Cultural Humility in Behavioral Health _ ________________________________________________________
LESBIAN, GAY, BISEXUAL, TRANSGENDER, QUEER/QUESTIONING POPULATION (LGBTQ) The LGBTQ population is another historically oppressed group in the U.S. Until the 2015 Supreme Court decision legalizing same-sex marriage, LGBTQ individuals were not able to marry in most states. Despite the ruling and although there are more than 5.5 million LGBTQ individuals living in the U.S., the LGBTQ community faces barriers to fair and equal access to employment, housing, healthcare, and public accommodation. There are several nondiscrimination laws at the federal, state, and local level that aim to protect people from discrimination based on factors such as age, sex, and national origin. However, until a Supreme Court decision in 2020, fed- eral law did not protect individuals from discrimination based on sexual orientation or gender identity (Roebig, 2020). Even since 2015, LGBTQ individuals can be both fired and denied housing because of their sexual orientation and/or gender identity in many states and municipalities (U.S. Department of Housing and Urban Development [HUD], 2017). Aside from being historically denied fundamental rights enjoyed by the majority of the population, many LGBTQ persons report repeated experiences of bullying and harassment in school, work, and community environments. A recent annual study of national school climate found con- tinued challenges for LGBTQ students and their experiences of school safety, biased language, harassment and assault, and discriminatory school policies (Kosciw et al., 2020). LGBTQ students report feeling unsafe at school because of their sexual orientation (59.1%), their gender expression (42.5%), and their gender (37.4%), which resulted in nearly one-third of respondents (32.7%) missing a full day of school in the most recent month and one-quarter of those students (8.6%) miss- ing at least four days in that same month. In addition, most avoid school functions (77.6%) and extracurricular activities (71.8%). Considering anti-LGBTQ remarks at school, nearly all students (98.8%) heard gay used in a negative or an inten- tionally derogatory manner (e.g., “That’s so gay,” “No homo,” “Dyke,” “Faggot”), and less than one-fifth of students (13.7%) reported consistent staff intervention when they heard the comments themselves. A vast majority of students (86.3%) experienced harassment or assault by classmates, with many reporting verbal (68.7%) or physical (69.7%) harassment. Oth- ers (11%) were physically assaulted or bullied at school (81%) or through text messaging or social networking sites (44.9%). More than half of all students (58.3%) reported having been sexually harassed or assaulted within the most recent year. In response to these experiences, less than half (43.4%) reported the incidents to school staff due to concerns over whether an effective intervention would occur, or out of fear of retaliation. Providing some credence to these concerns, of those students who did report the harassment and assault, more than half (60.5%) reported that school staff either “did nothing” or told the reporting student to “ignore it.”
As an extension of this type of engagement from school staff, most LGBTQ students (59.1%) reported personally experienc- ing discriminatory policies and practices at school, ranging from prohibited access to gender-consistent facilities (28.4%) and being prevented from utilizing chosen pronouns or names (22.8%), to being prohibited from discussing or writing about LGBTQ topics (16.6%) and being disciplined for even identify- ing as LGBTQ (3%). In fact, stigma consciousness, the personal understanding that historically and currently you are a member of a group that is a stigmatized population, is high among the LGBTQ popula- tion and often prevents individuals from being authentic or “out” at work (Gates, 2014). Having to hide such an important part of their identity can be stressful and have personal and professional negative effects on LGBTQ clients. The Center for American Progress conducted a national pub- lic opinion study on the state of the LGBTQ community in 2020. The survey included interviews with 1,528 self-identified LGBTQ adults ages 18 and older. The project was funded and operated by the National Opinion Research Center (NORC) at the University of Chicago (Gruberg et al., 2020). Major findings from the survey include the following (Gruberg et al., 2020): • More than one in three LGBTQ Americans faced discrimination of some kind in the past year. • More than three in five transgender Americans faced discrimination of some kind in the past year. • Discrimination adversely impacted the mental and economic well-being of many LGBTQ Americans, including one in two participants who reported moderate or significant negative psychological impacts. • More than half of LGBTQ Americans reported hiding a personal relationship to avoid experiencing discrimination. • An estimated 3 in 10 LGBTQ Americans faced difficulties accessing necessary medical care because of cost issues. • Fifteen percent of LGBTQ Americans reported postponing or avoiding medical treatment because of discrimination. • Transgender individuals faced unique obstacles to accessing healthcare, including one in three who had to teach their physicians about transgender people. • LGBTQ Americans may have also experienced significant mental and behavioral health issues that are related to the COVID-19 pandemic.
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