Queer Cafe

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LGBTQ People and Mental Health Issues in the Workplace

Most LGBTQ people have had mental health issues because of their jobs. Mental health issues in the workplace are a common occurrence for LGBTQ people, according to a poll conducted by YouGov on the behalf of Business in the Community and Mercer.

72% percent of LGBTQ employees have experienced mental health issues as a result of their workplace.

The survey also showed that a little more than a quarter of LGBTQ employees are not open about their sexual orientation in the workplace, and 28% of LGBTQ upper management and owners have been encouraged to hide their sexual orientation.

What’s more, people of color who were also LGBTQ were twice as likely to face negativity from customers and clients than their white LGBTQ counterparts.

Customers or colleagues have physically attacked 7% of LGBTQ workers, with that number rising to 13% among blue-collar workers. That also includes 15% of people of color, 20% of non-binary identified people, and 30% of seniors.

Additionally, 9% felt that being seen as LGBTQ prevented them from getting a job or a promotion, with 6% saying that it as a significant factor losing a job in the past year.

According to the report, good employee mental health is crucial to running a successful, sustainable organization. These numbers point to failures in handling employee mental health, particularly for LGBTQ and other minority populations in the workplace.

The report, titled “Seizing the Moment,” is Business in the Community’s 2018 report on mental health at work.

[Source: Gwendolyn Smith, LGBTQ Nation, October 2018]

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Promoting LGBTQ Student Well-Being

Research shows that LGBTQ youth are disproportionately bullied (whether in person or via cyberbullying), verbally and physically harassed, and assaulted in schools by peers and staff. Such hostility has been correlated to lower school performance and psychological and emotional distress, including suicidal ideation and attempt, depression and anxiety.

In the 2015 GLSEN (Gay, Lesbian & Straight Education Network) National School Climate Survey, LGB students reported higher levels of verbal, physical and sexual violence and bullying than did their heterosexual counterparts. Specifically, 98.1 percent of LGB students heard the word “gay” used in a derogatory manner, 85.2 percent reported verbal harassment, and 34.7 percent reported being physically harassed in the past year. In addition, a 2017 meta-analysis of 27 empirical studies on the effects of cyberbullying on LGBTQ youth revealed that compared with their heterosexual and cisgender counterparts, these students are disproportionately harassed online and through other technology-based means. Such harassment has been correlated to a range of behavioral and emotional difficulties, including suicidal ideation (with some studies suggesting rates as high as 40 percent among LGBTQ youth) and suicide attempts (with rates as high as 30 percent).

Many LGBTQ students identify school counselors as the one school staff member to whom they are most likely to disclose concerns related to their sexual and gender identity. Given this reality, school counselors are uniquely positioned to address myths about LGBTQ youth, to advocate for these students and to effect change.

[Source: Counseling Today / Abreu, McEachern, Hall, Kenny / October 2018]

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How Do Mental Health Conditions Affect the LGBTQ Community?

Without mental health we cannot be healthy. We all experience emotional ups and downs from time to time caused by events in our lives. Mental health conditions go beyond these emotional reactions to specific situations. They are medical conditions that cause changes in how we think and feel and in our mood.

The lesbian, gay, bisexual, transgender, queer and questioning (LGBTQ) community faces mental health conditions just like the rest of the population. However, you may experience more negative mental health outcomes due to prejudice and other biases. Knowing what challenges you may face as a member of the LGBTQ community and how to find and work with LGBTQ-inclusive providers can help ensure more positive outcomes.

LGBTQ individuals are almost 3 times more likely than others to experience a mental health condition such as major depression or generalized anxiety disorder. This fear of coming out and being discriminated against for sexual orientation and gender identities, can lead to depression, posttraumatic stress disorder, thoughts of suicide and substance abuse.

LGBTQ people must confront stigma and prejudice based on their sexual orientation or gender identity while also dealing with the societal bias against mental health conditions. Some people report having to hide their sexual orientation from those in the mental health system for fear of being ridiculed or rejected. Some hide their mental health conditions from their LGBTQ friends.

As a community, LGBTQ individuals do not often talk about mental health and may lack awareness about mental health conditions. This sometimes prevents people from seeking the treatment and support that they need to get better.

[Source: National Alliance on Mental Illness]

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LGBTQ Health Report

The Division of Gender, Sexuality & Health, at the New York State Psychiatric Institute and the Columbia University Department of Psychiatry, wrote this report regarding LGBTQ health issues.

Background

Over the past decade, and especially in the past few years, there have been sweeping changes in US society, law, and public policy, including the following:

--In 2003, the Supreme Court invalidated all remaining anti-sodomy laws in its ruling in Lawrence v. Texas.

--In 2004, individual states began adopting same-sex marriage.

--In 2010, the “It Gets Better” online campaign was launched, a signal of growing societal support for LGBTQ youths, parents, and families. It now has over 50,000 videos and 50 million views on YouTube.

--In 2011, the federal government repealed the “Don’t Ask, Don’t Tell" policy in the military and articulated LGBTQ rights as a foreign policy goal.

--In 2011, the Institute of Medicine (IOM) released a report on the health of LGBTQ people. Federal agencies such as CDC, SAMHSA, and others have also highlighted the issue.

--In 2012, marriage equality was endorsed by President Obama, the Democratic Party’s platform, and a plurality of poll respondents.

--In 2013, President Barack Obama, in his second inaugural address, articulated equality for a LGBTQ people as a priority area of his administration.

--In 2013, the Supreme Court allowed the restoration of marriage equality in California and struck down the provision of the Defense of Marriage Act (DOMA) that prohibited the federal government from recognizing married same-sex couples.

--In 2014, a range of challenges to state same-sex marriage bans are being pursued and the federal government continues to proactively implement the Supreme Court's partial overturning of DOMA.

--In 2015, the US Supreme Court legalizes same-sex marriage nationwide.

Troubling Statistics

Despite these advances, the health and mental health of lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals has emerged as a major concern across the nation. Numerous examples of stigmatization, discrimination and health inequities have been documented, including the following:

--Increased rate of suicide attempts and of homelessness among LGBTQ youth (Estimates indicate that as many as 40% of homeless youth are LGBTQ).

--Decreased utilization by lesbians of preventive services for cancer and increased risk factors and elevated rates of cancer (Estimated relative risk of invasive breast cancer among lesbians is 1.74).

--Higher risk of HIV and STDs among gay men, especially in communities of color (From 2006-2009, gay men accounted for 56-61% of all new HIV infections; MSM 13–29 represented more than 27% of all new HIV infections; among MSM 13-29, HIV among black MSM was up 48%).

--High prevalence among transgender individuals of HIV/STDs, victimization, mental health issues, and suicidal ideation (41% of trans respondents reported suicide attempt vs. 1.6% of the general population; 23% were impacted by at least three major life-disrupting events due to bias.)

--Barriers to health faced by elderly LGBTQ individuals because of isolation, and lack of social services and culturally competent providers (Older LGBTQ people are 2 times as likely to live alone; 1/3 plan to hide LGBTQ status if in long-term care).

Higher rates of mental health morbidities and tobacco, alcohol, other drug use (Alcohol abuse and smoking are more than 2 times greater among LGBTQ people).

--A significant proportion of people with serious mental illness (SMI) in the US are LGBTQ (Estimates suggest that about 720,000, or about 4% of people with SMI, are LGBTQ).

At the same time, new areas of concern are also emerging across the lifespan, such as:

--children "coming out" at ever-younger ages.
--schools trying to tackle the problem of bullying.
--early medical interventions becoming available for transgender youth.
--new family dynamics emerging among same-sex couples who are legally married and/or who are raising children.
--the first large cohort of openly LGBTQ people becoming senior citizens.

These are no longer merely potential or emerging issues with regard to mental and physical health. Rather, they are immediate and pressing needs demanding focused efforts in research, clinical practice, education, and public policy. Yet far too few LGBTQ individuals, particularly from within poor and marginalized communities have access to the quality services they need. Through the LGBTQ Health Initiative, we aim to address these and many other related issues.

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LGBTQ Wellness Notes: Risk Factors

Some of the health concerns and risk factors that are relevant to LBGTQ individuals may be shared by the general population, while others are more specific to the LGBTQ community, and still others are specific to different subgroups of LGBTQ individuals. These health concerns may be grouped into the following areas of concern:

Sexual behavior issues: STDs such as human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS), hepatitis A virus (HAV), hepatitis B virus (HBV), bacterial vaginosis, gonorrhea, chlamydia, and genital warts (human papillomavirus or HPV); anal, ovarian, and cervical cancer.

Cultural issues: body image, nutrition, weight, and eating disorders; drug and alcohol abuse; tobacco use; parenting and family planning.

Discrimination issues: inadequate medical care; harassment at work, school, or home; difficulty in obtaining housing, insurance coverage, or child custody; violence.

Sexual identity issues: conflicts with family, friends, and work mates; psychological issues such as anxiety, depression, and suicide; economic hardship.

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LGBTQ Psychological Concerns

Mental health practitioners are seeing a new cadre of psychological concerns in their work with lesbian, gay, bisexual and transgender clients. In the 32 years since patrons of the Stonewall Inn challenged police who raided the now-famous gay nightclub, lesbians, gays and bisexuals have grown in personal and political power, creating their own communities and finding acceptance in traditional ones as well.

Conversations taking place in today's therapy offices reflect this change. Although many LGBTQ people still bring issues of discrimination and fear of rejection to their psychologists' offices, they are just as likely to discuss such mainstream issues as parenting and fears about aging. Meanwhile, new trends have emerged in therapy, too, as younger generations of LGBTQ people wrestle with problems such as a resurgence of HIV infection among gay male youth and changing identity issues. Likewise, groups that have been more closeted, including transgender people, are finding their voice and appearing more often in treatment to work on identity and relationship concerns.

"Some issues haven't changed much at all since Stonewall, and others have changed dramatically," comments Doug Haldeman, PhD, a clinical faculty member at the University of Washington and an APA Council representative. "People still need help with coming out--when, how and to whom. Some cultures within our culture are still very homophobic." At the same time, Haldeman says, psychologists are seeing "a whole host of other issues related to the creation of LGBTQ families, LGBTQ people in the workplace, generational differences and the reality of multiple-minority identities--issues that demand our best research and clinical skills."

Generation gaps

Psychologists working with LGBTQ clients are finding the need to tune in to generational differences, experts note--whether it's understanding young LGBTQ clients' new ways of thinking about their sexuality or assessing reasons for depression in older gay men.

Many LGBTQ youth, for instance, now call themselves "queer" as a blanket term for their community, and they're more likely to accept variations in their ranks than previous generations, says Beth Firestein, PhD, a private practitioner in Loveland, Colo., and editor of "Bisexuality: The Psychology and Politics of an Invisible Minority", a compendium of research on bisexuality. In communities that include lesbians and bisexual women, for example, "there's more unity and community, cooperation and friendly relationships now than there was 10 or 15 years ago," she says.

Esther D. Rothblum, PhD, a professor of psychology at the University of Vermont, agrees it's more common for today's young LGBT people to express and accept fluid gender and sexual identities. "In the generation before mine, if you went to a lesbian bar and didn't identify as either butch or femme, they'd think you were an imposter," she says. "Now young lesbians are just as likely to say they feel butch one day and femme the next."

Another strong feature that distinguishes younger lesbians from their Baby Boomer counterparts is their lack of identification with the feminist movement, says sex therapist Suzanne Iasenza, PhD, a professor of counseling at the John Jay College of Criminal Justice in New York. "Their attitude is, 'What does my sexuality have to do with politics?'" says Iasenza. "You're not likely to find them saying they're lesbian as a statement against patriarchy or because they don't like the way men take over their bodies or their lives."

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Gay men, young and aging

Some young gay men are presenting a serious challenge for practitioners. Since protease inhibitors were introduced in the mid-1990s, researchers have reported a surge in the number of young gay men who practice unsafe sex, known these days as "barebacking," in part because they thought the drugs would protect them from HIV's worst effects.

Columbia University HIV-prevention researcher and clinician Alex Carballo-Dieguez, PhD, says that in addition to barebacking, he's spotting a body-image problem among his young gay clients. "Twenty years ago, your body image was about what you wore, how you wore your hair and so on," Carballo-Dieguez says. "Now, it's about the transformation of the body itself. These guys want to reshape their bodies to make them look a certain way"--muscled and perfectly toned. "A lot of times that's achieved with chemicals, hormones and even surgery," he says. This obsession becomes especially problematic when it comes to partner-shopping, with clients looking for Mr. Right only if he's also Mr. Buff, Carballo-Dieguez says.

To combat this problem, he has clients walk through their own sexual and emotional histories and take a realistic look at themselves. "They get to see that they've never been satisfied with the guys they score with," he says. "They're never certain that they're attractive enough or that the other person's attractive enough." This insight can help them stop the appearance-obsessed merry-go-round, he says. Gay men in their 40s and 50s also bring a "looks" challenge into therapy, says Haldeman.

"Middle-aged gay men face tremendous challenges because we grew up in such a youth-oriented gay culture," says Haldeman, who's 50. "Thirty-five is seen as old, and 50 is ancient! That's a blow to our narcissism. Not only are we not the pretty things when we walk into the bar, we're the age of the parents of the pretty things." Haldeman urges such clients to take a life inventory, to look at the past and see what's valuable there. "They need to ask themselves, 'Am I on a path where, when I look back, I'll be satisfied with my life?'" he says.

The silver lining to their aging regrets: "Thank God we're aging," Haldeman adds. "We buried so many of our generation years ago. So we have a special joy and appreciation of life that we might not otherwise have had."

Coming out, parenting

LGBTQ clients of all ages are still likely to face coming-out issues, clinicians report. Young people, though, are more likely to face a host of post-coming-out problems, since many are likely to already have come out to their parents, says Marny Hall, PhD, a psychotherapist and researcher in the San Francisco Bay area. While that's often good news, she observes, often their parents' acceptance is conditional. "Parents tend to display a sort of limited tolerance for their 'queer' kids--what I call tolerance without equality," Hall says. "The clients I see are constantly confronted with issues like this."

LGBTQ clients are also dealing with the flip side of that equation: being parents themselves. Many lesbians and gay men are the first generation of homosexuals to have children who are becoming teens. Some have found that while as younger children they had no problem accepting their gay parents, as they move into adolescence, some teens start to feel embarrassed by their parents' homosexuality, says Haldeman. "Some young people are really conflicted and may try to hide the fact they have two same-sex parents by having the parents pick them up from school in some secret location," he says--dynamics that affect the child's relationship with parents and peers and the parents' relationship.

Another spin on the parenting issue is that today, gays and lesbians have children not only from dissolved heterosexual marriages, but from broken-up gay relationships as well, Hall adds. Conflicts involving children of same-sex unions present particular difficulties because the legal ground for same-sex couples and their child-custody rights "is shifting all the time," she says. "When there are no clear guidelines, what often substitutes are conflicts within the couple," Hall says. "Relationship problems can really get played out in this arena." Psychologists are helping these clients separate parenting problems from relationship problems and devising solutions that don't require legal structures to implement, she says.

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Gender-blending and fluid identities

A final theme clinicians report in their practices is more questioning and fluidity around gender identity and sexual attraction. While these issues are central in the lives of transgender people, others are questioning these elements of identity and expression too, therapists report.

"Gender identity and sexual identity issues have frayed more and more around the edges," says Hall. And there's a greater emphasis on the "questioning" category. On one hand, there's a push for LGBTQ young people to come out at earlier ages, she notes; on the other, more young people are pausing indefinitely in what she calls the "lingering" category. "There are no more givens about gender identity," she says. "Young people don't take sexual identity for granted."

Bisexuals represent another group that turns conventional thinking on its head, says Firestein. "Often bisexuals want to label themselves as lesbian or gay because occupying a middle ground is so difficult in a culture that dichotomizes sexual orientation and gender identity," she says. Conventional thinking has it that if bisexuals are attracted to people of both sexes, they must have more than one partner, and that defies society's value on monogamy. Bisexuals tend to internalize this social tension, Firestein says, so a common therapeutic question is, "If I identify as bisexual, what does that mean about my choice of partners?"

To help bisexual clients face this concern, Firestein conducts an exercise demonstrating that the number of partners you have and your sexual orientation exist on different dimensions. As two examples, you can be monogamous and bisexual, and you can be heterosexual and have more than one sexual partner.

For transgender folks (people who have nontraditional gender identity or expression) issues include coming to terms with their feelings about their true gender and then deciding whether and how to act on those feelings. In her work with transgender people, New York City private practitioner and gender expert Katherine Rachlin, PhD, notes that transgender people struggle not so much with who they are as with finding ways to fit into a society that doesn't understand them. She says that transgender people, who do not identify as either male or female, sometimes work on accepting a fluid gender identity. More often, Rachlin says, they choose to identify as one gender or the other because it's too challenging to live in a gender-dichotomous society otherwise.

Therapy with transgender people requires extra education and perception, Rachlin believes. She spent hundreds of hours with this community before she had a good understanding of how to work with "trans" clients, she says. In her 15 years of being involved with the trans community, Rachlin has appreciated learning a new and different way of looking at gender. "There's a great mystery that underlies transgenderism, and it does change the way you see the world," she says. "I had to redefine male and female, man and woman, for myself. These concepts are now disproven to me."

[Source: Tori DeAngelis, Syracuse, NY, Feb 2002]

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Unique Strengths of the LGBTQ Community

In the face of oppression, minority groups develop unique LGBTQ strengths and character traits.

It sometimes feels like every day brings with it a new study about minority stress, reports about public policy that neglects or harms LGBTQ Americans, or a news item about the horrific treatment of transgender people in the workplace. And while it’s hugely important to identify and discuss the microaggressions and overt discrimination that all LGBTQ people face, this continued emphasis on the negative aspects of being an LGBTQ individual is ultimately an incomplete picture of what it means to be queer these days and can lead to self-perpetuating patterns of defeatism.

The persistence that’s been required of the LGBTQ community in the face of continued oppression has actually given way to a unique set of strengths. While our backgrounds are as distinct and varied as our personalities, LGBTQ individuals are strong, creative, funny, interesting, and above all, resilient. Research shows that for the queer community, what doesn’t kill us really does make us stronger.

We’re Socially Intelligent

Studies show that LGBTQ people tend to possess high levels of social intelligence and the skills related to perceiving and using emotional information to make decisions in social interactions. LGBTQ people have the ability to get along with others, get them to cooperate with you, and successfully navigate complex interpersonal interactions.

Researchers suggest that the experience of being a sexual or gender minority actually fosters social and emotional intelligence. For example, it was found that bisexual people are more capable of modifying their behavior to address unique situations and problems compared to both their heterosexual and homosexual counterparts — a trait that researchers describe as “cognitive flexibility.” Another study found that trans men and women had high levels of social intelligence, based on insights into what it means to experience life beyond the gender binary.

Because LGBTQ individuals are statistically more likely to be minorities in group settings, they learn to modify their behaviors and reactions in order to minimize aggression or suspicion from their peers. This generally results in the ability to “read a room” and evaluate the “correct” social responses. And while these motivations are symptoms of an insidious, culturally enforced intolerance, they’ve given way to an adaptive social skill set that cisgendered heterosexual people are less likely to possess.

We’re Courageous

Research shows that, because LGBTQ individuals are essentially required to cope with near-constant minority stress, bravery is likely to be an LGBTQ strength. In a culture where threats of physical violence, job discrimination, social exclusion, and political inequality are condoned by the federal government, the LGBTQ community encounter near-constant risks that their heterosexual counterparts rarely face. The process of coming out and confronting heteronormativity on a daily basis requires bravery on a daily basis.

We’re Empathetic

When surveyed, LGBTQ people indicate that the process of coming out involves a tremendous amount of personal insight and reflection — exercises that ultimately improved their ability to empathize with others. This self-reinforcing chain positively reclaims power for individuals and reinforces good stereotypes while disrupting negative ones. LGBTQ people transform reactions to institutionalized oppression and stigmatization into empathy and social activism.

We’re Authentic

LGBTQ people feel less pressure to conform to societally defined roles and narratives like getting married or having children on a certain timeline — or at all. Other themes included freedom from gender-specific roles within relationships or society at large, freedom to explore sexuality and relationships, and freedom to enjoy egalitarian relationships, which all lead to authenticity being a particular LGBTQ strength. One lesbian explained that being lesbian allows us to choose to have children and how to raise children in ways not claimed by straight women. One gay man noted that there is less pressure on gay men to have children and, as such, the decision for a gay man to have or not to have children may involve a healthier process.

We’re Resilient

On a daily basis, LGBTQ people are faced with oppression from political and social forces and have to find construction ways to cope. When LGBTQ individuals are actively involved as change agents they are better insulated against the damage wrought by anti-LGBTQ politics and legislation. Becoming involved enhances individuals’ ability to cope and builds resilience for the future. Nearly three quarters of LGBTQ individuals demonstrated at least one of five “resilience factors” that helped them in coping with adversity, including social support, connection with the LGBTQ community, emotional coping, self-acceptance, and positive reframing.

Because LGBTQ individuals are more likely to face identity-related discrimination and accompanying emotional hardships than their straight counterparts, they often have no choice but to develop resilience. This breeds a unique strength of character that is not so ubiquitously present in majority groups.

We’re Highly Creative

The experiences of LGBTQ individuals have not only necessitated heightened social awareness and resilience, but creativity in how queer people choose to craft their own stories and invent themselves. Without established narratives against which to chart their experiences, members of the LGBTQ community have been liberated to form tight-knit social circles, families of choice, and safe spaces that celebrate shared identity traits. Creativity is largely seen as an LGBTQ strength, and there is quite a bit of evidence to support that LGBTQ people tend to be creative.

Focusing on the Positive

It’s imperative that research into the LGBTQ experience look beyond the negative aspects of belonging to a sexual or gender minority group. Ultimately, only looking at the hardships we face ignores the incredible things we’ve built despite those hardships. And while raising awareness into the realities of both the systemic and social discrimination that we face on a daily basis is necessary, so too is examining the ways in which our community has persevered and grown.

Equipped with empathy, resilience, strength of character, and a tight-knit community support system, there’s no telling what we’ve yet to accomplish.

[Source: Lighthouse 2018, Michelle D. Vaughan & Eric M. Rodriguez 2014, Julie Konik & Mary Crawford 2014, Laura Brown 1989]

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