What Being L, G, B, or T, Means for Your Mental Health
AHP’s Growing Beyond Disparities symposium presented in honor of the agency’s 30-year anniversary showcased leading researchers in mental health on August 2, 2014. The audience was treated to presentations of cutting-edge research, covering the L, G, B and T, which reflected a wide range of findings, and included education about the history of the LGBT movement. Participants had an opportunity to listen to lively discussion between researchers while engaging in conversations with the panelist about what health care providers should (and shouldn’t) be doing to create affirming environments for their clients.
According to the researchers at the symposium, we have a long way to go before we have the sort of robust data that might inform LGBT mental health services. Epidemiologist Susan Cochran opened up the day by discussing the way mental health research has been conducted in the past and the importance of improving our research methods for the future. Cochran first showed examples of national surveys that did not ask sexual orientation at all, and then reminded the audience that even asking sexual orientation alone is not the answer since it does not always describe a person’s sexual behavior. “Who we see is one thing,” she emphasized, “who is out there is a whole different thing.” Cochran’s colleague, Vickie Mays, argued that future research must pay special attention to the racial minorities who are most at risk. Lack of resources, low economic and social status, and poor living circumstances make LGBT individuals of color at higher risk for depression, stress, and substance abuse.
Esther Rothblum reminded the audience that the Diagnostic and Statistical Manual of Mental Disorders, the bible of mental health care, was not actually reprinted to remove homosexuality as a mental illness until 1980 and still in 1987 homosexuality was listed as an “ego-dystonic mental disorder.”During her talk on transgender mental health care, Jae Sevelius highlighted “micro-aggressions,” the subtle “everyday” language that presumes a person’s gender and sexual identity. Sevelius urged health professionals to rid their own practices of such micro-aggressions in a variety of contexts, from the greetings delivered by front-desk staff, to the choices health questionnaires offer for characterizing sexual or personal identity, and the bias communicated in bedside manner.
According to Gregory Herek, we need to put LGBT identity in the context of history before we understand how to treat the mental health issues that LGBT people face today. He recounted how LGBT and non-gender conforming behaviors were first seen as religious sins, then as criminal acts, and finally, medicalized into a mental illnesses. These different views—which still resonate within U.S. culture—continue to influence the ways that society characterizes gay, bi, lesbian, transgendered, or queer people and the way LGBT people think about themselves. Herek asserted that although we’ve made great strides in the last decade to bring visibility to the LGBT community, we must continue to advocate for the social change and openness that is necessary for us to attain true LGBTQ wellness.
Ilan Meyer likewise acknowledged all the successes the LGBT community has achieved in the past 20 years. But he wondered if homophobia is declining, shouldn’t we see the same sort of decline in suicide rates in LGBT youth? He posed the theory that with all the recent legal triumphs of LGBT folks, perhaps there’s been a backlash against the LGBT community. Rafael Diaz focused on the stigma surrounding HIV and remarked, “there’s something about belonging to the gay community that is healing . . . but there are people who get left behind.” Diaz also underscored the tenacity of racism and prejudice—both externalized and internalized—within the gay community and recognized it as a sign of how far we still need to go.
While the topics discussed by our presenters were as diverse as our community, and there is much more to discuss, one sentiment rang clear: we must change the status quo approach to conducting research and providing mental health services to the LGBT community. We need to advocate for funding for additional research, and we need to pay attention to those who are most at risk within the LGBT community, such as people of color, low income, and immigrant community members. Finally, we need to ensure that the law advances with the research and that all people in the LGBTQ rainbow are included and protected in our research and service delivery systems.