Cultural Diversity Series:
Meeting the Mental Health Needs of
Gay, Lesbian, Bisexual and Transgender Persons
Executive Summary
People who are gay, lesbian, bisexual and transgender (GLBT) represent a substantial minority of the U.S. population, yet pervasive prejudice and stigma often inhibit the development and provision of appropriate services for them. This report provides basic information regarding common mental health concerns of GLBT persons to aid in the development of culturally competent mental health services and supports.
Sexual Minority Identity Development
Not all GLBT individuals are at the same stage of self-acceptance and identity development; some may be afraid or ashamed of their feelings while others are quite comfortable with themselves and with publicly disclosing their sexual minority status. Skilled mental health interventions with gay, lesbian or bisexual consumers include an assessment of where the individual is in the process of identity development and an awareness of how their stage in development affects their mental health, stress levels, self concept and access to social supports. Sexual minority individuals who are also ethnic minorities often experience a "dual oppression" that requires that they cope with racism as well as homophobia; GLBT persons with mental illness experience similar dual stigmatization.
Special Concerns of GLBT Youth
Providers and agencies must be aware of the special needs of GLBT youth, who face complex developmental tasks in an atmosphere that often includes isolation, hostility, prejudice and potential danger. They may be the targets of harassment from both peers and adults. As a result, GLBT youth are more likely to attempt suicide than their heterosexual peers, more likely to be victims of violence, and are disproportionately represented among homeless and runaway youth.
Prevalence and Effects of Violence
Against Sexual Minorities
The prevalence and social acceptance of prejudice and violence against sexual minorities impose unique stressors on their mental health and well being. One study estimates that 40 percent of gays have been victims of violence because of their sexual orientation and that family members were responsible for this violence in 49 percent of the cases. Hate crimes against transgender persons tend to be more severe and more often lead to murder. Effects of such victimization may include lowered self-esteem, shame, guilt, depression, school-related problems, running away and homelessness, post-traumatic stress, substance abuse and suicide.
Substance Abuse
Research findings vary on rates of alcohol and drug abuse among lesbians and gay men, but experts maintain that drug and alcohol abuse are significant health and mental health concerns for sexual minorities. One study found that lesbians and gay men were twice as likely to be moderate drinkers, but about equally as likely to be heavy drinkers, as heterosexuals. Experts note the likelihood of a link between internalized homophobia, low self-esteem, ongoing discrimination and increased use of alcohol and drugs. GLBT consumers who seek treatment for substance abuse problems may encounter barriers to treatment in unsupportive service settings.
Suicide
One study found that lesbian, gay or bisexual students and those who had had same-sex experiences were four times more likely to have attempted suicide than heterosexual students. Ethnic minority gays and lesbians may be at higher risk for suicide attempts than white gays and lesbians. Heterosexual youth who have been victims of anti-gay harassment also have shown higher rates of suicide attempts, suggesting a direct relationship between discrimination and self destructive behaviors. Several factors are associated with higher risk for attempting suicide, including coming out at a younger age, loss of others to suicide, gender identity concerns, rejection due to sexual orientation, and substance use or abuse.
Transgender Concerns
Some individuals choose to challenge societal norms regarding sex roles, but do not question their own anatomical gender. Transsexuals are persons with a persistent sense of schism between their anatomical sex and their felt gender identity; they typically report gender identity confusion dating from as early as age 3 or 4. Transgendered persons often suffer lifelong persecution and misunderstanding. They may seek therapy for a variety of reasons, including depression, suicidal thinking, and a range of complex feelings related to their gender identity concerns, or to pursue comprehensive assessment, diagnosis, and referral for medical treatments.
HIV and AIDS
AIDS is a highly stigmatized illness that disproportionately affects a variety of populations already stigmatized or underserved within the United States. Experts note that the uniquely stressful impact of the slow and progressively debilitating nature of HIV infection changes the mental health needs of infected persons at different phases of the illness; a model is offered for understanding these transitions. Clients with HIV express a number of common concerns, such as issues related to illness, sexuality, grief, isolation, or death and dying. Many of these can be challenging to providers; it is important that providers and agencies develop strategies for avoiding provider "burnout." Some special HIV concerns affecting sexual minorities include the effect of widespread loss and multiple bereavements on the GLBT community, and the unique needs of HIV-negative gay men.
Model Programs
The report concludes with profiles of model programs providing culturally competent mental health services to gay, lesbian, bisexual and transgender consumers. Each profile describes the program's philosophy and values, services and supports, funding sources and available evaluation data. The three programs featured are: