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This RCPCH principle statement was updated in November 2024. It is endorsed by Royal College of Psychiatrists, Mermaids and Royal College of General Practitioners.

Background

LGBTQ+ stands for lesbian, gay, bisexual, transgender, queer or questioning and the + is inclusive of all identities and sexualities, regardless of how people define themselves. The terms used when discussing gender and the trans and non-binary community are many and varied, and can change and shift over time. Equally, the expression of gender by a particular person can vary over time, and so terms such as gender variant have emerged to include younger children whose gender identity has not fully established.  

We recognise the discrimination that arises as a result of misleading and prejudiced information, and the additional significant harm this can cause to LGBTQ+ children, young people and their families.  

Health outcomes are worse for LGBTQ+ children and young people (CYP) than for the rest of the population. LGBTQ+ CYP are more likely to experience poorer mental health due to complex reasons, including the increased stigma, prejudice and discrimination they can encounter.1  Research estimates that 1 in 5 LGBTQ+ people are not out about their sexual orientation to any healthcare professional when seeking general medical care, and that 1 in 7 LGBTQ+ people have avoided treatment for fear of discrimination.2  Children and young people experiencing gender dysphoria currently face long waiting times to access NHS gender identity services, which can further negatively impact their health and wellbeing.3

In England, the NHS Long Term Plan4  commits to tackling health inequalities for LGBTQ+ people within a decade. This will not be possible to achieve without action on LGBTQ+ healthcare at all levels of the NHS and social care system. For Wales,5   the ‘A Healthier Wales’  plan makes similar commitments. Scotland’s Mental Health and Wellbeing Strategy6   recognises the mental health inequalities experienced by members of the LGBTQ+ community in Scotland. Finally, the Northern Ireland Executive has yet to publish their promised LGBTQI+* and gender equality strategies.  

The NHS Rainbow Badge initiative that originated at Evelina London Children’s Hospital, and developed with RCPCH & Us, works to make a positive difference by promoting a message of inclusion.7  A recent evaluation of the initiative demonstrates that it increases awareness of LGBTQ+ issues amongst NHS healthcare staff, and supports the creation of safe, inclusive environments for young people in healthcare settings, and thus helps to improve the healthcare for LGBTQ+ CYP patients.8

Key messages for health professionals

The RCPCH talked to young people about their experiences of being LGBTQ+ and accessing health care, and their hopes for when they are using services.9  Young people shared their priorities for improving healthcare experience for LGBTQ+ young people:

• Understand the significance of confidentiality, discretion and privacy: remember that LGBTQ+ young people might be living or going to school in environments where there are openly negative views about the LGBTQ+ community. This can lead to complex relationships and they need health professionals to provide safe advocacy and support, allowing these young people to talk and be listened to without judgement and be involved in discussions about why, when and how, and if at all parents or carers need to be involved in their healthcare.
• Increased awareness of LGBTQ+ issues and local services among health professionals so they can create a safe, open and welcoming atmosphere and provide access to support which these young people may not be able to access in other areas of their lives.
• Be aware that young people may be not as confident, have all the knowledge or know how to ask about sex and relationships, and so need to have people to talk to who have the right information and advice. Be mindful of the support they might need and how sensitive it is - for example, when a trans young person who identifies and lives as male needs to get support from a school nurse, GP or hospital for heavy periods.
• Healthcare professionals to remember that these young people are individuals and that their specific health needs should be the focus of attention, only bringing in conversations about their sexuality or gender identity if it is directly relevant.
• The need for young people to be accepted as how they choose to identify. The use of preferred pronouns and gender identifiers are important to trans and gender non-binary children and young people. When health care professionals use identifiers inappropriately, or don’t ask children and young people in the first place, they lose trust in those caring for them and the therapeutic relationship can be lost. Additionally, administrative items and processes like sign in screens and name call outs are often prefixed with Mr or Miss, which creates anxiety about appointments.  

Role and responsibilities of health professionals

• Act at all times in an accepting, non-discriminatory way towards LGBTQ+ children and young people, and demand the same from your colleagues.
• Understand that gender questioning and gender diversity are common, not pathological and frequently begin in early childhood.
• Help parents, schools and other agencies to adopt a supportive, flexible and responsive attitude to affirm a child’s expressed sexuality and gender, whilst being sensitive to change over time. This will involve making appropriate adjustments.
• Be able to enquire about the mental health of LGBTQ+ children and young people, who are likely to have higher rates of low mood, anxiety and thoughts of wanting to die, and know when they may need specialist referral.
• Remain mindful that sometimes mental health needs do not relate to LGBTQ+ identities. Many young people require support for issues relating to academic pressures or family relationship difficulties. LGBTQ+ children and young people should be able to access all available mental health services.
• Maintain confidentiality as would be the case for all patients. As children get older, they may choose not to involve their parents or carers in all aspects of their personal life. Follow the principles of Gillick Competency, the Fraser Guidelines and the relevant devolved nation's guidance on capacity to assess whether a child or young person is capable of making decisions without their parents or carers.
• Recognising the changing political landscape and how this impacts LGBTQ+ young people’s access to healthcare, health professionals should proactively seek training to increase awareness and knowledge of LGBTQ+ issues to remain informed, and know where to signpost young people to further resources or local support if required.  

RCPCH policy and advocacy commitments

• We will ensure we maintain an LGBTQ+ inclusive attitude in policy development and influencing.
• We will advocate for LGBTQ+ inclusive services in health and other sectors.
• We will contribute positively to evidence-based media reporting of LGBTQ+ issues in the health arena.
• We will maintain awareness of the developing evidence base on the healthcare of LGBTQ+ CYP, and do so in collaboration with LGBTQ+ people and their families.  

Further information

You can read the full report on the views of LGBTQ+ children and young people that was produced by the Association for Young People’s Health.

England

Useful guidance is available that has been tailored specifically for children and young people on explaining and understanding and . Find .

Wales

Further resources for Northern Ireland

•  -  health organisation that works to improve the physical, mental & emotional health and wellbeing of LGBTQIA+ people and their families
• - provides regional LGBT+ groups with support and advice, and awareness training to professionals and volunteers
•  - for lesbian and bisexual women
•  - for the transgender community

Further resources for Scotland

• LGBT Health and Wellbeing published the ‘’ report in 2024, which puts the spotlight on the health inequalities experienced by LGBTQ+ adults over 16 in Scotland. 

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• 4NHS. NHS long term plan. Jan 2019. .
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• 9www.rcpch.ac.uk/resources/review-lgbtq-young-people-led-association-young-peoples-health-2024