What is the HSE Rainbow Badge
The HSE Rainbow Badge initiative is a way for HSE staff to demonstrate that they are aware of the issues that LGBTI+ people can face when accessing healthcare.
The badge itself is intended to be a simple visual symbol identifying its wearer as someone an LGBTI+ person can feel comfortable talking to about issues relating to sexuality or gender identity. It shows that the wearer is there to listen without judgement and signpost to further support if needed.
Our model emphasises that wearing a badge is a responsibility. We provide basic education and access to resources for staff who want to sign up to the project. The information we provide outlines the challenges that LGBTI+ people can face in relation to accessing healthcare and the degree of negative attitudes which are still found. When an individual signs up to wear a badge, they acknowledge why the project is needed and what their responsibility entails.
Committing to the project emphasises that you promote an environment that is open, tolerant and inclusive. The aim of this initiative is to actively break down barriers which LGBTI+ people may face within the HSE.
Why does it matter
Mental health issues such as depression and anxiety are significantly more common in people who identify as LGBTI+ (lesbian, gay, bisexual, transgender, intersex; + denoting inclusion of all identities). Many people still feel afraid to disclose their sexual or gender identity - being unable to do so often increases their risk of physical and mental health problems.
Research has shown that, tragically, negative attitudes towards LGBTI+ people remain prevalent within the HSE; as a result, LGBTI+ people can be reluctant to disclose their sexual and / or gender identity to healthcare workers, affecting the quality of the care they receive. These barriers lead to marked inequalities in healthcare for this extremely vulnerable group of people.
2018 saw the publication of Stonewall’s Unhealthy Attitudes, highlighting shocking inequalities in healthcare for LGBTI+ patients in the NHS, with an appalling statistic of 1 in 7 patients avoiding treatment for fear of discrimination. These statistics are mirrored in Ireland: three-quarters of Irish LGBTI+ people feel healthcare providers lack knowledge and sensitivity to LGBTI+ issues, with almost 50% seeking LGBTI+ friendly clinicians because of bad experiences (Maycock et al, 2009). LGBTI+ people identify specific barriers to accessing health services: fear, lack of understanding of LGBTI+ issues and lack of appropriate language (Maycock et al, 2009).
It’s a real problem for children and young people: more than half of Irish LGBTI+ young people self-harm; 2 in 3 seriously consider suicide; and tragically 1 in 3 have attempted suicide. The average age of first attempt is just 15. The statistics are similar for older LGBTI+ people in Ireland, with levels of attempted suicide three times the national average (LGBTIreland Report, 2016).
Young people who identify as LGBTI+ experience additional emotional and psychological stresses when compared to non LGBTI+ youth. This can be attributed to having to manage a stigmatised identity, being faced with heteronormative and gender norms within society, and also experiencing victimisation, bullying and discrimination due to their LGBTI+ identity (Acevedo-Polakovich et al. 2013, Rodgers, 2017, Price-Feeney et al. 2020, Higgins et al. 2020).
A recent Irish study has demonstrated that LGBTI+ young people held negative perceptions regarding mental health services ability to help with high levels of fear regarding encountering stigmatising reactions and inappropriate treatments. Young LGBTI+ young people also indicated a lack of culturally competent practitioners as a barrier to accessing mental health services (Higgins et al, 2020).
In Ireland, older LGBTI+ people grew up in a time when homosexuality was considered a mental illness and when sexual relationships between same-sex couples was considered a criminal act, immoral and sinful (LGBT Ireland, 2018). One in 10 older LGBTI+ people have seriously considered ending their life and 5% have self-harmed. Heterosexuality was seen as the only legitimate sexual orientation and LGBTI+ people were marginalised, rendered invisible and socially excluded.
The report ‘Visible Lives’ (2011) details stigma, marginalisation and discrimination that older LGBTI+ people have faced in their lives and the social and emotional impacts this adversity had on their lives and indeed continues to have for some. This includes, rejection by family/friends, isolation/loneliness, loss, grief including disenfranchised grief and high levels of substance misuse and emotional struggles as a means to cope with adversity. Older people who identify as LGBTI+ also encounter difficulties in healthcare, with only 1 in 3 believing that their healthcare provider has sufficient knowledge about LGBTI+ issues and only 43% of older LGBTI+ people feel respected as an LGBTI+ person by their healthcare professional. Older people have experienced high levels of poor-quality service from healthcare professionals with 40% considering these poor experiences as a result of their LGBTI+ identify (Higgins et al. 2011).
Linn Dara CAMHS & the HSE Rainbow Badge
The pilot project at Linn Dara Child & Adolescent Mental Health Services was funded by innovation funding from the Nursing and Midwifery Practice Development Unit for Dublin South, Kildare and West Wicklow.
Linn Dara CAMHS Approved Centre staff noted an increase in young people presenting who identify as LGBTI+ and a corresponding deficit in staff knowledge in working with this cohort of young people. Staff felt they required additional knowledge and information in order to be culturally component.
To mark LGBTQ Pride Dublin Festival in 2019, HSE Linn Dara Child and Adolescent Mental Health Service launched an initiative to promote a positive message of inclusion for LGBTI+ young people, families and colleagues. 2019 was a huge year for the LGBT+ movement as we celebrated 50 years since the historic Stonewall Riots, an important point in history, considered by many to be the birth of the modern LGBTI+ rights movement.
Staff from Linn Dara CAMHS have been signing up to wear a specially designed HSE Rainbow badge to show support for those that identify as lesbian, gay, bisexual, transgender/trans+, intersex or who do not identify as heterosexual or male/female.
“Simple visual symbols such as the HSE Rainbow Badge, can make a real difference to young people exploring their sexuality or questioning their assigned gender. These badges are a visual commitment to young people and families, who may be worried about the reaction they may receive if they were to disclose their sexuality or gender identity when in contact with our services; that they are valued and respected” said Mike Healy who is driving the initiative as Assistant Director of Nursing for Linn Dara CAMHS Approved Centre.
Other Services and the HSE Rainbow Badge
Children’s Health Ireland (CHI) officially launched the HSE Rainbow Badge in 2021 following a delay in 2020 due to the COVID Pandemic. CHI have been instrumental in mainstreaming the project. Further information for the CHI project is available HERE. Funding for the role out of the HSE Rainbow Badge across Children’s Health Ireland was supported by the organisation.
Other services across the health sector have taken the project on and implemented it within wards, units, departments and hospitals. There may be some variation in sites, however the main principles still apply.
Individual Community Healthcare Organisations, Acute Hospital Groups or HSE funded organisations could explore funding from equality, diversity and inclusion budgets, quality improvement budgets, internal management funding or via an application for charitable funding from affiliated charities.
How to bring the initiative to your organisation
Increased awareness of the issues surrounding LGBTI+ people when accessing healthcare on the part of HSE staff can make significant differences to LGBTI+ people’s experience, and, in turn on their physical and mental health.
Simple symbols, such as the rainbow, are an effective way to signal to LGBTI+ people that they are in a positive, inclusive, safe environment, and encourage them to talk about things they may otherwise have felt unsure or uncomfortable disclosing. They also encourage conversations amongst staff themselves about the importance of being aware of issues of equality, diversity and inclusion, and help to reinforce the shared responsibility that HSE staff have in this regard.
We suggest a planned roll out of a whole department or whole service approach to the initiative:
- Agree Funding
- Agree communication plan
- Agree lead person/team
- Agree resources
- Adopt sign up
- Consider education sessions
Please see the implementation pack for further details on suggestions for project roll out.
The HSE have launched an online training programme on HSELand.ie titled “LGBT+ Awareness and Inclusion: the basics”.
Designed for all HSE staff, this module will give you an understanding of LGBT+ identities and provide tips on how to be more inclusive of LGBT+ service users. Login to http://HSeLanD.ie to access this programme.
Supporters of HSE Rainbow Badge Initiative
Health Service Executive
BeLonGTo – Supporting Lesbian, Gay & Trans young people in Ireland
TENI – Transgender Equality Network Ireland
Linn Dara Child & Adolescent Mental Health Services
Children’s Health Ireland
@Temple Street https://www.cuh.ie/
@NCH Tallaght https://www.tuh.ie/CHI-at-Tallaght/
Royal College of Physicians of Ireland
RCSI – Royal College of Surgeons Ireland
Nursing & Midwifery Planning & Development Unit, Dublin South, Kildare and Wicklow (NMPDU, DSKW)
Irish Association of Emergency Medicine
Mental Health Nurse Managers Ireland
Irish Institute of Mental Health Nursing
RCPCH - Royal College of Paediatric & Child Health
Downloads / Resources
- HSE Rainbow Badge Implementation Toolkit (PDF, size 2.97 MB, 25 pages)
- HSE Rainbow Badge Practice Guide for Healthcare Professionals (PDF, size 2.47 MB, 40 pages)
- CHI Rainbow Badge Poster (PDF, size 3.15 MB, 1 page)
- CHI Rainbow Badge Leaflet (PDF, size 1.97 MB, 2 pages)
- CHI Rainbow Badge A5 Pin Card (PDF, size 1.83 MB, 2 pages)
- Linn Dara Badge A5 Pin Card (PDF, size 373 KB, 2 pages)
- Linn Dara Pledge Sign Up (PDF, size 95 KB, 1 page)
- Linn Dara Pledge Large (PDF, size 143 KB, 1 page)