Creating a safe space for the LGBTQ+ community

Nick Coller discusses the significance of Pride Month and how dental practices can create a safe place for the LGBTQ+ community.

Pride Month commemorates the Stonewall Riots of 1969. Tired of oppression and harassment, the LGBTQ+ community rioted after police raided the New York’s Stonewall Inn. These protests gave birth to the gay rights movement.

We might think of Pride Month as parties and celebrations, but it’s history is based in protest. You only need to look around the world now to see that LGBTQ+ rights are hard won and easily lost. I enjoy the rights I have today because people before me fought hard for them.

It can be tempting to think that increased visibility of LGBTQ+ people in the media equates to a general societal acceptance of the community in general. Sadly, this is often not the case.

I wrote an article for Dentistry a couple of years ago about treating members of the LGBTQ+ community which I chose to be factual in its nature. However, I have wanted to write an article like this one well before now, but I have been nervous to do so. After all, this will appear in front of an audience of my predominantly straight, cisgender (cis) – people whose gender identity is the same as the gender they were assigned at birth – peers. Will I appear too terminology obsessed, too woke or too angry? There goes Nick with his LGBTQ+ obsession…

Try to understand

I understand these thoughts come from a place of shame which even I have to challenge on a regular basis. They stem from a childhood knowing I was different, not understanding why but ‘knowing’ there was something ‘wrong’ with me. I wasn’t like other boys. Whatever it was that I was, it was in no way positive and it was better not to be discussed with anyone.

As a child, the word ‘gay’ was the worst insult of all – for many it still is. The word ‘gay’ is still used often by many (and disappointingly by adults) nowadays as slang to mean ‘pathetic’. Pride for me is not a day or a month. It is an ongoing process of shaking off the shame that I feel because I am ‘not like you’. Pride is the opposite of my internalised shame, which I obtained growing up in the straight world with its cultural norms and institutional practices.

I am not looking for sympathy – I am asking you to try to understand. Indeed, I consider myself to come from a place of privilege as a white cis gay man living in the UK, married to the man I love. I cannot imagine how difficult life must be for other members of the LGBTQ+ community who are far more marginalised and stigmatised than me.

I invite you to imagine living in a world knowing there are countries in which you would be in danger if you were born there. There are currently 64 countries where it is illegal to be gay and even more where it is still dangerous to be gay, even if it’s not illegal.

I invite you to imagine growing up thinking that you wouldn’t be able to get married to the person you love. There are currently only 37 countries where same sex marriage is recognised. It was only legalised in the UK in 2013.

Raising awareness

So often conversations around the LGBTQ+ community are toxic. We’re angry, we want more rights than other people, we want special and different treatment, we want to take over other people’s safe spaces. The truth is we have often have not had safe spaces of our own. We have known prejudice, violence, bullying and harassment in ways other members of society have not.

Members of the LGBTQ+ community face unique challenges that can all too easily get overlooked. We suffer from ‘minority stress’. We are more likely to suffer from depression and anxiety. Our community has a far greater incidence of self-harm, eating disorders, drug abuse, homelessness and suicide compared to the rest of the population.

I don’t hold myself out to and I can’t possibly hope to speak for the entire LGBTQ+ community. I can, however, try to raise awareness this Pride Month of the challenges that members of my community face – be they patients or colleagues.

Part of our duty of care is to ensure we treat our patients without discrimination. This can mean challenging our own preconceived ideas and prejudices towards members of society that we might not come into regular contact with outside of our working environment. However, according to Stonewall, one in seven LGBTQ+ people avoid seeking healthcare due to fear of discrimination by staff.

Ultimately, I believe that you, like me, might have chosen dentistry as it is a caring profession. I take it that you have an interest in people, appreciate differences and you want to make a difference in helping others.

So, how do we ensure that the dental practice is a safe space for the LGBTQ+ community?

Making the dental practice a safe space

Be kind, foster trust and a healthy working environment

Treat people like you want to be treated. Keep an open mind
- Avoid unnecessary gossip about colleagues’ or patients’ sexuality or gender identity. Be prepared to challenge such gossip if it occurs. Stopping these things at the outset stops them escalating. Ensure all members of staff are aware of the practice’s non-discrimination policy, which should encompass sexual orientation, gender identity, and gender expressionDon’t slip into generalisations or discriminatory language
- Remember that it is not just LGBTQ+ patients that we might encounter in the dental practice. Dental staff members need to feel supported and included regardless of their sexual orientation or gender identity.
According to the most recent GDC statistics, only 1% of dentists identify as a gay or bisexual man, with none identifying as a gay woman. For dental care professionals, the figure is 1%. Compare this to the most recent 2021 census figures which showed that 3.2% of the UK population aged 16 and over identified as gay, lesbian, bisexual, or another sexual orientation (LGB+)
Research in 2018 conducted by Stonewall reported that one in five LGBT people in the workplace had been the target of negative comments or conduct by staff purely because they were LGBTQ+.

Be informed

While advances have been made, inclusion and diversity training is still not a core component of teaching at dental institutions in its own right. This means the onus is on each individual and practice to seek ongoing training about treating and caring for the needs of the LGBTQ+ community
Remain up to date with current terminology. Conversations about sexual orientation, gender identity and gender expression are constantly evolving, so this is, by its nature, an ongoing process. It is reasonable to expect that dental professionals have as much understanding and empathy as possible. See the terminology below…
Apologise if you slip up and move on
Pay special attention to the care needs of vulnerable stigmatised patient groups, eg HIV positive or trans patients.

Avoid assumptions

Other members of society have the right to live differently to you and to experience the world in a different way than you do. Be prepared to challenge your own prejudices and received cultural norms
Don’t assume a patient or colleague’s gender identity or sexual orientation based on how they look or sound. If in doubt simply ask what pronouns they would prefer to use
Review the language in registration and medical history forms (eg include a range of gender identities and to allow them to identify in a way that they feel comfortable)
Be aware of the needs of same sex parents. LGBTQ+ families face particular challenges in health care
Avoid assumptions about the gender of parents and their partners.

Terminology

Sexual orientation = An emotional, romantic or sexual attraction to other people
Gender identity = A person’s sense of being boy/man/male, girl/woman/female, another gender, no gender
- All people have a gender identity
Gender expression, eg non-binary = External appearance of one’s gender identity which does not need to conform to characteristics typically associated as masculine or feminine
T = Transgender. People whose gender identity is different from the gender they were thought to be at birth
Cis = People whose gender identity as the same as the gender they were assigned at birth (cisgender)
Q = Queer. This used to be considered derogatory but has been reclaimed by the LGBTQ+ community as an umbrella term for inclusivity.

In conclusion, there is much evidence that the LGBTQ+ community have disproportionally worse health outcomes and experiences.

Minority stress affects the LBGTQ+ community in ways that members outside of this community might not realise. Appreciation of the difficulties that members of this community face, the barriers to treatment, and a willingness to become and stay informed are key to ensuring that members of the dental team create a safe space for their LGBTQ+ patients.