The Lesbian, Gay, Bisexual, Transgender, Queer, Questioning, Intersexed (LGBTQI*) community represents a diverse range of identities and expressions of gender and sexual orientation. In addition to these identities, members of the community are diverse in terms of race, religion, ethnicity, nationality and socioeconomic class. This intersectionality — the combined and overlapping aspects of a persons’s identity — brings diversity of thought, perspective, understanding and experience. This complexity is important to understand as a unique and valuable aspect of the LGBTQI community that can result in a strong sense of pride and resiliency.
While belonging to the LGBTQI community can be a source of strength, it also brings unique challenges. For those who identify as LGBTQI, it’s important to recognize how your experience of sexual orientation and gender identity relates to your mental health. Although the full range of LGBTQI identities are not commonly included in large-scale studies of mental health, there is strong evidence from recent research that members of this community are at a higher risk for experiencing mental health conditions — especially depression and anxiety disorders. LGBTQI adults are more than twice as likely as heterosexual adults to experience a mental health condition. Transgender individuals are nearly four times as likely as cisgender individuals (people whose gender identity corresponds with their birth sex) individuals to experience a mental health condition.
LGBTQI youth also experience greater risk for mental health conditions and suicidality. LGBTQI youth are more than twice as likely to report experiencing persistent feelings of sadness or hopelessness than their heterosexual peers. Transgender youth face further disparities as they are twice as likely to experience depressive symptoms, seriously consider suicide, and attempt suicide compared to cisgender lesbian, gay, bisexual, queer and questioning youth.
For many LGBTQI people, socioeconomic and cultural conditions negatively impact mental health conditions. Many in the LGBTQI community face discrimination, prejudice, denial of civil and human rights, harassment and family rejection, which can lead to new or worsened symptoms, particularly for those with intersecting racial or socioeconomic identities.
Important Risk Factors Of LGBTQI Mental Health
Positive changes in societal acceptance of LGBTQI people act as a protective factor for mental health. However, this shift in acceptance has meant that many LGBTQI youth “come out” or share their sexual orientation or gender identity at younger developmental ages, which can impact their social experiences and relationships. This can have negative mental health impacts, particularly for youth who are not in supportive environments.
For many in the LGBTQI community, coming out can be a difficult or even traumatic experience. It can be difficult to cope with rejection of something as personal as one’s identity from family or close friends, within the workplace, or in a faith community.
According to a 2013 survey, 40% of LGBT adults have experienced rejection from a family member or a close friend. A 2019 school climate survey showed that 86% of LGBTQ youth reported being harassed or assaulted at school, which can significantly impact their mental health.
Homophobia, biphobia, transphobia, bullying and feeling identity-based shame is often traumatic for people.
The LGBTQI community faces many forms of discrimination, including: labeling, stereotyping, denial of opportunities or access, and verbal, mental and physical abuse. They are one of the most targeted communities by perpetrators of hate crimes in the country.
Such discrimination can contribute to a significantly heightened risk for PTSD among individuals in the LGBTQI community compared to those who identity as heterosexual and cisgender.
Substance misuse or overuse, which may be used as a coping mechanism or method of self-medication, is a significant concern for members of this community. LGB adults are nearly twice as likely as heterosexual adults to experience a substance use disorder. Transgender individuals are almost four times as likely as cisgender individuals to experience a substance use disorder. Illicit drug use is significantly higher in high school-aged youth who identify as LGB or are unsure of their identity, compared to their heterosexual peers.
It is estimated that LGBTQI youth and young adults have a 120% higher risk of experiencing homelessness — often the result of family rejection or discrimination based on gender identity or sexual orientation. This risk is especially high among Black LGBTQI youth. Many members of the LGBTQI community face the added challenge of finding homeless shelters that will accept them, and experience elevated rates of harassment and abuse in these spaces.
Many people in this community struggle in silence — and face worse health outcomes as a result.
- The LGBTQI population is at a higher risk than the heterosexual, cisgender population for suicidal thoughts and suicide attempts.
- High school students who identify as lesbian, gay or bisexual are more than four times as likely to have attempted suicide compared to their heterosexual peers.
- 40% of transgender adults have attempted suicide in their lifetime, compared to less than 5% of the general U.S. population.
Inadequate Mental Health Care
The approach to sexual orientation and gender identity in mental health care often groups together anyone in the LGBTQI community, when these communities are considered at all. This method can be problematic as each sub-community faces unique challenges, rates of mental illness and experiences.
The LGBTQI community encompasses a wide range of individuals with separate and overlapping challenges regarding their mental health. Other identity factors including race and economic status can affect the quality of care they receive or their ability to access care.
Additionally, members of this community may face harassment or a lack of cultural competency from potential providers. These experiences can lead to a fear of disclosing sexual orientation and/or gender identity due to potential discrimination or provider bias.
Confronting these barriers and mental health symptoms with an LGBTQI-inclusive mental health provider can lead to better outcomes, and ultimately recovery.
How To Find The Right Mental Health Professional
There are important considerations when seeking LGBTQI-competent care. Here are a few steps to find a professional.
Step 1: Think About What You’re Looking For
While considering the type of mental health professional you are looking for, it is important to consider the following:
- If you want a provider who shares specific parts of their identity with you, you may be able to find out if your provider is LGBTQI by reading their profiles or websites.
- It may be easier to find a provider that has a baseline competency in LGBTQI issues, rather than one who specializes in LGBTQI care. If your mental health conditions are not rooted in sexual orientation and/or gender identity, it may not be necessary for the provider to be specialized in LGBTQI issues.
- If you are transgender and are seeking a mental health professional to write a letter of support for gender affirming medical care or for legal documentation change, you should seek a provider who understands the insurance or legal requirements of support letters.
Step 2: Gather Referrals
Many websites that provide mental health professional directory searches, including insurance company websites, have filters that allow you to show only mental health providers who have a specialty or competency in working with LGBTQI patients. Many insurance companies also have information numbers, and they can help find you providers that are in your area, accept your insurance and list LGBTQI competency in their profile.
These directories, however, are not the only way to find LGBTQI competent providers. Many LGBTQI organizations and community groups provide directories that have been vetted by other LGBTQI people. You may want to check with:
- Local LGBTQI community centers
- Local LGBTQI health centers
- LGBTQI community groups such as equality groups, health collectives, social organizations, support groups
- Affirming places of worship
Step 3: Make the Call
Some people find it difficult to make an initial call to a mental health provider. Transgender people in particular may feel uncomfortable talking on the phone due to concerns about being misgendered due to their natural voice range. If you find you’re reluctant to call, ask a friend or family member to call for you.
When making the initial call, you may want to ask the provider then if they have previous experience with LGBTQI patients or if they are comfortable working with LGBTQI patients. You can wait to ask this during the first appointment, but you may save time and energy by asking from the start.
Step 4: Ask Questions:
Providers expect and welcome questions from their patients or clients, since this helps them better understand what is important in their treatment. In your first visit with a mental health provider, be forthright about the fact that you are looking for an LGBTQI competent provider. You should not feel like you need to educate providers about the basic concepts of LGBTQI identities. To prevent that, consider asking the following questions:
- My identity is ______. What experience do you have working with people with that identity?
- What experience do you have with the LGBTQI community?
- Do you have any specific training or certifications that relate to working with LGBTQI clients?
Additionally, to avoid selecting a practitioner that uses the discredited and harmful practice of conversion or reparative therapy — aimed at changing a person’s sexual orientation or gender identity — you may also want to ask, “Do you provide conversion therapy or reparative therapy?” and follow up by asking how they feel about that specific practice to make sure you are not selecting a provider that advocates for this type of treatment.
Step 5: Build a Relationship
It may take several calls to find the right provider for you. If the provider does not have the knowledge or experience that you are looking for, you can move on to the next provider and keep searching.
Remember, you are seeking a person that is going to help you improve your mental health. By stating your needs and asking the right questions, you can find someone who can mindfully address your identity throughout the duration of your treatment.
*This list of initials is not an exhaustive list of identities included in this community and related groups. We want to be explicit in our support of all people who identify as community members, whether their identity is commonly acknowledged or not. This includes those who are non-binary, two-spirit, third-gender, asexual and more.
Please note: The resources included here are not endorsed by NAMI, and NAMI is not responsible for the content of or service provided by any of these resources.
The American Psychological Association (APA)
Provides educational and support resources on a range of LGBTQ topics.
The Association of Gay and Lesbian Psychiatrists
Offers many resources for LGBT individuals experiencing mental health conditions and psychiatric professionals with LGBT clients.
The Gay and Lesbian Medical Association’s Provider Directory
A search tool that can locate a LGBTQ-inclusive health care provider.
The LGBT National Help Center
Offers confidential peer support connections for LGBT youth, adults and seniors, including phone, text and online chat.
The National Center for Transgender Equality
Offers resources for transgender individuals, including information on the right to access health care.
The Trevor Project
A support network for LGBTQ youth providing crisis intervention and suicide prevention, including a 24-hour text line (text “START” to 678678).
Society for Sexual, Affectional, Intersex, and Gender Expansive Identities (SAIGE)
Delivers educational and support resources for LGBTQ individuals, as well as promotes competency on LGBTQ issues for counseling professionals.
“Members of the LGBTQI community with mental health conditions may find themselves fighting a double stigma, based on their sexual orientation and gender identity, as well as the stigma associated with mental health conditions,” says Elizabeth Stephens, NAMI WLA’s Program Director. “The impacts of this stigma and resulting discrimination are felt starting at a young age and have lasting, negative mental health impacts. LGBTQ+ youth are almost five times as likely to attempt suicide compared to heterosexual youth (source: The Trevor Project). Pride is a space where people in the LGBTQI community can connect to celebrate who we are, who we love, and how we identify. The power of this strong community increases visibility and makes us feel like we belong. It’s similar to the experience we feel when engaging in broader conversations about mental health; when we share our lived experience and engage vulnerably in safe spaces, it helps us feel like we are not alone.”