LGBTQ Mental Health: What Every Clinician Needs to Know

LGBTQIA individuals often face significant barriers in accessing the mental health services wherein the barriers to care includes fear or discomfort in disclosing their identity because of perceived or real biophobia, homophobia or transphobia due to differences set by culture and perception of the individuals, or assumptions on the intake of forms during health care encounters.

Moreover, the historic and continued pathologization of the individuals belonging to the LGBTQIA community by the psychiatrists/medical professionals, including previous experiences or stories of the “reparative” or “corrective” therapies along with the historical inclusion of homosexuality in DSM (removed in 1973) and the controversial continued inclusion of the gender dysphoria in DSM IV, may contribute to the mistrust of the mental health professionals on the part of the individuals that identifies as being a part of gender/sexual minority group. 

1. Dual Alienation

Dual Alienation refers to the idea that the individuals who belong to more than one marginalized group, are doubly marginalized. Individuals suffering from mental health concerns who are also identified to be belonging to the LGBTQIA community fall under two traditionally marginalized groups. If they also happen to belong to other marginalized groups based on their race, socio-economic status, ability, or other factors, the marginalization they experience can be cumulative and more complex.

2. Increased Risk

Individuals who belong to gender or sexual minority groups have an increased risk for some mental health concerns. For eg, LGBT identified individuals have 2-6 times higher lifetime risk for depression or suicide as compared to the general population. Also, among trans-identified individuals, the statistics on suicidality are astonishing, with 77% of respondents in the Canadian study reported that at some point in their lives, they have seriously considered suicide and 43% reporting that they had made at least one suicide attempt in their life. In a large study done on 6450 respondents who are identified as gender variant, 41% reported attempting suicide at some point in their lives. 

Moreover, the increased risk for various mental health concerns in this population/community could be mostly because of marginalization, discrimination, and homophobia, biphobia, or transphobia, rather than something inherent to having the LGBTQIA identity.

Marginalization, discrimination, and homophobia/biophobia or transphobia rather than something inherent to having the LGBTQIA identity can be the factors that resulted in the increased risk of various mental health conditions among this population. The members of this community experience increased vulnerability to mental health concerns due to the factors such as bullying, discrimination, violence, etc, the potential, the loss of support, and facing rejection from the family and friends. In a study done on LGBT identified youth, those who came from highly rejecting families were 8 times more likely to have attempted suicide as compared to the peers who reported low or no rejecting from the family.

3. Education and training

It is seen that in most health care programs, there is a lack of training on concerns related to LGBTQIA. In a study done in North America over 150 schools, the median number of hours of education which was dedicated to LGBTO related concerns was only 5 hours, and more than half of the schools reported having 0 hours of clinical training related to LGBTQIA. This lack of education and acceptance can prove to have a negative effect on the care for this population and further contributes to barriers faced by individuals accessing safe culture, high quality, and appropriate mental health care.

Moreover, some clinical also adopt a neutral position on the concerns of their client’s gender identity and sexual orientation, believing that these concerns do not or should not affect their treatment in any way. However, neutrality can equate to dismissiveness in this stance, which doesn’t take into account the person’s identity and life experiences (ie. Does not incorporate an understanding of biophobia, homophobia, or transphobia along with the experiences of discrimination or marginalization).

4. Treatment approaches

Whilst there are certain unique risks and concerns among LGBTQ identified individuals that need to be emphasized that LGTBQ individuals also have many of the same concerns as the general population goes through. Mental health professionals should be mindful of taking a client-centered, holistic approach by treating each client as a unique individual whole rather than a collection of risk factors.

Another important issue to reflect upon is that the LGBTQIA populations are often combined as a single entity for clinical or research purposes wherein each of these identities represents a distinct population with their own specific health needs. The experiences of LGBTQIA individuals are not uniform and are shaped by intersectional identities and factors such as ethnicity, race, socio-economic status, disability, geographical location, age, and religion.

5. Access and Quality of care

To improve access and quality of mental health care for individuals who are identified as LGBTQIA, professionals need to become allies to this marginalized community. The professionals can create a safe space and support the members of the community by:

How to be an Ally

1. Reflect on your feelings and reactions.
2. Examine your language use.
3. Speak up when you see insensitivity, discrimination, and gaps in knowledge action.
4. Advocate for policy changes that are LGBTQ-affirmative.
5. Include gender identity, sexual orientation, and gender expression in a zero-tolerance discrimination policy at your organization.
6. Come out as an ally!

Creating a positive space in mental health care settings requires more than simply placing a rainbow sticker on the clinic office door, it requires multiple layers of action which demonstrates to LGBTQ clients that their concerns and identity are important and normalized as a part of the diversity wherein all clients are equal. There are various ways to create an LGBTQIA positive space in the mental health care facility, such as:

Positive space for safety and acceptance

1. Use of inclusive language during the interview and the intake of forms.
2. Reflect the language used by the client including the use of preferred pronoun or name.
3. Do not make any assumptions about the client’s sexual orientation or gender identity.
4. Display posters, pamphlets, or signs that are inclusive for the members of the community.
5. Offer gender-inclusive washrooms
6. Accept and celebrate diversity
7. Post a non-discrimination policy that includes gender identity, sexual orientation, and gender expression.

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