Meeting of the Parliament (Hybrid)

Meeting date: Wednesday, May 11, 2022

Official Report 1131KB pdf

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Alcohol Services (LGBTQ+ People)

The final item of business is a members’ business debate on motion S6M-3631, in the name of Emma Roddick, on LGBTQ+ people’s experiences of alcohol services in Scotland. The debate will be concluded without any question being put.

Motion debated,

That the Parliament welcomes the publication of the report, What are LGBTQ+ people’s experiences of alcohol services in Scotland? A qualitative study of service users and service providers, which was carried out by Prof Carol Emslie and colleagues at Glasgow Caledonian University, and funded by Scottish Health Action on Alcohol Problems (SHAAP); understands that the report highlights significant alcohol-related health inequalities experienced by LGBTQ+ people in Scotland, including in the Highlands and Islands region; further understands that people who identify as LGBTQ+ are more likely to experience problems with alcohol; considers that the central role of alcohol in the community, combined with barriers to accessing treatment and support, are the key areas that surfaced with regards to alcohol misuse; notes the calls for alcohol services to demonstrate appropriate inclusivity and diversity policies, LGBTQ+ training, and work towards the LGBT Charter; further notes the view that alcohol services need stronger links to mental health services, and notes the recommendations to policy makers that LGBTQ+ people should be considered in the forthcoming Alcohol Treatment Guidelines, that alcohol-free spaces for LGBTQ+ people should be supported, and that the Parliament should show leadership on LGBTQ+ issues to help tackle the stigma that people face.

17:45  

I was really pleased that, a couple of months ago, Scottish Health Action on Alcohol Problems reached out to me, as the co-convener of the LGBTI+ cross-party group, to share its report. The publication is incredibly important, and I thank Professor Carol Emslie, Dr Elena Dimova, Dr Rosaleen O’Brien, Professor Lawrie Elliott, Dr Jamie Frankis and everyone else who was involved in the report for their work, as well as Jane Gordon at SHAAP for communicating with my office on the issue.

LGBTQI issues are important to me, both because I live them and because I feel, as many others in the community do, that an issue for one of us is an issue for all of us. Until recently, I had not really thought about alcohol specifically as a queer person, and I had not known that someone who is LGBTQI is more likely to drink excessively and experience alcohol harm. Alcohol has been around me as I have grown up, and I felt pressure to join in at school with folk who drank it. Particularly in some circles in the Highlands, including in queer cliques, alcohol and drugs are seen as akin to a morning coffee—it is something that is part of your day, helps you to function and makes social interactions easier.

I have said to friends in conversations about dating that I feel that it is quite hard to meet people in Inverness outwith pubs if you did not go to school there. However, the wider issue around the LGBTI community, its spaces and alcohol never really clicked for me until now, and I have not been able to shake the report since I read it.

When you, as a young or newly out queer person, try to meet others in the community, where do you go? You go to a gay bar, with alcohol, to a house party, with free-pour alcohol, or to pride, with novelty-shaped glitter shots and some of the most creative ways to get drunk that I have ever seen. I do not know how many of my colleagues have ever tried to enjoy a gay club sober, but, let me tell them, it is a very different experience—one that I will not be repeating in a hurry.

Alcohol is so closely tied into queer culture that it is very difficult to avoid it, and that is before we get to the mental health aspect. It is an inescapable truth that many people are still judged, criticised or even excluded—not just from social circles but from employment or their family—for being bisexual, trans or gay. I have heard people say that they have to drink before they can have sex or just so that they can live with themselves. They have internalised this idea that they are weird and wrong, because that has been pressed on them for most of their lives.

That feeling can be, and is, intensified when someone lives in a rural area or small town, where it seems like everyone knows their business. From when I was a teenager to when I was elected to the Parliament, I volunteered on a couple of suicide lines and chatted anonymously to people who were struggling. One was a national line and one focused on the Highlands. The fact that, on the local service, such a great percentage of our service users were LGBTQI will never leave me. They would tell me things such as, “You don’t get it. There is nobody else in this town who is trans”, “If I tell my GP how I am feeling, they will put me on medication, and my aunt works in the chemist, so everyone will know”, or, “Nobody else in my school is gay.” Often, I knew that that was not true—someone with a similar postcode, just a few streets away, was saying the same things. In one case, I remember lying awake, hoping beyond hope that some random encounter would bring them together—that one would be behind the other in the queue in the shop when they were buying the same thing, or that they would be reading rainbow-coloured books near each other in the park—so that they would start to chat and learn that they did not have to feel so abnormal, vulnerable and alone.

We have come a long way in terms of acceptance, but young people who are in school right now regularly have that experience. It is not surprising to me, having read the accounts in SHAAP’s report, that some people reported drinking more in the pandemic. It is about isolation, and being queer really can make someone feel isolated.

LGBTQI people are not genetically programmed to drink more alcohol than our cisgender, heterosexual neighbours. This is a societal problem to fix. Given that we know that LGBTQI people experience a particular push towards drinking alcohol at harmful levels, it is vital that alcohol services are equipped to provide appropriate, specific and inclusive support.

People often talk about inclusive language, policies, and efforts as though they are a nice extra that we cannot really afford to do all the time, because more important things are going on. They talk about equality as though it is unimportant or given too much attention, but the report, which clearly shows that people in my community are far more likely to experience alcohol harm, shows that the issue is not being given enough attention. Inclusivity is not a nice extra, and its omission is not harmless; it is necessary and, without it, people like me are being hurt or killed. It is life or death.

If someone is seeking help from an alcohol service due to mental health issues that relate to their sexuality, that aspect cannot be ignored. It is key to where they are now, to how they can recover and to what recovery would look like for them.

Queer people already learn from WhatsApp groups, online forums and whispers the things that schools and families teach cis, straight people by default. That includes everything from learning how to shave to learning how to have safe sex and relationships. If alcohol services are designed for straight people and are prepared to deal only with straight people—even if that is just the perception—it is immediately less likely that we will get queer folk through the door, let alone be able to help them to deal with their issues.

I will follow up this members’ business debate with engagement with the Scottish Government, and I am sure that SHAAP and others will continue to engage with the LGBTI+ CPG. There is a lot of work to be done—much of it in here—and it would be a big start if the Parliament provided leadership on equality and inclusivity. Those are not scary or dangerous words; they are fundamentally necessary.

I will finish by thanking in advance my colleagues across the chamber who are about to contribute to the debate. I thank them for joining me this evening and for helping the Parliament to show leadership on LGBTQI issues.

17:52  

I thank Emma Roddick for bringing the debate to the chamber, and I welcome her as a fellow co-convener of the Parliament’s cross-party group, on which she is already having an impact. The fact that, despite our obvious political differences—those have been clear in the past couple of hours in the chamber—we can come together on some very important issues that affect so many people in Scottish society is proof that the group is a genuine cross-party group.

Members will be pleased to know that I will not share my experiences of glitter bombs and having to spend a night in a gay club having not had a drink, although I absolutely appreciate that sentiment—I do not recommend that to anyone. However, that raises an important wider point, which is how LGBT people use alcohol in their lives. I will come on to that in a second.

I thank all the charities and organisations that have provided input for the debate, including LGBT Youth Scotland, Glasgow Caledonian University, which has done some excellent academic work on the issue, and SHAAP.

As far back as 2015, SHAAP identified the role that alcohol plays in so many LGBT people’s lives. Sadly, according to the statistics, very little has changed. Recently, Stonewall did some research that found that a third of lesbian and bisexual women drink three times more than heterosexual women drink in a week, and that 42 per cent of gay and bisexual men drink three times more than those in the general population drink during the week. The National LGBT Partnership found that trans people are twice as likely to drink in a way that is harmful or potentially harmful to their health. That is why alcohol services for the LGBT community are so important, as niche as the issue might sound to so many.

Of course, we cannot have a stand-alone debate about the problem of alcohol in society, because the issue is inextricably linked to the problems of mental health, on which the statistics are even more shocking than those on alcohol consumption. One in 10 LGBT people in Scotland aged 18 to 24 attempted to take their own life in 2018-19. I do not have more up-to-date statistics. I hope that the number has come down, but I suspect that it will not have done, given the pressures of the pandemic. According to Stonewall, half of LGBT people in Scotland experienced depression in the same period, and that number jumps up to seven in 10 for trans people. One in six LGBT people in Scotland have deliberately harmed themselves. Therefore, there is clearly an existential link between alcohol consumption, as a method of self-medication and coping with stress and anxiety, and other mental health issues.

Recently, I wrote an article of a couple of pages in Holyrood magazine about my family’s experience with alcohol and how traumatic that was, but I did not share my own experiences in it.

The question is: why? What are people building the wall around themselves with, and why? Well, the with is the alcohol, the drug, the gambling or the self-harm, but the why is more important. In the SHAAP report, I was quite struck by a comment that was made by one of the contributors, who said:

“Alcohol gave me the courage to go out and just be who I wanted to be ... I felt that I was under pressure to be a sort of ‘normal’ person ... and I had to shut all that away.”

What is “normal” these days? Are we not all normal?

The problem is that the services just are not there. Mental health services are not meeting the demands of people in Scotland. As of March, only seven out of 10 people were getting mental health support within the Government’s 18-week target. That figure drops to five in 10 in places such as Dumfries and Galloway. It is simply not true to say that support services are universal. It is an understatement to say that support is patchy. Arguably, it is failing.

Another issue that I do not have much time to talk about is drug misuse. There is clearly a pandemic in relation to the misuse of drugs, particularly party drugs, club drugs and drugs that are used in sexual activity. We are fooling ourselves if we do not admit that there is a specific problem with drug use in the gay and bisexual community. That has to change. Far too many young men are dying of overdoses in that community.

I thank Emma Roddick for bringing this very short debate to the chamber. It should be the start of the conversation, not the end of it. I know that our cross-party group will do more work on the issue, but I hope that we can spend more chamber time looking into the what and the how, including what the Government is doing. I hope that the minister, in her summing-up speech, will set out some specific Government plans on the matter. I thank members from across the chamber, whatever they identify as, for attending today’s debate and understanding its importance.

17:57  

I am proud to speak in this important debate. I thank Emma Roddick for bringing it to the chamber and for her characteristically outstanding speech.

I welcome the report by researchers at Glasgow Caledonian University and thank those involved for carrying out such important work. I also want to pay tribute to LGBT Youth Scotland for its report “Life in Scotland for LGBT Young People”, which is a vital piece of research. Sadly, both reports highlight that the rights of LGBT people in Scotland are not being fully realised and that, in many cases, things have actually moved backwards. There is still much to do if we want to meet our aspiration of ensuring that Scotland is the best place in the world for everyone to grow up and live in. LGBT Youth Scotland’s survey found that, overall, the percentage of LGBT young people rating Scotland as a good place to be LGBT+ has fallen in the past five years, from 81 per cent in 2017 to 65 per cent in 2022. That makes for very sad reading.

The motion focuses on LGBT people’s experience of alcohol services. The report that is referenced makes it clear that those services are simply not meeting their needs right now. We have heard from others in the debate about that.

In Scotland in 2022, too many people still feel shame, stigma and rejection because of their sexual orientation or gender identity. That is an unacceptable situation, not only because no one should feel any of those things for being lesbian, gay, bisexual or trans, but because we all know that stigma, shame and rejection have a detrimental impact on mental health and wellbeing, and can lead to excess drug and alcohol use.

The link between alcohol and drug use and the shame that is felt by LGBT people is deeply worrying. So, too, is the likelihood that that shame can also result from substance abuse, so we must do all that we can to address both those things. We start by recognising that tackling substance use must come hand in hand with reducing the negative experiences and discrimination that LGBT people face.

Trans people, in particular, face stigma and hostility, which is being exacerbated by the vacuum that exists in relation to forthcoming legislation—the Gender Recognition Reform (Scotland) Bill. I am proud of how most members across the parties have handled that bill in recent weeks, however. I believe that we have a duty to continue in that respectful tone and to seek to remove the hostility and abuse towards trans people that has been stoked up in recent years. As legislators, we have a responsibility to ensure that we do all that we can to address the stigma that is faced by trans people, and to make sure that Scotland is a place where they can live equally. Believe me—we still have a long, long way to go.

The relationship between stigma, poverty and inequality has, of course, been known for a long time, as we have heard. Those things are key drivers of drug and alcohol abuse. It is not just financial inequality, but inequality in all its forms, including the inequality that is faced by LGBT people, that drives minorities’ stress and can lead to use of harmful substances.

I was pleased to see the report, which marks a path to improvement. All of us in Parliament must commit to considering its recommendations and to supporting their implementation wherever and whenever we can.

Alcohol and drug abuse is a public health issue and must be treated as such. It damages lives—not just the lives of those who abuse alcohol and drugs, but the lives of their families, too. My dad was an alcoholic and my best friend was a drug user, so I know from personal experience how hard it is to see the people whom you love turn to use of substances as a coping mechanism, and how hard it is to see them when they have nowhere to turn.

We must make sure that questions about the reasons for people’s substance abuse can be asked in a way that does not make service users feel uncomfortable about any of it, but instead respects people’s rights to be who they are. We must also make sure that the people who turn to services feel confident in doing so. That means that we must address the heteronormative assumptions that underpin services, and tackle the concerns that exist around confidentiality and the worries that diagnosis or treatment could be negatively affected by disclosure of sexual orientation or gender identity.

That also means funding of services—we need proper investment; we cannot do it on the cheap—including mental health services. We must halt tax on budgets for the third sector, local authorities, support services and alcohol and drugs partnerships.

Crucially and lastly, there must be an end to the practice of diverting drug users and people who are addicted to alcohol from mental health services until they have addressed addiction, because very often people need both together.

Presiding Officer and colleagues, I believe that all of us here this evening have a common objective: to improve the experiences of LGBT people in Scotland and ensure that they can access support services that meet their needs, so that they can enjoy their human rights equally. I urge colleagues to work across the chamber, wherever possible, to achieve that.

18:03  

First, I congratulate Emma Roddick on securing her first member’s debate. I must apologise because I will be leaving early, as I am sponsoring an event tonight in the Parliament.

The debate is important and timely. I am a member of the Health, Social Care and Sport Committee, which took evidence last week from the minister about our relationship with alcohol, in Scotland. I specifically raised the issue of LGBTQ+ persons’ experience of alcohol services at the evidence session, following the submission to the committee from Scottish Health Action on Alcohol Problems. I thank SHAAP and LGBT Scotland for their hugely helpful briefings, ahead of the debate. Different social groups are affected by alcohol problems in different ways, and people develop negative relationships with alcohol for a number of reasons. Emma Roddick highlighted that extremely well, for which I thank her.

It is important that we do not generalise about people who use alcohol to the detriment of their health. We need to recognise that harmful use is a complex issue that requires various responses. There is no one-size-fits-all solution.

The harm that is caused by alcohol is a very serious problem in the LGBTQ+ community. A study that was carried out by Alcohol Focus Scotland suggests that up to 25 per cent of the LGBTQ+ community has moderate alcohol dependency, compared with 5 per cent to 10 per cent of the general population. Additionally, 25 per cent of bi women reported heavy drinking.

Despite the many challenges, awareness of LGBTQ+ harm from alcohol is growing, and many treatment facilities now tailor programmes—or, at least, aspects of programmes—to meet the unique needs of LGBTQ+ individuals. That is welcome, but as SHAAP has pointed out, work must continue in order that we ensure that our alcohol services meet the needs of the LGBTQ+ community. It is particularly important that the work be carried out quickly, because SHAAP’s study reported

“service providers assuming that all patients were heterosexual”

and that services and peer-support groups tend not to provide “safe and welcoming” spaces.

In order to tailor services to the needs of individuals, it is important to look at why LGBTQ+ people have higher levels of alcohol dependency. One of the most important reasons is the bigotry that the LGBTQ+ community faces daily, with stigma, shaming and abuse. I echo what Emma Roddick said about people feeling abnormal, vulnerable and alone, especially during the pandemic.

That is all very true. One of the more difficult things, though, is that high drinking levels in the community have a social aspect. Drinking is one of the few ways that people find make it easier to meet fellow LGBT people. Perhaps the solution is to encourage different ways of fraternising, if you like, and socialising. People could join shared-interest groups for sport, music and other activities. Such groups would provide a different environment in which to meet, socialise and make friends.

I thank Jamie Greene for that intervention. I agree that we need to make it easier for LGBT people to identify others and to engage in whatever activity they want to do. We can support them. One of the things we talk about in the Health, Social Care and Sport Committee all the time is reducing and tackling stigma. It is a huge issue that we need to address.

We know that services can be harder to access in rural areas like Galloway and the Scottish Borders. It was interesting that Emma Roddick also mentioned rural issues. Here is what I ask of the minister: can the Government commit that rural Scotland will continue to be included when it is improving alcohol services for LGBTQ+ people?

Alcohol use has become deeply engrained in LGBTQ+ society as a result of history and we have spoken about alcohol providing an easy way to meet. When I lived in California, that was the way people met each other and it was acceptable: individuals felt safe in gay bars. Stonewall has stated that that is why excessive drinking has become normalised. It is important that we work to change that.

The SHAAP report shows that some alcohol service providers are, due to lack of training, uncomfortable discussing LGBTQ+ issues, particularly trans issues. As a former nurse educator, my final ask of the minister is this: what training is being provided to alcohol service providers on LGBTQ+ issues so that they can support people to achieve the best possible treatment outcomes?

18:08  

I thank Emma Roddick for bringing what is a very personal debate for her to the chamber. I congratulate the team at Glasgow Caledonian University on completing such an important study for SHAAP.

It is important not to brand all LGBTQI people as drinkers and to recognise that they are not a homogeneous group. However, the SHAAP report notes a growing body of international research that suggests that people who identify as LGBTQI are more likely to become dependent on alcohol. Members will have noted that big-name commercial brands have supported pride. Although such corporate support for LGBTQI equality is welcome, I have some concern that those brands may be cashing in on what they know are higher levels of alcohol consumption in that community.

Although alcohol plays a central role in social connections, for some in that community drinking may be a response to discrimination, family rejection or forming their identity. Let me share the words of one of my constituents:

“I started to drink when I was about 16. Initially I drank ‘just to fit in’ at the weekend, normal teenage stuff. However, my drinking became more problematic in the run up to, and after, I came out as gay at 17. The single memory I have that led me to drinking more frequently was a teacher pulling me aside ahead of a school trip and saying to me, ‘You’ll be sharing a room with other boys so no funny business’. This event sticks in my head so vividly it made me feel isolated and ashamed of my sexuality. After this I began to drink almost every night after school and there were a few occasions where I drank at lunchtimes during the school day. There is no doubt my shame of being gay definitely led me to me drinking more heavily.”

I must thank him for sharing his story, which was very sad and very revealing.

When LGBTQI people become dependent on alcohol, as highlighted in the SHAAP report, they face perceived barriers in gaining access to alcohol services, including the perception that services are aimed at middle-aged, straight men who have been drinking for decades.

For many years, the Scottish Government has invested in prevention and treatment services and has reduced the country’s alcohol-related death rates. However, some thought is required to ensure that those services are more open to everyone, including minority groups. It seems that more training is required. As the report found, some staff at alcohol support services are worried about getting it wrong or upsetting people when talking about sexuality or sexual orientation. With the report’s recommendations, we could make a real difference to the experience of LGBTQI people.

I welcome better links between alcohol and mental health services, as well as more of a focus on denormalising drinking for young LGBTQI people—indeed, all young people. It is good to see on the Kinder Stronger Better website more alcohol-free social spaces where people can meet, as there is obviously a demand for them. I welcome Jamie Greene’s comments in that regard.

Scotland is already leading the way as the first country in the world to embed LGBTQI inclusive education across the curriculum, to help all young people reach their full potential. We are proud to place inclusivity at the heart of what we do, so let us listen to this community and use their lived experience to improve our public services’ offering to them.

18:12  

Like colleagues, I begin by thanking Emma Roddick for bringing the motion and the debate to the chamber. I also thank Jamie Greene for his contribution as co-convener of the LGBT+ cross-party group and both colleagues for the work that they do on that group; indeed, I thank all other colleagues who are members of or who support that group. I think that it does vitally important work in our Parliament in representing the important issues for LGBT+ people across Scotland—and none is more important than the issue that we are debating this evening.

I also thank SHAAP for its work with Glasgow Caledonian University on the report. If I may, Presiding Officer, I would like to plug an event that is coming up in the Parliament in June. I am delighted to be hosting SHAAP and Glasgow Caledonian University to mark pride month, which will give us all an opportunity to hear more about their work and to engage more fully in it. I would welcome all colleagues to that event.

As we have heard already, many communities in Scotland suffer from health inequalities when it comes to the overconsumption of alcohol, and Scotland’s LGBT+ community is among them. Evidence shows that although alcohol-free spaces for LGBT+ people are highly valued where they exist, alcohol still plays a central role in most LGBT+ safe spaces. We have heard from colleagues about their own experience of that, and I would echo much of what has been said. It is so important that our towns and cities have a gay scene and areas where there are bars, cafes and other places that are safe spaces for LGBT+ people. However, those spaces are often based around a drinking culture and alcohol, and that can be very challenging for some people. We need to widen out those safe spaces and ensure that many of them are as safe as they can be.

I point to what Jamie Greene said about the challenges that we know exist around access to sports for LGBT+ people. Historically, many people have not engaged in sports and find it difficult to do so. We know that LEAP Sports Scotland and others are doing a huge job of work to try to make sport more accessible and to ensure that people are welcomed.

The SHAAP research points to challenges for LGBT+ people in accessing alcohol support services as a result of misconceptions that are embedded in those services regarding the sexuality or gender identity of their service users. Indeed, very often how people’s sexuality or gender identity influences wider relationships with alcohol is misunderstood.

We have made great strides in Scotland when it comes to protecting the rights of LGBT+ people and amplifying voices, but it is clear that we still have a lot of work to do. The threat and reality of discrimination can have a devastating impact on wellbeing and can contribute to the reality that LGBT+ people are particularly vulnerable to experiencing poor mental health. Colleagues—particularly Pam Duncan-Glancy—have spoken about LGBT Youth Scotland, evidencing some of their recent work in that regard.

Testimonies have shown that mainstream health services are not always inclusive. Members of the LGBT+ community are not just more likely to struggle with mental health issues and alcohol misuse, but less likely to receive the support that they need when they are facing those struggles. Glasgow Caledonian University’s report displays the LGBT+ community’s concerns that alcohol services are often intimidating and oriented towards white, straight men, and that support groups are not gay friendly. We all have a right to support and it is vital that that right is accessible to everyone across all communities, especially marginalised groups such as LGBT+ people.

We must commit to the provision of additional alcohol-free spaces in the LGBT community and more widely. We must provide spaces where people can express themselves and unite, free from alcohol, if that is what they choose to do. That is a key step towards improving things for people who are isolated and providing social support, and I think that it is particularly important for people who are under 18. I think that we would all want to try and engage with LGBT Youth Scotland and others to look at those issues, in particular.

Once again, I thank Emma Roddick for bringing this timely debate and urge all colleagues to attend the event with SHAAP in June.

18:17  

I begin by thanking Emma Roddick for lodging this motion and all members who have taken part in discussing what we all can agree is a very important issue. I welcome the opportunity to respond on behalf of the Government. I also extend my thanks to the researchers at Glasgow Caledonian University and to those who took the time to share their experiences with them. The results tell us that we must empower LGBT+ people to seek treatment for their alcohol use when it is needed.

I must admit that I had not particularly made the link between the LGBT+ community and alcohol culture but, as soon as it is pointed out, the link is very clear. LGBT+ people have been so pushed to the outskirts of society for so long that they have found gay bars and gay clubs a safe space in which to be themselves and in which to socialise, so undoubtedly alcohol has become an integral part of the culture.

It is vital that the experience that LGBT+ people receive when seeking treatment should be non-judgmental and person centred. On that note, I was going to mention as a wee aside the work that was done with NHS Scotland boards to launch the NHS Scotland pride badge. I am not sure whether Emma Roddick or other members are aware that that has a wee link with the Highlands because it was developed by a paediatrician now working in London, Mike Farquhar, who is from Inverness.

The NHS Scotland pride badge showcases our commitment to fostering an environment that is open and tolerant and inclusive for all. Racism, homophobia, biphobia, transphobia and any form of bigotry have no place in our NHS. Our health system is based on the core values of care, compassion, openness, honesty, dignity and respect for everyone. I am delighted that that badge launched in June 2021 to coincide with pride month in Scotland. It encourages open and constructive conversations on difficult issues pertaining to ethnicity, age, sex, and sexuality. I think that it is a very useful tool in our NHS.

It is vital that the experience that people receive when they seek treatment should be non-judgmental and person centred, as I said. We have set out a national mission to improve lives and save lives, at the core of which is ensuring that every individual, no matter what their sexual or gender identity is, should be able to access the treatment and recovery that they need. Increased investment from the national mission on tackling drug-related deaths is being used by alcohol and drug partnerships across Scotland to support people who are facing problems because of alcohol and drug use.

However, more can and must be done to get people into appropriate treatment quicker in order to reduce harms and help with recovery. There should be no shame or stigma in reaching out for support, and the voices of those with lived and living experience are critical to this process.

I forgot to make a plug in my speech—there is always a plug, isn’t there?—for organisations such as the LGBT Foundation or even FRANK, which has a dedicated LGBT service. It is fine if services are aimed at the LGBT community, but my question is about what happens when people interact with regular public services. Is there any perceived conflict over whether medical professionals or service providers, who have quite a mixed view according to the report, should be asking these types of questions? Is it appropriate to ask someone who comes asking for alcohol support whether they are LGBT+, for example?

I am not going to give a clinical opinion during this debate, but let me say that I am very clear that our services need to be open and welcoming to all. It is vital and lifesaving that they are. There are many communities—we talked at committee last week about some of the health inequalities experience. SHAAP has done another brilliant piece of work on people living in socioeconomic deprivation. Paul O’Kane mentioned that people regularly say that alcohol services appear to be targeted at middle-aged men; women feel excluded from them too. We want services that are open and welcoming to all and we want people who need help to be able to ask for it easily and to get help easily.

We are working with the United Kingdom Government and the other devolved Administrations on reviewing and updating clinical guidelines for alcohol treatment. That guidance will look to introduce new approaches to treatment and support the development of alcohol-specific treatment targets.

We are working with Public Health Scotland to review the evidence on the current delivery of alcohol brief interventions. That work is in the early stages, but it is critical to ensuring that alcohol brief interventions are as effective as possible. We are also exploring the evidence around managed alcohol programmes and are delighted to be able to contribute to the running and evaluation of the model that has been piloted in Glasgow by the Simon Community; homeless people are another community who are often missed in the targeting of our services.

Many of the recommendations in the report are for our alcohol service providers, and I encourage them to act on them to ensure that their services are as inclusive as possible. Like Evelyn Tweed, I note that the report discusses the harmful impact of targeted marketing of the LGBT+ community. We know that there is a direct link between exposure to alcohol marketing and consumption of alcohol. I personally find that deeply troubling and I am determined to cut down on the volume of alcohol advertising and promotion that young people in particular see and to reduce the appeal that alcohol has to them. This is why we are planning on consulting on a range of new measures to restrict alcohol advertising and promotion in Scotland in the autumn. That consultation will be vital in helping us to consider whether new legislation is needed.

The Government’s long-term goal is to create a Scotland where everyone can flourish, and improving health and reducing health inequalities are vital if we are going to achieve that. Unfortunately, we know that the pandemic has exacerbated pre-existing inequality in society and has had a big impact on the mental health of some groups, including the LGBT+ community. That is why the mental health transition and recovery plan commits to making the mental health of those groups a priority, including better understanding and responding to the needs of the LGBT+ community.

I absolutely agree with Pam Duncan-Glancy that, for many people, the twin issues of alcohol and mental health are so closely intertwined that it is impossible to treat one without the other. We are well aware that people need person-centred and holistic care to recover. Both Angela Constance and I are working to deliver that.

In doing that, will the minister look at the practice of people attending mental health services having used substances at the time and at whether there is an option to divert them on to a different path so that they do not leave the services?

Certainly, we are more than happy to look at that and, if the members writes to me with specific instances, I am more than happy to pick that up with her. I know that Angela Constance is also working in that area.

We need to create the conditions that nurture health and wellbeing, and that responsibility needs to be shared widely across many organisations, sectors, communities and individuals. The potential impact of that combined talent, expertise and commitment is huge. We work with a wide range of third sector organisations, including the registered charity Stonewall Scotland, to ensure that the voices of those with lived experience help to shape policy and practice to improve outcomes for LGBT+ communities.

I will just pick up on a couple of issues that Emma Harper raised. We have staff training for NHS colleagues to address any issues that they might have in terms of equality, diversity and inclusion, and we are more than happy to promote that further.

Emma Harper’s final question was about rural areas and, of course, like her and Emma Roddick, I am from a rural area. I recognise the challenges both in delivering services in rural areas and in finding ways to socialise other than through alcohol, and I am determined to make progress on that issue by tackling the long-term relationship with alcohol that we have in Scotland. I am under no illusions about the enormity of that task, but by continuing to work together, learning from our recent experiences, and building on our successes, I am confident that we can make lasting changes that reduce alcohol consumption and its associated risks, which will improve the health and wellbeing of everyone in Scotland.

Thank you very much. That concludes the debate and I close this meeting of Parliament.

Meeting closed at 18:26.