Among the biggest issues the LGBTQIA+ community faces globally, are mental health issues and the discussion around them is one that needs to be had over and over again, in order to establish change in the life of individuals, and shape communities into safer, caregiving spaces that can encompass them with support and compassion.
The following things need to be cleared up: what are the issues faced by the LGBTQIA+ community, and how do they vary among the different identities and intersecting groups its members belong to? What are the causes of these issues? What can we do to make society and the healthcare system more accessible, reliable and supportive for LGBTQIA+ people? How do we tackle these situations when we are LGBTQIA+ people dealing with mental health issues, or wish to become allies to these people?
Let’s start with the numbers. The LGBTQIA+ population in its total demonstrates higher rates of suicidal tendencies or performed attempts, depression, anxiety, PTSD, and other mental health issues, compared to the rest of the heterosexual, cisgender population. More specifically, a stark 34% of young LGB people have made one or more suicide attempts, 55% of LGB students have fallen victims of homophobic bullying in school, and the rates of bi and lesbian women facing chronic mental health issues are about 3-4 times higher than those of heterosexual women. As for gay men, depression seems to be six times higher the rate of affected straight men, and as for trans people, anxiety and depression affects nearly half of the population.
Of course numerous studies on the issue have been conducted. One can find them with a simple search and compare all the different results based on the goal, social context and target group of each study. Another research performed with gender non-conforming and LGBT young people showed how the negative experiences caused by homophobia and transphobia in a young age can lead to depression and other mental health issues later on in life.
For LGBTQ Youth the situation can be even harder, since it brings together all the issues young people face in Western countries in crisis today, together with the prejudice and the potential lack of support from the family and educational environment. This can also be demonstrated through the National School Climate Survey conducted by GLSEN (Gay, Lesbian and Straight Education Network).
But what causes these issues? A series of obstacles LGBTQIA+ people have to face everyday, some of them shared with non-LGBTQ people (such as self-esteem issues, biological and social reasons, unemployment, homelessness, family issues, grief etc.), but many of them experienced more deeply or with different nuances because of one’s identity under the LGBTQIA+ umbrella.
Homelessness and unemployment in themselves, along with other forms of discrimination in healthcare, employment, the academia etc. caused by the homophobia, biphobia and transphobia in our society, can lead to severe mental health issues. Past trauma coming from abuse, sexual harassment, manipulation, and bullying, often experienced by LGBTQIA+ people living in a homophobic, biphobic and transphobic society, contribute greatly to these issues. Isolation, internalized homo/trans-phobia, physical health problems are issues linked with LGBTQIA+ experiences and negatively affect our mental health.
Invisibility outside of and within the community, the anxiety of coming out, the pain that comes with the lack of acceptance from family and loved ones, erasure, insecurity, lack of (or negative) representation of our identities in public dialogue and media, intersecting oppressions one can face due to multiple co-existing identities (eg. being a woman, being black, being disabled, being of a non-dominant religion etc.), hatred phrased constantly in public discourse against LGBTQIA+ people, being told that our sexuality, gender identity, expression, or body characteristics are abnormal, being told that our problems aren’t valid and that we’re simply overreacting, and even a lack of understanding and validation from the very mental health professionals we may approach for support, are some of the most prominent issues that negatively affect the mental health of LGBTQIA+ individuals.
Of course, oftentimes the stigma and discrimination simply coexist and further affect pre-existing mental health or neurological conditions, such as anxiety, schizophrenia, borderline and bipolar disorder, and depression. There is also stigma in mental illness per se, and there is no way to make things better for mentally ill people than dismantling this stigma or neurotypicality and ableism.
Mental illness is not rare. 1 in 4 adults overall experiences mental illness every year and getting help in the US isn’t as easy as it sounds, especially for LGBTQIA+ people whom even the medical and psychiatric community may often view as abnormal and ill because of their sexuality or gender identity, and not in spite of it. This is a remnant of the past, when homosexuality used to be considered a mental illness and was included in the DSM (Diagnostic and Statistic Manual of Mental Disorders of the American Psychiatric Association) and it wasn’t removed until 1973. Today the trans identities are still pathologized by the ICD (International Classification of Diseases), but in the DSM only gender dysphoria is included.
In addition, the situation varies greatly when it comes to specific identities under the LGBTQIA+ umbrella. For bisexual people, even the alarming rates of mental health issues that we get from various researches are not fully accurate and reliable, since there isn’t enough bisexual-specific research. Still, the problems are very real and apparent in the bi/pan community, since these identities are often marginalized because of invisibility, exclusion and the invalidation of people’s identities. You can read more about the specific issues bi and pan people face here.
For trans people the situation can be even worse because of a special need many (but not all of) trans people have: to go through medical transition. In most Western countries a condition for that is to be assessed and certified by a psychiatrist, but due to the transphobia that still exists in the medical community that can be a great obstacle. Grave psychological problems can arise for trans people when they are not permitted an easy access to transition services. In addition, trans people (like all other people) face other mental health issues such as anxiety, PTSD and depression, which are not always linked to their gender identity, but because of it they are often denied proper medical and psychiatric care, and they can’t find proper health support for their problems. Here you can find great resources with studies, essays, stories and reviews concerning trans people, the issues they face, and how these affect their mental health.
There is also specificity in the issues faced by the Asexual community, due to internalized stigma and discrimination caused by a society that expects and demands from everyone to be sexually active, within or out of certain normative standards of what is considered a “healthy sexual life”. The study of asexual identities also isn’t supported by sufficient data, but here there also exists the problem of pathologization within the psychological and psychiatric community, and therefore the solutions sought are often ineffective and irrelevant to the real problems faced by asexual, grey-sexual or demisexual individuals.
A letter that often goes forgotten – and that is a grave flaw of our communities – is the I in the LGBTQIA+ that stands for Intersex people: the people who are born with sex characteristics (that means biology, not who we are attracted to, or our gender identity) that is to say chromosomes, internal and external reproductive organs, hormones, primary and secondary sex characteristics, that are atypical of what the medical society has classified as either “men” or “women”. Intersex people have through history, and continue to, undergo unconsented medical operations and other interferences in infancy that can lead to a very difficult life full of discrimination and the loss of bodily autonomy. Genital mutilation on Intersex children is actually considered to be a violation of human rights and a form of torture by the UN Committee against Torture.
Due to the trauma, stigmatization and marginalization many members of the Intersex community have to live with, the need for effective mental health support is urgent. Intersex activists, many of whom have undergone such inhumane treatment in their infancy, childhood and adolescence, call for the need of proper psychological support for Intersex children and adults, as well as for the need for community support.
Moreover, when it comes to people of color, there are added issues. For many people who are not white, finding proper mental health support is even harder due to stigma and shame that may exist in communities of color, as well as the lack of cultural competence. It’s also important to keep in mind that for many people whose first language is not English, it might be difficult to find a mental health professional who can work with them. Often people may prefer to seek help from a person they can relate with, whether that may be a person of color who is a mental health provider, or one who belongs in the LGBT community. Fearing you will be encountered with negative and discriminatory reactions can hold you back from seeking support.
But what is there to be done in order to ameliorate the mental health care system so that it can efficiently support LGBTQIA+ people? According to health professionals, legal and governmental prejudice and inequality can add to the already existing problem of discrimination, stigmatization and invisibility. Jack Drescher, clinical professor of psychiatry at New York Medical College, says: “The position statements of the American Psychiatric Association and American Psychological Association in support of marriage equality all reviewed the positive health benefits of marriage, in general, in making the argument that gay people should have access to those rights and benefits.”
If you are a LGBTQIA+ person dealing with mental health issues and don’t know where to start from, here are some great resources. Here is an article on dating while having mental health issues. Here is the Association for LGBT Issues in Counseling. This is a wonderful masterpost with personal stories, essays, art and writing on various mental health issues and LGBT. Here is a comic with survival tips for people who face mental health issues. The Trevor Project is a network for LGBTQ young people who seek support through crisis and offers suicide prevention.
It is vital to actively work towards the amelioration of the mental health care system so that it can include LGBTQIA+ people. The current situation when it comes to the prevention and support of mental health issues faced by LGBTQIA+ people is not sufficient to solve the real problem of stigmatization and lack of understanding of the obstacles we face every day.