LGBTQIA+ Mental Health: A Complete Guide

Mental health in the LGBTQIA+ community is something we need to talk about. Why? The answer is simple. The lesbian, gay, bisexual, transgender, queer or questioning, intersex, and asexual or allied (LGBTQIA+) population has staggering statistics surrounding mental health and wellness. In fact, according to recent studies:

A reported 48% of LGBTQ youth engaged in self-harm, and 40% have considered suicide, within the last year.
LGBTQIA+ youth are two times more likely to report extreme feelings of hopelessness or sadness than others. 

68% of LGBTQ youth say they’ve had symptoms of a generalized anxiety disorder…in the last 14 days.

But adolescents and youth aren’t the only ones who are affected by mental health concerns. Young adults and older adults are in need of help, too.

A LGBT person is twice as likely to live alone and be single — studies show that loneliness can shorten life by 15 years. 
53% of older LGBT people feel isolated.
Sexual minorities are more likely to have mental health issues and substance abuse issues. 
An estimated 58% of transgender people had at least one Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnosis in a recent study.

With all of these alarming statistics, we need to talk about LGBTQIA+ mental health. We can’t afford to keep not talking about it. Where and how you can find mental health services or help is important, and we’re dedicated to ensuring you know as much as possible about common issues and conditions, risk factors, and LGBTQIA+ therapy resources.

Common LGBTQIA+ Mental Health Issues

There are several LGBTQIA+ mental health issues to be aware of. Many of them stem from the discrimination and oppression that those who identify as LGBTQIA+ experience throughout their lives. 

Before we begin to discuss what types of mental health struggles the LGBTQIA+ community may face, the most important thing to note is that they do not have a mental illness or disorder. 

That said, there are a number of mental health struggles that the LGBTQIA+ community may experience. For example, a person in the LGBTQ community may feel fear or shame that can add to their struggles with mental health. It’s also common for the LGBTQ community to: 

Deal with depression or depressive symptoms
Have anxiety
Have suicidal thoughts, tendencies, or attempts

Looking at factors that can impact LGBTQIA+ mental health can help us better understand what we can do and where to find mental health services or help.  

Risk Factors That Can Impact LGBTQIA+ Mental Health

There are multiple risk factors that can have a significant effect and impact on those who are LGBTQIA+. 

“LGBTQIA+ individuals are at higher rates for depression, anxiety, suicidality, substance use disorder, homelessness, and unemployment. The coming out process can be difficult, especially for a LGBT youth. This process can be very anxiety-provoking, and it can be very difficult if the young person does not have supportive friends or family members to navigate work, school, and relationships. Additionally, mental health outcomes for this community are poorer than for heterosexual individuals. There can be issues of bias and discrimination in treatment. LGBTQ therapists can offer useful guidance, reassurance, and advice to help you navigate difficult situations without causing further anxiety.”

Talkspace therapist Reshawna Chapple, Ph.D., LCSW

Some of the most important risk factors to recognize are listed below.

The decision to come out

Despite the fact that we see increased societal acceptance for the LGBTQIA+ community, much work still needs to be done. Many still feel that the social experiences they have after coming out contribute to a negative mental health impact. This is especially true for those who aren’t in supportive or accepting environments.

Making the decision to come out as a young person might be one of the bravest things you’ll ever do in life. For many people, it doesn’t come easy. However, therapy can help you feel confident and give you the strength you need to live an authentic life and be true to yourself.

Trauma

Many young adults in the LGBTQIA+ community report experiencing some form of discrimination in their life. Homophobia, transphobia, biphobia, LGBTQ bullying, and more can all contribute to identity-based shame that’s traumatic for individuals. 

People report feeling labeled, being denied opportunities, being stereotyped, or experiencing mental, verbal, or physical abuse as a result of their identity. Many times, this trauma can result in severe mental health conditions such as post traumatic stress disorder (PTSD).

Trauma can contribute to many mental health conditions. Through therapy, you can learn how to handle harmful thoughts or behaviors and heal from trauma you’ve experienced in your life.

Rejection or fear of rejection

The fear of rejection after coming out, or actually being rejected after coming out, would be difficult for anybody. Particularly if it’s family members or close friends who aren’t accepting, the mental health impact of rejection can be traumatic and extremely difficult to navigate.

Whether you’ve recently come out and are facing rejection, or you want to come out but are afraid of being rejected, a good therapist can help you set boundaries and heal from your fear or pain. 

“Navigating relationship stress is difficult enough without having to explain what it feels like to be part of this community. There can also be guilt, shame, or embarrassment associated with their sexual orientation. LGBTQ-friendly therapists can offer useful guidance, reassurance, and advice to help you navigate difficult situations without causing further anxiety,” Chapple said.

Homelessness

It’s a staggering statistic: it’s estimated that LGBTQIA+ youth have a 120% higher chance of becoming homeless in their lifetime. 

Some of the challenges members of the LGBTQIA+ community face that often contribute to homelessness include family rejection, discrimination at work, school, or home, and an increased chance of abuse and harassment in their social and living environments. 

Support and therapy is available and can be helpful if you’re having trouble finding housing or need resources to find a safe space. 

Substance use or abuse

Substance use or abuse can be overwhelming for members of the LGBTQIA+ community. The following statistics around LGBTQ substance abuse speak volumes.

Adults who identify as LBG are more than twice as likely to have a substance use disorder.
Those who identify as transgender are almost 4 times as likely as those who are cisgender to have a substance abuse disorder. 
School-aged youth who identify as LGB, or those who are not sure about their identity, report a much higher instance of illicit drug use than peers who identify as heterosexual do.

Group or individual therapy can be helpful in managing addiction. It can help you learn better, healthier coping techniques if you’re using substances to mask any pain. 

Mental health care that’s inadequate or ineffective

Unfortunately, inadequate or inappropriate mental health care is common for the LGBTQIA+ community. The biggest issue comes from the fact that often the approach taken in addressing sexual orientation or gender identity and mental health is lumped together as one large issue. Yes, it’s true that some challenges do tend to overlap across identities. But there are separate, specific, and important needs that are within each individual group. 

Everything from the challenges faced, to the conditions experienced, should be addressed and treated from a unique and individual standpoint. Treatment and therapy should be directly based on each person’s own needs and goals when seeking mental health treatment. 

Barriers to proper mental health care

Other important factors when looking at mental health care for the LGBTQIA+ community are the barriers they’re likely to face simply even accessing care. Economic status, race, and other identity factors can all have a strong impact on what type of care someone receives. It’s essential that we address these barriers and focus on LGBTQIA+ inclusive mental health care that’s specific to individual identities and needs. 

Therapy can help you on a number of fronts. Finding the right therapist will be instrumental in how effective your treatment is. 

Suicide

The LGBTQIA+ population is at a higher risk than cisgender or heterosexual populations when it comes to thoughts of suicide or direct suicide attempts. Depression, anxiety, isolation, a history of mental health struggles, and other mental health conditions are all contributing factors to the increased risk for suicide.

Therapy can offer a much-needed outlet to learn coping techniques and strategies to handle suicidal ideation and thoughts you may be experiencing. 

The Importance of LGBTQIA+ Friendly Therapy

As we discussed previously, therapy can be intrusive and ineffective — even harmful — if it’s not coming from a productive and skilled place. If you’re looking for a LGBTQIA+ friendly therapist to help you navigate your identity, you might want to actively try to find someone who understands your specific needs and goals. An LGBTQIA-competent therapist will be skilled at working with the LGBTQIA+ community.

“LGBTQ individuals can have poor mental health outcomes and difficulty connecting with therapists, especially if the therapist they’re working with is not culturally responsive. “A therapist who has a background working with this population can generally connect more quickly  to get to the root of the problem to establish a better connection in therapy.”

Talkspace therapist Reshawna Chapple, Ph.D., LCSW

How to Help Yourself or Someone You Know

If you or someone you love is looking for an LGBTQIA+ therapist, or needs help navigating any mental health struggles, you can find the help you’re looking for. Finding the right therapist may not be as difficult as you might expect. And, resources for LGBTQ teens and adults are more accessible.

Identify your goals and what you’re looking for. Do you want a therapist who identifies like you do? Are your mental health conditions linked to or rooted in your identity or sexual orientation? Are you transgender and seeking professional support for gender-affirming care? All of these are things you may want to think about when looking for a therapist.

Ask for referrals. If you don’t have someone in your life you can get a referral from, there are online mental health professional directories you can start with. Filter search results by specialty or competency, and look for therapists who have experience working with the LGBTQIA+ community. Finding an LGBTQ-friendly therapist ensures mental health care is tailored to you. You can also check community centers, health centers, community groups, social organizations, or support groups for recommendations or referrals.

Reach out. Making that first call might feel overwhelming, and that’s OK. If it’s just too hard to do on your own, there’s no shame in asking a friend or family member you trust to make that first call for you.

Ask questions or interview. Be upfront about the fact that you’re looking for a therapist who’s specifically skilled in working with the LGBTQIA+ population. If you’re unsure how to go about this, keep it short and simple. 
Introduce your identity, and ask what experience they have working with others who identify like you do.
Ask if they have certifications or training specific to working with the LGBTQIA+ population.
It may feel awkward, but keep in mind that therapists and doctors are prepared for these types of questions. Any therapist worth working with will welcome them. Their goal is to give the best care possible and ensuring that a therapy relationship is going to work well is their number one priority.

Begin working on building trust and a relationship. Once you find a therapist you want to work with, you can begin meeting with him or her and forging a relationship based on trust. Be prepared that you may not end up working with the first therapist you reach out to. That’s fine – it’s more important that you find the right fit, so to speak, than it is to start working with somebody who’ll ultimately not benefit you and your needs.

Sources:

1. LGBTQ+ Communities and Mental Health. Mental Health America. https://www.mhanational.org/issues/lgbtq-communities-and-mental-health. Accessed September 5, 2021.

2. LGBTQ+ Mental Health: Insights from MHA Screening. Mental Health America. 

https://www.mhanational.org/lgbtq-mental-health-insights-mha-screening. Accessed September 5, 2021.

3. 9. LGBTQI | NAMI: National Alliance on Mental Illness. Nami.org. https://www.nami.org/Your-Journey/Identity-and-Cultural-Dimensions/LGBTQI. Accessed September 5, 2021.

4. Mason, MA, LPCC S. Mental health challenges in the LGBTQ community | HealthPartners Blog. HealthPartners Blog. https://www.healthpartners.com/blog/mental-health-in-the-lgbtq-community/. Accessed September 5, 2021.

5. Missed Opportunities: LGBTQ Youth Homelessness in America. Voicesofyouthcount.org. https://voicesofyouthcount.org/wp-content/uploads/2018/05/VoYC-LGBTQ-Brief-Chapin-Hall-2018.pdf. Published 2018. Accessed September 5, 2021.

6. Medley G, Lipari R, Bose J. Sexual Orientation and Estimates of Adult Substance Use and Mental Health: Results from the 2015 National Survey on Drug Use and Health. NSDUH Data Review. https://www.samhsa.gov/data/sites/default/files/NSDUH-SexualOrientation-2015/NSDUH-SexualOrientation-2015/NSDUH-SexualOrientation-2015.htm. Published 2016. Accessed September 5, 2021.

7. Wanta J, Niforatos J, Durbak E, Viguera A, Altinay M. Mental Health Diagnoses Among Transgender Patients in the Clinical Setting: An All-Payer Electronic Health Record Study. Transgend Health. 2019;4(1):313-315. doi:10.1089/trgh.2019.0029.

8 YOUTH RISK BEHAVIOR SURVEY DATA SUMMARY & TRENDS REPORT. Cdc.gov. https://www.cdc.gov/healthyyouth/data/yrbs/pdf/trendsreport.pdf. Published 2017. Accessed September 5, 2021.

9. Suicide Risk and Prevention for LGBTQ People. Lgbtqiahealtheducation.org. https://www.lgbtqiahealtheducation.org/wp-content/uploads/2018/10/Suicide-Risk-and-Prevention-for-LGBTQ-Patients-Brief.pdf. Published 2018. Accessed September 5, 2021.

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