Different aspects of your personal identity - be they sexuality, gender identity, ethnicity, religion, class, age, or anything else - and the discrimination you face as a result of them, can understandably impact on your mental health. February is LGBT history month and, according to the NHS, people who are gay, lesbian and bisexual demonstrate higher levels of anxiety, depression, suicidal feelings, and drug and alcohol abuse than heterosexuals.
In January, Barbara Warren, an expert on LGBT health from Mount Sinai Health System in New York City, spoke about the need to pay special attention to LGBT health concerns, since people within this community may be more reluctant to seek medical care out of a fear of discrimination from health professionals.
Addressing mental health, Ms Warren said: "The LGBT community faces an increased burden of mental health concerns, including depression, anxiety and substance abuse - but this doesn't mean LGBT people are inherently mentally ill. Instead, LGBT mental health issues are largely related to the stresses of belonging to a minority group. We can change that by changing the way the world perceives, treats and includes LGBT people."
We can change LGBT mental health issues by changing the way the world perceives, treats and includes LGBT people.
Since issues around sexuality, gender identity, and homophobic discrimination clearly have a significant impact on the mental health of lesbian, gay, bisexual and trans people, we asked RSCPP therapists to explain some of the issues at play, and how therapists can be more aware of these factors when treating LGBT clients.
"Isolation and the feeling of being different can make people in the LGBT community feel depressed and anxious. It can foster a deeper sense of 'not being right', which can contribute to mental health problems," says Registered Counsellor David Hayter. "People who are lesbian or gay, bisexual or transgender may find it difficult to go to mental health services because they feel that they will be treated differently, that they may be asked embarrassing questions, or that assumptions will be made about them. Some will worry that mental health professionals will assume that they take drugs, or have multiple partners; some will worry that they will be disapproved of because of their lifestyles."
Outside of mental health services, discrimination and homophobia can play a broader role in LGBT people's mental health. "Some LGBT people may feel worn down by living in a society where the presumption is that you're straight, and that being straight is better, rather than a society where diversity is valued. The internalised pressure to be perfect, and to justify yourself and seek validation, is quite high within the LGBT community," explains Registered Counsellor Thomas Sherry.
"Being subjected to low level or more extreme forms of homophobia has a traumatic effect, and there is a strong link between trauma and drug use, as well as depression and suicidal feelings. The message that being LGBT is a failing may be internalised, and this shame can be experienced as internalised homophobia," he adds.
Being subjected to homophobia has a traumatic effect.
When many LGBT people experience this discrimination and prejudice in their everyday lives, it is hardly surprising that they may be more reluctant to seek help, or that they fear facing similar discrimination from the health professionals who should instead be helping them. David believes professionals and services must address this problem head on. "They should be clear that each person will be treated as an individual, that the service is not there to approve or disapprove of lifestyle, but to support and care for the individual, whatever their sexuality or gender identity," he says.
Registered Psychotherapist Jaimie Cahlil believes it can be helpful, when seeking treatment for mental health conditions, for LGBT people to work with health professionals who have an existing knowledge of the issues particular to them: "When an LGBT person wishes to find a therapist, it can really make a huge difference when that therapist has some kind of experiential understanding of the issues that may arise from either the individual's sexual orientation and/or their gender identity," he explains.
"This is particularly the case with gender identity, in my experience, as the therapist who is able to draw on not just professional training but also experiential material is most likely to have a depth of understanding, plus helpful insights and suggestions to offer."
It can make a huge difference when a therapist has experiential understanding of LGBT issues.
For health professionals without that existing experience, Thomas says: "I think therapists need to have a willingness to learn more about the struggles of LGBT clients, and that there are difference within this group so their experiences and issues will not necessarily be the same."
He adds, "For a trans person they are coming out every time they are seen, and the issue of passing for male or female can be a cause of distress. For a lesbian woman or gay man, there may be speculation over their sexuality, and every time they meet someone new it is a coming out process of explaining something they may not wish to have to justify or explain."