Understanding the Needs of Lesbian, Gay, Bisexual, and Transgender People Living With Mental Illness

Christian Huygen, PhD

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In This Article

Mental Health Concerns of LGBT Consumers

A study by Lucksted,[1] commissioned by the Center for Mental Health Services, found that a number of issues and problems were frequently cited by hundreds of LGBT mental health consumers across the country. In mainstream mental health settings, they often feel compelled to hide their sexual orientation or gender identity; conversely, in the LGBT community, mention of their mental health status is often unwelcome. In addition, most programs and practitioners seem to assume that LGBT people do not exist, and that all their clients are heterosexual. LGBT patients say they are often made to feel that their care providers neither understand nor like them, and that any exploration or expression of their sexual or gender identity is further evidence that they are mentally ill. Moreover, especially in inpatient units and day programs, other consumers are frequently derogatory or even threatening toward LGBT patients. The mental health staff is often slow to discourage this behavior. These instances of homophobia and heterocentrism within the mental health system needlessly impede the recovery process and the effectiveness of the treatment and services being provided.[13]

Unfortunately, mental health professionals have helped to create this unacceptable situation. Until 1973, the American Psychiatric Association (APA) defined homosexuality as a mental illness. LGBT people with mental illness are acutely aware of their dependency on their care providers, and often hesitate to do anything that might cause providers to withdraw their care and support. Many LGBT people have experienced the loss of friendships, family relationships, and the support of religious communities as a result of disclosing their sexual or gender identity. This often leaves LGBT individuals with a sense of hypervigilance toward cues that a particular individual may or may not be supportive and affirming. Given the healthcare profession's history of stigmatizing and pathologizing patients' sexuality, care providers are, unfortunately, in a position of "guilty until proven innocent" in the eyes of many LGBT patients. Unless they do something to demonstrate the potential to accept and affirm patients' choices regarding the expression of their sexual or gender identity, patients are likely to assume that their providers will reject and stigmatize them.

Even in a large, sophisticated metropolitan center such as New York City, I have heard numerous LGBT mental health consumers say that they are not comfortable disclosing their sexual or gender identity to their therapists or psychiatrists. One woman continued to see a therapist she knew was homophobic, and avoided disclosing her sexual identity or relationships to him because, as she put it, "I needed him. There's a lot of things I need to get off my chest." Another patient pointed out that according to the APA, homosexuality is no longer a mental illness and was told by his psychiatrist, "Yes, but in your case it is a mental illness." Both consumers stated that their ability to freely discuss their sexuality in these treatment relationships was nonexistent (personal communications with author by members of Rainbow Heights Club, 2004).

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