A recent article quoting Associate Professor of Communication and Media, Rob Cover, suggested that legalisation of same sex marriage would not improve suicide rates in young GLTBI people. As medical doctors, we can confidently state from the scientific literature that this view is incorrect, and in fact the evidence shows that marriage equality will improve public health.
It is well observed that institutional discrimination and stigma against non-heterosexual persons worsens mental health and increases suicide rates amongst this community. In US States where laws were amended to specifically ban same sex marriage, there was a measurable increase in psychiatric disorders including mood disorders, generalised anxiety disorder and alcohol abuse disorders.
In contrast, when same sex marriage was legalised the mental and physical health of gay people improved as a result of the increased in community acceptance of non-heterosexual persons. A study in Massachusetts showed a significant decrease in clinic visits for non-heterosexual men for mental health reasons in the twelve months following the legalisation of same sex marriage, compared to the previous year. This was not related to whether the men involved actually got married – suggesting that the increase in societal acceptance directly improved their mental health.
A/Prof Cover states that "marriage and relationships are not the primary concerns of.. gay youth struggling with intolerable emotional pain". As pointed out above – the legalisation of same sex marriage has an effect on all members of the GLTBI community, regardless of whether they are in a relationship or not. This includes gay youth who are far from an age when they are considering marriage and has a measurable impact on suicide attempts. One study found that LGB youth suicide rates were 20% lower in those who lived in positive social environments1.
Marriage is a valuable institution that provides unique benefits both physically and psychologically. Married adults live longer, have less diseases, suffer with less disability, smoke less cigarettes, drink less alcohol, have less mental health problems and have lower suicide rates than those who are single or in de facto relationships.# These benefits are not noted in relation to de facto relationships or civil partnerships – and therefore these are not an adequate substitute. If these benefits of marriage are extended to non-heterosexual people, this has the potential to significantly improve public health.
In a recent article in the Sydney Morning Herald, Dr Tanveer Ahmed opined that "Laissez-faire liberalism ...has left too many people adrift, without sufficient structure, sense of obligation or meaning in their lives," and somewhat inexplicably used this as an argument against the legalisation of same sex marriage. As we have already explained, removing gender discrimination from the marriage act will decrease the burden of psychiatric disease that Dr Ahmed's queer patients experience. It is also confusing as to how marriage is framed as a conservative, civilising institution when it is applied to heterosexuals but suddenly becomes a meaningless, obligation-free, structureless bastion of liberalism when applied to homosexuals.
For those who are concerned about increased rates of sexually transmitted infections amongst same sex attracted men, consider this: high risk sexual behaviour is directly correlated with increased stigma and discrimination. That is, when people are allowed to develop interpersonal relationships openly, without fear of recrimination, they behave much like the rest of the community. When people are forced to repress and hide their sexuality, they are far more likely to opportunistically partake in high risk activity with multiple, or anonymous partners in locations such as bars or clubs.
It is also well known that people in long term monogamous relationships engage in far less risky sexual behaviour and therefore have significantly lower rates of sexually transmitted infections. Therefore legalisation of same sex marriage can lead to a reduction in the rates of sexually transmitted disease by decreasing stigma and discrimination and also promoting long term, monogamous relationships as an option for LGBTI persons.
Ultimately, marriage is an expression of love and commitment between two adults. Allowing those of different sexual orientation to marry has not been shown to harm heterosexual marriages in any way. On the other hand, the ongoing discrimination in the marriage act against homosexual and intersex Australian is responsible for a large burden of psychological distress and physical illness in our country. As medical practitioners who have taken an oath to put the wellbeing of our patients first, we are calling on the government to legalise same sex marriage before more harm is done.
Dr Amanda Villis has practised in major teaching hospitals in Perth since graduating with her medical degree in 2007. She began training as a general practitioner in 2010 and has worked in rural Western Australia since that time. She is now working as a general practitioner and visiting medical officer at the local hospital in Mount Barker, a small rural town in southern Western Australia.
Dr Danielle Hewitt currently works in Royal Children's Hospital, Brisbane and is training to be a specialist paediatrician. She is interested in all areas of child health and has also worked in adult medicine in Perth prior to moving interstate.