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What is the 'hostile environment'? An introduction to immigration policy in Britain

How has the 'hostile environment' shaped migrant homelessness in the UK?

Gorczynski, Paul

Forensic Science International: Mind and Law 2 (2021) 100067
Available online 31 July 2021
2666-3538/© 2021 The Author. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
LGBTQ+ mental health in detention settings 
Paul Gorczynski * 
University of Portsmouth, School of Sport, Health and Exercise Science, Portsmouth, UK   
Individuals who identify as lesbian, gay, bisexual, trans, or queer 
(LGBTQ+) experience higher rates of mental health symptoms and 
disorders than cisgender and heterosexual populations (Gorczynski & 
Fasoli, 2020). For instance, LGBTQ + individuals experience higher 
rates of depressive and anxiety symptoms, thoughts and attempts of 
suicide, and substance use. LGBTQ + individuals also experience high 
rates of non-accidental violence, including discrimination, harassment, 
and abuse, which can be psychological, physical, or sexual (US Institute 
of Medicine, 2011). Research from Scotland has shown that 64 % of LGB 
individuals and 80 % of trans individuals have experienced a hate crime 
at some time in their lives (Pearson, 2017). Meta-analytic research 
across the lifespan has pointed to LGBTQ + individuals experiencing 
greater levels of loneliness than cisgender and heterosexual populations, 
which further compounds mental health symptoms and disorders 
(Gorczynski & Fasoli, ). Despite these identified mental health needs, 
LGBTQ + individuals have been often left out of mental health research 
programmes, where data pertaining to essential demographic informa-
tion with respect to their gender identity and/or sexuality have not been 
asked about, nor collected (Westwood et al., 2020). Unfortunately, in 
the author’s view, this deficit of information has led to a problem: the 
inability to design and deliver rigorous, culturally sensitive, and 
appropriate mental health interventions for LGBTQ + individuals. 
Within detention settings, LGBTQ + individuals represent a dispro-
portionate part of the total prison population, when compared to de-
mographic data collected for general populations. In England and Wales, 
for example, approximately 7 % of the total prison population self- 
identify as LGBTQ+ (Prison Reform Trust, 2021). Within the United 
States, it has been estimated by the National Gay and Lesbian Taskforce 
and National Center for Transgender Equality that one in six transgender 
individuals has been incarcerated (Grant et al., 2011). Time spent in 
custody within detention settings for LGBTQ + individuals is often 
fraught with difficulties and challenges brought on by stigmatized atti-
tudes, fractured social interactions, and discriminatory policies rooted 
in cultural practices shaped by homophobia, biphobia, and transphobia 
(Fernandes, Kaufmann, & Kaufmann, 2020). Unfortunately, as a stig-
matized group within detention settings, the general day-to-day living 
needs, let alone specific mental health needs, of LGBTQ + individuals 
are rarely acknowledged or addressed. 
To provide mental health services to LGBTQ + individuals within 
detention settings would require a high degree of mental health literacy, 
as well as cultural competence with respect to understanding the lived 
experiences of LGBTQ + individuals, on the part of staff and adminis-
trators who work in detention settings. Mental health literacy is defined 
as “knowledge and beliefs about mental disorders which aid their 
recognition, management or prevention” (Jorm Korten, Jacomb, Chris-
tensen, Rodgers, & Pollitt, 1997, p.182). Cultural competence, from a 
mental health perspective, would imply that individuals are aware of 
and understand the importance of social and cultural factors that may 
impact a patient’s perceptions of mental health, attitudes, and overall 
care practices (Betancourt, Green, Carrillo, & Ananeh-Firempong, 
2003). To demonstrate cultural competence with respect to LGBTQ +
individuals, staff and administrators who work in detention settings 
would need to acknowledge and support diverse life experiences, views, 
beliefs, and mental health needs. Training in mental health literacy and 
cultural competence are important components of an ecological model 
of public health where a whole organizational focus is taken in a 
detention setting to promote overall health (Baybutt & Chemlal, 2016; 
Van Hout, Kewley, & Hillis, 2020). 
Researchers who conducted survey research within the United States 
have demonstrated that staff who work in detention settings have low 
levels of mental health literacy, and that these low levels of mental 
health literacy predicted negative and stigmatized views of people living 
in detention settings with mental health needs (Hebert, 2020). Unfor-
tunately, this study did not collect information on gender identity or 
sexuality. Low levels of mental health literacy, compounded with known 
discrimination of LGBTQ + individuals living in detention settings in the 
United States, as well as other forms of known discrimination based on 
ethnicity, race, indigeneity, (dis)ability, religion, and age, has created a 
situation where LGBTQ + individuals are unlikely to receive any mental 
health support (The Fenway Institute, 2019). 
A study that examined the experiences of LGBTQ + individuals living 
in prisons and institutional policies and structures within English and 
* University of Portsmouth, School of Sport, Health and Exercise Science, Portsmouth, PO1 2ER, UK. 
E-mail address: paul.gorczynski@port.ac.uk.  
Contents lists available at ScienceDirect 
Forensic Science International: Mind and Law 
journal homepage: www.sciencedirect.com/journal/forensic-science-international-mind-and-law 
https://doi.org/10.1016/j.fsiml.2021.100067 
Received 27 July 2021; Received in revised form 29 July 2021; Accepted 29 July 2021   
Forensic Science International: Mind and Law 2 (2021) 100067
2
Scottish prisons showed that LGBTQ + individuals lacked access to 
support structures and mental health services and often felt segregated 
and isolated because of their gender identity and/or sexuality (Fer-
nandes et al., 2020). Some individuals who lived in prisons stated that 
they felt frustrated by the lack of support from staff and that unless they 
experienced physical health issues, their mental health needs would not 
be acknowledged. Some individuals stated that they felt that staff lacked 
knowledge and experience in dealing with the health needs of LGBTQ +
individuals. When staff were asked to provide their comments on the 
treatment of LGBTQ + individuals living in prison, they said that human 
resource policies, budgetary shortfalls, a lack of resources, staff short-
ages, and job-related stressors impacted their ability to acknowledge and 
address the mental health requirements of LGBTQ + individuals. 
Additionally, some staff stated that they specifically lacked training in 
LGBTQ + diversity and inclusivity. 
Although there have been previous calls for further rigorous primary, 
secondary, and tertiary research to better understand the lived experi-
ences of LGBTQ + individuals in detention settings (see: Gorczynski, 
2016), and how health interventions may be designed, this research has 
largely not occurred (Fernandes et al., 2020). Despite this lack of coor-
dinated research, several areas of best practice to address the mental 
health needs of LGBTQ + individuals in detention settings have been 
provided by numerous advocacy groups, charities, and researchers in 
the United States (The Fenway Institute, 2019; Trimble, 2019) and the 
United Kingdom (Fernandes et al., 2020; Van Hout et al., 2020), as well 
as the World Health Organization (Enggist, Møller, Galea, & Udesen, 
2014). These include:  
- Providing training to staff and administrators who work in detention 
settings to ensure they are aware of and understand the unique lived 
experiences and mental health needs of LGBTQ + individuals, 
including provisions that may be necessary to protect the identities 
of LGBTQ + individuals in a confidential manner;  
- Providing mental health literacy training to staff and administrators 
who work in detention settings so they may understand the different 
expressions of mental health symptoms and disorders, address stig-
matized views of mental illness, and are able to listen and address the 
mental health needs expressed by LGBTQ + individuals;  
- Providing access to information about mental health to LGBTQ +
individuals;  
- Providing access to and space for LGBTQ + support groups in 
detention settings;  
- Providing LGBTQ + individuals with access to mental health 
services;  
- Ensuring that mental health services in detention settings are staffed 
by individuals who have awareness, knowledge, and experience in 
providing mental health care to LGBTQ + individuals, including 
specific care services for individuals who may transition while 
experiencing incarceration. 
In the author’s opinion, for any of these best practices to be mean-
ingfully enacted, appropriate increases in funding and resources would 
need to be directed toward detention settings. Given the current COVID- 
19 pandemic, this is unlikely to be a government priority, and it is highly 
improbable that any meaningful changes will occur anytime soon 
(Johnson, Gutridge, Parkes, Roy, & Plugge, 2021). During this time, a 
call-to-action for researchers is further needed to address deficits in 
knowledge and ensure epidemiological data on gender and sexuality are 
collected and analyzed, and rigorous and culturally sensitive and 
appropriate mental health interventions for LGBTQ + individuals are 
designed and evaluated. 
Author statement 
There are no known conflicts of interest associated with this publi-
cation and there has been no significant financial support for this work 
that could have influenced its outcome. 
References 
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P. Gorczynski                                                                                                                                                                                                                                    


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