This summarizes key points discussed during a June 2020 Webinar sponsored by Myriad Neuroscience called “LGBTQ+ and Depression: Addressing Double Stigma in Mental Healthcare.”

Patients who identify as lesbian, gay, bisexual, transgender, queer or questioning, and other gender and sexual orientations (LGBTQ+) can often experience a double stigma in which they feel they are not accepted by either the mental health community due to their LGBTQ+ identities or the LGBTQ+ community due to mental health issues including depression.

During the webinar, mental health practitioners shared how simple actions and meaningful inclusion practices can help LGBTQ+ patients with depression feel more supported in clinical environments. The panel featured:

• Deborah Thomas, EdD, APRN, PMHCNS-BC, PMHNP-BC, CMP (she, her), emeritus professor at the University of Louisville SON and owner/medical director of Here & Now Psychiatric Services in Louisville, Kentucky
• Jon Diggs, LPC (he, him), psychotherapist with Mainspring Counseling and Training in Decatur, Georgia
• Ginny Brown, LCSW, LCADC, CCS (she, her), behavioral health director of the Broadway House for Continuing Care in Maplewood, New Jersey

Addressing Discomfort Between Patients and Clinicians

Jon Diggs said that there are many unknowns when a patient first speaks to their doctor about mental health. His advice is to “give yourself permission to tell the truth.”

Diggs elaborated that it can be easy for doctors to fall into the trap of feeling like they are the expert and know more than the patient. However, this mindset can create a barrier, as doctors may not always understand or know how to help their patient’s mental health struggles. Being more explorative about their patient’s journey can help doctors support and build rapport.

Deborah Thomas recommended leaning into the discomfort: doing so can allow clinicians to be equitable partners with their patients. She suggested that providers, at the start of each meeting, ask patients about their goals and where they want the conversation to go.

“My journey is not your journey,” summarized Ginny Brown. “I need to be curious and understand your journey and be patient.”

Different Eras: The Unique Issues Affecting Older LGBTQ+ Depression Patients

 For older LGBTQ+ individuals, the effects of lesbian, gay, bisexual and transgender discrimination throughout their lives still linger. Brown said it is incumbent on healthcare providers at nursing homes and assisted living facilities to provide a space that welcomes the LGBTQ+ community and subtle reminders that show LGBTQ+ depression patients are welcome.

For example, Thomas acknowledged she still has a visceral reaction to the word “queer” due to the hateful context of the word in her own youth. Though the word has been reclaimed by the LGBTQ+ movement, practitioners should be aware of the history and how language could have an impact on how and what patients share about their mental health as a result.

Many senior LGBTQ+ individuals “have already experienced a ‘living death,’” according to Diggs. Many may have received an HIV diagnosis alongside a traumatic event.

These patients were asking themselves in their youth: “Will I live to see 30?” As a result, Diggs said they “never gave themselves permission to live.”

During the later days of their lives, these people may experience retraumatization. To help them manage the mental health implications of retraumatization, doctors should be kind, compassionate, and open themselves to what that experience could feel like.

LGBTQ+ Youth Depression

All panelists agreed that there seems to be more openness among today’s youth regarding both mental health and sexual orientation.

Diggs observed that younger LGBTQ+ clients are allowing themselves to be defined by more than their gender and sexuality. They are granting themselves permission to live – and work on other aspects of their life, like their careers.

While LGBTQ+ youth may feel comfortable with their sexual orientation among their friends, Thomas indicated there may still be friction and lack of support in family life that causes many patients to make an appointment with her.

Discrimination vs. Stigma

While many LGBTQ+ individuals experience double stigma, Thomas made an important distinction. Though individuals may use the word “stigma” to describe negative feelings against LGBTQ+ individuals, she said it’s become a white-washed term: “it’s discrimination and it is unconscionable and reprehensible.”

“When prejudice gets in the way of the care these individuals need and deserve, and affects their school, work and relationships, that’s discrimination,” said Thomas. “It’s incomprehensible that 28% of trans or gender non-conforming people put off necessary medical care due to not being accepted for gender status. That’s a public health issue that affects all of us.”

It can be tough as a provider to help LGBTQ+ patients who have faced years of sexual discrimination, because often these patients don’t know where they fit in in society or their own family, emphasized Diggs. Further, they may not know where they fit in the mental health spectrum and fear dual alienation by mental health providers and/or members of the LGBTQ+ community. Diggs says it’s important to recognize the resiliency of these individuals who have shown the courage to speak with someone about their mental illness and recommends that providers welcome that part of each patient’s story into the practice.

Allowing LGBTQ+ Patients to be the Expert of their Own Experience

 To be more effective, mental health professionals need to be students of their patients’ experiences. Mental health professionals shouldn’t ask their patients to educate them on the whole history, culture and language of the LGBTQ+ experience. Practitioners should do their own learning about this community.

“A lot of times, our patients who are in the LGBTQ+ community are a little weary of having to continually educate all of their providers,” Thomas said. “We should take it upon ourselves to educate ourselves, and not expect our clients to educate us.”

Brown agreed: “We do have a responsibility to go to trainings, and we have a responsibility to become informed… Once we have that foundation, then we can listen properly, we can listen actively and we can really help the resident/client/patient tell their story.” She added that listening properly helps to provide the safe space where patients can explore their issues.

Many clients perceive the therapist as holding all the power in the relationship, Diggs pointed out. However, if given the space and support to speak, patients can practice communication, giving them the confidence and experience needed to be more open in other aspects of their life.

Simple Ways Clinicians Can be Better Allies to their LGBTQ+ Patients

The panel and some participants offered simple actions doctors can take to help their LGBTQ+ patients feel more welcome in their practice:

• Introduce yourself using your preferred pronouns
• Ask patients to share their preferred pronouns on intake paperwork
• Display visible symbols of inclusiveness, like the pride/transgender flag or artwork
• Share information about local LGBTQ resources

Following the discussion, the GeneSight team shared that donations were made to LGBTQ+ advocacy organizations in the communities of each of the three panelists, including: Kentucky Fairness, Atlanta Lost & Found Youth, and the Marsha P. Johnson Institute.

To learn more about the multiple stigmas associated with LGBTQ and Depression, and to find more mental health resources, visit: https://genesight.com/lgbtq-mental-health/