manifesting in feelings of paranoia, often thinking people are spying on them or listening in through devices and the like, and we also hear about some very significant challenges in services like emergency departments.’
The report details the significant barriers to accessing help, with people citing issues like waiting lists, costs and limited numbers of sessions. Lack of awareness was also a major barrier, however, with 40 per cent of LGBTQ + Londoners never having tried to access support – and half unaware that chemsex-specific services even existed. That statistic was also‘ sadly not’ a surprise, says Moncrieff.‘ We know it can often be difficult for people to recognise when chems are becoming a problem for them, which was echoed in our discussions with healthcare professionals. But it’ s also difficult for services like ours to advertise ourselves too much because we wouldn’ t be able to cope with the increased demand. There’ s no tariff payment activated for everyone we support, like there would be in sexual health for example.’ Instead the money tends to go to local services that LGBTQ + clients can be reluctant to access, he says.‘ We need to do more work to make sure what’ s there already can meet the needs of LGBTQ + people, and those engaged in chemsex, appropriately.’
SHAME AND STIGMA Staff in both drug treatment and sexual health services are increasingly encountering complex chemsex-related needs but lack the capacity to respond properly, the report warns. Perhaps inevitably, shame and stigma were also identified as major barriers to accessing support, with many respondents stating that mainstream drug and alcohol services‘ didn’ t understand LGBTQ + lives’, leaving them feeling unable to engage.
One interesting finding was that drug workers themselves wanted more training,
RECOMMENDATIONS
The report’ s recommendations are based on survey findings and are intended to shape future service development, investment, and commissioning across London.
» Expand access to LGBTQ +-specific care
» Integrate mental health support into chemsex pathways
» Commission a structured LGBTQ + peer mentor programme
» Increase community-led and peer-led interventions
» Reduce practical barriers and improve accessibility
» Strengthen harm reduction communications
» Improve visibility and public information
» Tackle stigma and shame
» Strengthen research and ongoing monitoring
with more than 40 per cent saying they’ d like more education around methamphetamine and GHB / GBL, while almost half wanted more mephedrone training. Some respondents had positive experiences of the support they did access, however, with more than half rating it excellent or very good, while about a third rated it fair, and 16 per cent poor.‘ There were fairly mixed results in what kind of interventions were helpful or not – one-to-one keywork and counselling scored most highly – but this just emphasises the importance of offering a range of intervention types to meet differing needs,’ says Moncrieff.‘ But the need for support to be LGBTQ + specific was really strongly indicated, so we do know people want more targeted interventions.’
The document also calls for mental health support to be properly integrated into chemsex pathways, via embedded therapists and support groups, and better links generally between services. How optimistic is he this will happen over the next few years?‘ It should be happening already, and not just for chems users,’ he states.‘ We know how much mental health support other people who use drugs often require, so it always feels astonishing to me that we haven’ t got this right yet. We still hear of services routinely not accepting clients unless they’ ve addressed their drug use first – this was something the clients in our focus group were particularly vocal about.’
While it can be difficult for people to engage in very structured mental health interventions
if they’ re still using drugs, mental health support can be‘ integrated in so many ways’, he says.‘ We’ ve had to adapt our services to bring it in and be more holistic, as well as bringing in interventions that help people look at their sexual behaviour and health. Psychoeducational
Monty Moncrieff has been working in the LGBTQ + sector since 1996, campaigning for equality and delivering support services, including ten years as a helpline volunteer. He established Antidote in 2002, joined London Friend in 2011, and was appointed chief executive the following year.
In June 2018 he was awarded an MBE in the Queen’ s Birthday Honours List.
‘ Around half of our clients already have a mental health diagnosis, but far more experience issues around their identity, shame and stigma around chems use, and very frequently loneliness.’
workshops are a good way of doing this, but these need to be rooted in the experiences of LGBTQ + people and delivered in ways that are safe for them to disclose what’ s been going on for them. This just can’ t be achieved through most existing mixed groups – people need to know they’ re safe to talk about chems use and sex and won’ t be judged. The respondents were so clear about needing LGBTQ + specific services to do this, so we just can’ t keep expecting them to fit into mixed groups in treatment services.’
STRATEGIC APPROACH Alongside things like mandatory LGBTQ + awareness training for frontline staff, including on chemsex culture, the report says that visibility around the support that is available needs to be improved. How is this best achieved – through targeted campaigns via apps and venues, wider awareness campaigns, or a mix of both?‘ I think we need to maximise all opportunities really,’ he says.‘ Professionals asking about chems use in sexual health appointments is really helpful, as it gives people permission to open up and talk frankly and honestly. We’ re also trying to piggy-back onto existing
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