Out in the cold

On the rare occasions when chemsex is covered in the mainstream media, mental health issues don’t tend to figure.

A recent report, however, offers a very different perspective.

A report by London Friend and LGBT HERO has revealed that mental health issues like trauma, loneliness and isolation are the biggest chemsex-related concerns for LGBTQ+ people in London (DDN, May, page 5). With nearly three-quarters of the 334 survey respondents citing the mental health impacts of chemsex, the findings paint a ‘stark picture of unmet need’, the organisations say.

A supplementary report heard from service users at Antidote – the specialist LGBTQ+ drug and alcohol support service operated by London Friend – as well as healthcare professionals supporting people with chemsex issues. The results challenge some common assumptions, the organisations say, with survey respondents ‘consistently’ linking their drug use to coping with poor mental health. This meant that chemsex was ‘often rooted not just in risk-taking behaviour, but in unmet emotional and psychological needs’, the report states.  

So were the findings a surprise? ‘Not really,’ London Friend chief executive Monty Moncrieff tells DDN. ‘Very often when chemsex starts to cause difficulties for people we find there’s underlying mental health issues – around half of our clients already have a mental health diagnosis, but far more experience issues around their identity, shame and stigma around chems use, and very frequently loneliness. Chemsex helps people connect in the moment, but if any of these issues are underlying already they can be exacerbated by chems use and the comedowns.’ 

Higher risks

ONS analysis of mortality statistics from 2021 to 2024 by sexual orientation found that lesbian, gay and bisexual people had a 2.8 times higher risk of death related to drug poisoning than the heterosexual population. Overall rates of substance use tend to be higher in the LGBTQ+ community – whether because of the more central role of the bar and club scene, or self-medication to cope with mental health issues – but some chemsex drugs carry a high risk of potential harm, such as the danger of overdosing on even small amounts of GHB/GBL.

The most common chemsex substances alongside GHB/GBL tend to be mephedrone and methamphetamine, with the latter associated with more and more cases of psychosis, Moncrieff says. ‘We see it manifesting in feelings of paranoia, often thinking people are spying on them or listening in through devices and the like, and we also hear about some very significant challenges in services like emergency departments.’ 

The report details the significant barriers to accessing help, with people citing issues like waiting lists, costs and limited numbers of sessions. Lack of awareness was also a major barrier, however, with 40 per cent of LGBTQ+ Londoners never having tried to access support – and half unaware that chemsex-specific services even existed. That statistic was also ‘sadly not’ a surprise, says Moncrieff. ‘We know it can often be difficult for people to recognise when chems are becoming a problem for them, which was echoed in our discussions with healthcare professionals.

But it’s also difficult for services like ours to advertise ourselves too much because we wouldn’t be able to cope with the increased demand. There’s no tariff payment activated for everyone we support, like there would be in sexual health for example.’ Instead the money tends to go to local services that LGBTQ+ clients can be reluctant to access, he says. ‘We need to do more work to make sure what’s there already can meet the needs of LGBTQ+ people, and those engaged in chemsex, appropriately.’

Shame and stigma

Staff in both drug treatment and sexual health services are increasingly encountering complex chemsex-related needs but lack the capacity to respond properly, the report warns. Perhaps inevitably, shame and stigma were also identified as major barriers to accessing support, with many respondents stating that mainstream drug and alcohol services ‘didn’t understand LGBTQ+ lives’, leaving them feeling unable to engage.

One interesting finding was that drug workers themselves wanted more training, with more than 40 per cent saying they’d like more education around methamphet­amine and GHB/GBL, while almost half wanted more mephedrone training. Some respondents had positive experiences of the support they did access, however, with more than half rating it excellent or very good, while about a third rated it fair, and 16 per cent poor. ‘There were fairly mixed results in what kind of interventions were helpful or not – one-to-one keywork and counselling scored most highly – but this just emphasises the importance of offering a range of intervention types to meet differing needs,’ says Moncrieff. ‘But the need for support to be LGBTQ+ specific was really strongly indicated, so we do know people want more targeted interventions.’ 

The document also calls for mental health support to be properly integrated into chemsex pathways, via embedded therapists and support groups, and better links generally between services. How optimistic is he this will happen over the next few years? ‘It should be happening already, and not just for chems users,’ he states. ‘We know how much mental health support other people who use drugs often require, so it always feels astonishing to me that we haven’t got this right yet. We still hear of services routinely not accepting clients unless they’ve addressed their drug use first – this was something the clients in our focus group were particularly vocal about.’

While it can be difficult for people to engage in very structured mental health interventions if they’re still using drugs, mental health support can be ‘integrated in so many ways’, he says. ‘We’ve had to adapt our services to bring it in and be more holistic, as well as bringing in interventions that help people look at their sexual behaviour and health. Psychoeducational workshops are a good way of doing this, but these need to be rooted in the experiences of LGBTQ+ people and delivered in ways that are safe for them to disclose what’s been going on for them. This just can’t be achieved through most existing mixed groups – people need to know they’re safe to talk about chems use and sex and won’t be judged. The respondents were so clear about needing LGBTQ+ specific services to do this, so we just can’t keep expecting them to fit into mixed groups in treatment services.’ 

Strategic approach

Alongside things like mandatory LGBTQ+ awareness training for frontline staff, including on chemsex culture, the report says that visibility around the support that is available needs to be improved. How is this best achieved – through targeted campaigns via apps and venues, wider awareness campaigns, or a mix of both? ‘I think we need to maximise all opportunities really,’ he says. ‘Professionals asking about chems use in sexual health appointments is really helpful, as it gives people permission to open up and talk frankly and honestly. We’re also trying to piggy-back onto existing sexual health outreach – often funded by HIV prevention programmes – to help outreach workers feel more confident to ask about chems, offer harm reduction, and strengthen referrals pathways into support services.

Crucially, if awareness is raised then how to sustain and expand services to meet the increased demand has to be properly thought through, he stresses. ‘Referring hundreds of people to somewhere they’re potentially going to be waiting months to be seen isn’t an effective intervention either – improving chemsex support needs a strategic and long-term approach.’  

More work to do

When DDN spoke to him more than a decade ago (April 2015, page 12) he was already highlighting the fact that people didn’t feel comfortable talking to mainstream services about their issues around chemsex – has there been much progress over the last decade? ‘I think there has, and I think more people working in services have had to improve their knowledge because chems are increasingly coming through the door,’ he says. ‘But it really varies. In our survey of healthcare professionals there was a wide range of scores when we asked people to rate their knowledge and confidence – some rated themselves at eight or nine, even some tens, but we had just as many rating themselves at one, two, three or four out of 10, so it feels like there’s still a lot of work to do. 

‘Sadly though, I think one of the reasons more professionals are having to work with chemsex is that the health and social issues people are experiencing related to their chems use are so much more complex,’ he continues. ‘So they’re having to use services to access more specialist and clinical help that’s beyond the psychosocial support we can offer at Antidote. Just like we did when we first started seeing chemsex and these newer drugs emerge, professionals are having to learn and adapt. Because the people are right there in their services.’

LGBTQ+ services for drugs and chemsex in London and Examining the drug, alcohol and chemsex experiences of LGBTQ+ people and the healthcare staff supporting them are available at londonfriend.org.uk/chemsexreport2026