How do behavioral health conditions impact LGBTQ+ people differently?
There is a higher suicide rate due to discrimination and internalized stigma. As a gay Black man, I have had plenty of experiences of discrimination in public schools and the workplace. Discrimination in terms of words spoken to me, but also as to how legally codified my relationship is. I have not experienced bad suicidal ideation because of the love that I experienced from my family, but that is not the case for everyone else. People are dying because of the stigma that they experience. This manifests as high rates of depression, anxiety, substance use disorders, and high-risk behavior leading to STDs and HIV. Poor behavioral health is in some ways a symptom of what it means to be a person with discriminated identities in our current society.
How does identity impact behavioral health?
Marginalized identity is a risk factor for discrimination, not a risk factor for behavioral health conditions themselves. The problem is not the identity. The problem is what is done to you when you hold that identity.
You identify as an aspiring compassion warrior. How does this relate to your work as a therapist?
Whether you identify with this community or not, everyone experiences some adversity. The environment we live in is sicker than any one individual patient. The patient is not the toxin; it’s the environment that is toxic.
For me, being a compassion warrior emerges from the idea of the Boddhisattva. I am using my own suffering to awaken. And whatever I learn along the way, I hope to pass on, to teach, to show other people that it is possible. As a gay Black man, I want to elevate the most marginalized among us, as well as alleviate my own suffering. I want to get out of the experience of my own internalized stigma of what it means to be gay or Black or feminine. I am no longer interested in continuing to believe myths that the larger environment would have me believe about myself. I want to help others stop believing the myths about themselves that society tries to tell them.
What are the biggest gaps in behavioral health care services for LGBTQ+ individuals?
Most folks would talk about access to insurance as well as access to care. Once you have insurance, it is difficult to find providers who are prepared and trained in the LGBTQ+ community, of the community or allied with the community. The other issue is tailored treatment. Trans youth need access to integrated physical and behavioral health care. Substance use treatment programs are another issue – people need access to addiction treatment centers that can affirm and be responsive to all their identities, not just their identity as a substance user. Finding medication providers who are well-trained is another challenge.
Administrative staff are critical. People in the front office who might or might not understand the nuances of the LGBTQ+ community are the ones who set the tone as to what treatment someone will receive. They are the ones who establish whether the environment will be welcoming or stigmatizing. The billing staff, the front office—everyone plays a part in creating a welcoming care environment.
How can Blue Cross and Blue Shield of North Carolina (Blue Cross NC) help assure that LGBTQ+ folks can access behavioral health services?
The biggest thing is continuing to support telehealth. Telehealth mitigates potential barriers, such as transportation and location. There are some rural queer folks who can’t find a local provider with whom they feel comfortable. They won’t have access to transportation or know people who can get them to the people who can provide competent services.
At the same time, there may also be rural providers who are knowledgeable about these issues. They might not be as full and could give treatment to someone who lives in a more populous area. We have to assure that there is capacity for LGBTQ+ adolescents. Their suicide risk far exceeds the risk for people who are cisgendered or straight. Adolescents are the most vulnerable. And if you add the challenges faced by Black youth who are sexual/gender minorities, these youth have a 40% increase in suicidal ideation.
Lastly, as much as we can, it’s important to match LGBTQ+ providers with patients who have that preference.
Are there any programs or interventions that you want to make sure that members and providers are aware of?
First, the W-PATH standards of care are a good starting point for physicians and therapists with trans and gender diverse populations. Fenway Health is an education and research institute for sexual and gender minorities. I’m all about looking at local options – providers need to make sure that they are reaching out to the community. I will tout the importance of a local LGBTQ+ center and finding providers who provide consultation. Queer folks will show up for other queer folks – there are innovations in providing material resources, donating money or clothing. Lastly, providers seeing LGBTQ+ patients should consult with providers who are of the community. When I take on trans clients, I pay for consultation with trans therapists because it is my due diligence to make sure that I’m not missing things, and also a way to receive education and provide monetary support for the community itself.