to either avoid discussing their rainbow identity or zero in on it at the expense of other important topics. They urged mental health professionals to “make the first move to show you are safe, so we don’t have to guess or gamble” and to “be educated and inclusive of all identities”.

There’s been a growing call from rainbow advocates and organisations for initial training and ongoing professional development on sex characteristic diversity, sexuality and gender for New Zealand mental health professionals. 

For an under-resourced and overloaded mental health workforce, however, finding time and funding to attend professional development training may be easier said than done. There’s also little breathing room within current curricula of mental health training programmes, leading to concern around what content would be cut to make way for training on rainbow people’s needs.

Until our mental health system receives the overhaul we’ve been promised, we need to find cost-effective and creative ways for mental health professionals to increase their awareness across all areas of cultural diversity. Providing professionals with easily-accessible resources is one way to help ensure our mental health services meet the needs of all New Zealanders.

That’s why we’ve used our research to create a resource for mental health professionals that guides their work with rainbow clients. It includes background information about sexuality, gender and sex characteristic diversity, tells the stories of rainbow people who have accessed support, and provides practical tips for developing rainbow-inclusive therapeutic practice. While our resource may not be a silver bullet, we see it as an important step towards supporting the wellbeing of New Zealand’s rainbow communities – and what better time to share it than in a week dedicated to mental health awareness?

Find the resource in English, te reo Māori or Chinese Mandarin at You can also download posters to put up in your service to show your commitment to supporting New Zealand’s rainbow people.

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