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

ental  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).

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.