The Center for American Progress conducted a national public 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). Significant 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 LGBT 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 health issues related to the COVID-19 pandemic. Evidence-Based Practice: Data indicates that LGBTQ students in schools with more positive school climates were at lower risk of suicidality and reported fewer depressive symptoms compared to students in less positive school climates. Note : From “The impact of positive school climate on suicidality and mental health among LGBTQ adolescents: A systematic review,” by Ancheta, A. J., et al., 2021. The Journal of School Nursing, 37(2), 75–86. The two most problematic issues related to the LGBT community and healthcare are heteronormativity and discrimination. Heteronormativity is generally pervasive in society, representing a norm and stigmatizing all who deviate from it (Krnel & Skela-Savic, 2020). LGBTQ people face a variety of barriers to healthcare. For lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) individuals, basic and essential healthcare services can be challenging to access (How Discrimination Impacts LGBTQ Healthcare, 2021). Discrimination against LGBTQ individuals has been associated with high psychiatric issues, substance abuse, and suicide rates. LGBTQ populations have the highest rates of drug use, including the use of tobacco and alcohol. Elderly LGBTQ people face additional barriers to health, primarily because of isolation and a lack of culturally competent providers (How Discrimination Impacts LGBTQ Healthcare, 2021). Examples of discrimination that negatively affects the health of LGBTQ individuals include the following: ● Legal discrimination in access to health insurance, employment, housing, adoption, and retirement benefits. ● Financial barriers. ● Lack of social programs that are inclusive for LGBTQ people of all ages. ● Shortage of healthcare providers who are knowledgeable and culturally competent in LGBTQ health (which can discourage LGBTQ people from seeking care). ● Negative provider attitudes. Furthermore, barriers to healthcare related to sexual and transgender stigma worsen with systemic racism and xenophobia. LGBTQ people who are immigrants or have limited English proficiency are especially vulnerable in the healthcare system. Many individuals who need care forgo it out of fear and distrust of the system. According to societal norms, children are expected to fit neatly into a corresponding gender identity
(boy or girl) and embrace the preferred activities and values that have been codified as “masculine” or “feminine.” Transgender and gender-nonconforming youth face particular mental health challenges as they reckon with this binary sex/gender system. Some, though not all, transgender people experience gender dysphoria (i.e., a feeling of distress when a person’s sex as assigned at birth does not align with their gender identity; How Discrimination Impacts LGBTQ Healthcare, 2021). Experiences of violence and victimization are frequent for LGBTQ individuals. The category of LGBTQ includes transgender individuals. Transgender is an umbrella term that describes people whose gender identity or expression does not match the sex they were assigned at birth. For example, a transgender person may identify as a woman despite having been born with male genitalia. They have long-lasting effects. According to the National Center for Transgender Equality, over 25% of transgender people have been victims of transphobic assault, and the percentage is even higher for trans women of color (How Discrimination Impacts LGBTQ Healthcare, 2021). Physician discrimination against the transgender population may be a combination of a deficit of knowledge and tolerance. Nevertheless, tolerance, bias, and competence continue to be present. If patients do not trust their providers, it is unlikely that they will return to see them in the future for medical care. Transgender patients are significantly more likely to be refused care than cisgender patients (Kattari et al., 2020). For this reason, interested patients must be connected to affirming providers who can adequately meet their needs; professional case managers can meet this demand. Underlying the discrimination faced by transgender patients in the healthcare setting is a fundamental lack of provider competency in transgender care. The failure to understand the transgender patient experience may not only contribute to healthcare practices perceived as discriminatory by patients. However, it may even perpetuate discrimination, as providers lacking adequate training in transgender healthcare issues may be more likely to perceive being transgender as deviant. Increasing provider education on the psychosocial aspects of being transgender and on healthcare screening, diagnoses, and treatments unique to this population may reduce the barriers faced by transgender patients in receiving quality care (Institute for Health Policy Leadership, n.d.). Few insurance programs cover transition treatments, and transgender people are less likely to have health insurance than heterosexual people (How Discrimination Impacts LGBTQ Healthcare, 2021). The complexity of individual diversity is inclusive not just of racial and ethnic identity but also of variables such as socioeconomic class, dis/ability, and LGBTQ status. While these facets of diversity are not exhaustive, they represent some essential diversity categories. Counselors must consider the unique array of diverse identities represented by each individual encountered in each counseling relationship. The complexity embodied within each client affects how the client understands and views the counselor and the counseling relationship, just as the complexity of the counselor’s diversity dimensions affects how the counselor understands and views each client. It is impossible to provide information that allows counselors to gain knowledge about categories of people and how they behave or view the world because not only is the variation within individual ethnicities and races endless, but the variation within each individual also is endless. Instead, clinicians should aim to understand the societal landscape that privileges and oppresses individuals. The experiences of oppression experienced by various diverse groups will likely provide them with a unique perspective on the larger society and the counseling relationship. Transgender Isolation and Violence Transgender and gender-expansive youth face heartbreaking levels of familial rejection, often from an early age. For many parents, their transgender or nonbinary child may be the first transgender or nonbinary person they have ever met
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