LGBT Individuals & Mental Health: What You Need to Know

June 11, 2015

The impact of stigma and discrimination on the mentally ill is well documented.  Being a lesbian, gay, bisexual or transgendered (LGBT) individual compounded with a mental health diagnosis just magnifies the effects of discrimination and stigma, and these individuals often confront seemingly insurmountable barriers to health care.

In a 2011 study, 50% of a sample population reported having to teach their medical providers about transgender care. (transequality.com/ngltf)  In a 2006 survey of medical students, 15% reported mistreatment of LGBT students within the school, and 17% of LGBT students considered their school environment to be hostile.  (AAMC)  In order to foster healthy communities, it is crucial that we bring awareness to this issue, and here are a few reasons why:

  • LGBT youth are 2 to 3 times more likely to attempt suicide.
  • LGBT populations have the highest rate of tobacco, alcohol, and other drug use.
  • LGBT youth are more likely to be homeless.
  • Lesbians are less likely than heterosexual women to get preventative services for cancer.
  • Lesbian and bisexual females are more likely to be obese.
  • Transgender individuals have a higher prevalence of mental health issues, and are less likely to have health insurance.
  •  (The National LGBT Health Education Center)

In the human services industry, being culturally competent is of crucial importance.  Cultural competence involves the ability to honor and respect beliefs, styles, attitudes and behaviors of persons across all cultures and ethnicities and to incorporate those values into their treatment.  Cultural competence is formed on a foundation of respect and empathy, and it includes comprehensive understanding and active information seeking on the part of the professional.  In health care, sexuality and sexual history are important factors to consider during assessment and treatment planning.  It is paramount to avoid judgement or bias and assure confidentiality when discussing these issues, as this is a marginalized population that has been historically discriminated against and misunderstood.  Sexuality and gender issues are highly politically charged and often controversial, especially in recent years.  As transitioning and sexual re-assignment have emerged to become part of the public dialogue, terms and definitions have also evolved.  Many people do not understand what the “T” stands for in LGBT.  It stands for “transgender” and is used to describe the sexuality of people who persistently identify their gender as the opposite to that of their biological birth.  Transgendered people feel that their gender identity/gender expression differs from any prevailing ideas of masculinity or femininity.  Often, they will undergo hormonal or surgical treatments so that their biological sex is congruent with their identified gender.   The following are some key definitions that may be helpful in seeking to enhance cultural competence with regards to this population:

Cross-sex hormone treatment: The use of feminizing hormones in an individual assigned male at birth based on traditional biological indicators.  Or the use of masculinizing hormones in an individual assigned female at birth

Gender Assignment: Biological sex at birth

Gender Dysphoria: The clinical diagnosis that indicates significant distress due to incongruence between one’s expressed gender and one’s assigned gender *

Gender Expression: Characteristics in appearance, personality, and behavior, culturally defined as masculine or feminine

Gender Identity: One’s basic sense of being male, female, or other gender (transgender, gender queer, etc.).  One’s gender identity can be congruent or incongruent with one’s sex assigned at birth based on external genitalia.

Gender Re-assignment: An official change of gender

Natal Gender: Gender assignment at birth

Sex: The biological indicators of male and female (understood in the context of reproductive capacity), such as sex chromosomes, gonads, sex hormones, and non-ambiguous internal and external genitalia.

Sexual Orientation: An individual’s physical and/or emotional attraction to the same and/or opposite gender.  Someone who feels a significant attraction to both sexes is said to be bisexual.

Transgender: People whose gender identity or gender expression differs from their birth sex.

Transsexual: A person who lives or seeks to live as a sex not associated with their birth sex after a process called “transitioning”, which may or may not include sex reassignment surgery or hormone therapy.

*It is important to note that Gender Dysphoria should be distinguished from non-conformity to gender roles.  Gender Dysphoria is accompanied by marked distress and impairment in social functioning and a strong desire to be of another gender.  See DSM-5 for more information on diagnostic critera.

Resources and support for professionals, consumers and advocates:

www.lgbthealtheducation.org

www.jointcommission.org/lgbt

www.transhealth.ucsf.edu

www.glma.org

www.nachc.com/client/lgbtinformationbulletinaugust20072.pdf

www.iom.edu/reports/2011/the-health-of-lesbian-gay-bisexual-and-transgender-people