This literature review identifies protective factors

for social, cultural and emotional wellbeing and risk

factors for suicide for Aboriginal and Torres Strait
Islander LGBTQIASB+ people. It also describes a range
of intersecting experiences that may increase the risk
and incidence of suicidal ideation and behaviours.

Aboriginal and Torres Strait Islander

LGBTQIASB+ people and
mental health and wellbeing
Madi Day, Bronwyn Carlson, Dameyon Bonson and Terri Farrelly
Stronger evidence,
better decisions,
improved health and welfare
Aboriginal and Torres Strait Islander
LGBTQIASB+ people and
mental health and wellbeing

Madi Day, Bronwyn Carlson, Dameyon Bonson and Terri Farrelly

 The AIHW is an independent statutory Australian Government agency producing
authoritative and accessible information and statistics to inform and support better policy
and service delivery decisions, leading to better health and wellbeing for all Australians.

© The Australian Institute of Health and Welfare 2022

All material presented in this document is provided under a Creative Commons Attribution 4.0
International licence, with the exception of the Commonwealth Coat of Arms (the terms of use for the
Coat of Arms are available at https://www.pmc.gov.au/government/commonwealth-coat-arms) or any
material owned by third parties, including for example, design, layout or images obtained under licence
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owned by third parties.
The details of the relevant licence conditions are available on the Creative Commons website (available
at https://creativecommons.org), as is the full legal code for the CC BY 4.0 license.

A complete list of the Institute’s publications is available from the Institute’s website www.aihw.gov.au.

ISBN 978-1-922802-39-2 (Online)

ISBN 978-1-922802-40-8 (Print)
DOI: 10.25816/nmvs-nc70

Suggested citation
Day M, Carlson B, Bonson D and Farrelly T, 2022. Aboriginal and Torres Strait Islander LGBTQIASB+ people
and mental health and wellbeing. Catalogue number IMH 15, Australian Institute of Health and Welfare,
Australian Government.

Australian Institute of Health and Welfare

Board Chair
Mrs Louise Markus
Chief Executive Officer
Mr Rob Heferen

Any enquiries about or comments on this publication should be directed to:

Australian Institute of Health and Welfare
GPO Box 570
Canberra ACT 2601
Tel: (02) 6244 1000
Email: [email protected]

Published by the Australian Institute of Health and Welfare.

Please note that there is the potential for minor revisions of data in this report.
Please check the online version at www.aihw.gov.au for any amendments.

ii
Contents

Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vi

Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
1.1 Data and research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Data collection and binary categories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1.2 Health outcomes and help-seeking behaviours. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Outcomes, risks and protective factors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Suicide-related behaviour for LGBTQIASB+ people . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
The compound risk for Aboriginal and Torres Strait Islander LGBTQIASB+ people. . . . . . 6
An overview of insights and solutions in this report. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Protective and risk factors for Aboriginal and Torres Strait Islander
LGBTQIASB+ people’s wellbeing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
2.1 Racism, discrimination and violence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Violence and the anticipation of violence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Domestic and family violence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
2.2 Trauma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Grief and loss. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Exposure to suicide deaths. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Incarceration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
2.3 Connection to family, community, culture and Country. . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
2.4 Social inclusion and exclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Youth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Relationships with mothers and family. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Relocation and connection to Country . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Navigating and influencing culture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
2.5 Identity and visibility. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Visibility and agency. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Negotiation skills and ‘shape-shifting’. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
2.6 Health and wellbeing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

iii
 2.7 Help-seeking and access to care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15
Aboriginal and Torres Strait Islander people and sources of help . . . . . . . . . . . . . . . . . . . 15
LGBTQIA+ people and sources of help . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Sources of help for Aboriginal and Torres Strait Islander LGBTQIASB+ people . . . . . . . . 16
2.8 Social media. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
2.9 A case in point: the COVID-19 pandemic response. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Increased risk of racism and marginalisation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Higher risk of transmission, due to disadvantage and living conditions . . . . . . . . . . . . . . 17
Engaging with the criminal justice system during a pandemic . . . . . . . . . . . . . . . . . . . . . . 18
Loss of access to community and cultural spaces. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Conclusions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Priority . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Self-determination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Policy responses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Data and research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Programs and services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Suggestions to strengthen LGBTQIASB+ services and programs . . . . . . . . . . . . . . . . . . . . 22

Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

About the cover artwork:

Artist: Linda Huddleston
Title: The journey towards healing
At the centre of the artwork is the Clearinghouse. The black half-circles are the people who come to the
Clearinghouse for information about mental health and suicide prevention.
The waves of red, yellow and white dots surrounding the inner circle represent strength and healing.
The footprints represent the journey towards healing.
The red and white circles around the edge represent different programs and policies aimed at helping people heal.
The hands represent success and wellbeing.

iv
Caution: Some people may find the content in this report confronting or distressing.

Please carefully consider your needs when reading the following information about
Indigenous mental health and suicide prevention. If you are looking for help or crisis support,
please contact:

13YARN (13 92 76), Lifeline (13 11 14) or Beyond Blue (1300 22 4636).

QLife is a counselling and referral service for LGBTIQ+ people (1800 184 527 - 3pm to
midnight daily).

The AIHW acknowledges the Aboriginal and Torres Strait Islander individuals, families and
communities that are affected by suicide each year. If you or your community has been
affected by suicide and need support, please contact Thirrili’s Postvention Suicide Support
service on 1800 805 801.

The AIHW supports the use of the Mindframe guidelines on responsible, accurate and safe
suicide and self-harm reporting. Please consider these guidelines when reporting on these topics.

v
 Summary
The high rates of suicide-related behaviour among Aboriginal and Torres Strait Islander people,
combined with similar evidence relating to LGBTQIA+ people, suggest that there is a need to
investigate the compound risk of suicide-related behaviour among people who are both Aboriginal
and Torres Strait Islander and LGBTQIASB+. This report highlights gaps in existing data collection and
research literature regarding the experiences of this group. It explores the risks to social, cultural and
emotional wellbeing, as well as protective factors for suicide, for this group.

This overview describes a range of intersecting experiences that may increase the risk and incidence
of suicidal ideation and behaviours:

• Discrimination and violence targeting Aboriginal and Torres Strait Islander and LGBTQIASB+
people can impact all aspects of life, including access to employment, health care, housing and
participation in people’s own communities and in broader Australian society. Aboriginal and Torres
Strait Islander LGBTQIASB+ people are at a higher risk of family violence as well as assault and
harassment which results in compounded and layered trauma. Life trauma, youth, disability and
incarceration are also factors which intersect and may further compound the risk for this group
(Phelan and Oxley 2021).

• Disconnection and exclusion from community, culture and Country are risks to social, cultural and
emotional wellbeing for Aboriginal and Torres Strait Islander LGBTQIASB+ people. Colonisation
introduced religious ideology to Aboriginal and Torres Strait Islander communities, contributing
to discrimination and violence towards Aboriginal and Torres Strait Islander people who are also
LGBTQIASB+. Conversely, feeling fully accepted – both as Aboriginal and/or Torres Strait Islander
and as LGBTQIASB+ – and being able to fully participate in community and society, are protective
factors against suicide.

• Both Aboriginal and Torres Strait Islander people and LGBTQIA+ people experience poorer health
outcomes. Due to past and ongoing discrimination and to resulting feelings of distrust, individuals
from both groups may also be hesitant to access health, mental health and other suicide
prevention services.

• However, since colonisation, Aboriginal and Torres Strait Islander LGBTQIASB+ people have shown
significant agency and resilience in the face of violence, marginalisation and discrimination. More
recently, this has included the use of social media to form communities of care and for social and
cultural nourishment, as an alternative to formal help-seeking.

This report recommends that:

• Aboriginal and Torres Strait Islander LGBTQIASB+ people be treated as a priority group for
research, policy and programs that address the compounding impacts of racism, discrimination
and trauma

• Aboriginal and Torres Strait Islander LGBTQIASB+ communities be resourced and empowered to
lead this response.

vi
1

Introduction

1
 1 Introduction Some terms in use
It is important to note that, in their
While our understanding of suicide risk and of protective languages (including Aboriginal
factors for wellbeing among Aboriginal and Torres Strait English and Kriol), Aboriginal and
Islander people is growing, we know very little about Torres Strait Islander people use a
range of terms to describe sexual
these factors as they apply to Aboriginal and Torres Strait
and gender diversity.
Islander LGBTQIASB+ people. The intersections – and
LGBTQIA+ is an acronym of the
commonalities – between the life experiences and health
terms Lesbian, Gay, Bisexual,
outcomes of Aboriginal and Torres Strait Islander people
Transgender, Queer, Intersex and
and of LGBTQIA+ people are also an important (and Asexual. The addition of the ‘+’
under-researched) area for public policy. symbol serves as a reminder that
there may be other terms that
Based on a review of peer-reviewed articles, grey literature
should be included, including ‘non-
and databases, this report provides: binary’ and ‘pansexual’.
• an overview of available literature about Aboriginal and LGBTQIASB+ adds ‘SB’ to represent
Torres Strait Islander LGBTQIASB+ people and social and ‘Sistergirl’ and ‘Brotherboy’. Two
emotional wellbeing terms used by some Aboriginal and
Torres Strait Islander people, and
• a comparative analysis of literature about Aboriginal which refer exclusively to Aboriginal
and Torres Strait Islander people, LGBTQIA+ people and Torres Strait Islander women
and suicide. and men who are transgender.

1.1 Data and research

Data collection and binary categories

While this report uses statistics that refer to Aboriginal and Torres Strait Islander people as
‘male/female’, ‘men/women’ or ‘boys/girls’, this is not an adequate reflection of the reality of gender
in Aboriginal and Torres Strait Islander communities or the Australian population in general.

This is because:

• most demographic data and statistics collected on, and

about, Aboriginal and Torres Strait Islander people are The National Suicide and Self-harm
Monitoring Project was undertaken
limited to the binary categories of ‘male’ and ‘female’.
to improve the quality of suicide and
• data on Aboriginal and Torres Strait Islander self-harm data in Australia and has
LGBTQIASB+ people and suicide-related behaviour are included a focus on expanding data
also limited by the fact that, in Australia, information collection on LGBTQIA+ populations
(AIHW 2022a).
about sexuality and gender diversity is rarely recorded
at death, unless specifically included by a coroner
(Skerrett et al. 2014).

Thus, most research about Aboriginal and Torres Strait Islander people and suicide may be missing
significant cohorts, including those who are outside and beyond the gender binary.

2 Aboriginal and Torres Strait Islander LGBTQIASB+ people and mental health and wellbeing
Research
Aboriginal and Torres Strait Islander LGBTQIASB+ people
are under-represented in research and have been largely Aboriginal researchers, including
missing from national studies into sexuality, gender and Maggie Walter (2016a) and Sandy
O’Sullivan (2021a), have highlighted
sex diversity (AHRC 2015; O’Sullivan 2021a, 2022). In a
how data – and gaps in data – can
submission to the Australian Human Rights Commission misrepresent, reduce, and erase the
(AHRC) in 2015, Black Rainbow Living Well observed complexities of Aboriginal and Torres
the absence of a national strategy, plan or research to Strait Islander lives.
identify and meet the needs of Aboriginal and Torres Strait
Islander LGBTQIASB+ people.

With respect to suicide risk and protective factors, there is little available research literature to inform
public policy about the needs and experiences of Aboriginal and Torres Strait Islander LGBTQIASB+
people and such research is generally framed within the policy context of sexually transmissible
infection and blood-borne virus (AHRC 2015; Gays and Lesbians Aboriginal Alliance 1993;
Hodge 1993). A lot of what is known tends to be drawn from comparative studies of LGBTQIA+ and
Aboriginal and Torres Strait Islander communities separately. (An exception to this is Bonson (2016),
Dudgeon and colleagues (2015) and Kerry (2017), who note the risks of increased isolation; rejection
from community; exclusion from culture; suicide; homelessness; and mental health issues.)

It is only more recently that policy regarding health and wellbeing has begun to respond. (For a
comprehensive list of policy documents, see AIHW 2022b). However, there continues to be limited
information available to service providers on how best to work with Aboriginal and Torres Strait
Islander LGBTQIASB+ people, and where they access care (Uink et al. 2020). Recent efforts have
aimed to address this lack of research by exploring the needs and experiences of Indigenous
LGBTQIASB+ youth (see Hill et al. 2021; Liddelow-Hunt et al. 2021; Soldatic et al. 2020, 2021).

1.2 Health outcomes and help-seeking behaviours

Both groups experience poorer health outcomes and higher rates of health-impacting behaviours
arising from minority stress, social exclusion, discrimination and trauma (Lea and Reynolds 2014;
Krakouer et al. 2022). This report identifies a help-seeking quandary for Aboriginal and Torres
Strait Islander LGBTQIASB+ people who face barriers to
seeking care at both Aboriginal and Torres Strait Islander While acknowledging that social
and LGBTQIA+ specific services. Due to experiences of media can be a site of discrimination
discrimination and to the resulting feelings of distrust, and violence, the report also
identifies how Aboriginal and Torres
both Aboriginal and Torres Strait Islander communities
Strait Islander LGBTQIASB+ people
and LGBTQIA+ communities are also hesitant to engage
are now using social media for
in help-seeking or to access health, mental health and informal and interpersonal kinds
suicide prevention services. of support.

Aboriginal and Torres Strait Islander LGBTQIASB+ people and mental health and wellbeing 3
 Outcomes, risks and protective factors
The role of social and emotional wellbeing
For Aboriginal and Torres Strait Islander people, health is not only defined by the physical wellbeing
of an individual, but includes the social, cultural and emotional wellbeing of the whole community
(Gee et al. 2014).

Social and emotional wellbeing (SEWB) is a multidimensional concept, comprising the lifetime of
relationships between body; mind and emotions; family and kinship; community; culture; Country;
and spirituality and ancestors (Zubrick et al. 2014). These factors are recognised in the National Strategic
Framework for Aboriginal and Torres Strait Islander Peoples’ Mental Health and Social and Emotional
Wellbeing 2017–2023 (PM&C 2017), and also reflect many of the:
• ‘social determinants of health’ outlined by the World Health Organization (AIHW 2020)
• Aboriginal and Torres Strait Islander cultural and social determinants of health identified by the
Lowitja Institute (2014).
Disruption to these connections can result in poor wellbeing – while renewing, healing, and
strengthening these connections improves wellbeing (Gee et al. 2014).

Aboriginal and Torres Strait Islander people suicide rates

For Aboriginal and Torres Strait Islander people who died between 2011 and 2020, suicide was the
fifth leading cause of death, compared with 13th for non-Indigenous Australians (ABS 2020). The
age-standardised suicide rate for the general Australian population in 2020 was 12.1 deaths per 100,000
(a decrease of 6.2% from 2019). For Aboriginal and Torres Strait Islander people the rate was 27.9
(ABS 2020). For Aboriginal and Torres Strait Islander men, the suicide rate has increased between 2011
and 2020, from 31.7 to 42.9 deaths per 100,000 (ABS 2020). For Aboriginal and Torres Strait Islander
women the suicide rate has remained relatively stable over time (ABS 2020). It should be noted that such
statistics generally only record sex in terms of male and female (rather than gender).

The risk of suicide among Aboriginal and Torres Strait Islander people also differs across jurisdictions
and by age:
• In 2020, 31.4% of Aboriginal and Torres Strait Islander people who died by suicide had a usual
residence in Queensland (ABS 2020). When comparing data from 2011–15 with data from
2016–20, the number of Aboriginal and Torres Strait Islander deaths by suicide had increased in all
jurisdictions except South Australia and Western Australia (ABS 2020). Across the periods of 2011–15
and 2016–20, those living in New South Wales had a lower suicide rate, and those living in Western
Australia had the highest, compared with those living elsewhere (ABS 2020).
• Of those Aboriginal and Torres Strait Islander people who died by suicide between 2016–20, 81.9%
were aged between 15 and 44 years, and the rate was highest for males aged 35–44 years and for
females aged 15–24 years (ABS 2020). Suicide was the leading cause of death for Aboriginal and Torres
Strait Islander children. Over 73% of Aboriginal and Torres Strait Islander children who died by suicide
were aged between 15 and 17, and 53.8% were girls (ABS 2020).

Suicide risk and protective factors

Suicide risk factors that impact all populations include history of suicide-related behaviour, poor
support networks, discrimination, incarceration, alcohol and drug use, life stressors, access to
mental health care, and identifying as LGBTQIA+ (AIHW 2022b).

4 Aboriginal and Torres Strait Islander LGBTQIASB+ people and mental health and wellbeing
For Aboriginal and Torres Strait Islander people, cultural understandings of wellbeing, community
values and unique historical events can shape interactions with other factors that can protect an
individual from – or increase their risk of – suicide (Westerman and Sheridan 2020; AIHW 2022b).

A review of available literature has recently identified 17 key protective and risk factors as defined
in the literature that may contribute to Aboriginal and Torres Strait Islander suicide (AIHW 2022b).
Aside from the demographic factors of gender, age and place of residence, these include factors
specific to Aboriginal and Torres Strait Islander people such as:

• intergenerational trauma (as a result of colonisation, dispossession and marginalisation

• racism and discrimination

• grief and loss

• continuing social disadvantage

• connection (or loss of connection) to culture and Country.

To date there remains limited published work that

explores the contribution of these factors (AIHW 2022b). The importance of working
There has also been limited research exploring the towards suicide prevention
effectiveness of approaches to reduce the risk of suicide outcomes that are specific to
Aboriginal and Torres Strait Islander
in Aboriginal and Torres Strait Islander communities
communities has been recognised
(Ridani et al. 2015).
by the Australian Government
Often, such approaches have been transplanted from National Suicide Prevention
non-Indigenous contexts with little consideration of Taskforce and supported by various
mental health and suicide prevention
their appropriateness or their likelihood of addressing
policies, for both Aboriginal and
Aboriginal and Torres Strait Islander understandings of
Torres Strait Islander people and
wellbeing (Ridani et al. 2015). To fully understand and non-Indigenous Australians.
develop effective responses to address suicide among
(See AIHW 2022b for policy
Aboriginal and Torres Strait Islander people, these
documents.)
protective and risk factors – and how they interact – need
to be considered comprehensively (ATSISPEP 2016).

Suicide-related behaviour for LGBTQIASB+ people

Available evidence suggests that Australian LGBTQIA+ people are 5 to 11 times as likely to engage
in suicide-related behaviour, compared with the general population (Skerrett et al. 2015). The first
Australian National Trans Mental Health Study (Hyde et al. 2014) found that approximately one-fifth
(21%) of participants had experienced suicidal ideation or thoughts of self-harm on at least half of the
days in the previous two weeks.

Diagnoses for depression and anxiety are also higher for LGBTQIA+ people, and these outcomes
differ amongst particular sexually, gender and sex diverse groups (AHRC 2015).

Risk factors for LGBTQIA+ Australians

For LGBTQIA+ Australians, like Aboriginal and Torres Strait Islander Australians, discrimination is a lived
reality. Examples of state-sanctioned discrimination include laws that prohibit same-sex couples from
adopting children; access to fertility services; and various criminal and justice issues (AHRC 2015).

Aboriginal and Torres Strait Islander LGBTQIASB+ people and mental health and wellbeing 5
 Institutional discrimination can inhibit access to education and health services, impact employment
and housing, and prevent participation in community activities such as sport (AHRC 2015). Research
conducted by the AHRC (2015) found that LGBTQIA+ Australians often experienced discrimination
when attempting to access services operated by religious organisations, such as certain hospitals,
clinics, aged care and mental health services.

Interpersonal discrimination includes bullying, harassment and violence. Research consistently shows
that LGBTQIA+ Australians experience higher than average rates of harassment, verbal and physical
abuse, violence, and sexual assault, occurring in public and in all aspects of their lives (AHRC 2015).

The compound risk for Aboriginal and Torres Strait Islander LGBTQIASB+ people
The high rates of suicide-related behaviour among Aboriginal and Torres Strait Islander people,
combined with the evidence relating to LGBTQIA+ Australians, suggests a compounded risk of
suicide-related behaviour among Aboriginal and Torres Strait Islander LGBTQIASB+ people.
This risk may be increased when other intersecting factors are added (for example, youth,
disability, and incarceration) (Phelan and Oxley 2021).

Bonson (2017) has reported that Aboriginal and Torres Strait Islander LGBTQIASB+ people are also at
higher risk of serious assault, homelessness and psychological distress, and that there are disparities
in access to health care and social services. Such reports suggest the likelihood that the needs of
this population are not being met, either by Indigenous-specific or by LGBTQIA+-specific services.
COVID-19 pandemic responses and their potential impacts on Aboriginal and Torres Strait Islander
LGBTQIASB+ people may have affected access to care even further.

An overview of insights and solutions in this report

Firstly, the report explores trauma; racism, discrimination and violence; and connection to culture,
community and Country as significant factors impacting Aboriginal and Torres Strait Islander
LGBTQIASB+ people’s social, emotional and cultural wellbeing. This leads to an overview of the
significance, for Aboriginal and Torres Strait Islander LGBTQIASB+ people, of being fully seen,
safe and accepted as Aboriginal and/or Torres Strait Islander and as LGBTQIASB+.

As this report demonstrates, physical safety, navigating racism and discrimination, and family
and community acceptance for all aspects of their identity are consistent concerns in all available
literature on Aboriginal and Torres Strait Islander LGBTQIASB+ people.

COVID-19: a case in point

Finally, this report considers the impact of Australian governments’ responses to COVID-19 and
its implications for social and emotional wellbeing, for the everyday navigation of racism and
discrimination, and for health access for Aboriginal and Torres Strait Islander LGBTQIASB+ people
(O’Sullivan 2021b; Soldatic et al. 2020).

Given the significance of connection to culture and community as protective factors, as well as the
barriers to adequate health care access outlined in this report, more research is needed on how
the pandemic specifically impacted Aboriginal and Torres Strait Islander LGBTQIASB+ people and
their communities.

6 Aboriginal and Torres Strait Islander LGBTQIASB+ people and mental health and wellbeing
2

Protective
and risk
factors for
Aboriginal
and Torres
Strait Islander
LGBTQIASB+
people’s
wellbeing

7
 2 Protective and risk factors for Aboriginal
and Torres Strait Islander LGBTQIASB+
people’s wellbeing
A recent publication by AIHW (2022b) for the Indigenous Mental Health and Suicide Prevention
Clearinghouse has already detailed protective and risk factors for suicide among Indigenous
Australians and should be read in conjunction with this report. This report specifically seeks to outline
the potential risks to social, cultural and emotional wellbeing, and the protective factors, which are
specific to Aboriginal and Torres Strait Islander LGBTQIASB+ people.

We acknowledge that the factors identified here are by no means exhaustive nor comprehensive. We
also acknowledge that these factors overlap and interact, which further complicates and elevates risk.

Suicidal behaviour among Aboriginal and Torres Strait Islander people, and also among LGBTQIA+
people, have become dominant narratives in popular culture. Reports of such incidents in the media
– the focus of intervention and prevention initiatives; personal accounts shared by celebrities; and
the portrayal of these themes in movies, television programs, song lyrics and other forms of art
– have resulted in Indigenous identity, and/or being LGBTQIA+, becoming inextricably linked with
suicide risk in popular imagination. (Indeed, the way statistics and data about Aboriginal and Torres
Strait Islander people are represented also contributes to this narrative (Walter 2016a).)

These narratives are problematic because they position Aboriginal and Torres Strait Islander
people and LGBTQIA+ people as inherently vulnerable – taking away from the significant agency
demonstrated to date by Aboriginal and Torres Strait Islander people, LGBTQIA+ people, and
Aboriginal and Torres Strait Islander LGBTQIASB+ people.

This report emphasises that the following identified risks to wellbeing are not the result of some
vulnerability inherent with being an Aboriginal and/or Torres Strait Islander person who identifies as
LGBTQIASB+, but rather are the outcomes of experiences of racism, discrimination, marginalisation,
homophobia and transphobia (Mulé et al. 2009).

2.1 Racism, discrimination and violence

Research (including Bargallie 2020; Markwick et al. 2019; Temple et al. 2020) has established that
Aboriginal and Torres Strait Islander people experience high rates of racism and discrimination.
Evidence shows that racist discrimination against Aboriginal and Torres Strait Islander people is directly
associated with high levels of stress, suicidal ideation and psychiatric disorders, including depression
and anxiety (Cave et al. 2018; Haregu et al. 2022; Ketheesan et al. 2020; Sarnyai et al. 2016). Experiences
of discrimination extend into all facets of life (including education, employment, and interaction with
the health care system) and have detrimental impacts on health-seeking behaviour (Bargallie 2020;
Bodkin-Andrews and Carlson 2016; Wylie and McConkey 2019).

Aboriginal and Torres Strait Islander LGBTQIASB+ people have commonly reported experiencing
racism and discrimination in response to their Indigenous identity not only in the wider community,
but also within LGBTQIA+ communities in general – particularly if, according to their own assessment,
they are recognised as Indigenous (Hill et al. 2022; Soldatic et al. 2020).

8 Aboriginal and Torres Strait Islander LGBTQIASB+ people and mental health and wellbeing
However, Aboriginal and Torres Strait Islander
LGBTQIASB+ people have also reported experiencing Some terms in use
discrimination and ‘queerphobia’ in response to their Queerphobia is a fear or hatred
LGBTQIASB+ identity from within Aboriginal and/or Torres of people/culture perceived to be
Strait Islander communities (Hill et al. 2022; Kerry 2014). LGBTQIA+.
Transgender indicates a person with
Discrimination also occurs in holistic and overlapping
a gender identity other than the one
ways in relation to both identities: that is, being Aboriginal
they were assigned at birth.
and/or Torres Strait Islander as well as being LGBTQIASB+
Cisgender people are those whose
(Hill et al. 2022). Not only does this occur within the
gender identity and expression
general community, but also from a range of health, matches the biological sex they were
education and social support services (Bonson 2016; assigned when they were born.
Uink et al. 2020). Such experiences have been reported
to contribute to depression, anxiety, distress, suicidal
ideation and alcohol use (Soldatic et al. 2020).

Violence and the anticipation of violence

It is well established that violence, harassment and bullying adversely affect the wellbeing and quality
of life of those who experience it (AHRC 2015; Strauss et al. 2020). A review of Australian suicide cases
to which an LGBTQIA+ identity could be attributed found that, compared with control cases, these
individuals were more likely to have ever been beaten so badly they had to see a doctor, and to have
been sexually assaulted (Skerrett et al. 2016).

In Black Rainbow’s report on the impact of COVID-19 on Aboriginal and Torres Strait Islander
LGBTQIASB+ people, 51% of participants reported they did not feel safe where they lived because
they were LGBTQIASB+ (Day et al. 2022). As Farrell (2015) has noted, for Aboriginal and Torres
Strait Islander LGBTQIASB+ people it is not just the violence but the anticipation and expectation of
violence which impacts their wellbeing, including their ability to connect with family and community,
and to maintain and build relationships.

Domestic and family violence

LGBTQIA+ Australians are known to experience rates of domestic violence comparable with (if not
greater than) rates among the general population (Gibson et al. 2020). Aboriginal and Torres Strait
Islander LGBTQIASB+ people are at greater risk of family violence generally, and this risk can be
further magnified when it intersects with other factors such as disability and socioeconomic status
(Gibson et al. 2020).

The AIHW (2022b) has outlined how the experience of family or domestic violence is a risk factor
for suicide, and family conflicts and disruption are precursors to suicide for Aboriginal and Torres
Strait Islander people. Dudgeon and colleagues (2021) have detailed the relationship between family
violence and intergenerational trauma, and the links to poor health and wellbeing, including suicide.
They stress that the impact of broader systemic violence must be acknowledged when considering
the impact of family violence in Aboriginal and Torres Strait Islander communities.

Aboriginal and Torres Strait Islander LGBTQIASB+ people and mental health and wellbeing 9
 2.2 Trauma
Aboriginal and Torres Strait Islander families, communities,
cultures and Country have all suffered great damage Some terms in use
as a result of colonisation, and despite much resilience, Sorry Business is a period of cultural
strength and work towards healing, the impact continues practices that mark grief and loss.
to be devastating. These challenges – as well as the Postvention is a mental health
importance of connection to family, community, culture intervention designed to support
and Country as protective and risk factors for wellbeing the friends and family of a person
and suicide – have been explored in detail in publications who has committed suicide – since
they themselves may be at risk as
recently compiled for the AIHW Indigenous Mental Health
a consequence.
and Suicide Prevention Clearinghouse (2022b) and by
Dudgeon and colleagues (2021).

Trauma is strongly linked to suicidal behaviour (Dudgeon et al. 2021). Dudgeon and colleagues (2015)
have highlighted the compounded and layered trauma experienced by Aboriginal and Torres Strait
Islander LGBTQIASB people, who are subject to the racism, discrimination and trauma experienced
by Aboriginal and Torres Strait Islander people in general but are additionally subject to the specific
discrimination targeting people who are also sexually and gender diverse.

Grief and loss

The risks posed by trauma are further compounded by exposure to other life stressors such as
interpersonal conflict (Skerrett et al. 2016), to cumulative and unresolved grief and loss, and to the
suicidal behaviour of others (AIHW 2022b). Aboriginal and Torres Strait Islander people experience
relentless grief due to the large numbers of deaths in families and communities (Carlson and Frazer
2015; AHRC 2020). In many communities, the observance of Sorry Business can be an ongoing and a
heavy burden: there is no time to recover from one death before another follows.

Exposure to suicide deaths

Aboriginal and Torres Strait Islander people are more likely than non-Indigenous Australians to
be exposed to the suicide death of another person, and extremely likely to have multiple suicide
exposures (AIHW 2022b). Recent research into Aboriginal community perceptions and views of
discussing suicide found that suicide is viewed as a whole-of-community issue, and that suicide
deaths cause a ripple effect of trauma that is cross-generational and ongoing (Heard et al. 2022).

The research identified that in the communities studied, there is a silence about suicide,
characterised by a reluctance to discuss it; reacting to a bereaved family with silence; and a feeling of
shame that prevents discussion. With a lack of postvention support for families affected by suicide
(Dudgeon et al. 2021), that silence has its own impact. Heard and colleagues (2022) also found that
participants reported feeling powerless to act, not having the skills and confidence to discuss suicide,
and a fear that discussing suicide might spark more suicidal behaviour, cause more trauma, or cause
a person to be removed from the community.

10 Aboriginal and Torres Strait Islander LGBTQIASB+ people and mental health and wellbeing
Incarceration
Incarceration is another source of ongoing trauma for Aboriginal and Torres Strait Islander people,
as well as a source of re-traumatisation (Dudgeon et al. 2021). Incarceration of Aboriginal and Torres
Strait Islander children, youth and adults disrupts connection to family, kinship, community, culture
and Country (Dudgeon et al. 2021). Incarceration also increases the risk of suicide of Aboriginal and
Torres Strait Islander people (AIHW 2022b; Dudgeon et al. 2021).

According to the annual Closing the Gap report produced by the Productivity Commission (2021),
as of 30 June 2020 the imprisonment rate for Aboriginal and Torres Strait Islander people was
2,315 per 100,000 adult population, compared with 156.3 per 100,000 for non-Indigenous
Australians. On an average day in 2019–2020, the detention rate for Aboriginal and Torres Strait
Islander young people aged 10 to 17 years was 25.7 per 10,000, compared with 1.4 per 10,000 for
non-Indigenous young people. On any given day in the Northern Territory, most imprisoned children
are Aboriginal or Torres Strait Islander (Phelan and Oxely 2021).

2.3 Connection to family, community, culture and Country

As discussed, Aboriginal and Torres Strait Islander LGBTQIASB+ people experience intersecting
discrimination relating to their Indigenous and LGBTQIASB+ identities. Not being accepted by family
and/or the Aboriginal and Torres Strait Islander community for identifying as LGBTQIASB+ can force
many to leave and seek out a new base of support in the general LGBTQIA+ community (Kerry 2014).
However, racism from the LGBTQIA+ community can make this difficult, leading to social exclusion
from both communities.

2.4 Social inclusion and exclusion

Metrics for social inclusion and exclusion have been described by Indigenous-led research as
‘irrelevant’ when applied to the Indigenous population (Hunter and Jordan 2010). This is because
the life experiences, circumstances and value systems of Aboriginal and Torres Strait Islander
LGBTQIASB+ people are not comparable with those of non-Indigenous Australians. Also, such
metrics fail to account for differences in conceptualisations of what a ‘good life’ comprises
­­including Aboriginal and Torres Strait Islander connection to kinship, community, culture and
Country (Walter 2016b).

Youth
Recent research with Aboriginal and Torres Strait Islander LGBTQIASB+ youth has shed further
light on the issue of connectedness. For one study, Dalarinji (Your Story), 15 young people
(aged 14 to 25 years) from New South Wales were interviewed to gain a better understanding of
how the three intersecting identities of being Indigenous, young, and LGBTQIASB+ impact upon
their social, cultural and emotional wellbeing – with the goal of developing and equipping targeted
services to better support their needs (Soldatic et al. 2020, 2021). Findings highlighted that social
inclusion/exclusion for Aboriginal and Torres Strait Islander LGBTQIASB+ youth is a multifaceted,
complex issue that includes processes of disconnection, connection and reconnection with family,
community, culture and Country.

Aboriginal and Torres Strait Islander LGBTQIASB+ people and mental health and wellbeing 11
 Relationships with mothers and family
Participants consistently expressed the importance of mothers to feelings of being accepted,
supported and safe, which in turn was described as essential to their wellbeing. While the acceptance
of other family members was also described as important, mothers were particularly seen as being
role models, best friends, protectors and advocates within the community (Soldatic et al. 2020, 2021).

For another study, Walkern Katatdjin, 14 young Aboriginal LGBTQIASB+ people (aged 14 to 25 years)
living in Perth metropolitan region were interviewed about their service needs and experiences
(Liddelow-Hunt et al. 2021). Findings highlighted how relationships with family were often
complicated and changed over time. Some relationships ended or became more distant, while other
family members steadily became more accepting and supportive over time.

Some participants described learning to tolerate hurtful behaviour and having to ‘go back in the
closet’ around certain family members. Some described educating their family about LGBTQIASB+
people, issues and inclusive language, in the hope that their sexuality and gender might be
normalised within their family.

A lack of, or difficult, connection with family was explained by participants as related to the age of the
family members, to their generational experiences (such as being members of the Stolen Generations
who survived targeted government policies of forced removal) and to their religious beliefs and
values. Some participants reported that maintaining connection with extended family members who
were not accepting of them, caused ongoing anxiety about potential antagonisms of queerphobia
and discrimination. For other participants, the fear of such antagonisms was enough to make them
avoid further contact (Soldatic et al. 2020, 2021).

Relocation and connection to Country

Belonging in the Aboriginal and/or Torres Strait Islander community was highly valued, and as a
result, the fear of rejection caused significant distress. Participants consistently mentioned
wanting to give back to their community, and help other Aboriginal LGBTQIASB+ people,
however the feeling that they did not belong because they were LGBTQIASB+ proved to be a
barrier (Soldatic et al. 2020, 2021).

In regard to acceptance within their Aboriginal and/or Torres Strait Islander communities, some
participants reported a fear of rejection. Most of these participants reported already feeling they
were not entirely accepted by their community because they were fair skinned, didn’t grow up on
Country, were not well-connected, or did not know much about their culture. Acceptance within the
community was reported by participants in the Dalarinji study to be harder in small rural towns,
causing exclusion and encouraging relocation to larger urban areas in search of a space where
they could feel comfortable, accepted and supported.

For many, non-Indigenous LGBTQIA+ communities and friendship networks had the potential to
serve as a ’second family’, but could also be sources of racism, which made some of these spaces
unsafe, requiring careful navigation. While some participants reported that social exclusion forced
them to leave Country, it did not necessarily result in a disconnect from Country; some participants
described making trips back to Country specifically to reconnect (Soldatic et al. 2020, 2021).

12 Aboriginal and Torres Strait Islander LGBTQIASB+ people and mental health and wellbeing
Navigating and influencing culture
Participants also spoke of the importance of being connected to their Aboriginal and/or Torres Strait
Islander cultures, describing it as a source of strength that helped them maintain their social and
emotional wellbeing when faced with racism and queerphobia (Soldatic et al. 2020, 2021).

Some participants in the Walkern Katatdjin study came from traditionally accepting cultures that had
been disrupted by colonisation and the introduction of Christianity. They described a rich history
of LGBTQIASB+ acceptance that linked with other cultural laws such as coupling from the right
skin group, child-rearing, and gendered roles. These participants felt strong and supported in their
LGBTQIASB+ identities. Other participants recounted stories that they were told that condemned
homosexuality and traditions that forbade gender nonconformity.

Some of these participants reported finding connecting to culture distressing, while others looked
for different ways to connect. Several participants discussed the process of determining how to
participate in culture as an LGBTQIASB+ person, including whether the same avoidance rules applied
to same-sex relationships; how a non-binary person navigates men’s and women’s spaces; and how
to participate in Lore.

This was something that family and community members and Elders reportedly helped them
traverse, however, there was fear that queerphobic family and community members could cut them
off from connecting with their culture. Some expressed desire to become an Elder themselves to
have influence to change attitudes (Liddelow-Hunt et al. 2021).

2.5 Identity and visibility

The available research and anecdotal evidence show that many Aboriginal and Torres Strait Islander
LGBTQIASB+ people identify with both identities together. Others describe keeping the identities
separate from each other – but wishing for more opportunities for the two to coexist (Carlson 2019;
Hill et al. 2022; Liddelow-Hunt et al. 2021; Soldatic et al. 2020). There are some who experience a
sense of not feeling qualified enough to fully identify with either – feeling they are ‘not Aboriginal
enough’ to be fully accepted in the Indigenous community, and ‘not queer enough’ to be accepted in
the LGBTQIA+ community (Henningham 2019).

Others are aware of their role in actively and passively pushing the boundaries of common
perceptions of Indigenous identities beyond recognised heterosexual and cisgender boundaries
(Farrell 2021), challenging the perception that LGBTQIASB+ and Indigenous identities are
‘incompatible’ and that being LGBTQIASB+ is not part of ‘real’ Aboriginal or Torres Strait Islander
cultures (Carlson et al. 2021; Henningham 2019).

Visibility and agency

The need for visibility – to see more Aboriginal and Torres Strait Islander LGBTQIASB+ people ‘out and
proud’ in the media, in communities, working in education and service provision – is also a common
theme of the research findings described. The common belief is that this will provide education and
normalisation, help increase societal acceptance and thereby increase social inclusion for Aboriginal
and Torres Strait Islander LGBTQIASB+ people (Liddelow et al. 2021; Soldatic et al. 2020).

Aboriginal and Torres Strait Islander LGBTQIASB+ people and mental health and wellbeing 13
 Another recent study, Breaking the Silence, explored how a range of health, social support and
education organisations respond to the needs of Aboriginal and Torres Strait Islander LGBTQIASB+
people living in Western Australia (Hill et al. 2021; 2022). This study is believed to be the first of its
kind in Western Australia, both in terms of its research focus and also in being developed and led
by Aboriginal researchers who also identify as LGBTQIASB+. Findings noted participant expressions
of a sense of uniqueness and pride in their intersecting identities, and in how their Indigenous
identity disrupted the usual understandings of what being LGBTQIA+ means. There was also a
pride in agency and resilience, advocating for others like themselves, and being instrumental in
changing community attitudes.

Negotiation skills and ‘shape-shifting’

While there is undoubtedly a sense of pride in both identities which impacts positively on wellbeing,
there is also stigma, shame and fear, which impacts negatively and can lead to social exclusion
(Hill et al. 2022; Liddelow-Hunt et al. 2021; Soldatic et al. 2020). For many Aboriginal and Torres
Strait Islander LGBTQIASB+ people, this tension is managed through the development of skills of
negotiation and navigation to determine when either identity should be hidden or disclosed
(Hill et al. 2022; Liddelow-Hunt et al. 2021; Soldatic et al. 2020).

These skills and strategies are applied on a daily basis in various environments and social
interactions, as Aboriginal and Torres Strait Islander LGBTQIASB+ people ‘shape-shift’ between
identities in an attempt to gain a sense of belonging, protect personal safety and avoid racism,
discrimination, conflict and violence (Carlson 2019; Carlson and Frazer 2018).

2.6 Health and wellbeing

Issues relating to Aboriginal and Torres Strait Islander health and wellbeing and suicide risk have
been discussed in detail by the AIHW (2022b). LGBTQIA+ Australians report poorer health outcomes
in terms of cancer, sexual health and cardiovascular disease, as well as from health-impacting
behaviours such as alcohol, tobacco and substance use (AHRC 2015). These behaviours are
connected in both groups to experiences of minority stress, social exclusion, discrimination and
trauma (Lea and Reynolds 2014; Krakouer et al. 2022).

Research by the AHRC (2015) also found that the mental health and wellbeing of this group was
a particular concern. The rate of suicide for LGBTQIA+ Australians is estimated to be significantly
higher than for the general population, as are diagnoses for depression and anxiety. A study of
Australian suicide cases where an LGBTQIA+ identity could be attributed, found that, compared
with control cases, these individuals were more likely to have ever been a resident of a mental
health facility; to have had a current major depressive episode; to have been experiencing current
suicidality; to have made a previous attempt; to have a more elevated presence of generalised
anxiety disorder and posttraumatic stress disorder; to have a current psychotic disorder; to be
current substance and/or alcohol users; and/or to be unable to work because of mental health
problems (Skerrett et al. 2016).

14 Aboriginal and Torres Strait Islander LGBTQIASB+ people and mental health and wellbeing
2.7 Help-seeking and access to care
Historically, both Aboriginal and Torres Strait Islander and LGBTQIA+ people have suffered much
damage through the disciplines of psychiatry and psychology, and through the practices of associated
health professionals and researchers who have problematised and pathologised them (Phelan
and Oxley 2021). Within Australian society, this has excused and enabled the practices of racism,
discrimination, violence, oppression, exclusion, and criminalisation. This continues to negatively
impact help-seeking and engagement with care services by members of these groups (Phelan and
Oxley 2021). A simple example of this can be seen in findings of a recent survey where Aboriginal and
Torres Strait Islander LGBTQIASB+ people were least likely to use or rely upon doctors, chemists and
the government as sources of information about the COVID-19 pandemic (Day et al. 2022).

Aboriginal and Torres Strait Islander people and sources of help

For Aboriginal and Torres Strait Islander people at risk of suicide, there can be a ‘help-seeking
quandary’, in which both Indigenous-specific and mainstream help sources are inaccessible
(Farrelly 2008):

• The close-knit nature of Aboriginal and Torres Strait Islander communities increases the
likelihood that available services, such as Aboriginal Medical Services, are staffed by people
closely connected or known to the person wishing to seek help, potentially causing confidentiality
concerns and shame.

• Help-seeking options are further limited by both anticipated and experienced racism and
cultural incompetence of mainstream services, fostering a reluctance to seek help (Farrelly 2008;
Carlson et al. 2020).

• Aboriginal and Torres Strait Islander people have also reported a reluctance to seek help from
mental health services because traumatic past experiences involving poor treatment of themselves
or others (Heard et al. 2022). Coupled with an absence of Indigenous-specific mental health
services, the result can be an incapacitating sense of powerlessness (Heard et al. 2022).

LGBTQIA+ people and sources of help

Internationally, LGBTQIA+ people regularly experience stigma and discrimination when seeking
health care (Madrigal-Borloz 2020). In Australia, LGBTQIA+ people have expressed a reluctance
to access care for fear of discrimination (Carman et al. 2020) and research has shown there is
an overwhelming preference for LGBTQIA+ specific services (Grant and Walker 2020). Trans and
gender diverse people are more likely to experience discrimination from health workers and
practitioners, and exclusion from health care services (AHRC 2015). The AHRC (2015) noted that
many instances of discrimination against LGBTQIA+ people occur in institutions and services
operated by religious organisations.

Health care systems are typically gendered, and ‘unconscious bias’ is common in health service
provision. For example, assuming that a person is heterosexual when conducting a health
assessment often forces LGBTQIA+ people to have to ‘out’ themselves in order to receive more
accurate diagnoses or advice (AHRC 2015).

Aboriginal and Torres Strait Islander LGBTQIASB+ people and mental health and wellbeing 15
 Sources of help for Aboriginal and Torres Strait Islander LGBTQIASB+ people
The literature confirms that there are no health services that specifically provide care for Aboriginal
and Torres Strait Islander LGBTQIASB+ people (for example AHRC 2015; Briskman et al. 2022;
Day et al. 2022; Liddelow-Hunt et al. 2021; Soldatic et al. 2020; Spurway et al. 2022; Sullivan
et al. 2022; Uink et al. 2022).

With regard to Indigenous-specific services, Aboriginal and Torres Strait Islander LGBTQIASB+
people report a mix of experiences. Some encountered queerphobia or felt that services were not
knowledgeable in LGBTQIASB+ issues. Others felt services were under-resourced, confirming their
perception that LGBTQIASB+ issues were not being prioritised in their community (Liddelow-Hunt
et al. 2021; Soldatic et al. 2020; Spurway et al. 2022; Sullivan et al. 2022).

LGBTQIA+ specific services, on the other hand, were perceived by Aboriginal and Torres Strait
Islander LGBTQIASB+ people as seeing ‘whiteness’ as the normal, default identity. Services failed to
understand how an Aboriginal and Torres Strait Islander LGBTQIASB+ client’s Indigeneity informs
their experience of wellbeing (Sullivan et al. 2022). It is not uncommon for LGBTQIA+ services to refer
Aboriginal and Torres Strait Islander LGBTQIASB+ clients to Indigenous-specific services, leaving
them to feel that they are unfairly being denied access to care (Sullivan et al. 2022). Despite some
mainstream participation in LGBTQIA+ accreditation, service providers felt they were still not able to
meet the needs of Aboriginal and Torres Strait Islander LGBTQIASB+ clients (Uink et al. 2022).

Aboriginal and Torres Strait Islander LGBTQIASB+ people seeking care must often choose between
care that is able to cater to them as an Aboriginal and/or Torres Strait Islander person or as an
LGBTQIASB+ person – not both.

This choice means again having to navigate, negotiate and ‘shape-shift’ between identities, to receive
safe and appropriate care. Some Aboriginal and Torres Strait Islander LGBTQIASB+ people have
described finding health care services as a process of trial and error, as they attempted to locate a
provider that was versed in both Indigenous and LGBTQIASB+ health (Soldatic et al. 2020). Others
described choosing which services to access depending on what their needs were – essentially
toggling between the two as required (Sullivan et al. 2022).

Research has identified other barriers to accessing care as experienced by Aboriginal and Torres
Strait Islander LGBTQIASB+ people that did not relate to being Indigenous or LGBTQIA+ but related
to issues such as cost, location, opening hours, waitlists, familiarity, availability, not knowing what
services were able to be received, and a perception that the service provider would not be able to
help (Liddelow-Hunt et al. 2021).

2.8 Social media

Aboriginal and Torres Strait Islander people are avid social media users (Carlson and Frazer 2021).
Uptake and engagement with digital technologies surpasses that of non-Indigenous users (Carlson
and Frazer 2018). However, social media platforms can be both a protective factor and a risk to
Aboriginal and Torres Strait Islander LGBTQIASB+ people.

Carlson and colleagues (2015) found that Aboriginal and Torres Strait Islander people who use
social media do so to provide care for other Aboriginal and Torres Strait Islander people: that
Aboriginal and Torres Strait Islander people are engaging with platforms like Facebook to actively

16 Aboriginal and Torres Strait Islander LGBTQIASB+ people and mental health and wellbeing
seek help and give help for issues related to suicide and self-harm. Social media offer platforms
where communities of care can be established, and for many Aboriginal and Torres Strait Islander
LGBTQIASB+ people this has been essential when isolated from community (in COVID-19 lockdown
or due to homophobia) or unable to connect physically (Farrell 2021; Day et al. 2022). For many
who are isolated from their community or Country, social media can also provide social and cultural
nourishment (Farrell 2021; Carlson and Frazer 2021).

However, while new social technologies bring significant benefits, they also provide platforms for
harmful behaviours (Kennedy 2020). Social media is not always a safe space for Aboriginal and Torres
Strait Islander people in general and for those who also identify as LGBTQIASB+ (Carlson and Day
2021). As noted by Carlson and Day (2021:2) social media ‘gives white settlers new means to engage
in racist, transphobic, homophobic, and misogynistic behaviours’. The 2020 Galop report (Hubbard
2020) notes that online anti- LGBTQIA+ hate is not limited to ‘low-level’ incidents, with threats of
physical violence, sexual assault, and death also a common occurrence for many LGBTQIA+ victims
(Hubbard 2020).

While there is a growing body of research that examines suicide and social media it generally
focusses on the mainstream population of social media users (Robinson et al. 2012). There is very
little research that focuses on Aboriginal and Torres Strait Islander LGBTQIASB+ people, social media
and suicide (Carlson and Frazer 2015).

2.9 A case in point: the COVID-19 pandemic response

Research regarding Australian governments’ responses to COVID-19 and the impact on marginalised
communities is still emerging. Preliminary research conducted by Black Rainbow in collaboration
with the Department of Indigenous Studies at Macquarie University (Day et al. 2022) surveyed 112
Aboriginal and Torres Strait Islander LGBTQIASB+ people online about the impact of COVID-19 on
their lives. Most participants reported negative effects on their mental health, and half reported
having experienced suicidal ideation. This is particularly of concern when we consider the relatively
low rates of help-seeking and access to services reported by these same participants. Currently,
this is the only data available about the impact of COVID-19 responses on Aboriginal and Torres Strait
Islander LGBTQIASB+ people’s social and emotional wellbeing.

Increased risk of racism and marginalisation

Australia entered the COVID-19 pandemic in an already compromised position in terms of human
rights (HRLC 2020). In 2021, the AHRC reported their concern about the impacts of the pandemic
on vulnerable groups in Australia. They flagged increasing reports of racism, increasing rates of
domestic and family violence, and the compounding effects of ‘intersectional disadvantage’ (in which
different aspects of a person’s identity can expose them to overlapping forms of discrimination and
marginalisation) (AHRC 2021).

Higher risk of transmission, due to disadvantage and living conditions

It is well documented that, prior to the COVID-19 pandemic, Aboriginal and Torres Strait Islander
people faced socioeconomic marginalisation and social exclusion; continuing health disadvantage;
and racism and discrimination restricting access to health care, education, housing and employment.

Aboriginal and Torres Strait Islander LGBTQIASB+ people and mental health and wellbeing 17
 These kinds of institutional and systemic disadvantages put Aboriginal and Torres Strait Islander
people at a heightened risk of COVID-19 transmission, severity and fatality (Yashadhana et al. 2020).
(As noted above, these institutional and systemic disadvantages are also risk factors in relation to
suicide for Aboriginal and Torres Strait Islander people.)

Engaging with the criminal justice system during a pandemic

Aboriginal and Torres Strait Islander people are often targeted by police and policing practices, as
are LGBTQIA+ people, resulting in the overrepresentation of both these populations in the criminal
justice system, particularly youth (Phelan and Oxley 2021). Across the globe, criminalisation laws
have made LGBTQIA+ people more vulnerable to police abuse and arbitrary arrest and detention
(Madrigal-Borloz 2020).

A simple example of this is the fear reported by LGBTQIA+ Tasmanians as a result of the COVID-19
pandemic: that they would be targeted by police for alleged violations of social distancing because
of a failure to understand that same-gender partners are actually household contacts (Grant and
Walker 2020).

This is of particular concern when it comes to responding to gendered and family violence, which
increased exponentially during the COVID-19 pandemic and lockdowns (ANROWS 2021). Notably, in
Black Rainbow’s study of the impact of COVID-19 responses on Aboriginal and Torres Strait Islander
LGBTQIASB+ people, the majority of participants reported feeling unsafe where they live due to being
LBGTQASB+ during pandemic lockdowns (Day et. al 2022).

Loss of access to community and cultural spaces

Control measures such as isolation are particularly at odds with community living practices of
many Indigenous populations (Calí Tzay 2020). The lockdown responses to the COVID-19 pandemic
have prevented LGBTQIA+ people from being able to access community and cultural spaces, which
typically would be sources of protection, connection and support (Equality Australia 2020; Grant and
Walker 2020).

In 2020, the NSW Health COVID-19 Critical Intelligence Unit consulted with a group of 12 Aboriginal
community members from across New South Wales about their experiences and perspectives on the
indirect impacts of COVID-19 (Follent et al. 2021). They noted that the cancelling of community events
and gatherings – including for Sorry Business, funerals, marriages and births – negatively impacted the
practice of culture and connection to Country. Aboriginal communities in New South Wales reported
that many of the impacts of the COVID-19 pandemic had increased the health inequities they already
experience, such as reduced access to health care and food insecurity (Follent et al. 2021).

Follent and colleagues (2021) noted the compounding effect of the pandemic on top of recent
drought and bushfire events. This added to mental health issues, suicide risk and other trauma
histories particular to many Aboriginal community members, and the impact this may have on
wellbeing. The Black Rainbow survey of the impact of the COVID-19 pandemic on Aboriginal and
Torres Strait Islander LGBTQIASB+ people found the majority of participants experienced negative
effects on their mental health, and half of participants reported experiencing suicidal ideation
(Day et al. 2022). The proportion of participants in this study who reported suicidal ideation during
lockdowns indicates the need for further research into how government crisis responses impact on
Aboriginal and Torres Strait Islander LGBTQIASB+ people’s social and emotional wellbeing.

18 Aboriginal and Torres Strait Islander LGBTQIASB+ people and mental health and wellbeing
3

Conclusions

19
 3 Conclusions
The literature review conducted for this report has identified protective factors for social, cultural and
emotional wellbeing and risk factors for suicide for Aboriginal and Torres Strait Islander LGBTQIASB+
people. Further research is needed to improve policy, data, and program service response,
particularly following the impacts of the COVID-19 pandemic and government responses. Based on
the available evidence as well as on the gaps in literature, five recommendations are outlined below.

Priority
This report recommends that Aboriginal and Torres Strait Islander LGBTQIASB+ people be treated
as a priority group for policy, research, programs and services. Given the layering of systemic and
institutional disadvantage and discrimination that occurs for this community, it is urgent that more
is known about social and emotional wellbeing and factors contributing to suicide among Aboriginal
and Torres Strait Islander LGBTQIASB+ people.

Further recommendations are outlined below for treating Aboriginal and Torres Strait Islander
LGBTQIASB+ people as a priority group in policy, research, and programs and services –
recommendations which address the compounding impacts of racism, discrimination and trauma
as risk factors for suicide.

Self-determination
The pathway forward needs to be informed, owned, and driven by Aboriginal and Torres Strait
Islander LGBTQIASB+ people: self-determination is fundamental (Bonson 2021). As a result of the
challenges they navigate on a daily basis, Aboriginal and Torres Strait Islander LGBTQIASB+ people
have developed strong mechanisms of coping, surviving and thriving that are not known to others
who have not shared this lived experience (Madrigal-Borloz 2020). This knowledge is what must direct
the development of solutions to improve wellbeing and reduce suicide risk.

Aboriginal and Torres Strait Islander LGBTQIASB+ people need to lead discussions on how their own
issues should be appropriately defined and described, and how their communities should be serviced
and conceptualised. Research, programs and services specifically targeting Aboriginal and Torres Strait
Islander LGBTQIASB+ people need to be designed, delivered, managed and evaluated by Aboriginal
and Torres Strait Islander people, groups and organisations who are, or involve, LGBTQIASB+ people.
The need for targeted approaches, and for the design of policy and programs to be informed by lived
experience, is supported by the National Suicide Prevention Adviser and Taskforce (2021).

Policy responses
A national action plan is needed to specifically meet the needs of Aboriginal and Torres Strait Islander
LGBTQIASB+ people. The plan needs to involve the Australian, state and territory governments and
relevant agencies in a coordinated effort to gather information, support necessary research and
drive service provision.

The national action plan needs to particularly consider strategies to improve social, cultural and
emotional wellbeing, and to address suicide risk, by specifically targeting racism, discrimination and
violence, and connection to community, culture and Country.

20 Aboriginal and Torres Strait Islander LGBTQIASB+ people and mental health and wellbeing
It also needs to accommodate the diversity of Aboriginal and Torres Strait Islander people and
communities, and of LGBTQIASB+ people – noting that each of the identities represented under
this acronym have their own unique circumstances, experiences and needs. It needs to employ an
intersectional approach, addressing the compound disadvantage and marginalisation of Indigenous
and LGBTQIASB+ communities, and showing awareness of other crucial factors such as age, disability,
and incarceration.

In light of the COVID-19 pandemic, consideration should also be given to how LGBTQIA+ people, and
specifically Aboriginal and Torres Strait Islander LGBTQIASB+ people, are included in disaster and
emergency response and relief policy and planning.

Data and research

Data is needed that properly captures Aboriginal and Torres Strait Islander LGBTQIASB+ people and
their health and social, cultural and emotional wellbeing. Much data collection is currently impeded
by a lack of recording of sexuality and gender.

To the authors’ knowledge, there are currently no protocols for identifying sexually and gender
diverse populations in suicide and self-harm statistics. As noted, efforts to address this include the
National Suicide and Self-harm Monitoring Project (AIHW 2022a), and the National Agreement on
Closing the Gap Priority Reform 4 which aims to improve the collection, access, management and use
of data to better inform shared decision-making (Joint Council on Closing the Gap 2020).

Research led by Aboriginal and Torres Strait Islander LGBTQIASB+ people is needed to find out more
about Aboriginal and Torres Strait Islander LGBTQIASB+ people’s needs and experiences, including as
individual subpopulations, particularly in relation to:

• suicide and self-harm behaviour

• social, cultural and emotional wellbeing

• protective factors for wellbeing, and risk factors for suicide

• effectiveness of approaches to reduce suicide risk

• connection to community, culture and Country: how these connections are disrupted, restored,
fostered, maintained, nurtured, and how these impact wellbeing

• help-seeking and access to care and health information

• experiences accessing Indigenous-specific and LGBTQIA+ specific services

• how service providers can best deliver care

• how Aboriginal and Torres Strait Islander communities can work together to develop culturally
competent models of mental health care (Heard et al. 2022)

• impacts of the COVID-19 pandemic, including access to care

• the impact of racism, discrimination and violence

• the impact of trauma, grief and loss, exposure to suicide, incarceration and intergenerational trauma

• resilience and resistance: how Aboriginal and Torres Strait Islander LGBTQIASB+ people resist and
endure in the face of these challenges.

Aboriginal and Torres Strait Islander LGBTQIASB+ people and mental health and wellbeing 21
 Programs and services
Programs and services need to address the compound impacts of racism, discrimination and trauma.
While Aboriginal and Torres Strait Islander LGBTQIASB+ run organisations like Black Rainbow and
the BlaQ Aboriginal Corporation do significant work to advocate for, and support, their communities,
there is still demand for mental health and health services that adequately cater to Aboriginal and
Torres Strait Islander LGBTQIASB+ people and for Aboriginal and Torres Strait Islander LGBTQIASB+
specific programs.

Suggestions to strengthen LGBTQIASB+ services and programs

Suggestions include:

• empowering Indigenous-specific programs and services to be skilled and competent at working

with LGBTQIASB+ clients

• employing Aboriginal and Torres Strait Islander LGBTQIASB+ staff in positions that can reduce
LGBTQIASB+ barriers to access to care and encourage help-seeking

• training and educating mainstream and LGBTQIA+ specific programs and services to be culturally
competent and skilled at working with Aboriginal and Torres Strait Islander LGBTQIASB+ clients

• embedding Aboriginal and Torres Strait Islander LGBTQIASB+ leadership to drive processes.

Cultural competence of staff

Additionally, Aboriginal and Torres Strait Islander staff, LGBTQIA+ staff, and Aboriginal and Torres
Strait Islander LGBTQIASB+ staff should be employed in positions that can be openly promoted
within the community to encourage help-seeking and access to care. This is also supported by the
National Agreement on Closing the Gap Priority in Reform 3, which relates to transforming mainstream
institutions and organisations in terms of cultural competence (Joint Council on Closing the Gap 2020).

Programs and services targeting Aboriginal and Torres Strait Islander LGBTQIASB+ people should be
well-resourced and sustainable, evidence- and strengths-based, locally specific, and have a holistic
and cultural determinants approach to health and wellbeing (Dudgeon et al. 2021), be trauma-
informed, prioritise and centre intersectionality, and promote recovery and healing. They should be
sources of information and referral; promote resilience; and contribute to visibility. They should also
be equipped with strategies to operate effectively in the event of disaster and emergency response,
including inability to provide face-to-face services.

Help-seeking and confidentiality

The Aboriginal and Torres Strait Islander suicide help-seeking quandary (Farrelly 2008) needs to
be addressed to ensure that, for Aboriginal and Torres Strait Islander LGBTQIASB+ people at risk
of suicide, there are appropriate avenues available to seek help. Formal help sources, such as
Indigenous-specific services, need to consider how they can address confidentiality concerns.

Mainstream services need to consider how they can address racism, address issues of mistrust and
doubt, and have the capacity to be able to effectively provide assistance. Informal sources such as
family, friends and community members should be supported through the provision of skills and
confidence in discussing suicide and advocating for someone deemed at risk.

22 Aboriginal and Torres Strait Islander LGBTQIASB+ people and mental health and wellbeing
Acknowledgements
This paper was commissioned for the Indigenous Mental Health and Suicide Prevention Clearinghouse.
The Clearinghouse is funded by the Australian Government Department of Health and overseen by the
Indigenous Mental Health and Suicide Prevention Clearinghouse Steering Committee.

This paper was prepared on the lands of the Wallumattagal people, the Dharawal people, the Gadigal
people, and the Darkinjung people. The authors acknowledge that these are unceded, and that
Aboriginal and Torres Strait Islander people have always fought, and will always fight, for Country. The
authors would like to acknowledge the resilience and tenacity of Aboriginal and Torres Strait Islander
LGBTQIASB+ people, who are part of one of the longest running movements resisting colonisation.

We acknowledge Country and the efforts of Aboriginal and Torres Strait Islander people for their
continuing care of lands, waterways, sea and of each other and our communities. We pay our
respects to our Elders past and present.

The authors would also like to acknowledge Black Rainbow for their support and assistance with this
paper. Black Rainbow is a national Aboriginal and Torres Strait Islander LGBTQIASB+ organisation
working in the pursuit of positive health and wellbeing for Aboriginal and Torres Strait Islander
LGBTQIASB+ people.

We thank the Indigenous Mental Health and Suicide Prevention Clearinghouse Steering Committee
and Fadwa Al-Yaman for their advice and guidance on this publication during its development.
We also thank the Indigenous Mental Health and Suicide Prevention Unit for their support.

Aboriginal and Torres Strait Islander LGBTQIASB+ people and mental health and wellbeing 23
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Aboriginal and Torres Strait Islander LGBTQIASB+ people and mental health and wellbeing 29
 This review provides an overview of available literature
about Aboriginal and Torres Strait Islander LGBTQIASB+
people and social and emotional wellbeing. It also
includes a comparative analysis of literature about
Aboriginal and Torres Strait Islander people, LGBTQIA+
people and suicide.

Aboriginal and Torres Strait Islander

LGBTQIASB+ people and
mental health and wellbeing
Madi Day, Bronwyn Carlson, Dameyon Bonson and Terri Farrelly
Stronger evidence,
better decisions,
improved health and welfare