Essay: Treating LGBTQ Youth (mental health)

Introduction

Individuals in the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community are an interesting topic of discussion when it applies to mental health treatment. There are many intervention options available, as well as many more options that could be implemented in the treatment of mental health disorders. The LGBTQ community, specifically gay and bisexual men, have much higher rates of depression, generalized anxiety disorder, panic disorders, and post-traumatic stress disorder (PTSD). Depression is one of the most common mental illnesses in the United States, with a rate of 4.6% of the general population having this illness (Currin et al., 2018).

Theories. There are multiple theories that can be applied to treatment options for LGBTQ individuals. First, Andersen’s Behavioral Health Model (BHM; Andersen, 1995, 2008; Andersen & Anderson, 1967) was outlined with the hope to look at the barriers surrounding health care access. The BHM was not originally intended for the LGBTQ community, but rather was just supposed to look at the reasoning behind individuals using resources in the health care system (Currin et al., 2018). The overarching goal behind the BHM was to gain the equality between different families in their health care services (Andersen, 1995). This was originally done by looking at individuals’ predispositions to what using health care services meant, and then looking at whether those who sought out health care services actually needed such services (Andersen & Anderson, 1967). After looking at these factors, the BHM would then have the ability to predict the future usage by different individuals of particular health care services, such as mental health and physical health services (Andersen & Anderson, 1967).

The use of the BHM, as it applies to the LGBTQ community, allows health care providers to gain further understandings as to what barriers may look like for the community in receiving treatment for their mental health as well as their physical health (Currin et al., 2018). In a study conducted by Simpson and associates (2013) on LGB veterans residing in the state of Washington, the BHM was used to identify certain inequalities between LGB individuals versus cisgender and heterosexual men. With regards to the use of the Veterans Health Administration (VHA), there was a significantly stronger need for the LGB veterans to attain clinical treatment for their health concerns (Simpson et al., 2013). This study also reiterated that an individual’s sexual orientation does provide a significant predisposing characteristic that shapes whether or not individuals will seek out treatment for their health concerns (Simpson et al., 2013). Physical ailments, such as being HIV-positive or having a sexually-transmitted infection (STI) were also higher for the veterans in the LGB community as opposed to their cisgender and heterosexual counterparts (Simpson et al., 2013). The main point of the BHM is to use it as a resource to create new treatment intervention techniques that can address inequalities found in the BHM between the LGBTQ community and cisgender and heterosexual individuals (Currin et al., 2018).

Another model used in the discussion about the LGBTQ community and mental health treatment is Meyer’s Minority Stress Model (MSM; Meyer, 2003, 2013). The MSM is important when looking at the effects that particular stressors for minority groups have on overall mental health (Cramer et al., 2017). The MSM also outlines both positive and negative outcomes that minority stress has on an LGBTQ individual’s health. Some of these outcomes include feeling connected on a social level, which would be a positive outcome of minority stress, and suicidality, which would be one of the negative outcomes of minority stress (Cramer et al., 2017). The major reason that the MSM is so important for LGBTQ treatment interventions is that the coping strategies used by individuals are heavily reliant on the particularly stressful events that occur, such as the stress of social rejection leading to isolation (Cramer et al., 2017).

There are many types of stress that affect individuals, such as multiple general stressors like the experiences of individuals based on their sexual orientation, or proximal stressors like the rejection or homophobic expectation individuals in the LGBTQ community have, and finally, distal stressors like the violence or discrimination individuals face on a daily basis (Cramer et al., 2017). The MSM looks at how these stressors faced by the minority groups, like sexual minorities, impact how an individual will be able to cope with their situation, and what affect it will have on the overall mental and physical health of the individual (Cramer et al., 2017).

In the study conducted by Cramer and associates (2017), it was found that there was a strong relationship between affective well-being and minority stress coping strategies. It was also found that the more proximal stressors, that involve the more internalized feelings that stigmatization might occur, had a significant direct effect on individuals’ abilities to cope and attain better affective well-being within the LGBTQ community (Cramer et al., 2017). However, contrary to what one might believe, no significant effect was found between affective well-being and HIV status issues, such as the internalized stigmatization or victimization of HIV-positive individuals in the LGBTQ community (Cramer et al., 2017). So, it is possible that Meyer’s MSM needs improvements, due to the continued victimization that occurs in today’s society.

Intervention Options

School Interventions. In the United States, there are around 4,000 student groups called the gay-straight alliance (GSA; Poteat et al., 2012). The GSA is a student led organization in place at many high schools, and is becoming a trend for middle schools to implement this group as well (Poteat et al., 2012). Before becoming the student-led school organizations seen today, the GSA was intended to be a community-based program for LGBTQ youth with counselors and teachers as the leaders (Poteat et al., 2012). Now, the GSA is implemented into schools due to the younger and younger age range that individuals choose to “come out” to others (Poteat et al., 2012). As a result of coming out at these young ages, students find themselves becoming more susceptible to bullying by their peers.

The primary goal of the GSA is to provide a place for LGBTQ individuals to feel safe. The GSA also provides an arena for socialization to occur, especially between LGBTQ youth who don’t always have somebody else to go to who could understand fully what they go through. one piece of this socialization could even be emotional support for an individual who has just gone through some form of detrimental experience, such as “coming out” or being rejected by their family or friends (Poteat et al., 2012). In being able to safely share one’s experiences, individuals gain knowledge about how they may decide to go about addressing their own experiences, as well as being able to reflect upon one’s own experiences (Poteat et al., 2012).

In a study conducted by Goodenow and associates (2006) in Massachusetts, it was found that through the inclusion of LGBTQ support groups in a school setting, these individuals faced lower rates of suicidal thoughts and even experienced smaller victimization rates (Goodenow et al., 2006; Poteat et al., 2012). However, these findings were not solely seen in schools with GSA programs, but also applied to other programs tethered to LGBTQ experiences, leading to the assumption that there is a possibility that other programs may be effective at schools as well (Poteat et al., 2012).

Poteat and associates (2012) conducted their own studies regarding the GSA and sexual orientation. They found that there were significant interactions between the presence of a GSA program at school and certain risk factors, including smoking, drinking, sexual behaviors, and suicidality (Poteat et al., 2012). For instance, when LGBTQ youth had a GSA program to go to, these individuals tended to report less risky sexual events as well as less drug- or alcohol- related risky sexual behaviors (Poteat et al., 2012). The GSA program may have given individuals a social environment that was substance free for students to interact, and seeing that substance use disorders are especially prominent in the LGBTQ community, this is an important finding (Poteat et al., 2012). Another reason for less substance use with the presence of a GSA could be that these individuals are having discussions specific to LGBTQ youth and substance use, such as the risk associated with chronic discrimination by their peers (Poteat et al., 2012). LGBTQ students were also less likely to attempt suicide when a GSA program was present at their school (Poteat et al., 2012).

Being a student-led organization, the GSA also allows individuals to gain needed experience in leadership roles. Students acting as leaders under adult supervision leads to many positive outcomes, including generating a higher self-identity and feeling of empowerment or a better sense of well-being (Poteat et al., 2012). One other outcome of GSA involvement could also be a higher academic-based achievement (Poteat et al., 2012). Some of these leadership roles that students may take on include community programs or week-long events in the school (Poteat et al., 2012). These events include Ally Week and the Day of Silence, and the positive effects not only help members of the GSA, but these events also raise a great deal of awareness about LGBTQ culture for the entire community (Poteat et al., 2012). For LGBTQ individuals who are not members of the GSA, these programs like the Day of Silence or Ally Week may even give the perception that these individuals are not alone and serves as a symbolic gesture solidifying their identities (Poteat et al., 2012).

In a study conducted by Szalacha (2003) in Massachussetts, it was determined that both the LGBTQ and the heterosexual individuals in schools including a GSA group were much more positively diverse than schools not containing a GSA group (Szalacha, 2003; Poteat et al., 2012). This adds to the evidence supporting the idea that a GSA program may help more than just its members by simply spreading awareness about LGBTQ issues via community-based programs. Poteat and associates (2012) also found significant interactions between GSA presence and risky behaviors, such as sexual, alcohol or drug use, and smoking. Interestingly, this effect was also seen in the heterosexual youth. Even still, the effect was much greater in LGBTQ students than their heterosexual counterparts (Poteat et al., 2012). GSA programs provide a safe space at school where individuals can feel more comfortable as well as creating the idea of belonging at the school for heterosexual students in addition to LGBTQ members of the GSA (Poteat et al., 2012).

Even though GSA programs have shown effectiveness in helping individuals, there are still some downfalls to speak about. For example, Poteat and associates (2012) found that the presence of a GSA program did not foster a better academic career for students, even though students were much more likely to regularly attend school. Individuals would be more likely to attend school due to the supportive nature of the GSA and the wanting of individuals to have these interactions with their peers (Poteat et al., 2012). However, the GSA program cannot put an end to the bullying and victimization that occurs in the school setting, and the GSA puts a much stronger emphasis on psychosocial interactions than academic achievement (Poteat et al., 2012). Being victimized, on its own, has been linked to a lower achievement in academic arenas, so it could very well be the reason for the lack of interaction between the GSA and better grades (Poteat et al., 2012). It was determined by Poteat and associates (2012) that a GSA program alone cannot be the sole intervention technique for LGBTQ youth, but better protective policies may be necessary in order to see the positive effects on mental health, as well as increased counseling services at the school by individuals specifically trained in LGBTQ experiences.

In Canada, a new group has been formed, called the Healthy Relationships Program (HRP; Lapointe & Crooks, 2018). The aim of the HRP is very similar to that of the GSA, to foster student-led discussions that will engage students in socializing with their peers. The HRP’s major goal is to support more positive mental well-being in sexual and gender minority groups, such as LGBTQ and gender non-binary individuals (Lapointe & Crooks, 2018). The HRP’s program involves seventeen separate sessions, consisting of a 45-minute discussion about the diversity of sexual, gender and romantic identities. These discussions are tethered to the LGBTQ students attempting to teach them how to cope with the discrimination and oppression they face from their peers (Lapointe & Crooks, 2018). Some examples of the individual sessions include “Mine to Name: Identities/Ways of Being” and “My Journey: Coming Out” (Lapointe & Crooks, 2018). The HRP also runs another session dealing with safety, teaching LGBTQ individuals how to create exit plans from harmful or toxic situations (Lapointe & Crooks, 2018). Within these sessions, individuals sit around a circle and are given the safe space to tell their preferred pronouns and tell the group exactly how they feel (Lapointe & Crooks, 2018). The HRP provides the arena to legitimize sexual and gender minority identities, and understand that they are more than the “other” identity they often see in surveys or at school that point to their identities being something abnormal or undesirable (Kumashiro, 2002; Lapointe & Crooks, 2018).

It has often been discussed whether the presence of a student LGBTQ organization alone can supply members with better mental wellness. LaPointe and Crooks (2018) discussed that maybe it’s the actual activities of these programs, such as the sessions in the HRP, rather than the general presence of such groups. They found that due to the particular topics of each session being included in the HRP, LGBTQ individuals were introduced to certain themes they may not have even thought about (Lapointe & Crooks, 2018). Through the program’s acceptance of sexual and gender minority groups, individuals were able to find themselves and accept who they are instead of feeling the dehumanization they face in the public. In fact, Lapointe and Crooks (2018) found that giving these LGBTQ individuals affirmation, the HRP helped one particular individual talk about her difficult experiences without the fear that somebody would call it “weird.”

The HRP was also shown to help individuals with coming out to their family and friends. Many LGBTQ individuals feel fear at the thought of telling family or friends about their sexual or gender identities, and need to learn some tools to cope with the hetero-centrism of culture today (Lapointe & Crooks, 2018). Many members of school programs are trying to figure out the best way to “come out” to others, and may need a helping hand, including hearing about other experiences and what the outcomes of such experiences were (Lapointe & Crooks, 2018). Craig (2013) stated that when people are able to share their stories about “coming out”, they experience a strong decrease in their feelings of isolation, and are much more able to rely on their peers in the groups for support (McCormick et al., 2015). Adolescents require specific support systems in order to discuss their particular LGBTQ difficulties as well (Toomey et al., 2017).

LGBTQ youth were also taught how to handle families who were either abusive or unsupportive of their identities, because this is a major source of stress for these individuals (Lapointe & Crooks, 2018). Especially in the case of transgender individuals, Toomey and associates (2017) found that the HRP program aided individuals in acquiring the coping skills necessary for increased resilience, which then increases mental health well-being. One individual stated that because of how young members of the group are, everybody is still trying to find out who they are and don’t have the strong capability for communicating to others about their experiences, and don’t necessarily have good coping skills (Lapointe & Crooks, 2018).

Peer Advocacy Interventions

Transitional Living Programs. By January of 2015, the amount of homeless youth was around 37,000 and between 20 and 40 percent of these individuals were LGBTQ (Prock & Kennedy, 2017). Also, more than half of these homeless youths were not in homeless shelters, but were living in abandoned houses or their cars (Prock & Kennedy, 2017). LGBTQ individuals face a much larger likelihood of being kicked out or running away from their family’s homes after “coming out,” leading to the rather high rate of LGBTQ homeless youths (Prock & Kennedy, 2017). Even worse, LGBTQ homeless individuals are often facing increased sexual victimization, which may then increase the likelihood of further mental health problems or increased substance use (Prock & Kennedy, 2017). This sexual victimization includes multiple scenarios including being sexually assaulted or becoming part of a sex trade in order to survive while homeless (Prock & Kennedy, 2017). LGBTQ individuals often choose not to stay in homeless shelters, due in part to fears of discrimination by their peers, or even the workers in the shelters (Prock & Kennedy, 2017). However, by living with acquaintances or friends rather than a known facility for homeless individuals, LGBTQ teens increase the likelihood of falling prey to the sexual victimization (Prock & Kennedy, 2017).

Homeless LGBTQ youth also face the increased likelihood of suicidality to the point of true attempts that require medical attention (Prock & Kennedy, 2017). Homeless individuals face much greater likelihoods of developing post-traumatic stress disorder (PTSD) or substance use disorders (SUD’s) as well, due to the inability to properly cope with their stressful experiences, including victimization that prevents individuals from feeling safe enough to sleep at night (Prock & Kennedy, 2017).

With all of the increased possibilities for developing severe mental health problems, it has become of the utmost importance to create some kind of living situation for homeless individuals who identify themselves as being LGBTQ. There are many factors to consider when creating this shelter, including therapeutic services that will help individuals in the LGBTQ community learn to cope with their experiences (Prock & Kennedy, 2017). For example, affirmation therapy could be extraordinarily helpful to the LGBTQ population, especially considering that they may have been kicked out by their family upon “coming out” (Prock & Kennedy, 2017). Beyond therapeutic interventions, the LGBTQ homeless shelter needs to include medical facilities for transgender individuals to attain their hormone replacement therapies without fear of being victimized by the public (Prock & Kennedy, 2017). Also, something as simple as a gender-neutral bathroom could make a difference in the mental well-being of an LGBTQ individual, as it affirms their identity rather than placing them into a situation where they are not comfortable choosing one of two genders (Prock & Kennedy, 2017). On top of medical or thereapeutic necessities in the LGBTQ homeless shelter, proper training for the staff must be required in order to ensure that individuals do not face further discrimination in the place that is supposed to feel safe and open for individuals to be themselves without fear of persecution (Prock & Kennedy, 2017).

Transitional Living Programs (TLP’s) are federally funded programs offered to homeless youth as a shelter for the short-term up to eighteen months long, with the intending outcome of giving the homeless teens the tools necessary to become self-sufficient and make the transition to living on their own (Prock & Kennedy, 2017). However, these TLP’s are not LGBTQ-specific, and some even deny LGBTQ homeless youth. With the experience of such overt discrimination, LGBTQ individuals often make the choice to sleep on a street corner instead of in a TLP shelter (Prock & Kennedy, 2017).

Prock and Kennedy (2017) conducted their own research about TLP’s in the United States, finding that most of these programs existed in the Midwest or the South. However, the TLP’s that specifically offered services tailored to the LGBTQ community were overwhelmingly located in the Northeast or the West Coast (Prock & Kennedy, 2017). In fact, less than half of the 124 TLP’s in the study indicated offering any LGBTQ-specific service, and only ten were true LGBTQ TLP’s (Prock & Kennedy, 2017). Most TLP’s reported that all homeless youths who came into the shelters were receiving the same services, not allowing for any specific services for LGBTQ individuals (Prock & Kennedy, 2017). It was expected that if LGBTQ homeless individuals needed some specific service, they would clearly ask for it. However, teens oftentimes will not ask for some service that is outside of the norm, so maybe it should be the shelter’s responsibility to simply provide LGBTQ-specific services (Prock & Kennedy, 2017). Also, only about six percent of the TLP’s surveyed offered any treatment for SUD’s, which is a very large concern for LGBTQ individuals (Prock & Kennedy, 2017).

The therapeutic and medical treatments are necessary for LGBTQ-specific TLP shelters. However, there are many more factors to consider while creating these TLP’s, including the style of the home. A large majority of the homes in this study were group home styling (Prock & Kennedy, 2017). This could foster greater social connections only if individuals in the home are all LGBTQ, because if there are other individuals in the home, it may become unsafe for these individuals who will begin to fear the discrimination and victimization. However, at the moment, there are many state and federal regulations that are requiring shelters to separate genders in the group homes, even though somebody’s gender at birth may not be the gender they identify with anymore (Prock & Kennedy, 2017). This not only reinforces the idea that an LGBTQ individual is out of the “norm”, but also creates stressful situations for individuals feeling uncomfortable with housemates, or even roommates.

All in all, the necessity for programs for LGBTQ individuals is clear. These LGBTQ-specific TLP’s need to provide therapeutic services such as group therapy sessions, maybe even programs like the HRP, and affirmation therapy (Prock & Kennedy, 2017). Further, these LGBTQ-specific TLP’s should be inclusive to all gender options, rather than existing as a gender binary shelter.

Barriers to Attaining Treatment

Many obstacles exist when talking about LGBTQ individuals attempting to receive treatment for their mental health concerns. For example, the family dynamics of LGBTQ individuals have the tendency to be less supportive and possibly abusive to the individual, which then generates an intense amount of stress for the LGBTQ individual (Lapointe & Crooks, 2018). Transphobia is a large topic in American society today, and if somebody’s own family has these same values, then it becomes that much more difficult to “come out” for fear of their family not accepting them. Also, not much research has been done regarding an adolescent’s ability to cope as a sexual minority individual, as outlined by Lapointe and Crooks (2018). There is the strong possibility that individuals from the LGBTQ community may need to deal with their stress by seeking out other individuals from the LGBTQ community, because the stress experienced by individuals within a community will most likely be rather similar (Lapointe & Crooks, 2018).

The geographical region within the United States provides another barrier for LGBTQ individuals trying to seek help for their mental health concerns. Being that members from this community are more likely to experience mental health concerns, such as depression, a panic disorder, or generalized anxiety disorder, treatment options are a necessity around the entire country (Currin et al., 2018). For example, the Southern part of the United States tends to be less accepting of LGBTQ individuals, and may not have as many options for treatment (Currin et al., 2018). The South is distinct from the Northern part of the United States, due in large part to the cultural importance placed on religion in the South (Currin et al., 2018). As a result, there are many more hoops that LGBTQ individuals must jump through before getting the necessary treatment for their mental health concern, and these individuals may be turned away altogether. Just the thought of having to disclose their sexual orientation sometimes in the South leads members of the LGBTQ community to greater isolation and worse health habits (Currin et al., 2018). Individuals who live in the more conservative areas of the United States, such as the South, have been shown to have much lower self-acceptance rates and a lot less communication with family and friends to the point that they may not even know about the individual’s LGBTQ status (Fisher et al., 2013).

The stigmatization of the homosexual community and HIV is yet another barrier to individuals seeking treatment. The stigma surrounding the gay community and HIV is strong, and puts individuals in a situation where they may feel that withholding the truth may be necessary in order to avoid being the subject of a hate crime. However, not seeking treatment for one’s HIV status could lead to more serious complications involving physical health. Also, without treating HIV, this leads to the formation of AIDS, as well as the chance of spreading the virus even further to any sexual partner the individual has. Due again to the stigma surrounding HIV and the gay community, individuals begin to engage in very risky behaviors, that could very easily result in another individual getting HIV. For example, Currin and associates (2018) saw the pattern that LGBTQ individuals tend to have more condomless anal sex because it makes the individual feel less isolated. It has also been suggested that when an HIV-positive individual from the LGBTQ community is lonely, he or she will engage in more unprotected sexual acts with other HIV-positive individuals (Currin et al., 2018). The stigma surrounding HIV also leads individuals to begin using drugs because of their ability to regulate emotions by acting on neuroreceptors in the brain (Currin et al., 2018).

Conclusion

Due to the impact of several barriers that LGBTQ individuals face while trying to search out mental health treatment, it is of the utmost importance to refine what the treatment options available to individuals are. This extends beyond the United States, for Icelandic adolescents also faced much lower levels of acceptance by their families as well as friends (Thorsteinsson et al., 2017). These low acceptance rates by the people that individuals rely on for emotional support could lead to increased mental health concerns, such as behaviors related to suicidality, or other risk-taking behaviors like unprotected sex. Thorsteinsson and associates (2017) found that the acceptance of a family with relation to LGBTQ status can be predictive of having a much better overall health, leading to the possibility that family therapy could be beneficial to LGBTQ adolescents in order to help with gaining positive affect.

There are many treatment options available to LGBTQ individuals, specifically adolescents. For example, within a school setting, there are multiple options that can provide LGBTQ adolescents with a social community, such as the GSA or HRP. Each of these options have been shown to be beneficial to individuals, and should definitely be implemented into more schools, including the more conservative areas in the Southern part of the United States. More than that, peer advocacy groups could be extraordinarily beneficial, even if it’s more community-based as opposed to school-based. It is necessary for the United States to begin to find the inequalities that exist with regards to health care for LGBTQ individuals, and work to refine the policies in order to bring them to a state of equality with their cisgender and heterosexual counterparts.

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