Mr. Chair and members of the standing committee, it is a privilege to address you this afternoon. My name is Travis Salway and I'm an epidemiologist and a post-doctoral research fellow at the University of British Columbia, where I study how stigma and stress affect the health of sexual minorities.
In my statement I will use the term “sexual minorities” to refer to those of us who identify as bisexual, lesbian, gay or queer, as well as those who experience non-heterosexual attractions but may not easily assign labels to their feelings. I will not be speaking specifically about the health of transgender people in my statement as this is not my area of expertise; however, I do encourage the committee to consider how my recommendations may additionally benefit the well-being of transgender Canadians.
The rate of suicide in Canadian sexual minorities is unacceptably high, and this is why I'm here today. In the past 25 years we have seen dramatic gains in the legal rights and social status of sexual minorities in Canada, and yet despite these gains, at least one in six sexual minorities, a quarter of a million Canadians, have attempted suicide at least once. This rate is four times higher than the rate in the heterosexual population.
These statistics indicate that more government action is needed. Specifically, I will recommend action to increase the availability of and access to mental health supports though expansion of the Public Health Agency of Canada's community action fund; ban conversion therapy; and increase research on sexual minority people's health.
First, to give you some context and to situate my research, I will define the concept of minority stress. Everyone experiences daily stressors—a late bus, a deadline at work. Sexual minority people, however, experience additional stress because of their minority status. Minority stress comes in many forms and adds up over time because of repeated exposure.
Through my research interviews with adult gay men who had attempted suicide, there was seldom just one stress that caused the suicide attempt. Rather, multiple assaults and stresses accumulated. One man reflected upon a hurtful remark from his father, who saw a gay couple on television and reacted by calling them “mentally sick fruits”. This remark was internalized. It became an echo throughout the interviewee's life, reinforced when he was mocked or rejected by others in the schoolyard, in the locker room, online, but also later in life, even when, as an adult, he came out and tried to join a gay support group but found it hard to connect with other men there. This is how minority stress gets under our skin, into our bodies and into our minds. The stigma lodges itself there and slowly kills us from the inside.
Minority stress is not only about discrimination and hateful language. It also comes from within us, through low self-confidence and low self-worth. Another participant I interviewed talked about “withholding [the] major secret...of being gay”. He blamed his multiple suicide attempts on the fundamental pain associated with withholding this secret.
Withholding is something every sexual minority individual experiences. Even those of us who live in environments that are open and accepting of minority sexualities must repeatedly revisit the decision of whether to disclose and when it is safe to disclose our sexual minority status. This creates a particular kind of stress.
The many forms of minority stress and the accumulation of that stress over time take their toll on mental health. This is one important reason the policies and legal rights recognized in our country during the past 25 years have not yet fully alleviated the burden of mental health struggles among sexual minorities. But there is hope for sexual minorities who are struggling, and I want to offer some tangible ways forward today.
In Vancouver, where I work, one-third of sexual minorities we talked to want to talk to a health care provider about depression, anxiety, suicide or substance use, but are unable to do so. In response to this backlog of unmet mental health care needs and the limited available services offering sexual minority-affirming care, my colleagues and I have co-founded a collaborative of individuals and organizations in Vancouver—the LGBTQ2 mental health round table. Most members work for organizations that were established in response to the HIV epidemic, and that historically have received funding from the Public Health Agency of Canada's HIV and hepatitis C community action fund. We recognize that the same community-based infrastructure that was created to address HIV and AIDS is needed to similarly reach sexual minorities with unmet mental health needs.
The work of our round table is undertaken by volunteers and other individuals who are not formally tasked with addressing mental health-related epidemics affecting our communities. These individuals are nonetheless committed to this work because the levels of need are so high. Our work effectively reaches sexual minorities because it is led by organizations with long histories of working with sexual minority communities. For these reasons I recommend expansion of the Public Health Agency of Canada's community action fund to address suicide, depression, anxiety and substance use epidemics in the same way this fund has created equitable responses to the HIV and hepatitis C epidemics.
The research I have done on minority stress has allowed me to see with particular clarity the harm associated with an ongoing and overlooked practice here in Canada, that of conversion therapy.
Conversion therapy is an umbrella term for practices that intend to change an individual's sexual orientation and gender identity. It is among the most extreme forms of psychological abuse and violence, leaving those exposed to manage the stress associated with a severe form of withholding for many years. Conversion therapy is thus the sharpest edge of minority stress. For this reason, conversion therapy has been unequivocally denounced by the Canadian Psychological Association and multiple other professional bodies.
Despite those denouncements, in a recent Canadian survey, 4% of sexual minority men reported having attended conversion therapy. On this basis, as many as 20,000 sexual minority men and countless more sexual minority women and transgender people have been exposed. Exposure to conversion therapy was associated with numerous health problems in the study we conducted. Most notably, one-third of those who had completed conversion therapy programs attempted suicide.
Sexual minority youth are especially vulnerable to being enrolled in conversion programs against their will, yet in Canada we lack federal policies to protect our youth from these harmful practices. Many, if not most, conversion programs are practised outside health care providers' offices. Thus, the current situation in which some provinces ban conversion practices by a subset of providers is insufficient and inequitable. Therefore, I recommend a federal ban on the practice of conversion therapy.
Minority stress is harmful, but it is not the entire story of sexual minority health. From data gathered through the Canadian community health survey, we know that sexual minorities are less likely to be married or partnered, and thus miss out on some of the beneficial health, social and financial benefits conferred through partnership. Sexual minorities, most notably bisexual people, are more likely to be living in poverty. Even in environments where minority stress is diminished, sexual minorities often lack social support networks as robust as those of heterosexuals.
Those patterns are striking, because in the general population we see that partnership, income and social support networks are among the largest and most consistent protective factors for suicide. This suggests that the suicide statistics I shared with you earlier are products of more than minority stress alone. For this reason, we need to deepen and expand Canadian research on sexual minority people's health.
As others have stated to this committee, Canada lags behind other countries in the routine collection of sexual and gender minority data. The sexual and gender minority research office of the U.S. National Institutes of Health lists 13 publicly available national datasets that measure sexual or gender minority status. In Canada, we have just two.
The opportunities in harnessing multiple large, linked federal datasets to more fully characterize sexual and gender minority health issues have yet to be realized. I therefore recommend the addition of sexual and gender minority measures to all federally funded health surveys and for respondents of all ages.
Furthermore, much of the evidence I have referenced today stems from research supported by the Canadian Institutes of Health Research. This research has established initial Canadian estimates of the prevalence of health outcomes among sexual minorities that we're discussing today and has helped us understand some of the pathways through which minority stress causes these outcomes. However, acknowledging that we still have much to learn about the various other causes of ill health among sexual minorities, I recommend that special funding be identified to accelerate new research on the health of sexual and gender minority Canadians.
In closing, I believe the government actions I have recommended will make a substantial contribution to reducing the inequitably high rates of mental ill health for sexual and gender minority people in Canada. Again, my recommendations are, first, to increase the availability of mental health supports through expansion of the community action fund; second, to ban conversion therapy; and third, to increase research on sexual minority people's health.
I thank the committee for undertaking this study, a historic and pivotal step toward national leadership in addressing the health needs of LGBTQ2 people. Yet another profound effect of minority stress is that it often leads to a sense of hopelessness, and in this context, a federal study on the needs of sexual and gender minorities is itself a formidable intervention. Congratulations on this important work.