We all experience emotional ups and downs caused by events in our lives. Mental health conditions, however, go beyond common emotional reactions to specific situations. They are medical conditions that can cause intense changes in our moods - how we think and feel.
The lesbian, gay, bisexual, transgender, queer and questioning (LGBTQ) community can face mental health conditions just like the rest of the population. However, the LGBTQ experience may be even more intense due to isolation, prejudice and other social issues. Knowing the challenges you may face as a member of the LGBTQ community with a mental illness and how to find LGBTQ-inclusive providers will help ensure more positive outcomes.
How Do Mental Health Conditions Affect the LGBTQ Community?
LGBTQ individuals are almost 3 times more likely than others to experience a mental health condition such as major depression or generalized anxiety disorder. Fear of coming out and being discriminated against for sexual orientation and gender identities, can lead to depression, post-traumatic stress disorder, thoughts of suicide and substance abuse.
LGBTQ people may experience stigma and prejudice based on their sexual orientation or gender identity while also dealing with the societal bias against mental health conditions. Some people report having to hide their sexual orientation from those in the mental health system for fear of being ridiculed or rejected. Some hide their mental health conditions from their LGBTQ friends.
Prejudice & Stigma
Often termed “minority stress,” disparities in the LGBTQ community stem from a variety of factors including social stigma, discrimination, prejudice, denial of civil rights, abuse, harassment, victimization, social exclusion and family rejection.
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. Though not all people will face mental health challenges, discrimination or violence, many people report less mental well-being and satisfaction.
The LGBTQ community is at a high risk for suicide. The risk is higher when peer support is lacking, or a person faces harassment, mental health conditions and substance abuse issues. For LGBTQ people aged 10–24, suicide is one of the leading causes of death. LGBTQ youth are 4 times more likely and questioning youth are 3 times more likely to attempt suicide, experience suicidal thoughts or engage in self-harm than straight people. Between 38-65% of transgender individuals experience suicidal ideation.
Family support plays a particularly important role in affecting the likelihood of suicide. Someone who faced rejection after coming out to their families were more than 8 times more likely to have attempted suicide than someone who was accepted by their family after revealing their sexual orientation.
Major factors contributing to substance use by LGBTQ people include isolation through prejudice, discrimination, lack of cultural competency in the health care system and lack of peer support.
An estimated 20-30% of LGBTQ people abuse substances, compared to about 9% of the general population.
25% of LGBT people abuse alcohol, compared to 5-10% of the general population.
LGBTQ young people face fear, hatred and prejudice in school, with friends, in the community and at home, which can lead to higher risks of self-harm and thoughts of suicide. LGBTQ teens are six times more likely to experience symptoms of depression than the general population. Additionally, LGBTQ youth struggle in coming out to family members, friends, classmates and teachers, especially those that are not accepting of the LGBTQ community.
GLSEN, the Gay, Lesbian and Straight Education Network has developed 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.
Early intervention, comprehensive treatment and family support are the key to helping LGBTQ youth on the road to recovery from a mental health condition. There are many resources available to help teens and young adults, including the It Gets Better campaign and The Trevor Project, which provides a national, 24-hr, toll-free confidential suicide hotline for LGBTQ youth at 866-488-7386. The Trevor Project also provides an online chat and confidential text messaging—text “Trevor” to 202-304-1200.
Disparities in Care
The history of mental health treatment of lesbian, gay, bisexual, transgender and questioning (LGBTQ) populations is an uneasy one. 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.
Though more therapists and psychiatrists today have positive attitudes toward the LGBTQ community, people still face unequal care due to a lack of training and/or understanding. Health care 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.
Finding A Provider
You may feel hesitant to access care because you fear being discriminated. While these concerns are completely understandable, it is important to seek help.
Finding a mental health care provider who understands your personal experiences and how they affect your mental health will help you in your recovery. Try to find a mental health provider you can trust. You should feel comfortable with your provider, so you can be open and feel safe. Ideally you will find a provider that is LGBTQ- friendly and knowledgeable about the specific cultural considerations and issues faced by LGBTQ individuals with mental health conditions.
Come with questions you want to ask so that you can be better prepared to share your concerns. After your initial visit think about your interactions. Did this person seem at ease with you? Did he or she talk openly about your sexuality or gender identity? Did you feel comfortable?
Here are some ideas to help 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.
Tips for Talking 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 many 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.
This article is contributed by NAMI, National Alliance on Mental Illness. For more information, go to https://www.nami.org/Find-Support/LGBTQ. If you would like to speak with someone at NAMI in Sonoma County, call (707) 527-6655 or go to https://namisonomacounty.org/
If you are experiencing mental health symptoms, you can call Aurora Santa Rosa at 877.717.0085 to speak with a professional or make an appointment for an assessment.