How to Navigate Behavioral Health in the LGBTQIA+ Community

Mar 11

Ball Culture & Mental Health

How to Navigate Behavioral Health in the LGBTQIA+ Community: Breaking Barriers and Embracing Support

Written By: Aaliyah Pierce, BSW Student Intern

Introduction

The Lesbian, Gay, Bisexual, Transgender, Queer or Questioning, Intersex, Asexual, Plus (LGBTQIA+) community represents a diverse collection gender and sexual orientation identities and expressions. In addition to these identities, community members are diverse in race, religion, ethnicity, nationality and socioeconomic class. This intersectionality brings diversity of thought, perspective, understanding and experience to the community. While belonging to the community can be a source of strength and support, it also brings unique challenges. For those who identify as LGBTQIA+, it’s important to recognize how your experiences of sexual orientation and gender identity relate to your mental health. Hi, my name is Aaliyah Pierce and today we will be shining a light on the discrimination and stigma individuals within the LGBTQIA+ community often face and the uphill battles facing them in finding culturally competent care to address their mental health concerns. In this article, we will emphasize both the barriers and the avenues to treatment and support.

Barriers To Treatment

The task of finding treatment specifically tailored to the needs of LGBTQIA+ individuals can be daunting and draining. Many LGBTQIA+ individuals face financial constraints, homelessness, unemployment, addiction to a substance, lack of insurance coverage, and limited access to LGBTQIA+ affirming healthcare providers. Moreover, the fear of discrimination or encountering non-affirming clinicians often deters individuals from seeking help. “The Rainbow Health survey found that 40% of Minnesota adults identifying as LGBTQIA+ didn’t go to the doctor when they needed to because they feared disrespect or discrimination (HealthPartners, 2018).” These fears aren’t without reason – it has not always been a simple task for LGBTQIA+ individuals to receive culturally competent, gender-affirming care in the U.S.

Finding Treatment and Support

Despite the challenges, avenues for treatment and support do exist within the LGBTQIA+ community. Additionally, teletherapy and virtual support services have become increasingly popular, providing convenient and confidential avenues for seeking help. If you identify as LGBTQIA+, here are some ways to find the best fit for your mental health treatment:

Find out if your provider is LGBTQIA+ by reading their profiles and/or websites. You can also find this out by asking your provider directly.
It may be easier to find a provider that has baseline knowledge of LGBTQIA+ issues instead of a provider specializing in LGBTQIA+ issues.
Gather referrals to LGBTQIA+ affirming care from the community centers, health centers, support groups, and gender affirming places of worship.
It is a common fear for LGBTQIA+ individuals to feel anxious about making phone calls to new place or people due to the fear of being misgendered over the phone due to their voice. If this applies to you, don’t be afraid to ask someone else to call for you if you are unable to simply (which is perfectly fine and normal, you're not alone).
Don’t be afraid to ask questions! In the same way that your provider has expectations for you, you should have expectations of them. Here are some good questions to ask:

My identity is ______. What experience do you have working with people belonging to myidentity?
What experience do you have working with the LGBTQIA+ community?
Do you have any specific training or certifications that relate to working with LGBTQIA+ clients?

It may take several phone calls and a few trial-and-error moments before finding the right provider for you, but eventually you will. By being straightforward about what you are looking for in a provider, it will help you in the long run to find the very best fit for yourself to improve your mental health.

Social Factors Contributing to the Mental Health of the LGBTQIA+ Community

Discrimination & Violence

For many LGBTQIA+ people, poor socioeconomic and cultural conditions negatively impact mental health conditions. Many in the LGBTQIA+ community face discrimination, prejudice, denial of civil and human rights, harassment and family rejection, which can lead to new and/or worsened symptoms, especially for those with intersecting racial and/or socioeconomic identities. In other words, LGBTQIA+ individuals are more susceptible to discrimination and violence at the hands of society and/or family members and friends, which significantly impact their mental well-being. Hate crimes, bullying, and microaggressions contribute to heightened levels of stress, anxiety, and PTSD within the community creating a larger need for mental health treatment. Fear of rejection or violence can lead to hypervigilance and chronic stress, further exacerbating mental health conditions and therefore putting off treatment due to the shame and fear being produced by the thought of being discriminated against or harassed at their doctor’s office.

Depression, Anxiety, and Substance Use

Depression and anxiety rates are disproportionately high among LGBTQIA+ individuals due to societal stigma, discrimination, and rejection. The struggle for acceptance and visibility can exacerbate feelings of isolation and inadequacy, leading to mental health challenges. Additionally, substance abuse often becomes a coping mechanism for dealing with the stressors and traumas associated with belonging to the community. The National Alliance on Mental Illness, also known as NAMI, found that, “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 (NAMI, 2023).”

How Culturally Competent Care Assists in Overcoming Stigma

Culturally Competent Care

Cultural Competence, also referred to as intercultural competence, is a set of skills and knowledge that allow an individual to practice effective and appropriate communication with people of other cultures. Culturally competent care is an essential part of addressing the unique needs of LGBTQIA+ individuals. Healthcare providers must undergo training to understand the nuances of sexual orientation, gender identity, and expression. Creating a safe and affirming environment where individuals can openly discuss their concerns without fear of judgment is paramount in promoting mental wellness and one of the main values surrounding Free Baltimore.

Stigma & Pronouns

Stigma surrounding mental health and LGBTQIA+ identities often intersect, creating additional barriers to seeking treatment. Many individuals fear being labeled as "mentally ill" or "different," further perpetuating the cycle of silence and shame. Moreover, the importance of using correct gender pronouns cannot be overstated. Misgendering and invalidating someone's gender identity can have profound negative effects on their mental health and self-esteem. Using preferred pronouns is an especially important way to show support for people who are LGBTQIA+ and do not subscribe to the same general pronouns as others – it can even save lives. According to a survey conducted by the Trevor Project, trans youth were half as likely to consider suicide when their chosen pronouns were used versus when they were misgendered by others. An effective and simple way of asking someone their pronouns would go something like this:

“Hi, my name is Aaliyah, and my preferred pronouns are she/her. It is wonderful to meet you, what are your preferred pronouns?”

Breaking the Silence: How to Use Your Voice to Overcome the Unique Challenges Facing LGBTQIA+ Mental Health

Breaking the silence surrounding mental health in the LGBTQIA+ community requires collective effort and advocacy. Educating society about the unique challenges faced by LGBTQIA+ individuals, challenging discriminatory policies, and promoting inclusive healthcare practices are essential steps toward creating a more supportive and affirming environment. Navigating behavioral health in the LGBTQIA+ community is wired with challenges, yet it is also a journey of discovery, strength, and resilience. By addressing systemic barriers, promoting cultural competence, and creating inclusive spaces, we can establish a future where every LGBTQIA+ individual has access to the support and resources they need to thrive mentally, emotionally, and spiritually. Free Baltimore continues to amplify LGBTQIA+ voices, break down barriers, and pave the way for a more compassionate and inclusive society.

Ball Culture and Mental Health

The History of Ballroom Culture

With Black and Latine/x communities at the center, Ballroom culture creates a celebratory safe space for queer, trans, and nonbinary people, possessing a holistic sense of belonging that is rarely seen elsewhere. The history of Ballroom Culture stretches as far back as the late 1860s in Harlem, New York with The Hamilton Lodge No. 710 hosting the first Annual Odd Fellows Ball featuring men & women dressed in drag. Nearly a century later, Marcel Christian organized the first Black Drag Ball and launched the House of LaBeija for displaced and unhoused Black & Latine/x queer youth. Still currently, Black and Latine/x queer youth are overrepresented in the homeless population. “A recent report from the Williams Institute found that the top reasons for LGBTQIA+ and SGL youth homelessness were either being forced out by guardians or running away due to rejection of their sexual orientation, gender identity, or gender expression (SOGIE), This occurred at rates of 55% among LGBQ youth and 67% among transgender youth (Toxic Stress in LGBTQIA+ Communities: How Ball Culture Heals, 2021a).” Because it is so common for Black & Latine/x youth to become homeless, more houses were birthed during this time creating new families for the displaced queer youth.

Houses can host & attend Balls with house members competing individually or on behalf of their house in performing categories based on gender & sexual identity, body presentation, gender expression, fashion, and voguing. Oxford Dictionary defines voguing as “dance to music in such a way as to imitate the characteristic poses struck by a model on a catwalk” however, the word ‘vogue’ has it’s origins in late 16th century French meaning “fashion”. This term and dance rose even further into popularity within the community after the release of the 1990s hit single from Madonna titled “Vogue” and the release of the iconic film Paris is Burning (1991). The song was an instant hit among the Ballroom scene and thanks to Paris is Burning stars like Dorian Corey, Paris Dupree, and Pepper LaBeija, the song became the theme for the art of voguing. In the present day, you can vogue to any song, but Paris is Burning forever changed the community on that fateful day in August of 1991.

A great show suggestion for those who are interested in learning more about the history of Ballroom and what it was like during the height of Ballroom culture is a tv series titled ‘Pose’ created by Ryan Murphy, Brad Falchuk, and Steven Canals. Similarly to Paris is Burning, the show highlights NYC Ballroom Culture between the 1980s and the 1990s throughout its three seasons following the stories of various Black & Latine/x LBGTQIA+ individuals.

How Ballroom Culture Heals the LGBTQIA+ Community

Allostasis is a phenomenon that physiologists define as an over exposure to stress creating allostatic load. Essentially, this means that when the human body perceives constant stress or a threat, it releases a cocktail of hormones cortisol and adrenaline which trigger the “fight or flight” response. Exposure to stress for a substantiated period can overload the body, making it difficult to return to homeostasis and wreaking havoc on every bodily system. For those within the LGBTQIA+ community, allostatic load is an everyday reality. Social and structural stressors such as bullying, shame and fear, homelessness, trauma, unemployment, rejection, and many other things face LGBTQIA+ individuals daily. How do many of them cope? Ballroom Culture.

Research shows that access to a supportive community has the power to alleviate stress build-up. Supportive, accepting community is the central theme and concept of a unique form of community known as Ball Culture amongst Black & Latine/x queer youth. “Scholars have explored the healing power of dance, with overlap between performance and therapeutic communities. Dr. Judith Hanna notes that the release of endorphins during dance can produce analgesia and euphoria, diverting a person’s attention away from stress, pain, and unhappiness. It can also create a sense of control over one’s body and life, mitigating feelings of powerlessness.”These events are always irreverent, sexually expressive, flamboyant, and pulled together graciously through collective community efforts serving as sites for education about self-health, self-worth, and self-knowledge.

Reaching the Ballroom Community as Mental Health Providers

Psychiatry.org states that LGBTQIA+ individuals are 2.5 more likely to experience depression, anxiety, and substance misuse than their heterosexual counterparts due to stigma and discrimination. Despite the increasing need for mental health treatment in the LGBTQIA+ community, individuals within the community face fear of discrimination among many other barriers to seeking treatment and can struggle to find someone to help them properly while also being culturally competent. For all patients, finding a therapist can be difficult and it is all too common for someone to have a bad experience in therapy that further pushes them away from treatment. Sometimes, even when providers mean well, they may still hurt patients with their micro-aggressions without noticing. Here are some tips that providers can keep in mind to improve passionate care and offer their client a safe space:

Educate yourself and your staff: Our understanding of gender and sexuality is ever evolving and you as a provider should be ever evolving as well. Language changes and some of the terms you use may be outdated. Do not define your client’s sexuality or gender identity, instead allow them to define these things and tell you what’s correct and what’s not.
Practice Gender Affirming Healthcare: Use proper pronouns for clients always! Enable LGBTQIA+ patients/clients to feel comfortable being honest with you, safe, and supported.
Be Inclusive and Be Mindful of Intersectionality: When making others feel accepted, a little bit goes a long way. Consider using gender neutral terms like “partner” instead of “wife” or “husband” and ask everyone for their preferred pronouns instead of assuming based on the way they present themselves. Do not assume and attribute your client’s stressors to their sexuality, instead realize how the client/patient’s gender and sexual identity impact their mental health in addition to other factors such as age, race, location, etc., and allow the client to notify you of what their stressors are.

References

Brands, Therapy. “5 Ways to Improve Mental Health Care for LGBTQIA+ Patients.” Therapy Brands, 8 June 2022, therapybrands.com/blog/5-ways-to-improve-mental-health-care-for-lgbtqia-patients/#:~:text=5%20Ways%20to%20Improve%20Mental%20Health%20Care%20for. Accessed 11 Feb. 2024.

Mason, Shawn. “Mental Health Challenges in the LGBTQ Community.” HealthPartners Blog, 19 Mar. 2018, www.healthpartners.com/blog/mental-health-in-the-lgbtq-community/. Accessed 4 Feb. 2024.

National Alliance on Mental Illness. “LGBTQI | NAMI: National Alliance on Mental Illness.” Www.nami.org, 2023, www.nami.org/Your-Journey/Identity-and-Cultural-Dimensions/LGBTQ.

News Today, Medical. “Toxic Stress in LGBTQIA+ Communities: How Ball Culture Heals.” Www.medicalnewstoday.com, 10 July 2021, www.medicalnewstoday.com/articles/queer-homeplace-and-midnight-wisdom-how-ball-culture-helps-heal-toxic-stress.

SAMHSA. “SAMHSA Releases New Data on Lesbian, Gay and Bisexual Behavioral Health.” Www.samhsa.gov, 6 June 2023, www.samhsa.gov/newsroom/press-announcements/20230613/samhsa-releases-new-data-lesbian-gay-bisexual-behavioral-health. Accessed 4 Feb. 2024.

“Toxic Stress in LGBTQIA+ Communities: How Ball Culture Heals.” Www.medicalnewstoday.com, 10 July 2021, www.medicalnewstoday.com/articles/queer-homeplace-and-midnight-wisdom-how-ball-culture-helps-heal-toxic-stress#Stress-among-historically-marginalized-communities. Accessed 5 Feb. 2024.