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Over the past decade, there have been profound social and legal changes for Lesbian, Gay, Bisexual and Trans (LGBT) people in the UK that impact on the practice of social work. These include the legal recognition of same-sex partnerships, eligibility to apply to adopt a child, protection from dismissal from employment, legal recognition of homophobic hate crime and rights of succession to a tenancy if a partner dies. Until the introduction of the Equality Act (Sexual Orientation) Regulations in 2007, there was no legislation to prohibit discrimination against LGBT people in public services. Changes in legislation have been accompanied by more positive social attitudes. In 1987, the British Social Attitudes Survey revealed that 75% of people believed that homosexuality was ‘always or mostly wrong’ (EHRC, 2009: 10). By 2008, the proportion of people holding such beliefs had fallen to 32%. ‘Beyond tolerance’, an online survey of 5,000 people for the Equality and Human Rights Commission (EHRC), showed that 84% would be happy or neutral to be treated by an openly LGBT doctor (EHRC, 2009). The survey also revealed that only a third of heterosexual men agreed that gay men could be ‘equally good at bringing up children as other men’ and they also agreed that lesbians and gay men will find it harder to adopt a child than other men and women (EHRC, 2009: 63). Beliefs that LGBT parents are second best have an impact on social work practice and may mean that LGBT people’s parenting capacity is assessed less favourably than that of other people.

Social work is practised with those who are among the disadvantaged in society; its core aim is to work collaboratively with people to bring about change in their lives. In order to work alongside people to enable them to bring about lasting change, social workers must have attitudes and values that demonstrate their recognition of people’s lives and circumstances.

The international requirement for social workers to promote social justice for lesbian, gay and bisexual people is included alongside those of other equality grounds in the code of ethics developed jointly by the International Federation of Social Workers (IFSW) and the International Association of Schools of Social Work (IASSW) in 2004. It requires social workers to promote social justice not only in relation to the people with whom they work but also in society generally:

Social workers have a responsibility to challenge negative discrimination on the basis of characteristics such as ability, age, culture, gender or sex, marital status, socio-economic status, political opinions, skin colour, racial or other physical characteristics, sexual orientation, or spiritual beliefs. (IFSW and IASSW, 2004: s 4.2)

With the development of the degree in social work in the UK, a number of organisations have been responsible for setting standards for best practice in social work. The General Social Care Council (GSCC) is currently the awarding authority for the degree and the profession’s regulatory body in England and Wales until these functions transfer to the College of Social Work and the Health Professions Council in 2012. The GSCC Codes of Practice (2010) (agreed across the four countries of the UK) describe the standards of professional conduct required of social care workers and student social workers in their everyday work:‘treating each person as an individual’, ‘respecting diversity and different cultures and values’, ‘promoting equal opportunities’ and ‘protecting the rights and promoting the interests of service users and carers’ (GSCC, 2010: 5–6).

Linking theory and practice is something that many practitioners and social work students grapple with. Theory is sometimes perceived as separate from practice and an aspect of social work learning that takes place predominantly in the university. The complexities of people’s lives do not appear to fit into a neat box labelled theory. But theory provides a rationale for social work interventions (why one course of action is more appropriate than another), can aid understanding of the processes and the barriers that people may experience in their everyday lives, and can help to clarify potential outcomes. Theory helps social workers to guard against ‘quick-fix’ solutions and helps move the beginning practitioner from unconscious incompetence to conscious competence (Luft and Ingham, 1955).

In comparison to other social divisions, there has been relatively little theoretical development in social work and sexual orientation (for exceptions, see Hicks, 2005). Over a decade ago, Hardman (1997) critiqued the lack of social work models available to inform the development of good practice in work with service users. When social workers were asked to discuss their responses to practice scenarios, many of them had not considered the sexual orientation of the service user in their assessments, problem formulations or interventions. She argued that in the absence of theory to underpin their practice, many social workers will consider that ‘a problem is a problem’ and seek to use the same interventions with all their service users (Hardman, 1997: 545). Much of the practice learning for social work students occurs with practice assessors. Trotter and Gilchrist (1996) revealed that few practice assessors or students discussed heterosexism or homophobia in supervision or provided reflection about their work with lesbian, gay, bisexual and trans (LGBT) service users in their practice curriculums.

Children and young people have been at the centre of two of the most contested pieces of legislation relating to LGBT people. In 1986, a children’s book entitled Jenny lives with Eric and Martin, which was stocked in the library of the Inner London Education Authority, caused huge media controversy because it was the first to discuss the everyday family life experiences of a child (five-year-old Jenny) and her gay male parents. The ensuing debate led to the introduction of arguably one of the most regressive pieces of legislation, the Local Government Act 1988, which outlawed the promotion of homosexuality in schools and prohibited teaching about the acceptability of homosexuality as a ‘pretended’ family relationship. During the 1990s, the age of consent was the highest-profile issue in LGBT politics. The legal age for sex between men (sex between women has never been illegal) was reduced from 21 to 18 and then to 16; this equalised the age of consent with that for heterosexual young people.

The Children Act 1989 (and the Children (Scotland) Act 1995) signalled a new direction in children’s social policy by promoting children’s rights; specifically a child’s right to have their feelings and wishes taken into account bearing in mind their age and perceived level of understanding. The Act introduced duties that required local authorities to make due consideration of religion, racial and cultural origin, and linguistic background (section 22 and Schedule 2(11)). Subsequent guidance has recognised that children are not a homogeneous group: their identities, needs and aspirations are shaped by their ‘race’, class, gender, disability, religion and age.

The ‘baby boom’ generation, people born in the post-war period (1945–64), represent a significant demographic group currently approaching retirement. It is estimated that in the next 25 years, older people in the population will outnumber those under 16 for the first time. Baby boomers were born at the time the modern welfare state came into being: better living and working conditions and universal health care have contributed to increased longevity. During the 1930s, men could expect to live until the age of 53 and women until age 59. Current life expectancy is age 76 and 80 for men and women, respectively. Although the welfare state has offered social protection for people as they grow older, its founding principles were constituted around the notion of the heterosexual, nuclear family. These ideologies have shaped the provision of social care and contributed to inequalities for LGBT communities (Concannon, 2007).

Social work services are demarcated at the state retirement age: those who are aged 65 and over come under the remit of older people’s services. The focus on chronological age has a tendency to homogenise older people: not only will people’s needs differ widely depending on whether they are 65 or 85, but among those who are 65, there will be considerable difference in levels of mobility and independence. Although ageism is prohibited by legislation, stereotyping and prejudicial attitudes persist, including assumptions that older people are a burden on the state, unable to make their own decisions, lonely and asexual.

The meanings attached to ageing shape how one sees oneself and how one is perceived by others.

In the practice scenario, Amiyah believes that sexual abuse in her childhood led to her being lesbian as a young woman. Some studies have found higher rates of sexual abuse in lesbians in comparison to heterosexual women (Hughes et al, 2001). If a woman believes that her identity was formed as a result of sexual abuse, her feelings of shame and internalised homophobia may be intensified. It may be that she accounts for her lesbianism in this way because this means that her identity is neither chosen nor something she was born with, but rather a consequence of her life experiences. It may be a way of deflecting blame for being lesbian. Research conducted in Brighton suggests that those who had been abused as children were more likely to also say they had experienced depression, anxiety, suicidal thoughts and to have engaged in self-harming behaviour than those who had not (Browne and Lim, 2008a).

As women are more likely to be survivors of sexual abuse, its impact may be greater on women in a relationship with a woman. Traumatic experiences of childhood sexual abuse are not unique to lesbian and bisexual women, yet few mental health professionals or social workers would assume that sexual abuse in childhood leads to heterosexuality. A survey participant in Prescription for Change provides a contrasting perspective:

Mental health problems can be crippling, but when this involves being abused as a child it would be really nice if the first question you are asked is not: ‘and do you think this is the reason why you prefer relationships with women?’.

The medical model has formed the traditional approach to disability (Brothers, 2003). The approach defines disabled people by their health condition – by what they are not able to do – rather than their abilities. It is sometimes known as the individual model because it promotes the view that the disability is the responsibility of the individual and that an individual disabled person should fit in to the way that society is organised; the problem is with the individual disabled person not with society. It assumes that a disabled person is dependent and needs to be cured or cared for. Consequently, disabled people’s lives have often been regulated by health and social care professionals who make decisions about disabled people’s lives without fully consulting with them or offer limited choices. Medical diagnoses are used to determine access to welfare, housing, education, leisure and employment.

By contrast, the social model of disability, which was developed through the Disabled People’s Movement, offers a politicised approach to understanding disability (Gillespie-Sells et al, 1998). It considers that discrimination and prejudice in society limit the life chances of disabled people. Disability is the disadvantage a person experiences that results from the barriers they encounter in their everyday lives, including the attitudes of professionals and the general public, inaccessible environments, and organisational barriers. It is the removal of these barriers that is necessary to ensure that disabled people are able to take an active role in society. In the words of one social worker, the social model:

is very much around being about people not patients; it’s being about practice that is built around the person; it’s about an holistic approach to meeting that person’s needs; it’s hopefully about the individual themselves needing … a kind of definition of the outcomes that they’re looking for; the support that they need to help them to achieve that.

Substance misuse became a key area for social policy in the early 21st century where it was linked to a number of social problems including criminal activity, unemployment and anti-social behaviours. Misusing drugs applies to legal substances, such as alcohol, or illegal substances, like cannabis or cocaine. In the popular imagination, people who misuse substances are often seen to be the agents of their own problems and are believed to be ambivalent about changing their behaviour. For many people who are dependent on substances, the greatest harm is not to others, but to themselves. The impact on the body of excessive alcohol includes cirrhosis of the liver, cardiovascular problems, the destruction of brain cells, increased risk of cancer and diabetes, malnutrition, and sexual problems. Many people use substances to enhance pleasurable experiences; others come to rely on them as a mechanism for coping with life’s challenges, often from a young age, and substance use can lend a temporary boost in self-esteem or social confidence. Drug use becomes misuse when someone becomes dependent or the use becomes problematic or harmful to themselves or others. Many people use drugs on a regular basis while maintaining their employment and continuing to effectively parent their children.

Drugs have formed a key focus for government intervention with four policy initiatives since the mid-1990s. Central to the policy objectives of Drugs: Protecting Families and Communities 2008–2011 (Home Office, 2008) was the recognition that best outcomes could only be achieved if the needs of members of all communities were taken into account. It noted that some groups were under-represented in treatment or access to other services and providers should understand the nature and level of need and plan and deliver services accordingly.

The international setting provides an important context for LGBT people’s rights in the UK because many of the rights they enjoy have come about because of judgments made in the European Court of Human Rights or through human rights advances globally for LGBT people (de Jong, 2003). Since 2007, the International Lesbian and Gay Association (ILGA), a campaigning organisation for LGBT people’s rights worldwide, has published an annual report – State Sponsored Homophobia – which identifies the international legal situation for LGBT people. The struggle for social equality has gained momentum by the collaboration of advocates from diverse countries globally and not only those in Western nations. A group of experts met in Yogyakarta, Indonesia in 2007 to draw up a universal guide to human rights and sexual orientation and gender identity. The Yogyakarta Principles outline 29 fundamental freedoms including the right to found a family, the right to social protection measures and the right to seek asylum (International Service for Human Rights, 2007).

Globally, there are unequal protections for LGBT people in United Nations (UN) member states despite the existence of a UN resolution which recognised that sexual orientation should be a status that is protected from discrimination. This resolution was recently overturned by a UN General Assembly meeting that voted to remove sexual orientation and gender identity from a resolution on extrajudicial, summary or arbitrary executions in 2010. Around the world, people face discrimination, violence, rape, imprisonment, torture or execution because of their actual or perceived sexual orientation or gender identity by the state or people acting on behalf of the state, from their own communities or their families (de Gruchy and Fish, 2004).