Choosing the right mental health professional when you're LGBTQIA+

As a mental health advocate, it's not only my profession but my passion to promote the importance of physical and psychological health. My long-term vision celebrates the diversity of our community and embraces inclusion, and nowhere is this more important than with the LGBTQIA+ community.

I grew up in a small rural town in northwest Pennsylvania. I was a small boy from a large Western European family that loved and promoted sports and all things rugged and outdoorsy. The boys were raised to be tough and not talk about our feelings. And, while I embraced and loved our family outings to fish, camp, and hunt, I also embraced cooking and the performance arts. In fact, I would spend many hours singing and dancing to the latest hits from Paula Abdul, Ace of Base, and Janet Jackson.

Dr. William Marsh

Remember the Easy-Bake Oven? I coveted it and repeatedly asked for it for my 7th birthday. To my complete surprise, my parents finally broke down and agreed to purchase it for me. I felt sheer joy and unconditional love as we drove the 45-minutes to the closest toy store. My feelings quickly changed when I witnessed my parents remain complacent and complicit when the cashier said it was for “girls only," and I was only allowed to buy the Creepy Crawler Oven. After reigning in my tears of disappointment, I still loved my new Creepy Crawler Oven; it just wasn't my dream gift. I imagine many of us in the LGBTQIA+ community have a similar story.

Like so many in the LGBTQIA+ community, the journey that helped me become the proud gay man I am today wasn't always easy. As I grew up, I witnessed overt and covert hate. It came in the form of discrimination, abuse and assault, bullying, microaggressions or insults.

Well-intended guidance from adults in the form of shaming and directives that I should conceal my differences, stop exploring "alternative" interests, with constant reminders that homosexual thoughts and acts are sins. I can't recall how many times I heard things like, “hate the sin, not the sinner."

When inundated with these messages and grappling with my own internal experiences, I didn't feel like I had resources and an affirmative support system. Thank goodness for my Aunt Zephyr. She saw my “rainbow aura," as she put it, and encouraged me to let it shine. She told me, “black sheep are needed; they are just as important as any other sheep… you can't change their wool, so why not celebrate what they are?" There is a theme in my life that I lean on, 'always shine…no matter what is happening or where you are in life, keep shining, and you will find your way.'

There is strong evidence suggesting people in the LGBTQIA+ community are at a greater risk for experiencing mental health issues—especially depression and anxiety. Some studies have shown that LGB adults are more than twice as likely as heterosexual adults to experience a mental health condition. For transgender individuals, that rate is nearly four times. Our community has some of the highest suicide rates across the lifespan compared to heterosexuals. The gravity of this situation weighs heavy on our community. Change must happen.

Belonging to the LGBTQIA+ community can be powerful and healing but creating your family-of-choice is not always easy or simple. Some will self-isolate or engage in high-risk activities in order to feel a part of something…to feel something. When we want to find help or support, we often face some unique challenges.

Our community often has to jump through additional hoops to access healthcare. There are high numbers of homeless non-heterosexual youth as well as unemployed/underemployed adults without adequate insurance coverage. Couple that with the stigma surrounding mental illness and the fear of seeing a professional who is not affirming or accepting explains why many individuals make the disastrous decision not to reach out for help. This is unacceptable, and we must work together to change it.

The LGBTQIA+ community represents a wide range of individuals, each with different yet overlapping challenges. However, when looking for care, our community is often looked at in its entirety. This is problematic and can make searching for a healthcare provider feel like a monumental and challenging task.

There are many important factors to consider when looking for a mental health professional. Here are some thoughts to get you started…

What do you want in a mental health professional, and what's most important to you?

Do you want a provider who shares specific parts of their identity with you? You may be able to glean this information from a website and profile. Suppose your reason for seeking help is not rooted in sexual orientation and/or gender identity. In that case, it may not be necessary for the provider to share specific parts of their identity or specialize in LGBTQIA+ issues.

Referrals are important. Do your homework.

When I was young, my resource was the Internet, and I spent hours researching to uncover answers to my many questions. I encourage you to put the time in, too.

These days most mental health professional directories have filters that allow you to search for mental health providers with a specialty or competency in working with LGBTQIA+ people. A good indicator of how familiar and comfortable the provider is with our community is their intake form. Look to see what gender identifiers they use and if there is other hetero-normative language. Once you identify a couple of options, please verify that the providers accept your insurance and list LGBTQIA+ competency in their profile.

An important note, if you do not have insurance or have extremely high deductibles, you can always email or call to inquire if they have a “sliding scale" fee. This is a reduced rate that most therapists and agencies offer.

Make the telephone call, and don't be afraid to ask questions.

Websites can only tell you so much. It's essential to make an initial call and discuss the provider's comfort and previous experience with LGBTQIA+ people.

Providers expect and welcome questions. Try to be upfront about what you are looking for in an LGBTQIA+ competent provider. This is for YOU. It is not your job to educate providers about the basic concepts of LGBTQIA identities. It is a provider's ethical duty to be competent.

Remember, you are seeking a person that is going to help you improve your mental health. By stating your needs and asking the right questions, you can find someone who can respect your identity(ies) throughout your treatment.

And finally…don't give up. You are important. Finding the right provider who values you for who you are may take time. In the end, it will be worth it.

About the author

Dr. William Marsh is a Clinical Director and a primary supervisor for the APA accredited clinical psychology internship program with Southwest Behavioral & Health Services. With all areas of his work, he incorporates his passion for fostering positive interpersonal dynamics that help others identify, support, and reach their goals and dreams. More information about programs and services available at www.sbhservices.org.

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