● 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
U.S. Despite the Supreme Court decision and slight changes in public opinion, many LGBTQ individuals still experience discrimination in this country. Currently, in many states and municipalities, LGBTQ individuals can be fired and denied housing because of their sexual orientation and gender identity (Harvard Law Review, 2015; Housing & Urban Development, 2017). Aside from being denied fundamental rights enjoyed by most of the population, many LGBTQ people report repeated experiences of bullying and harassment in school, work, and community environments. A recent national study of school climate found schools “hostile environments for a distressing number of LGBT students, the overwhelming majority of whom routinely hear the anti-LGBT language and experience victimization and discrimination at school. As a result, many LGBT students avoid school activities or miss school entirely” (Kosciw et al., 2014, p. xvi). Even outside of the school environment, many LGBTQ individuals experience similar difficulties in the work environment. Over 40% of LGBT workers (45.5%) reported that they experienced employment discrimination or harassment because of their sexual orientation or gender identity at some point in their lives (Sears et al., 2021). The employment discrimination and harassment reported by LGBT employees ranged from being fired or not hired to experiencing verbal, physical, or sexual harassment because of their sexual orientation or gender identity. Beyond being fired or not hired, respondents also reported other types of unfair treatment based on their sexual orientation and gender identity, including not being promoted, not receiving raises, being treated differently than those with different-sex partners, and being excluded from company events. LGBT employees continue to experience discrimination even after the U.S. Supreme Court held in Bostock v. Clayton County that discrimination based on sexual orientation and gender identity are forms of sex discrimination prohibited by Title VII. The decision extended nondiscrimination protections to LGBT employees nationwide as of June 2020 (Sears et al., 2021). Many LGBT employees report hearing many discriminatory comments. The most frequent type of comment that respondents received involved being told that they were “going to hell,” would “burn in hell,” or were not going “to heaven.” Having to hide such an essential part of their identity can be stressful and have personal and professional adverse effects on LGBTQ clients. 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.
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