The lesbian, gay, bisexual, transgender, queer and questioning (LGBTQ) community, historically one of the most marginalized segments of society, have made impressive advances in their struggle for equality. From increased visibility in pop culture to halls of influence and power (including the United States Congress), queer identified individuals have seen rapid gains in acceptance. So much so, that it can be easy for some to forget the extent of the bigotry and vitriol that continues to be directed at the LGBTQ community. We wanted to learn more about the ways in which the prejudices and biases queer people experience might impact the mental health of LGBTQ people, and how this impact might manifest as anxiety among many queer-identified people.
The State of LGBTQ & Mental Health
Lindsey Rogers is a second-year doctoral student studying psychology at the University of San Francisco and currently completing her practicum at an LGBTQ clinic in San Francisco’s Castro neighborhood. “All of my clients are queer-identified. Some identify as gay, lesbian, bisexual, transgender, questioning, intersex, or just queer. The ages are anywhere from 25-years-old to about 50-years-old. Some of the clients are people of color and come from different cultural backgrounds. Many come in for substance abuse treatment, and anxiety, depression, trauma, often related to their queer identity and the oppression and marginalization that they experience in the community,” says Lindsey. The National Alliance on Mental Illness (NAMI) notes that LGBTQ individuals often experience worse mental health outcomes as the result of prejudice and other biases they struggle against and the accompanying trauma they experience.
Lindsey shares NAMI’s assessment that the LGBTQ community suffers poorer outcomes related to mental illness overall, but to avoid sounding as though there is something wrong or unhealthy with being queer itself, she makes it clear that their being queer is not generally the cause.“One’s queer identity isn’t necessarily the cause of their mental health concerns. There are so many other causes for their mental health issues than their sexual orientation or queer identity,” says Lindsey. Rather, it’s often the way that society perceives or treats queer people that can be the root of any number of mental health problems found within the larger LGBTQ community.
While the same causes of mental illness among straight and cisgender individuals are also at work among LGBTQ people, there is no denying that the additional stress of marginalization and for some, brutalization, translate to significantly higher rates and poorer outcomes within the queer population. It has been documented that fear of coming out and subsequently facing discrimination for one’s sexual orientation or gender identity, can lead to depression, posttraumatic stress disorder, thoughts of suicide and substance abuse.
Double the Stigma
Like other communities, LGBTQ individuals do not often talk about mental health and may lack awareness about mental health conditions. As Lindsey points out, “stigma around therapy influences the queer community just like it would anyone else.” This can sometimes prevent people from seeking the treatment and support that they need to get better.
LGBTQ people must confront prejudice on an almost daily basis. And for those with mental illness, they must also deal with the societal bias against mental health conditions. The effects of this dual stigma can be particularly harmful, especially when someone seeks treatment. Often termed “minority stress,” disparities in the LGBTQ community stem from a variety of factors including social stigma, discrimination, prejudice, denial of civil and human rights, abuse, harassment, victimization, social exclusion and family rejection. Some examples of traumas frequently faced by queer people that Lindsey sees at her clinic include:
- Physical and sexual abuse
- Hate crimes
- Sexual harassment
- Negative interactions with medical providers, which can prove quite traumatic, especially for trans individuals
Rates of mental health conditions are particularly high in bisexual and questioning individuals and those who fear or choose not to reveal their sexual orientation or gender identity. “This may be because belonging to a community can help insulate a person from the effects of widespread bias,” says Lindsey. But those that do not identify as a part of that community are often left to struggle against discrimination alone, an experience that is frequently isolating and damaging to one’s mental and emotional wellbeing. Though not all queer people will face mental health challenges, discrimination or violence, many people report less mental wellbeing and satisfaction.
Disparities in Care
The history of mental health treatment for LGBTQ populations is a painful one, and until quite recently, many psychiatrists believed that homosexuality is itself a mental illness. Historically, gay men and lesbians were often subjected to treatment against their will, enduring traumas like forced hospitalizations, aversion, and electroshock therapy. Fortunately, there have been great strides made in the nearly 35 years since the American Psychiatric Association removed homosexuality from the Diagnostic and Statistical Manual of Mental Disorders, or the DSM. Despite this, there are still disparities and unequal treatment among LGBTQ groups seeking care. In fact, NAMI notes that some people have reported hiding their sexual orientation from those in the mental health system for fear of being ridiculed or rejected.
Though more therapists and psychiatrists today have positive attitudes toward the LGBTQ community, people still face disparities in the quality of the care they receive, due in large part to a lack of training and/or understanding among providers. Mental health providers still do not always have up-to-date knowledge of the unique needs of the LGBTQ community or training on LGBT mental health issues. Providers who lack knowledge and experience working with members of the LGBTQ community may focus more on a person’s sexual orientation and/or gender identity than a person’s mental health condition, which can often be counterproductive.
How You Can Help LGBTQ Individuals
For those who are not LGBTQ, it can often be challenging to know when or how to engage as an ally to LGBTQ individuals. Lindsey, who is sympathetic to this struggle, offered the following ideas for how you can get involved.
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- Start by educating yourself on the proper terminology to use with the queer community – i.e. asking a trans-identified person what their preferred gender pronoun is.
- Avoid expecting that a queer person will or can explain all things queer to you. Being asked to do this can itself, often be retraumatizing.
- Advocate for queer people’s rights within policy or join/donate to a queer organization.
- Even just talking to a friend and letting them know that you are a nonjudgmental ear that they can share their experiences with.
- Combatting or pushing back when others express misconceptions or when you see an act of oppression.
Tips for Finding and Talking to a Provider
While it’s not always easy to find, a supportive or allied mental healthcare provider, there are many great resources available to help individuals through this process. In fact, NAMI has a list of suggestions for individuals looking to locate an LQBTQ-inclusive provider:
- Use the Gay and Lesbian Medical Association’s Provider Directory to look through a list of inclusive medical providers.
- Check out the Healthcare Equality Index to find the LGBTQ-inclusive policies of organization leaders in healthcare.
- Review resources on the rights and experiences of LGBTQ people in mental health care, including the Center for American Progress and the National Transgender Discrimination Survey.
- Ask friends and local LGBTQ centers for referrals or suggestions of LGBTQ-friendly healthcare providers.
- Call ahead and ask if a provider you are considering has any LGBTQ patients.
- If you are uncomfortable about coming out and being open with your provider, bring a trusted friend or family member with you to your appointment.
They also provide a list of recommendations for how to talk to your provider:
- If you feel comfortable, come out when you meet with your provider.
- Ask questions about the provider’s experience working with LGBTQ people.
- Be confident about disclosing relevant information about your sexual orientation and/or gender identity.
- Be open about your thoughts and feelings of depression, suicide, anxiety, fear, and self-harm.
- Ask for more information about any health-care-related referrals, including to other therapists and psychiatrists.
Support & Resources
If you are experiencing a mental health condition, it’s possible to take control of your health care and improve your chance of recovery. There are several resources available:
- The Association for Lesbian, Gay, Bisexual & Transgender Issues in Counseling offers a list of resources for LGBT individuals and works to educate counseling professionals on LGBT issues.
- The Association of Gay and Lesbian Psychiatrists offers numerous resources for LGBT people who are experiencing mental health conditions, including a directory of LGBT-friendly therapists.
- The Center for American Progress offers a variety of resources, including a report called Why the Gay and Transgender Population Experiences Higher Rates of Substance Use.
- The GLBT National Help Center provides multiple resources and access to a hotline and a youth chat line.
GLSEN (the Gay, Lesbian and Straight Education Network) provides an annual report called the National School Climate Survey, which reports on the experiences of Lesbian, Gay, Bisexual and Transgender Youth in U.S. schools.
- The Pride Institute is an unlocked, LGBT-exclusive facility that offers a residential treatment program, including psychiatric care for depression, anxiety, and other needs.
- The Rainbow Access Initiative works to inform and educate health care providers on LGBTQ specific issues.
- The Trevor Project is a multimedia support network for LGBTQ youth providing crisis intervention and suicide prevention.