Part 2: Wholistic Health Equity Determinants and the LGBTQIA++ Community

    This blog post first appeared in Ellen’s Interprofessional Insights, and is published with explicit permission of the author

I appreciate the buzz about my last blog; it’s a quick read if you missed it. To catch you up, the LGBTQIA++ community face pervasive Wholistic Health Equity Determinants (WHED): SDoH, SDoMH, PDoH, and the systemic racism that perpetuates them. Discrimination, dismissal, and rejection trigger trauma across every demographic, and intensify integrated health incidence across the community. This Part 2 post explores the unprecedented exacerbation of behavioral health conditions and escalation in mental illness for the community. Additional focus is placed on novel resources to mitigate the WHED faced by this population.

The Behavioral Health Landscape

     Let’s be clear; the LGBTQIA++ community is a marginalized population with morbidity and mortality rates that are far higher than other groups. Increasing attacks on the community’s legal rights have amplified the impact of historical, experiential, and event traumas for the population.

The following data sources span The Trevor Project’s 2023 U.S. National Survey on the Mental Health of LGBTQ Young People, the 2020 National Survey on Drug Use and Health, and other research.

Suicide

There has been a dramatic uptick in suicidal ideation and gestures among LGBTQIA++ individuals, especially for the community’s youngest members:

• 41% considered attempting suicide:
  • 46%: Ages 13-17
  • 34%: Ages 18-24
• Of those who attempted suicide:
  • 17%: Ages 13-17
  • 9%: Ages 18-24
  • 22%: Native/Indigenous
  • 18%: Middle Eastern/N. African
  • 17%: Multiracial
  • 16% Black
  • 15%: Latinx
  • 11%: White
  • 10%: Asian American/Pacific Islander

Mental Health and Access to Care

The incidence of mental health faced by the community is alarming with higher rates for depression and anxietycompared with non-community members. The prevalence of post-traumatic stress disorder impact upwards of 47% of the community.

Yet, the rates for mental health realities faced by LGBTQIA++ youth concern me greatly:

• 67%: symptoms of anxiety
• 25%: symptoms of depression
• 56% who wanted mental health care were unable to get it:
  • 47%: afraid to talk about their mental health with someone else
  • 41%: didn’t want to get their parent’s/caregiver’s permission
  • 40%: afraid that they wouldn’t be taken seriously
  • 38%: couldn’t afford it
  • 27%: were not out about their authentic self and were afraid of being outed
  • 23%: didn’t feel they would understand their sexual orientation or gender identity
  • 20%: parent/caregiver didn’t allow them to go
• <50% of transgender and nonbinary youth found their school to be gender-affirming
• 30% said theirmental health was poor most of the time or always from anti-LGBTQ policies and legislation.
• Nearly 66% affirmed how hearing aboutpotential state or local laws banning people from discussing LGBTQ people at school made their mental health worse.

Substance Use

The community experiences substance abuse at higher rates than their heterosexual counterparts:

• LGB Adults: 2X as likely
• Trans Adults: 4X as likely

21.8%: Diagnosed with an alcohol use disorder vs. 11% of the general population

Persons with Disabilities

Members of the LGBTQIA++ community have a higher likelihood of disabilities, whether physical, cognitive, or intellectual. Incidence is upwards of 40% of persons, though fewer of these disabilities are often expressed by individuals or formally identified.

As an already marginalized group, individuals with disabilities may feel “unseen” and experience more profound stigma and discrimination. Cumulative effects of this marginalisation can occur over the life course, with older members of the community experiencing higher rates of disability, depression, anxiety and isolation than the general community, and decreased social support. They are less likely to advance academically, with fewer persons attending college or attaining beyond a 2 or 4-year degree.

Transgender, non-binary, or gender non-conforming people with disabilities can often feel silenced. Abundant literature affirms they are more likely to experience chronic illnesses, including cardiac disease, high blood pressure, high cholesterol, diabetes, stroke, arthritis, and asthma compared to persons living without disabilities.

Advocacy and Action

Advocacy and action have ramped up for dedicated funding, legislation, and program development. Educating industry stakeholders is vital, as is ensuring mentoring and support for LGBTQIA++ youth, adults, and their families. Registries of providers, practitioners, and treatment specialists who offer concordant care are essential. Here's a list of novel community-focused efforts:

• The Department of Housing and Human Development has launched a new LGBTQIA++ Youth Housing initiative. HUD will partner with local communities, service providers, and young people directly impacted by residential insufficiency to address barriers to housing and shelter access. The recent press release lists further details
• GLADD provides a clearinghouse of population-specific resources for advocacy, legal, and other general information across the life span. Military members and veterans can access specific linkages to various entities such as OutServe and the Service Members Legal Defense Network.
• The Human Rights Campaign strives to advocate and promote equity for all persons within the movement. Their massive resource database encompasses topics to empower allies and other community stakeholders from coming out to maneuvering college, elections, hate crimes, health and aging, parenting, religion and faith, and workplace support.

            HRC’s Foundation supports the National LGBTQIA++ Health Education Center, which provides educational programs, resources, and consultation to  healthcare organizations to optimize quality, cost-effective care for the population. Accessible webinars span topics as behavioral health, population-based health, trauma-informed care for Trans and Gender Diverse Patients, reproductive health.

• NAMI offers general guidance on mental health issues faced by the community, and considerations for seeking LGBTQIA++-competent care.
• Outcare Health offers concordant care directories:
  • A 50-state community resource directory for LGBTQIA++ affirming practitioners, primary care, mental health, youth groups, shelters, support groups, and STI testing.
  • An interactive map on U.S. legislation targeting LGBTQIA++ rights across the states.
  • Prescription savings and medical management
  • Grocery guidance to enhance understanding of nutritional sufficiency
  • Support groups across the U.S
  • Research opportunities for funding to enhance community health and well-being
  • LGBTQIA++ healthcare and equity training for individuals and providers
• Rainbow Labs in Los Angeles, addresses the bullying, isolation, and lack of support often faced by Queer and Gender non-conforming youth (QGNC). The organization provides mentorship, support groups, and linkage with safe individuals, advocates, and programs. One Bold Summer is a free 8-week summer mentoring initiative for QGNC youth (ages 12-18) that pairs QGNC youth with mentors.
• SAGE is the largest and oldest U.S. organization dedicated to improving the lives of LGBTQIA++ older adults. The group has been on the forefront of advocacy for elders, quality of long-term care, housing, and other resources. Their National Resource Center on LGBTQ+ Aging hones in on the unique needs of community older adults such as caregiving, elder abuse and neglect, benefit programs, financial, and other health-related social needs.
• SMYAL is among a growing number of locale-based housing programs that ensure safe, LGBTQ-affirming support, through tiered residential options: transitional housing, extended transitional housing, and rapid re-housing. Residents can access a range of courses and community engagement opportunities including nutrition and cooking classes, financial literacy, healthy relationships and communication, and resume workshops.
• The Trevor Project provides 24/7 information, support, and resource connection for LGBTQIA++ Youth around the world. Mechanisms allow for immediate access to trained counselors via call, text, or chat, and linkage to an international community for LGBTQ young people

What’s Next?

     I have been a fierce ally of the LGBTQIA++ community for well over 45 years, with countless family, friends, and colleagues in this space. Despite efforts to address the massive WHED faced by the community, innumerable challenges remain. The list of resources in this post is broad swipe of efforts on the move. Blog readers are encouraged to contribute resources as they know of them. The work to mitigate WHED for this population will take our collective and concerted action!