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People with intellectual disability feel invisible in relation to their gender and sexual identity
Many people with intellectual disability feel invisible in relation to their gender and sexual identities.  Health, disability and social services professionals often lack confidence in discussing these issues with people with intellectual disability, leading to needs and concerns being ignored by service providers.  This is often due to a lack of staff training, concerns about the reactions of carers and family members, and fear of being responsible if there are negative consequences. 
Care and service providers often assume people with intellectual disability are asexual/heterosexual/cisgender
Those who provide care and support to people with intellectual disability often assume that the person is asexual (or, if the person is sexual, that they are heterosexual). This means that there is often a blind spot when it comes to people with intellectual disability and their sexual health needs. Similarly, it is often assumed that people with intellectual disability are cisgender (i.e. their gender matches the sex they were assigned at birth) and have not considered that a person may be transgender. For transgender and gender diverse people with intellectual disability, this may mean they do not receive the appropriate support to affirm their gender and access essential health services.
People with intellectual disability may not know that it is OK to talk about sexual health needs
As many service providers do not proactively bring up sexuality and relationships, people with intellectual disability may not know that it is OK to talk about their sexual health needs or ask for support around LGBTQ+ issues.  They also may not have the appropriate understanding or language to initiate a conversation with service providers or ask questions.
Key challenges in meeting the mental health needs of people with intellectual disability who identify as LGBTQ+
In the general population, people who identify as LGBTQ+ experience more psychological distress than those who identify as heterosexual and are at greater risk of mental health problems. [3, 4] For people with intellectual disability who are already at higher risk of developing mental health problems, this could have a compounding effect for those who also identify as LGBTQ+.
Sexuality and identity are topics that may not necessarily be discussed or considered when trying to meet the mental health needs of people with intellectual disability. This may be due to a lack of recognition that people with intellectual disability have sexuality needs and concerns just like people without intellectual disability. This lack of recognition means that trauma and other challenges faced by people with intellectual disability, including those who identify as LGBTQ+, are often missed during mental health service provision. Some of these challenges may include sexual abuse or assault, physical assault, and partner violence.
LGBTQ+ people with intellectual disability may experience “layered stigma”, which can affect access to appropriate services and supports. Some people with intellectual disability may not embrace sexual and/or gender diversity, and some LGBTQ+ communities may not welcome people with intellectual disability. People with intellectual disability often rely on support networks to advocate for their rights. For LGBTQ+ people with disability, this may mean the negative attitudes of their support networks around sexual and gender diversity can be an additional barrier to getting the support they need.
Layered stigma can lead to further marginalisation, social exclusion, and reduced opportunities to develop meaningful relationships for people with intellectual disability, especially those with higher support needs. In turn, these experiences may lead to isolation, loneliness, and difficulties gaining acceptance. People with intellectual disability who identify as LGBTQ+ experience high incidences of bullying and abuse. 
Internalised homophobia or transphobia from a lack of education about relationships, and sexual and gender identity can lead to distress and mental health problems for people with intellectual disability. Particularly at risk are those who hold negative views but may be questioning their own identity.
How I can meet the mental health needs of LGBTQ+ people with intellectual disability
It is important to recognise that people with intellectual disability can be LGBTQ+. This includes recognising issues and challenges within the population of LGBTQ+ people with intellectual disability and providing psychosocial support. For example, this might include recognising the existence of trauma, bullying, abuse, or negative sexual experiences and providing appropriate support. See additional information within the People who have experienced trauma section.
It is also important to recognise that people with intellectual disability are capable of and have the right to have relationships and sex.
Resources to help improve knowledge and skills
- Acon Pride Training provides training on LGBTQ+ topics via in-person, e-learning and webinar formats. Some of the training offerings are free.
- Though not disability-specific, the Australian Psychological Society has a list of tips for psychologists and others working with people who identify as LGBTIQ+.
- Family Planning NSW’s resources for health professionals may be useful in improving your knowledge and skills. They also provide training specifically around sexuality and disability.
- LGBTIQ+ Health Australia has workforce resources that can help you to improve your knowledge about inclusive practice. They also provide workplace training, but some of this training may only be available to members.
- NSW Health staff can access HETI’s e-learning module on Promoting Inclusive Healthcare: LGBT through My Health Learning.
Be aware of community and support networks in the local area and put the person in touch with these networks or support the person to access them. One community group that raises awareness for queer people with disabilities is Sydney Queer and Disability Community (SQuAD).
LGBTQ+ people with intellectual disability often feel that support groups are safe places where they can be themselves without feeling judged, which can improve perceived mental wellbeing.  You can research support groups in your area and support the person to access them.
Educate people with intellectual disability about their rights when it comes to relationships, safe sex, and discrimination. This can help the person recognise when they are being taken advantage of and be aware of the consequences of sexual activity, including what may be considered criminal activity. Education can help to reduce instances of sexual victimisation or criminalisation.
Engage the person in age-appropriate educational programs that normalise sexual behaviours and the exploration of sexuality in people with intellectual disability. It is important that the programs are age-appropriate and not focused on a person’s cognitive ability.
You could consider referring the person with intellectual disability to a program like Family Planning NSW’s Sexuality and Disability Service. It provides specialist sexuality and relationships support to people with intellectual disability and is available through telehealth. If the person has an NDIS plan, all sessions in the program are included in their plan with no out-of-pocket expenses.
Providing information in an accessible format is important to ensure that people with intellectual disability know about sexual and gender identity, healthy relationships, and where and how to access advice and support. Family Planning NSW has a series of accessible factsheets called All About Sex that cover a range of topics including relationships, sexual/gender identity, and sexual health. Many people will still require support to use these types of factsheets (see 3DN’s Making mental health information accessible for people with intellectual disability – A Toolkit for more information).
It is also important that there is accessible information for transgender people with intellectual disability, especially those in the process of transitioning. This includes not only health information (e.g. about hormones) but also information about where to get support for their mental health. All About Sex contains a factsheet on transgender people with intellectual disability.
In addition to providing information to people with intellectual disability, it is important that there is education for carers, support networks, and support staff in parallel. Often, negative attitudes that people with intellectual disability hold about sexuality are passed on by others with whom the person lives and interacts. Ensuring that people with intellectual disability and those involved in their care are appropriately educated can help to reduce negative attitudes.
The NDIS has a LGBTIQA+ Strategy that recommends actions relevant to the disability sector.
Many organisations and support services only offer partial support – either for intellectual disability or for LGBTQ+ issues. Therefore, it is important for all supports to work together on a continuing basis, where appropriate.
- Family Planning NSW’s Sexuality and Disability Service is available across NSW via telehealth. It is for people with intellectual disability, autism or acquired brain injury and offers individual and group-based programs tailored to the sexuality support needs of its audience. For participants with an NDIS plan, sessions are included in the person’s NDIS plan with no out-of-pocket expenses.
- Family Planning NSW also has an Easy Read factsheet series called All About Sex, which covers a wide range of topics, including relationships, sexual health, and sexual identity.
- LGBTIQ+ Health Australia has community resources that may help inform your practice. There are webinars, brochures, factsheets, and other resources about sexual identity. For example, this webinar on LGBTIQ+ People, Mental Health and the NDIS might be of interest.
- Acon Pride Training provides training on LGBTQ+ topics in in-person, e-learning, and webinar formats. Some of the training offerings are free.
- Outing Disability is a photographic journey documenting the stories of LGBTQ+ people with disability. There are resources that accompany the Outing Disability project, including From Outing Disability to Inclusivity: An Introductory Guide for Disability Services on how to be LGBTIQ+ Inclusive. While aimed at disability services, the information in this guide may also be helpful for other kinds of services.
- Relationships & Private Stuff offers counselling and workshops around relationships and sexuality for people with disability. They also offer a professional development course for counsellors, therapists, and support staff who support people with disabilities.
- Twenty10 provides specialist services for those between the ages of 12 and 25 years who identify as LGBTQ+ across NSW. The services include counselling, mental health, housing, and social support but are not specific to people with disabilities.
- QLife is a chatline that provides anonymous and free LGBTQ+ peer support and referrals. The service is offered between 3pm and midnight every day and is available through webchat or by phone on 1800 184 527.
- Sydney Queer and Disability Community (SQuAD) is a community group on Facebook that raises awareness for queer people with disabilities. The group has a long-term goal of becoming an advocacy group.
- Rainbow Rights and Advocacy is a self-advocacy group run by and for LGBTQ+ people with intellectual disability.
- McCann E, Lee R, Brown M. The experiences and support needs of people with intellectual disabilities who identify as LGBT: A review of the literature. Res Dev Disabil. 2016;57:39-53.
- Abbott D, Howarth J. Still off‐limits? Staff views on supporting gay, lesbian and bisexual people with intellectual disabilities to develop sexual and intimate relationships? Journal of Applied Research in Intellectual Disabilities. 2007;20(2):116-26.
- King M, Semlyen J, Tai SS, et al. A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people. BMC Psychiatry. 2008;8:70.
- Meyer IH. Identity, Stress, and Resilience in Lesbians, Gay Men, and Bisexuals of Color. Couns Psychol. 2010;38(3).
- Dinwoodie R, Greenhill B, Cookson A. 'Them Two Things are What Collide Together': Understanding the Sexual Identity Experiences of Lesbian, Gay, Bisexual and Trans People Labelled with Intellectual Disability. J Appl Res Intellect Disabil. 2020;33(1):3-16.
- Tallentire L, Smith M, David L, et al. Stories of people who have attended a lesbian, gay, bisexual and trans support group in a secure intellectual disability service. Journal of Applied Research in Intellectual Disabilities. 2020;33(1):17-28.