From Academic Training to Professional Practice, the Field of Mental Health Is Ignoring LGBTQ People of Color and Leaving Us Behind

Mental health is the quality of cognitive, emotional, behavioral functioning. As a concept, it’s study should benefit all people. However, psychological theories, approaches, and practice are typically written by white, straight cis-men. In a world that is filled with a variety of cultures, gender expressions, and sexual orientations, academic study of mental health is failing to represent this diversity.

I am a bisexual Latina; one of four people of color (out of 20 students), and the only LGBT person of that group. Reading about Freud, Carl Jung, and Pavlov I wonder: how do these men understand my experience? How would they approach my unique intersection of issues without denying my ethnic background and sexual orientation?

 

Historical Misdiagnoses & Treatment of LGBT Populations

While the Gay Liberation Movement was in the mainstream of television, radio, and newspapers, psychologists sought to address homosexuality as a symptom of severe mental health dysfunction. Many psychologist saw LGBT people as “sick” and needing “treatment” to help with their feelings of depression and anxiety “due to their sexuality or gender expression.” This was further supported in the official diagnostic manual for psychologists, the DSM-II, though it was later removed in 1973 after much evidence that social ignorance influenced the way people cope with their identities.

Psychologists have made drastic changes to their ideas on homosexuality and gender expression, but still have overlooked cultural factors that influence the quality of life for this population.

LGBT people of color have historically endured more risk than their white LGBT peers. In the U.S. alone, up to 40% of homeless youth are LGBT and up to 60% are youth of color. HIV is rising in communities of color, particularly in Black and Latinx populations. Further, the lack of financial resources for health insurance, affordable housing, and cultural constrictions on our identities are contributing factors.

Non-white LGBT people are constantly at risk of higher levels of depression anxiety, and substance abuse which are intrinsically related to experiences of violence and racism. The LGBT Health and Human Services Organization in New York City found that nearly 24% of Black respondents had probable depression, as did 22% of Latinx and one-in-five mixed race respondents, compared to 15% of white people who took the survey. The highest reported percentage here nearly doubles for Native Americans whose rates of depression reach a devastating 47%. When systemic racism is further compounded by misogyny and homophobia, this information adds context to the reasons why LGBT people of color experience higher rates of substance abuse, and are more frequently targeted and criminalized for engaging in sex work (which also carries a disproportionate health risk for this population).

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A report from the National Anti-Violence Coalition found that “transgender people of color were 28% more likely to experience physical violence compared to people who were not transgender people of color.” A different study found that “Black and Latino LGB individuals may be at elevated risk for suicide attempts even in the absence of the traditional markers of depression and substance abuse.” Though there is significant evidence that systemic and structural factors contribute to these dynamics, many institutions fail to understand what that means in developing a more holistic mental healthcare practice. The specific challenges that LGBT people of color face are being overlooked while reinforcing the divides between one’s sexual orientation, gender identity/expression, and cultural identity.

Relatedly, many non-white LGBT people have noted a sense of having to choose between two identities: race/ethnicity, or queerness. This all too common form of oppression was highlighted in a study looking at racism within the LGBT community. Researchers found that 84 % of gay men of color reported racism within the community and that it is indeed a significant source of stress to be accounted for in what is supposed to be a more equitable, protected space.

 

Access to Mental Health in the LGBT Community

Mainstream LGBT communities pride themselves on offering a safe space, but they often leave people of color out of important conversations and ignore their concerns. This is especially prevalent in the limited ways we have come to understand broader issues of healthcare and mental illness. How, then, might mental health professionals in particular develop resources for non-white queer people when so much of psychological theory is based on the work of white cis-men?

One intervention has been the growing prevalence and social understanding of Intersectionality, which was first introduced in 1989 by Kimberlé Crenshaw. This may appear as a buzzword for many, but it has gained a new significance with its introduction into the mental health field which has been more focused on separating issues of gender and race as discrete identities rather than recognizing the ways their social constructions overlap. When approaching mental health of LGBT people, many practitioners are undereducated in issues of cultural competence during their academic training. Most do not understand the effects of socioeconomic status on one’s resources, for example, and academia does not cover this critical part of our client’s world. Unfortunately, the practice is not the place to learn. I urge academia to look at minority stress, to look at belongingness, to look at intersectionality with an open mind.

It is still commonly known how difficult it is to find affordable and reliable mental health professionals. Many LGBT people of color, specifically, either: don’t have health insurance, don’t trust the medical field, or don’t feel they have a voice within the community. To supplement this lack of resources, nonprofits focused on this issue provide services that are otherwise unavailable or inaccessible. According to the 2016 LGBT Community Center Survey Report, “82% of LGBT community centers offer specific programming for LGBT youth, 88% for transgender people, 61% for LGBT older adults, and 51% for LGBT people of color.” Taking the lead from these important organizations, mental health providers must look at how one’s culture, gender identity, socioeconomic status, and history reflect our challenges as well as our resilience.

We know that Black, Latinx, Asian, SWANA, and Indigenous people all have varying forms of mental health challenges. Therefore, our coping mechanisms can also be different -- and this shouldn't be seen as a hindrance to professional healthcare services and providers. Familisimo may be a safe space to resist the pressures of machismo, for example. Others will find safety with chosen family or turn to community organizing where they can more comfortably confront issues of intra-community racism, homophobia, and misogyny. To supplement professional care resources, some LGBT people of color may turn to holistic healing that is deeply rooted in cultural practices. Though it may run counter to traditional Western medicine, some of us seek wisdom from our communities’ elders who often face exclusion due to ageism and ignorance.

If mental health professionals want to truly support richly diverse populations, then they must begin to understand and respect the different ways each group engages with practices of care.

As queer people, we should not be treated as a monolith. I, for one, will never be just a psychologist. I am bisexual. I am Latina. I am the daughter of an immigrant. I am an American. I am a student. All of these are important ways that I understand and live my identity. As a mental health professional, I want to bring this knowledge into my practice and I urge others in the field to do the same. Mental health professionals must remember how our lives are layered with a rich sense of culture,  resources, and ideas. Every psychologist wants to help people, but to do so we need our academic training to reflect this, and we need practitioners to respect cultural differences and unique social needs.

 

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Article References:

2016 LGBT Community Center Survey Report: Assessing the Capacity and Programs of Lesbian,  

     Gay, Bisexual, and Transgender Community Centers. (2016).

     http://www.lgbtmap.org/file/2016-lgbt-community-center-survey-report.pdf

A Blueprint for Meeting Health and Services Needs in New York State. (2008).   

      https://gaycenter.org/file/docs/network/LGBT-HHS-Blueprint.pdf

Dixon, E., Jindasurat, C., & Toba V.  (2011). Hate Violence Against Lesbian, Gay, Bisexual,

      Transgender, Queer, and HIV- affected Communities In the United States in 2011. New York  

      City Anti-Violence Project.

Han, C., Ayala, G., Paul, J., Boylan, R., Gregorich, S. E., & Choi, K.-H. (2015). Stress and

    Coping with Racism and Their Role on Sexual Risk for HIV among African American,

    Asian/Pacific Islander, and Latino Men Who Have Sex With Men. Archives of Sexual

    Behavior, 44(2), 411–420.

    doi: http://doi.org/10.1007/s10508-014-0331-1

O’Donnell, S., Meyer, I. H., & Schwartz, S. (2011). Increased Risk of Suicide Attempts Among

       Black and Latino Lesbians, Gay Men, and Bisexuals. American Journal of Public Health,

       101(6), 1055–1059.

       doi: http://doi.org/10.2105/AJPH.2010.300032