Introduction

Public understandings of the mental health needs of lesbian, gay, bisexual and trans (LGBT) people have shifted over time, from a tendency to locate the ‘problem’ with individual pathology, for example, in the International classification of diseases and related health problems (ICD; published by the World Health Organization) until 1992, to a focus on social and health inequalities that may impact negatively on mental wellbeing.

This chapter focuses attention on the Welsh context of policy making, service provision and social inclusion of lesbian, gay and bisexual (LGB) identifying adults with mental health issues. With a population of 3.1 million, Wales has its own unique history of language, cultural identity and geography, and the chapter explores areas in which Wales is making a distinctive contribution in legislative frameworks and policy initiatives regarding equalities and mental health. How these policy and societal landscapes interact with the lives of LGB people is explored further using illustrative extracts from recent Wales-wide research into LGB adults who have experienced mental health issues, and their responses to the societal attitudes and quality of services they have encountered.

The landscape of equality and mental health social care in Wales

Since the late 1990s, Scotland, Northern Ireland and Wales have been devolved nations within the United Kingdom (UK), with powers granted by the UK Parliament at Westminster to make separate legislation in some, although not all, areas of public policy. In Scotland and Wales, referenda were held in 1997, requiring a simple majority in favour of devolution. In Wales, a narrow majority in favour led to the Government of Wales Act 1998 and the establishment of the National Assembly for Wales, the legislature with powers to determine how the budget for Wales should be spent. The Government of Wales Act 2006 followed, which created the executive body of elected members: the Welsh Assembly Government. Another referendum in 2011 was in favour of further devolved powers, now named the Welsh Government (Llywodraeth Cymru) to encompass both the legislative and executive arms.

The Welsh Assembly was the first administration in the UK to introduce legislation – the Government of Wales Act 1998 – on protecting and promoting equalities in the public sector, with the duty to have due regard for the principle of equality.