Queer Cafe

What’s Good About Being Gay?: Perspectives From Youth
Healthline: Finding an LGBTQ Affirming Therapist
Research: Unique Stressors for Gay Men

Kelsey Darraugh: Bisexual Comic Gets Real About Mental Health

Info: Addiction and Recovery

Queer Youth Mental Health: Biomedical Model May Reduce Stigma but Obscure Impact of Cisheterosexism
APA: Psychologist Guidelines for Working With LGBTQ Clients

Jamie Feldman Video: Health Promotion Strategies for LGBTQ People

Research Update: Crucial Role of Community Members in the Lives of LGBTQ Youth

Research Update: Crucial Role of Community Members in the Lives of LGBTQ Youth

It’s safe to say that middle school and high school can be some of the best and worst years of our lives. For some, it depends on what classes you’re taking, what activities you’re in, how many friends you have, or what your report card says. But what about how your gender expression and sexual orientation are affected by these extremely formative years?

All youth have natural have ups and downs in their feelings of safety and belonging, and their relationships within their community, but a Search Institute study revealed a profound gap between LGBTQ youth and non-LGBTQ youth in regards to developmental relationships and feelings of belonging within one’s community.

In 2018, 11 public schools from a rural region in Minnesota participated in a survey through Search Institute that asked a multitude of questions ranging from students’ feelings of safety and security in their communities to how students view their relationships with friends and family. This survey also allowed the students to anonymously identify as lesbian, gay, bisexual, transgender, queer, or gender non-conforming, which offered us more comparisons across differences. Of the 3,011 6th- through 12th-graders who participated, 545 (18%) identified as a member of the LGBTQ community.

When compared to non-LGBTQ youth in these communities, LGBTQ youth were less likely to report:

--Feeling safe (particularly emotionally safe), accepted, and that they belong in school.
--Feeling secure with their future paths.
--They are glad they are themselves and they believe in themselves.
--They have strong relationships with family members, especially parenting adults.

In almost every facet of this survey, non-LGBTQ youth were more likely to report positive experiences than their LGBTQ peers. Focus areas of questions included interest and participation in the community, time spent outside of school, experiences in the community, perceptions of self and future, school experiences and attitudes, and experiences and priorities in their relationships. Through the analysis, some discrepancies were particularly striking:

--LGBTQ youth were much less likely to report strong developmental relationships with parenting adults, grandparents, and community adults, and slightly less likely to report strong developmental relationships with friends and teachers.
--39% of LGBTQ youth say that they have no strong developmental relationships in their lives, whereas only 25% of non-LGBTQ youth say they have no strong developmental relationships in their lives.
--LGBTQ youth were much less likely to report that they felt like they belonged and were valued in their community, were safe (particularly emotionally), and had opportunities in their community when compared to their non-LGBTQ peers.
--LGBTQ youth were much less likely to report having strong goals and a hopeful future when compared to their non-LGBTQ peers.
--LGBTQ youth were much less likely to report feeling glad they are themselves and believing in themselves.
--LGBTQ youth are less likely to report positive school experiences and attitudes when compared to their non-LGBTQ peers for all questions except, “I enjoy learning.” 50% of both non-LGBTQ and LGBTQ youth said they enjoy learning.

Movement Advancement Project’s 2019 report Where We Call Home: LGBTQ People in Rural America echoes the findings from our study. They also found that LGBTQ youth in rural communities often struggle to find a sense of belonging, perhaps as a result of not having access to spaces where they feel safe to be their authentic selves (Movement Advancement Project, 2019). According to the Movement Advancement Project, LGBTQ groups, allies in schools, and shared community spaces are vital but are not always experienced by youth. Organizations and individuals in rural communities can leave LGBTQ youth feeling isolated from the rest of the community if they’re not intentional about inclusivity.

Similarly, parents of LGBTQ youth in rural communities may experience less access to information and fewer support systems. They may also be less likely to seek out resources, as it can be very hard for some parents to accept or advocate for their LGBTQ child (Movement Advancement Project, 2019). This can often leave the child isolated from their family members, forcing them to seek support elsewhere. We see some evidence of this pattern in the survey in the LGBTQ youth who reported similar levels of developmental relationships with friends and teachers as their non-LGBTQ peers, but were less likely to report strong developmental relationships with family members.

According to the survey, LGBTQ youth in these communities spend significantly less time participating in activities or programs in a religious community than their non-LGBTQ peers. Participation in faith communities is often a significant part of the lives of people in rural communities, including LGBTQ folks. However, it tends to be easier to find LGBTQ-accepting congregations in urban areas than it is in rural areas, and this can often lead to rejection or the feeling of not being welcome for many LGBTQ folks (Movement Advancement Project, 2019). According to the Movement Advancement Project, this can cause a ripple effect of disconnection to one’s community, when the religious community is a center point of the rural community experience. This disconnection deprives LGBTQ youth of crucial support, resources, relationships, and opportunities to contribute that a faith community has the potential to offer.

Consistent with many other studies, recent Search Institute research published in the Journal of Youth and Adolescence highlighted the higher rate of suicide attempts among LGBTQ youth—particularly transgender youth (published in Pediatrics)—compared to non-LGBTQ youth. Those risks are well known. The study in these rural communities points to some of the ways communities can make a difference.

In 2019, the Trevor Project released a national study that, along with many other important findings, uncovered that having at least one supportive adult in the life of a young person who identifies as LGBTQ reduces the chance of a suicide attempt by 40%. This study and future Trevor Project studies hope to better understand the association between supportive adults and the alleviation of minority stress (the stress placed on an individual who is a part of a marginalized group) on LGBTQ youth.

Of course, supportive adults and friends cannot, and should not, take the place of mental health or crisis services. At the same time, LGBTQ youth should not be left to their own devices to sort out questions of identity and belonging in the community, only to seek help when they reach a serious crisis point. Being a supportive adult or friend is something everyone can and should do.

As community members, we cannot continue disregarding the feelings and experiences of LGBTQ youth. You don’t have to be someone’s parent to be a supportive adult; support to youth from a marginalized group can come from neighbors, teachers, coaches, community leaders, and everyone in between. Based on this survey, LGBTQ youth in rural communities can really benefit from more supportive, inclusive, and accepting community members who aren’t legally obligated to care for them.

Change can happen in many ways at many levels. As community members, we have the ability and responsibility to support diverse and marginalized groups, and that includes LGBTQ youth. That support can start by being part of a web of positive developmental relationships that value, guide, care for, respect, inspire, and open up new possibilities for them as they navigate issues of identity, growing up, and feeling that they belong and have a positive future.

[Source: Mackenzie Steinberg, Research and Development Communications VISTA at Search Institute, January 2020]

Study: Gay & Bi Teen Boys Are Coming Out to Parents in Record Numbers
What’s Good About Being Gay?: Perspectives From Youth

Survey: More Than 1 In 3 LGBTQ Youth Experience Discrimination At Work
Many LGBTQ Youth Don’t Identify with Traditional Sexual Identity Labels
Trevor Project: 40 Percent of LGBTQ Youth Considered Suicide in the Past Year
Survey: More Than Half of LGBTQ Youth Have an Eating Disorder
SAIGE: Society for Sexual, Affectional, Intersex, and Gender Expansive Identities

LGBTQ Mental Health Blogs

Instagram Accounts to Follow that promote LGBTQ Mental Health...

Therapy To A Tea, Company
@therapytoateaco

Expansive Therapy
@gaytherapy

The Trevor Project: Suicide Prevention and Crisis Intervention
@trevorproject

The LGBTQ Psychologist: Dr. Glenn Mason
@the.lgbtq.psychologist

Wednesday Holmes
@hellomynameiswednesday

Psychology Help: Best LGBTQ Friendly On-Line Counseling

Why is the LGBTQ Community so Anxious?

Video: Sociocultural and Behavioral Detriments to LGBTQ Health

SAIGE: Society for Sexual, Affectional, Intersex, and Gender Expansive Identities

Why is Depression More Prevalent in the LGBTQ Community?

Info: Domestic Violence

Best On-Line Therapy Services for the LGBTQ Community

NAMI: LGBTQ Mental Health

High Rates of Depression Among Rural LGBTQ Population
Talk Space: On-Line LGBTQ Therapy

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]

Huff Post: LGBTQ Wellness

Pride Counseling

What’s Good About Being Gay?: Perspectives From Youth

Internalized Homophobia: What is it? And How Do You Overcome it?

NAMI: How Mental Health Conditions Affect LGBTQ Community

Jennifer Potter Video: Health Promotion Strategies for LGBTQ People

Mental Health Challenges for LGBTQ Youth

LGBTQ Life Center

Why is Depression More Prevalent in the LGBTQ Community?

Research: Unique Stressors for Gay Men

Witter Wellness Collective: Active LGBTQ Support Groups

Info: Healthcare

Queer Youth Mental Health: Biomedical Model May Reduce Stigma but Obscure Impact of Cisheterosexism

Good Therapy for LGBTQ Persons

Family Doctor: LGBTQ Mental Health Issues

Unique Strengths of LGBTQ Community

Havello: LGBTQ Social Haven

Pride Counseling: On-Line Therapy

You Are Beautiful

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]

NAMI: How Mental Health Conditions Affect LGBTQ Community

2018 Survey: LGBTQ Youth and Suicide

Scott Leibowitz Video: Health Promotion Strategies for LGBTQ People

Family Doctor: LGBTQ Mental Health Issues

Kelsey Darraugh: Bisexual Comic Gets Real About Mental Health

Info: Alcohol/Drug Abuse

NAMI: LGBTQ Mental Health

Psychology Help: Best LGBTQ Friendly On-Line Counseling

Ethical Guidelines for Professionals Working With LGBTQ Clients

Mental Health Issues Lesbian Women Cope With

What’s Good About Being Gay?: Perspectives From Youth

SAIGE: Society for Sexual, Affectional, Intersex, and Gender Expansive Identities

Bolstering Resilience in LGBTQ Youth

Gay Man and His Psychologist

Best On-Line Therapy Services for the LGBTQ Community

Internalized Homophobia: What is it? And How Do You Overcome it?

Video: Stress and Resilience in the LGBTQ Community

APA: LGBTQ Health Disparities

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]

Mental Health America: LGBTQ Mental Health Notes

Research: Unique Stressors for Gay Men

Info: Reparative Therapy

Havello: LGBTQ Social Haven

APA: Psychologist Guidelines for Working With LGBTQ Clients

Jamie Feldman Video: Health Promotion Strategies for LGBTQ People

Why is the LGBTQ Community so Anxious?

Witter Wellness Collective: Active LGBTQ Support Groups

Pride Counseling

Video: Sociocultural and Behavioral Detriments to LGBTQ Health

Why is Depression More Prevalent in the LGBTQ Community?

Info: Domestic Violence

LGBTQ Life Center

High Rates of Depression Among Rural LGBTQ Population

Personal Shame: Internalized Homophobia

"Methinks thou dost protest too much."

-William Shakespeare

"They will call you the things that they themselves are or are afraid that others see them as."

-Psych Central

"Blaming and attacking you for what they fear is true in themselves."

-Very Well Mind

Internalized homophobia happens when bisexual men and women, lesbians, and gay men experience negative social attitudes and beliefs towards gay people and the gay community. In turn, they internalize those and develop feelings of self-hatred. This usually manifests as homophobic behavior towards themselves or other people in their community.

Other Terms For Internalized Homophobia

Not everyone agrees with the term “homophobia” to describe these perceptions and negative attitudes about queer people. After all, homophobia isn’t a phobia or fear per se but rather a pervasive set of biases, stereotypes, and negative attitudes towards queer people. As such, some folks prefer to use different terms to describe internalized homophobia, including:

Internalized homonegativity
Internalized sexual stigma
Heterosexism
Sexual prejudice
Antigay bias
Internalized oppression

What Causes Internalized Homophobia?

We live in a heteronormative society. Heteronormativity is the assumption that everyone is or should be heterosexual. This assumption leads to a prevailing stigma surrounding those who challenge or go against what is considered “the norm”.

As such, most of us are socialized from a young age into thinking that sexual minorities (anyone who isn’t cis or heterosexual) and anything related to them are strange, “abnormal”, or even morally wrong – and that these people should be avoided or made to feel ashamed for their same-sex attraction and sexual behavior.

Here are some of the biggest factors that contribute to internalized oppression:

Growing Up Around Homophobic Religious Conservatives

Most religious institutions condemn same-sex sexual behaviors, refuse LGBTQ people from leadership positions, and do not recognize same-sex marriage as a legitimate union. Some religious groups will also offer conversion therapy camps to those who want to rid themselves of their same-sex attractions.

However, studies have shown that not only is conversion therapy ineffective, it is also deeply harmful and can lead participants to experience psychological distress, depression, anxiety, and even suicidal tendencies. According to a study on religious affiliation and internalized homophobia in bisexuals, lesbians, and gay men, exposure to “non-affirming religion” is associated with higher internalized homophobia.

Lack of LGBTQ Representation

You’ll likely have heard that representation matters, whether it is an increased representation of people of color in films and television, or more positive portrayals of LGBTQ people in the media.

But why does representation matter? In a piece for Psychology Today, Dr. Jennifer O’Brien notes that when LGBTQ people see themselves represented in media, it can “foster a greater sense of affirmation of their identity” and can boost positive feelings of self-worth. On the other hand, when you don’t have LGBTQ role models you can look up to, or if you don’t see yourself in the media you consume, you can develop a sense that you are “invisible”, that you “don’t exist and you don’t matter”, or that there is something wrong with you.

Having A Limited Support System

Because an LGBTQ person is more likely to become a socially stigmatized person, it is important for them to have healthy relationships and support from friends and family. Without proper support, bisexual, lesbian, and gay people will have a harder time trying to overcome personal shame.

What Does Internalized Homophobia Look Like?

Here are some examples of how internalized homophobia can manifest in gay and bisexual men, based on the 1996 book Pink Therapy:

--You deny your sexual orientation or sexual identity to yourself and to other people.
--You have a very poor self-regard and feel like you aren’t “good enough” for the people you respect and admire.
--You feel like you can resist your same-sex desires and change yourself to become a completely heterosexual person.
--You can be obsessive about “passing ” as straight, believe that those who pass are better than those who are “obvious”, and monitor every aspect of your beliefs, behaviors, mannerisms, and language to prevent being “found out”.
--You attempt to distance yourself from LGBTQ people who are out and who are effeminate.
--You have very few interpersonal relationships with LGBTQ people, wanting no personal or social involvement with them.
--You attempt to overachieve because you believe that LGBTQ people need to prove their worth in society.
--You’ve experienced depression and anxiety from your shame.
--You resist your sexual feelings to the point where you end up engaging in unsafe sexual practices, such as having sex with people of the same sex without protecting yourself or learning their HIV status.
--You reinforce certain stereotypes about LGBTQ people to feel superior to heterosexuals (e.g. you believe that “gay men have a better fashion sense than straight men”).
--You tend to be attracted to unavailable and straight men, perhaps out of a deep-seated fear of pursuing a stable relationship.
--You prefer short-term relationships and avoid commitment.

Internalized homophobia can impact LGBTQ in a lot of different ways, which is what makes it so concerning. Here are some ways that internalized homonegativity can affect queer people:

Mental Health Issues

LGBTQ youth are more likely to be bullied than straight, cisgender youth. They are also more likely to have attempted self-harm and suicide than their peers. Rates of depression, anxiety, substance abuse, and other mental health problems are also higher among gay men and women than their heterosexual peers.

Relationship Issues

According to a 2009 study, internalized heterosexism resulted in lower quality relationships among lesbian women, gay men, and bisexuals.

This stigmatization of non-heterosexual identities can be seen and felt in places where we are supposed to feel safe and accepted, from home to school to our close friend groups to the workplace. When we feel that we are unable to trust those we are close to, we can develop an inability to form and maintain lasting and healthy relationships.

Higher Risk For STIs

STIs and HIV are among the leading health issues affecting lesbians and gay men. There is a negative stereotype that sexual minority adults like gay and bisexual men are more “promiscuous” and thus more susceptible to getting an STI.

However, many fail to realize that the shame and stigma surrounding queer sexuality, anal sex, STIs, and HIV in general lead many people to keep their status a secret. Because of this, LGBTQ people become more susceptible to getting sick and don’t get the care that they need.

How To Deal With Internalized Homophobia

So with all that being said, how can we combat internalized homophobia and the cultural and institutionalized heterosexism from which it stems?

According to Daniel Lyons in a piece for Psychology Today, the first step in dismantling the “deeply entrenched system homophobia” is acknowledging that everyone, regardless of race, sexual orientation, gender, or socioeconomic status, is capable of thinking or acting in a homophobic way.

Today, more and more people are challenging jokes and stereotypes about LGBTQ people, including ones that are shared by those in the community.

For example, drag queen Kim Chi performed the original song “Fat, Femme, and Asian” on the finale of her season of RuPaul’s Drag Race. The song is a biting commentary on internalized homophobia in the gay community and plays on the aforementioned “preferences” that gay men will use as an excuse for discriminating against more effeminate members of the community.

Filmmaker Jamal Lewis did the same thing, but a documentary rather than a song. Entitled No Fats, No Femmes, Lewis’ film features five black people of various backgrounds as they discuss the ways that desire among queer black people can be rooted in “problematic conceptions of different identities”.

Internalized homophobia is a systemic problem that runs deep – a symptom of the heteronormative society we live in. But it doesn’t have to keep affecting us. We just need to learn how to recognize the signs and commit to uplifting each other.

[Source: Matthew Walsh, LGBTQ Nation, January 2022]

Internalized Homophobia: What is it? And How Do You Overcome it?

Rainbow Project: Internalized Homophobia
Explaining Internalized Homophobia
Internalized Homophobia and Relationship Quality among Lesbians, Gay Men, and Bisexuals
What to Know About Internalized Homophobia
Revel and Riot: Internalized Homophobia

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.

Unique Strengths of LGBTQ Community
What’s Good About Being Gay?: Perspectives From Youth

Kelsey Darraugh: Bisexual Comedian Gets Real About Mental Health

HHS: LGBTQ Health and Wellbeing

Internalized Homophobia: What is it? And How Do You Overcome it?

HRC: Healthcare Equality Index 2018

Guide: Depression and Anxiety in LGBTQ People

Gay Man and His Psychologist

SAIGE: Society for Sexual, Affectional, Intersex, and Gender Expansive Identities

Scientific Report: Gay Couples are Less Stressful

Ethical Guidelines for Professionals Working With LGBTQ Clients

Psychology Help: Best LGBTQ Friendly On-Line Counseling

US Health & Human Services Reports: LGBTQ Health and Wellbeing

Queer Youth Mental Health: Biomedical Model May Reduce Stigma but Obscure Impact of Cisheterosexism

Info: Addiction and Recovery

Research: Unique Stressors for Gay Men

Best On-Line Therapy Services for the LGBTQ Community

Foundation for Better Understanding: The Health of LGBTQ People

Huff Post: LGBTQ Wellness
Video: Sociocultural and Behavioral Detriments to LGBTQ Health

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.

Unique Strengths of LGBTQ Community
Guide: Depression and Anxiety in LGBTQ People

US Health & Human Services Reports: LGBTQ Health and Wellbeing

Foundation for Better Understanding: The Health of LGBTQ People

Why is Depression More Prevalent in the LGBTQ Community?

Video: Sociocultural and Behavioral Detriments to LGBTQ Health

NAMI: How Mental Health Conditions Affect LGBTQ Community

High Rates of Depression Among Rural LGBTQ Population
LGBTQ Issues: Counselor Ethics

Resilience in LGBTQ Youth

Challenges LGBTQ Youth Confront

--Some 6%-10% of youth identify themselves as LGBTQ. Youth are “coming out” at earlier ages; as early as 13 years of age.
--80% of LGBTQ high school students report being verbally harassed, teased and 70% report being targets of sexual harassment and recipients of threats of physical harm because of their sexual orientation.
--80% report having been the target of mean rumors or lies. Some have been physically harmed.

As a result, they experience school as a “hostile environment,” and they are more likely to miss days attending school.

--63% felt unsafe at school because of their sexual orientation.
--29% skipped a day of school in the past month because of safety concerns. 28% of LGBTQ youth drop out of school due to harassment.
--LGBTQ youth often feel stigmatized, marginalized, excluded, ridiculed, victimized and fear disclosure (outing).
--The impact of such verbal and physical assaults are lower self-esteem, loneliness, isolation, lower academic performance, increased risk of anxiety, depression and suicide attempts.
--LGBTQ youth have a greater risk for suicide ideation and higher rates of suicide attempts than their heterosexual peers.
--LGBTQ youth are more than twice as likely to attempt suicide as their heterosexual peers, according to the Center for Disease Control and Prevention. The presence of comorbid psychiatric disorders such as depression, conduct disorders and substance abuse significantly increase suicidal risk.

Approximately 30% of LGBTQ youth attempt suicide at least once. Among those, approximately half have reported that the suicide attempt was related to their sexual orientation. Rates for suicide attempts in this population are commonly higher for male teenagers compared to their female peers. Factors associated with LGBTQ-related suicide attempts include early openness about sexual orientation, being considered gender atypical in childhood by parents, and parental efforts to discourage gender atypical behaviors. In a longitudinal study of specific risk factors in LGBTQ youth ages 16 to 20, a history of suicide attempts, impulsive behaviors, LGBTQ victimization and low social support were associated with greater suicidal ideation. This higher rate of suicide attempts occurs, especially if their gender identity has remained secret and there is accompanying anxiety over disclosure.

In a typical high school class of 30 students, one student will seriously consider suicide, 2 or 3 (one boy and two girls) will attempt suicide, and one student will make an attempt sufficiently harmful to require medical attention.

The challenges and impact vary for different subgroups, whether the youth is gay, lesbian, bisexual or transgender. For instance, transgender youth have the highest risk of self-harm and can be more stigmatized by peers than gay and lesbian youth. Sexual minority youth are particularly vulnerable. There is a need not to lump all of the LGBTQ youth into one group and a need to address their unique challenges.

It has been estimated that 1 in 8 youth in the US run away from home before age 18, and 40% do not return home. 40% of homeless youth are LGBTQ. The families’ rejection of the youth’s sexual orientation is often a major factor contributing to runaways.

In a recent study of LGBTQ youth who live on the streets of New York City , Meredith Dank reported that they often use "survival sex" in order to cope with homelessness and poverty.

--20-60% of youth in Child Welfare identify themselves as LGBTQ.
--13% of the detention population identify themselves as LGBTQ.
--20-33% of girls in the juvenile justice system have self-identified as being homosexual.
--LGBTQ youth are less likely to receive psychotherapeutic treatment, where it is indicated. For instance, one half of those who are clinically depressed do not receive any treatment.

Resilient Behaviors of LGBTQ Youth

In spite of these cumulative stressors, LGBTQ youth evidence a wide range of resilient-engendering behaviors:

--Resistance to Stereotypes
--Connectedness with Supportive Others
--Self-care Behaviors
--Social Activism
--Cognitive and Behavioral Flexibility

Examples of Coping Strategies Used by LGBTQ Youth

Resistance to Stereotypes
--Resist stereotypes associated with sexual attitudes of what it is to be masculine or feminine.
--Consider what is good about being LBGTQ.
--Experiment with gender roles. The ability to display both masculine and feminine traits. Free oneself from ideas of what it means to be a “man” or a “woman.”
--Belief in being who I am. Find enjoyment in being LGBTQ.
--Have a sense of freedom. Feel stronger for rejecting stereotypes.
--Not conceal sexual orientation and gender identity behind something or someone.

"The presence of at least one caring, emotionally available person at some point (even briefly) in the person’s life is a necessary
prerequisite to the development of resilience."

-Dyer & McGuiness

Connectedness with supportive others

--Have someone to share daily experiences. Develop a supportive network. Find an “ally” at school and at home.
--Seek support from others (school, counselor, psychologist, social worker, supportive minister), or from a website that provides advice from teens.
--Feel connected with others who are going, and who have gone through, similar experiences. Benefit from others’ experiences.
--Be a member of social support group. Hang around with other LGBTQ people.
--Visit websites, read books, attend concerts and meetings that help you become more resilient.
--Contribute to websites, social media, blogs, and chat lines.
--Join Gay-Straight Alliance Club and “It gets better” groups at school.
--Attend local support centers and related activities.
--Identify a "chosen family" to connect with when biological family has rejected them.
--At school, find an ally (teacher, coach, counselor, peer) who can be supportive and non-judgemental

Self-care
--Be safe and responsible to take care of one-self.
--Make “smart” decisions about sexual activities. Use condoms, avoid risky situations to avoid sexually-transmitted diseases and HIV.
--Engage in physical self-care. Avoid “high risk” activities such as drug use, risky sexual activities, antisocial delinquent activities, and the like.
--Avoid unsafe places.
--Be careful who you disclose to about your sexual orientation. The world is filled with homophobic and transphobic individuals and groups. Be vigilant and cautious when necessary. Use your risk assessment skills.
--Check to see if your personal space is safe and positive. Sometimes you may need to hide who you are and be safe, and that is “okay”.
--Engage in emotional self-care (seek help when needed, use relaxation, mindfulness and meditation procedures, seek opportunities to experience positive emotions of empathy, compassion, forgiveness, joy, gratitude, and the like.)

Engage in Social Activism
--Have a desire to be knowledgeable about issues that affect the LGBTQ community.
--Learn about the history of the LGBTQ community activities and sacrifices of others. Collect a list of names of famous people who are gay, lesbian, bisexual and transgender in the past and present. Look to them as role models.
--Educate and support other LGBTQ individuals. Promote well-being in younger LGBTQ youth.
--Educate others about the need to fight stereotypes, myths and misconceptions.
--Participate in community activities such as political rallies, public forums, gay activities, educational endeavors. Gain strength through advocacy. Engage in empowerment projects.
--Be assertive, where you think it is appropriate. For example, how do you respond when you hear people say, “That’s so gay”, or when you witness discrimination because of sexual orientation and gender?

Cognitive and Behavioral Flexibility
Resilient LGBTQ youth demonstrate flexibility in selecting from the various coping strategies in meeting varied demands and challenges. They evidence meta-cognitive executive skills of “noticing, planning, monitoring, evaluating, reflecting, sharing with others, enlisting help, and engaging inbehaviors that contribute to their acceptance and self-care.”

[Source: Donald Meichenbaum, PhD, Distinguished Professor Emeritus, Univ of Waterloo, Ontario, Canada
Research Director of Melissa Institute for Violence Prevention, Miami, Florida]

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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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